The Case of a Patient with Femoral Artery Stenosis Caused by Angio-Seal^® Use Treated with Endoarterectomy / 日本心臓血管外科学会雑誌

In cases of hemostasis of the femoral artery where the sheath is removed after percutaneous catheterization, there is greater improvement in patient condition and shorter duration of hospital stay when arterial puncture closing devices are used rather than standard manual compression because the use of these devices results in shorter hemostasis and rest times. However, some complications due to these devices have also been reported. Here, we report a case of femoral artery stenosis due to Angio-Seal^® use in a 67-year-old woman. Embolization of the basilar artery aneurysm by endovascular treatment was performed at another institution ; the percutaneous puncture site was the right femoral artery. When this treatment was provided, hemostasis of the artery was performed with the Angio-Seal^®. About one month after the embolization, right intermittent claudication occurred after a 300-m walk. Echography and computed tomography (CT) angiogram showed 75% stenosis of the right common femoral artery, and therefore endoarterectomy of the artery was performed. The postoperative course was favorable and the ankle brachial index score improved from 0.82 to 1.15. In addition, CT angiogram showed resolution of the stenosis of the right common femoral artery and right intermittent claudication ameliorated. Based on the intraoperative views, it was suggested that the arteriosclerotic lesion had existed at the common femoral artery before the endovascular treatment and it might be the cause of the complication mentioned above. In order to prevent complications due to Angio-Seal^® use, it is important to examine the indications of the use of this device by evaluating the puncture site of the artery with echography and other diagnostic techniques before the insertion of a sheath.

A Case of Klippel-Trenaunay Syndrome with Acute Submassive Pulmonary Thromboembolism Treated with Thrombolytic Therapy

Klippel-Trenaunay syndrome is a rare congenital mesodermal abnormality characterized by varicose veins, cutaneous hemangiomas, soft tissue and bony hypertrophy of limb. Potential complications such as deep venous thrombosis and pulmonary thromboembolism have not been reported in Korea to date. We demonstrate the case of a 48-year-old woman with Klippel-Trenaunay syndrome with extensive varicose veins on right lower limb, hypertrophy of left big toe and basilar artery tip aneurysm, complicated with acute submassive pulmonary thromboembolism treated successfully with intravenous thrombolytic therapy.

Abordagem atual aos aneurismas do topo da artéria basilar / Approaches to the basilar artery aneurysm

Objetivo: Revisão crítica das abordagens atuais para aneurismas do topo da artéria basilar. Análise dos aspectos anatômicos e angiográficos relevantes para cirurgia. Métodos: Revisão crítica da literatura e relato da experiência dos autores. Resultados: Os principais acessos para aneurismas de topo de basilar de acordo com sua posição em relação ao dorso da sela são: Kawase transpetroso para os aneurismas baixos, transcavernoso para os médios e temporopolar para os altos. A monitoração eletrofisiológica e com doppler pode minimizar complicações isquêmicas por clipagem prolongada, estenose ou fechamento inadvertido de perfurantes. Neuroproteção e hipotermia devem ser consideradas em lesões gigantes e complexas. Lesões complexas geralmente excedem ao tratamento endovascular. Conclusão: Existe uma tendência na literatura a considerar o tratamento cirúrgico dos aneurismas como método ultrapassado; entretanto a tecnologia de novas formas de proteção cerebral, técnicas microcirúrgicas e evolução dos clipes são indispensáveis para lidar com o cérebro em condições ruins na fase aguda. Os procedimentos endovasculares não drenam hematomas, não tratam hidrocefalia nem retiram coágulos das cisternas para prevenir o vasoespasmo. Entretanto é necessário um seguimento a longo prazo para uma avaliação mais precisa. O neurocirurgião deve dominar as duas opções de tratamento e ser hábil para indicar o tratamento mais apropriado.

Objective: To review the main approaches to basilar aneurysms and discuss relevant anatomy and angiographic features to choose the appropriate approach in each case. Methods: Literature review and author´s experiences are presented. Results: Current main approaches to basilar aneurysms regarding the level of the lesion from sellae dorsum are: Kawase transpetrosous for lower, transcavernous for middle and temporopolar for higher positioned aneurysms. Doppler, electroencephalography, somatosensory and motor evoked potential might minimize incidence of ischemic complications attributable to prolonged temporary occlusion or inadvertent perforator occlusion. Circulatory arrest and hypotermia may be considered for giant and complex aneurysms. The main principle applied is maximization of bone resection, which facilitates the use of surgical instruments and minimizes brain retraction. Complex basilar aneurysms frequently outdo endovascular treatment. Conclusion: There is a tendency in literature to consider the aneurysm surgery as an outdated method; however, technology of intensive care and anesthesia for brain protection, surgical techniques and clips evolution are indispensable for manipulate angry brain in aneurysms surgery after subarachnoid hemorrhage. Endovascular procedures do not remove clots from cisterns to avoid vasospasm, treat hydrocephalus or fenestrate the lamina terminalis to the same purpose; besides, longer follow up is necessary according to the final result. The neurosurgeon must dominate both treatment options and be able to differentiate exact indications.

