Endovascular treatment of a traumatic carotid pseudoaneurysm with the Tubridge stent; A case report / 中国脑血管病杂志

Traumatic intracranial pseudoaneurysm is usually caused by blunt or penetrating head injuries. It lacks of real blood vessel wall and is covered only by a fragile connective tissue layer. Traumatic intracranial pseudoaneurysm mainly occurs in the carotid, cavernous and petrous segments of the internal carotid artery. A case of traumatic internal carotid artery pseudoaneurysm successfully treated with Tubridge flow diverter device was reported. The 32-year-old male patient was diagnosed as a pseudoaneurysm of the left internal carotid artery after a traffic accident, and received treatment with Tubridge flow diverter device one month later. After stents release, angiography showed obviously retained contrast agent in pseudoaneurysm, decreased aneurysm size and well-opened stents. The size of the pseudoaneurysm was found reduced by magnetic resonance angiography reexamination on the 4th day after the operation,and a further decrease on the 10th day by digital subtraction angiography (DSA) reexamination. Four months after the operation, DSA showed the aneurysm was completely cured.

Recurrent epistaxis from a post-traumatic infraorbital artery pseudoaneurysm

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To present a rare case of post-traumatic recurrent epistaxis in an elderly woman.<br /><strong>METHODS:</strong><br />  <strong>Design:</strong> Case Report<br /> <strong> Setting:</strong> Tertiary Private Hospital<br /><strong>  Patient:</strong> One<br /><strong>RESULT:</strong> A  93-year-old  woman  had  multiple  admissions  for  recurrent  life  threatening  nose-bleeding  that  was  not  controlled  until  a  post-traumatic pseudoaneurysm  of  the  infraorbital artery was diagnosed and embolized.<br />CONCLUSION: The diagnosis of pseudoaneurysm should be considered in such cases, and treatment involving surgeons and interventional radiologists should be initiated to minimize morbidity and mortality.</p>

Endovascular repair of peripheral traumatic pseudoaneurysm with ViabahnTM self-expanding covered stent / 介入放射学杂志

Objective To discuss the feasibility, safety and validity of the use of ViabahnTM self-expanding covered stent in endovascular repair of peripheral traumatic pseudoaneurysm (TPA). Methods During the period from June 2012 to April 2014, a total of 8 patients with peripheral TPA were admitted to the Department of Vascular and Endovascular Surgery of Shanghai Changzheng Hospital . The clinical data were retrospective analyzed. The lesions were located at the common carotid artery (n=4), vertebral artery (n=1), subclavian artery (n=1) and superficial femoral artery (n=2). On the basis of acute and chronic TPA classification and different therapeutic principles, endovascular repair with ViabahnTM self-expanding covered stent was employed in 8 patients. Intraoperative angiographic findings, the size and number of the implanted stent, and the immediate angiographic results after stent implantation were recorded. All the patients were followed up to evaluate the improvement of the symptoms, the effectiveness of the repair of TPA cavity, and the occurrence of endoleak or restenosis. Results Successful implantation of ViabahnTM self-expanding covered stent was accomplished in all 8 patients, with a technical success rate of 100%. Angiography performed immediately after stent implantation showed that complete repair of TPA cavity was obtained in all patients, the distal segment of the parent artery was patent, and no endoleak was observed. The sizes of the stent used in the patients were 8×50 mm (n=2) and 9×50 mm (n=2) in common carotid artery, 6×50 mm (n=1) in vertebral artery, 11×100 mm (n=1) in subclavian artery, and 8×100 mm (n=2) in superficial femoral artery. The patients were followed up for 6-30 months (mean of 14.3 months), and the clinical symptoms disappeared in all patients. CT angiography indicated that there was no endoleak or restenosis. Conclusion Based on the different therapeutic principles, the use of ViabahnTM self-expanding covered stent in endovascular repair of peripheral TPA is technically simple and micro-invasive, and clinically feasible with reliable effect and safety. Therefore, this technique can be employed as a first-line therapy option for peripheral TPA.

Aneurisma de la aorta torácica descendente: Conducta a propósito de 3 casos / Aneurysm of the descending thoracic aorta: Actions because of 3 cases / Aneurisma da aorta torácica descendente: conduta a partir de 3 casos

Presentamos 3 casos que nos tocaron tratar en los últimos 5 años en la aorta descendente. Nos referimos a un caso de pseudoaneurisma post-traumático que fue tratado con varias endoprótesis en distintas oportunidades con complicaciones que fueron subsanadas paulatinamente. Otro caso se refiere a un paciente con un aneurisma de la arteria subclavia derecha aberrante, siendo tratada con una endoprótesis y un Amplazer pero a los dos años presenta leak con crecimiento importante del aneurisma, con desarrollo de ACV y edema en esclavina; debiendo tratarse con oclusión del leak con endoprótesis. A la vez que se colocó un stent en el confluente yugulosubclavio izquierdo. Finalmente, el tercer casos correspondió a una disección aguda con desarrollo de un aneurisma de la falsa luz gigante que se trata con endoprótesis. Evoluciona favorablemente hasta que luego de 2 años presenta elongación de la aorta con agrandamiento y dolor. Se debe colocar una nueva endoprótesis hasta el tronco celíaco. Se hacen consideraciones terapéuticas al analizar retrospectivamente los tres casos.

