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Vascular Specialist International Jun 2024Although intravascular atherectomy is widely used for debulking calcified atheromas in peripheral arterial disease, it is associated with complications. Delayed rupture...
Although intravascular atherectomy is widely used for debulking calcified atheromas in peripheral arterial disease, it is associated with complications. Delayed rupture with pseudoaneurysm formation is rare. We report the case of a 73-year-old man who developed a 24 mm×20 mm×27 mm popliteal artery (PA) pseudoaneurysm after rotational atherectomy. Initially, the patient presented with intermittent claudication. Preoperative computed tomographic angiography (CTA) showed a severely calcified atheroma in the PA. Rotational atherectomy was performed using the Jetstream™ device (Boston Scientific). Postoperatively, the ankle-brachial index and symptoms improved. However, 6 days after the atherectomy, the patient complained of calf pain and swelling. Follow-up CTA revealed a pseudoaneurysm and hematoma in the popliteal fossa. Open conversion with removal of the heavily calcified plaque and patch angioplasty were performed via the posterior approach. Delayed PA rupture and pseudoaneurysm formation after rotational atherectomy are rare; however, they require prompt management.
PubMed: 38918946
DOI: 10.5758/vsi.240046 -
Journal of Cardiothoracic Surgery Jun 2024Pleural solitary fibrous tumors (pSFTs) are rare mesenchymal pleural tumors with rich vascularity. Surgical resection is the cornerstone of pSFTs treatment, requiring...
BACKGROUND
Pleural solitary fibrous tumors (pSFTs) are rare mesenchymal pleural tumors with rich vascularity. Surgical resection is the cornerstone of pSFTs treatment, requiring careful preoperative imaging to delineate lesion extent and vascular supply including contrast-enhanced computed tomography and other examinations depending on its size and characteristics.
CASE PRESENTATION
The patient was a 34-year-old female with a mass measuring approximately 67 × 42 × 65 mm in the left posterior mediastinum. Intraoperatively, the mass demonstrated rich vascularity. Two veins originating from the abdominal cavity entered the lower pole, one converged from the superior pole, draining into the brachiocephalic vein. Additionally, two arteries arose directly from the descending aorta, while several veins drained into the intercostal veins. In response to unexpected intraoperative vascular findings, vascular clips and silk threads were used to ligate them. Subsequently, the tumor was successfully dissected, with approximately 600 ml of blood loss recorded during the 4-hour surgery. The patient exhibited a satisfactory postoperative recovery, and follow-up spanning over six months revealed no indications of recurrence or metastasis.
CONCLUSIONS
We firstly present a case of successful resection of a pSFT in a 34-year-old woman with a distinct feeding vessel arising from the descending aorta and describe the related surgical procedures. This case highlights preoperative evaluation of mass vascularity based on contrast-enhanced computed tomography. When blood supply is challenging to clarify, angiography can offer additional details, especially for giant pSFTs. Despite this, thorough intraoperative exploration remains essential to detect unexpected vessels. Appropriate interventions should be customized based on the vascular origins and the surrounding anatomical structures.
Topics: Humans; Female; Adult; Aorta, Thoracic; Solitary Fibrous Tumor, Pleural; Tomography, X-Ray Computed
PubMed: 38918857
DOI: 10.1186/s13019-024-02872-y -
Journal of Medical Case Reports Jun 2024Hemorrhage is the most common major complication after liver biopsy. Hemothorax is one type of bleeding and is very rare and dangerous. Several cases of hemothorax...
BACKGROUND
Hemorrhage is the most common major complication after liver biopsy. Hemothorax is one type of bleeding and is very rare and dangerous. Several cases of hemothorax subsequent to liver biopsy have been documented, primarily attributed to injury of the intercostal artery or inferior phrenic artery and a few resulting from lung tissue damage; however, no previous case report of hemothorax caused by injury of musculophrenic artery after liver biopsy has been reported.
CASE PRESENTATION
A 45-year-old native Chinese woman diagnosed with primary biliary cirrhosis due to long-term redness in urination and abnormal blood test indicators was admitted to our hospital for an ultrasound-guided liver biopsy to clarify pathological characteristics and disease staging. A total of 2 hours after surgery, the patient complained of discomfort in the right chest and abdomen. Ultrasound revealed an effusion in the right thorax and hemothorax was strongly suspected. The patient was immediately referred to the interventional department for digital subtraction angiography. Super-selective angiography of the right internal thoracic artery was performed which revealed significant contrast medium extravasation from the right musculophrenic artery, the terminal branch of the internal thoracic artery. Embolization was performed successfully. The vital signs of the patient were stabilized after the transarterial embolization and supportive treatment.
CONCLUSION
This case draws attention to the musculophrenic artery as a potential source of hemorrhage after percutaneous liver biopsy.
Topics: Humans; Hemothorax; Female; Middle Aged; Liver; Embolization, Therapeutic; Ultrasonography, Interventional; Image-Guided Biopsy; Angiography, Digital Subtraction
PubMed: 38918846
DOI: 10.1186/s13256-024-04619-8 -
Scientific Reports Jun 2024Cerebrovascular resistance (CVR) regulates blood flow in the brain, but little is known about the vascular resistances of the individual cerebral territories. We present...