Spontaneous regression of a giant basilar artery aneurysm in a young adult after surgical injury:case report and literature review / 介入放射学杂志

A giant basilar artery aneurysm of young woman with endocrine disturbance was misdiagnosed as a large pituitary adenoma and treated surgically via a trans-sphenoidal approach was planned.But the neurosurgery was finally aborted because of massive bleeding during the procedure. One year later, a cerebral angiography confirmed this basilar artery aneurysm was obviously regressed and then endovascular coiling was successfully performed. No neurological complication occurred post-procedure and the endocrine dysfunction symptom was obviously improved.

A Comparative Analysis of Endovascular Coiling and Surgical Clipping of Upper Basilar Artery Aneurysms

OBJECTIVE: Despite advances in both operative techniques (endovascular coiling or surgical neck clipping), management of basilar artery aneurysms has not been completed. The goal of this retrospective study is to evaluate endovascular coiling compared with surgical neck clipping of upper basilar artery aneurysms. METHODS: From january of 1990 to December of 2001, the authors treated 31 cases of upper basilar artery aneuryms. Among of those upper basilar artery aneurysms, 22 patients received surgical neck clipping and 9 patients recevied non-surgical endovascular coiling. Results from outpatient follow-ups for 12 months after operation were classified with Glasgow outcome scale (GOS) analyzed respectively. RESULTS: Overall, 11(50%) of the surgical neck clipping patients and 6(66.7%) in endovascular coiling patients were showed good outcomes(GOS 4~5). Morbidity of the surgical clipping is about 22.7%(5/22) and the endovascular coiling is about 22.2%(2/9) There were two death in the surgical clipping group due to vasospasm and brain stem infarction, but none in the endovascular coiling group. The major causes of surgical morbidity were direct brain damage, perforator occlusions, vasospasm and meningitis. Endovascular coiling group was shorter hospital stay and lesser hospital expenses than surgical neck clipping group. CONCLUSION: Non-surgical endovascular coiling of upper basilar artery aneurysms is considered to be useful alternative treatment in improving short-term prognosis(12 months follow-ups) and reducing medical expenses compared to surgical neck clipping although long-term follow-up is needed.

Reduction of Brain Infarct Size and Extracellular Glutamate Accumulation by Dihydrokinate in Spontaneously Hypertensive Rat after Transient Forebrain Ischemia

No abstract available.

Modified Transsylvian Approach with Orbitozygomatic Resection for Distal Basilar Artery Aneurysms / 대한뇌혈관학회지

Aneurysms arising from the distal basilar artery(BA) and relating to the origin of the superior cerebellar artery (SCA), posterior cerebral artery (PCA) account for more than 15% of all intracranial aneurysms and more than one-half of all aneurysms occurring in the vertebrobasilar circulation. The anatomic complexity of the interpeduncular cistern is directly related to the dangers of surgical manipulation in this region and it is undoubtedly difficult to operate on a distal basilar aneurysm which located deep in a very narrow operative field restricted by unremovable neural and vascular architectures. Although we can not choose no single operative approach suitable to this area because the indivisual patient's vascular, neural and bony anatomy is widly variable, using the modified transsylvian approach with orbitozygomatic resection the distal basilar artery aneurysms could be seen and clipped easily by upward and oblique viewing from below through the wide operative space consisting of the less retracted intracarotid artery, middle cerebral artery and oculomotor nerve. We have operated 64 distal basilar artery aneuysms. Among them, 27 patients were approached using the modified transsylvian approach with orbitozygomatic resection. The operative procedure is presented in detail and compared with other surgical approaches.

Profound hypothermia and circulatory arrest for aneurysm surgery / 대한마취과학회지

Direct surgical repair of complex intracranial vascular lesions is difficult. Sometimes the neurosurgery is performed under circulatory arrest, profound hypothermia and barbiturates cerebral protection. Total ischemia is tolerated for 30~60 minutes because oxygen requirements of the brain decrease exponentially as body temperature is lowered. We experienced that this technique was successfully used for inoperable basilar artery aneurysm. We reviewed the surgical and anesthetic considerations of basilar artery aneurysm.

Aneurysms of the Basilar Artery Treated with Circulatory Arrest , Hypothermia and Barbiturate Cerebral Protection - 2 cases - / 대한마취과학회지

Surgical and anesthetic management in patients with complex vascular lesions is often challenging. Cardiopulmonary bypass followed by total circulatory arrest, deep hypothermia and barbiturate cerebral protection are efficacious adjuncts in the surgical treatment of giant basilar artery aneurysm. These techniques were utillized in two large basilar artery aneurysm patients with good results, and the surgical and anesthetic considerations are reviewed.