Cerebrovascular resistance (CVR) regulates blood flow in the brain, but little is known about the vascular resistances of the individual cerebral territories. We present a method to calculate these resistances and investigate how CVR varies in the hemodynamically disturbed brain. We included 48 patients with stroke/TIA (29 with symptomatic carotid stenosis). By combining flow rate (4D flow MRI) and structural computed tomography angiography (CTA) data with computational fluid dynamics (CFD) we computed the perfusion pressures out from the circle of Willis, with which CVR of the MCA, ACA, and PCA territories was estimated. 56 controls were included for comparison of total CVR (tCVR). CVR were 33.8 ± 10.5, 59.0 ± 30.6, and 77.8 ± 21.3 mmHg s/ml for the MCA, ACA, and PCA territories. We found no differences in tCVR between patients, 9.3 ± 1.9 mmHg s/ml, and controls, 9.3 ± 2.0 mmHg s/ml (p = 0.88), nor in territorial CVR in the carotid stenosis patients between ipsilateral and contralateral hemispheres. Territorial resistance associated inversely to territorial brain volume (p < 0.001). These resistances may work as reference values when modelling blood flow in the circle of Willis, and the method can be used when there is need for subject-specific analysis.
Topics: Humans; Male; Female; Cerebrovascular Circulation; Hydrodynamics; Vascular Resistance; Middle Aged; Aged; Magnetic Resonance Imaging; Stroke; Carotid Stenosis; Hemodynamics; Computed Tomography Angiography; Circle of Willis; Blood Flow Velocity; Brain
PubMed: 38918589
DOI: 10.1038/s41598-024-65431-4 -
Cureus May 2024Persistent trigeminal artery disease is one of the most common types of persistent carotid-vertebrobasilar anastomoses. Usually, it is unilateral, and it can be...
Persistent trigeminal artery disease is one of the most common types of persistent carotid-vertebrobasilar anastomoses. Usually, it is unilateral, and it can be discovered with a magnetic resonance angiography (MRA), computed tomography angiography (angioCT), or classic angiography exam. It can be associated with non-specific symptoms, such as headaches, or more specific ones, such as III or VI nerve palsy or trigeminal neuralgia, but most of the time it goes undetected, being an incidental finding and not causing any symptoms. On MRA and angioCT, it has the characteristic "tau" sign. We present the case of a young woman who, incidentally, discovered this malformation after undergoing an MRA. She had been experiencing a persistent headache without a known cause, which did not improve despite medication.
PubMed: 38915981
DOI: 10.7759/cureus.61060 -
Cureus May 2024Ischemic myocardial injury in a diabetes mellitus (DM) patient can be a trigger or a complication of diabetic ketoacidosis (DKA). This case series examines the...
Ischemic myocardial injury in a diabetes mellitus (DM) patient can be a trigger or a complication of diabetic ketoacidosis (DKA). This case series examines the phenomenon of elevated troponin levels in patients with DKA in the absence of obstructive coronary artery disease. Two out of three cases showed ST-segment elevation on electrocardiogram (EKG). Despite the absence of obstructive coronary artery disease on coronary angiography, all cases exhibited troponinemia (>79 ng/dl). These elevated troponin levels and EKG changes may pose diagnostic challenges for clinicians. Alternatively, troponinemia could be due to myocardial injury caused by acidotic stress and free fatty acid utilization along with increased myocardial oxygen demand and not obstructive coronary artery pathology in every case. However, a better understanding of the complex interplay between DKA and myocardial injury needs further research.
PubMed: 38915971
DOI: 10.7759/cureus.61064 -
Cureus May 2024Peripheral artery disease (PAD) is the buildup of calcium and fatty deposits in the arterial walls (atherosclerosis). This is an important clinical issue, specifically...
Peripheral artery disease (PAD) is the buildup of calcium and fatty deposits in the arterial walls (atherosclerosis). This is an important clinical issue, specifically in cases with multilevel lesions. A patient underwent sequential angioplasty treatment for major PAD, which was characterized by multilevel lesions affecting both the infrapopliteal arteries. The proximal vessels and infrapopliteal vessels are mostly observed to be affected by PAD, thus the patient likely has PAD localized to the lower leg. In the femoropopliteal segment, lower extremity artery or aortic atherosclerotic occlusive disease can lead to significant outcomes. Severe claudication and pain during rest in both legs were observed in a patient with a history of hypertension and diabetes mellitus. With an angiography, the superficial femoral, popliteal, and tibial arteries have been shown to have major stenoses and occlusions. A progressive treatment was used because of the complexity of the lesions initiating with endovascular revascularization of the superficial femoral artery. The popliteal and tibial arteries were then repaired with angioplasty and stent placement. After the treatment, the patient's symptoms significantly improved, including elimination of their rest discomfort and claudication. Measurements of the ankle-brachial index (ABI) indicated that the affected limbs' perfusion was refined. Six months later, a follow-up angiography revealed intact vessels with no restenosis. This case report shows the successful outcome of recurrent angioplasty in curing complicated multilevel PAD, giving symptomatic relief and maintaining limb perfusion. This research is required to assess the long-term outcomes and longevity of this kind of treatment in patient populations that are comparable to others.
PubMed: 38915963
DOI: 10.7759/cureus.60982 -
Respirology Case Reports Jun 2024Bronchial Dieulafoy's disease (BDD), remains poorly understood, with only 88 cases reported globally. Herein, we present the largest case series ( = 7) from a single...
Bronchial Dieulafoy's disease (BDD), remains poorly understood, with only 88 cases reported globally. Herein, we present the largest case series ( = 7) from a single centre, between 2017 and 2023, retrospectively reviewed, detailing clinical presentations, diagnoses, management and up to 4-year follow-up outcomes. Diagnosis relied on characteristic lesions detected through white light bronchoscopy with or without endobronchial ultrasound (EBUS) or narrow band imaging (NBI), along with computed tomography (CT) scans or bronchial angiography. Identification of aberrant vessels beneath lesions and bronchoscopy details were documented. Treatment modalities and follow-up outcomes until December 2023 were noted. All patients were non-smokers. Review of imaging findings by an experienced radiologist was crucial in suspected cases due to risk of bleeding and often unconclusive results from biopsy. Management of BDD varied, with six patients undergoing bronchial artery embolization (BAE) and one requiring lobectomy; four patients received additional endobronchial therapy, one died due to malignancy, none experienced recurrence of haemoptysis. Identifying patients with large volume haemoptysis disproportionate to parenchymal disease in CT scans is important. A bronchoscopic surveillance is crucial to avoid biopsy; it can be confirmed using EBUS of NBI. While no established guidelines exist, BAE and endobronchial therapy emerge as valuable interventions, with surgical resection reserved for recurrent cases.
PubMed: 38915736
DOI: 10.1002/rcr2.1411 -
Case Reports in Cardiology 2024Rotational atherectomy is an effective procedure for heavily calcified lesions and those that cannot be crossed using conventional percutaneous coronary intervention...
Rotational atherectomy is an effective procedure for heavily calcified lesions and those that cannot be crossed using conventional percutaneous coronary intervention (PCI) devices. Here, we report a rare case of intracoronary burr entrapment in the coronary artery due to burr disconnection from the driveshaft. A 67-year-old man undergoing hemodialysis for nephrosclerosis presented with exertional chest discomfort. Coronary angiography revealed stenotic lesions in the right coronary artery, and PCI was performed using a Rotawire Floppy. During the procedure, the disconnected burr was successfully removed without surgery using the child-in-mother technique with a guide extension catheter. Notably, the patient remained hemodynamically stable throughout the procedure and his recovery was uncomplicated. He was discharged on the second postprocedural day. At the 6-month follow-up, the patient remained asymptomatic with no evidence of myocardial ischemia. This report informs clinicians of the possibility of burr disconnection and the non-surgical intervention used for its removal.
PubMed: 38915476
DOI: 10.1155/2024/5482922 -
Clinical Kidney Journal Jun 2024The aim of this work was to create and evaluate a preoperative non-contrast-enhanced (CE) magnetic resonance imaging (MRI)/angiography (MRA) protocol to assess renal...
BACKGROUND
The aim of this work was to create and evaluate a preoperative non-contrast-enhanced (CE) magnetic resonance imaging (MRI)/angiography (MRA) protocol to assess renal function and visualize renal arteries and any abnormalities in potential living kidney donors.
METHODS
In total, 28 subjects were examined using scintigraphy to determine renal function. In addition, 3D-pseudocontinuous arterial spin labeling (pCASL), a 2D-non-CE electrocardiogram-triggered radial quiescent interval slice-selective (QISS-MRA), and 4D-CE time-resolved angiography with interleaved stochastic trajectories (CE-MRA) were performed to assess renal perfusion, visualize renal arteries and detect any abnormalities. Two glomerular filtration rates [described by Gates (GFR) and according to the Chronic Kidney Disease Epidemiology Collaboration formula (GFR)]. The renal volumes were determined using both MRA techniques.
RESULTS
The mean value of regional renal blood flow (rRBF) on the right side was significantly higher than that on the left. The agreements between QISS-MRA and CE-MRA concerning the assessment of absence or presence of an aberrant artery and renal arterial stenosis were perfect. The mean renal volumes measured in the right kidney with QISS-MRA were lower than the corresponding values of CE-MRA. In contrast, the mean renal volumes measured in the left kidney with both MRA techniques were similar. The correlation between the GFR and rRBF was compared in the same manner as that between GFR and rRBF.
CONCLUSION
The combination of pCASL and QISS-MRA constitute a reliable preoperative protocol with a total measurement time of <10 min without the potential side effects of gadolinium-based contrast agents or radiation exposure.
PubMed: 38915436
DOI: 10.1093/ckj/sfae101