Apresentamos 3 casos que tratamos oportunamente nos últimos 5 anos referentes à aorta descendente. Relatamos um caso de pseudo-aneurisma pós-traumático, que foi tratado com várias endopróteses em diferentes ocasiões, com complicações que foram remediadas paulatinamente. Outro caso refere-se a um paciente com um aneurisma da artéria subclávia direita aberrante, sendo tratado com uma endoprótese e um Amplatzer, porém, após dois anos, apresenta um leak com crescimento importante do aneurisma, com desenvolvimento de ACV e edema denominado Doença de Madelung, devendo ser tratado com oclusão do leak com endoprótese, ao mesmo tempo em que colocou-se um stent no confluente jugular subclávio esquerdo. Finalmente, o terceiro caso correspondeu a uma dissecção aguda com desenvolvimento de um aneurisma da falsa luz gigante, tratado com endoprótese. Evoluciona favoravelmente até que depois de 2 anos apresenta alongamento da aorta, com aumento de tamanho e dor. Foi preciso a colocação de uma nova endoprótese até o tronco celíaco. Constam considerações terapêuticas ao analisar retrospectivamente cada um dos três casos.

We present 3 cases that we treated in the last 5 years in the descending aorta. We are referring to a case of a post traumatic pseudoaneurysm which was treated with several stents in different occasions, with complications that have been corrected gradually. We mention another case with an aneurysm of aberrant right subclavian artery, being treated with a stent and an Amplazer, but two years later, a leak with an important growth of the aneurysm with ACV development and edema in the cape is presented. At the same time, a stent in the left jugular subclavian confluence was placed. Finally, the third case was a severe dissection with development of an aneurysm of the giant light, which was treated with stent. It progesses well but after two years an elongation in the aorta is presented with enlargement and pain. A new stent up to the celiac body must be placed. Therapeutic considerations are made to analyse the three cases retrospectively.

Traumatic Pseudoaneurysm of the Superficial Temporal Artery diagnosed with 3-Dimensional Computed Tomography Angiography: Two Cases Report

PURPOSE: Superficial temporal artery(STA) aneurysms are very rare and mostly occur as pseudoaneurysms secondary to trauma. Clinical diagnosis of STA pseudoaneurysm is based on a history of trauma or surgery to frontotemporal region, which presents with pulsatile mass. To confirm diagnosis, many imaging strategies can be used such as digital subtraction angiography, sonography, CT and MRI. But, these imaging modalities are invasive or inaccurate or expensive. Thus, we used 3D CT angiography to confirm STA aneurysm and to get accurate information. METHODS: We have experienced two cases of pulsatile mass on the temporal area, suspected as STA pseudoaneurysms. On the basis of clinical information, we performed 3D CT angiography to get more accurate information about this pulsatile mass and to confirm diagnosis. On the basis of information from 3D CT angiography, we performed operation. RESULTS: The lesions were diagnosed as pseudoaneurysm of superficial temporal artery by 3D CT angiography, and surgically resected safely without any complication on the basis of information from 3D CT angiography. 3D CT angiography was excellent diagnostic method for detecting STA pseudoaneurysms, and effectively showed many information about pseudoanerysms such as relationship between the aneurysms and surrounding structures, and its size. CONCLUSION: We could effectively diagnose and treat on the basis of information from 3D CT angiography. We present our cases with a brief review of the literature related to STA traumatic pseudoaneurysms.

Intracerebral Hematoma Caused by Ruptured Traumatic Pseudoaneurysm of the Middle Meningeal Artery: A Case Report

Hematomas caused by ruptured traumatic pseudoaneurysms of the middle meningeal artery (MMA) usually present with extradural hematomas, whereas intradural intraparenchymal hematomas are extremely rare. We report a case of traumatic pseudoaneurysm of the MMA giving rise to an intracerebral hematoma after head trauma. A 70-year-old man suffered a massive intracerebral temporoparietal hemorrhage after a head injury. CT angiogram of the brain revealed a large hematoma in the right middle cranial fossa extending to the right sylvian fissure. Cerebral angiogram also revealed a pseudoaneurysm of the MMA, which was successfully treated surgically. Although traumatic MMA pseudoaneurysm producing intracerebral hematoma (ICH) is rare, it should be considered as a possible cause of intracerebral hematoma.

Traumatic Pseudoaneurysm of the External and Internal Carotid Artery Presenting as Epistaxis: Case Report / 대한이비인후과학회지

Post-traumatic pseudoaneurysm of the carotid artery is extremely rare but present with progressively severe, often fatal epistaxis. Because temporal course of epistaxis in patients with traumatic pseudoaneurysm of the carotid artery commonly demonstrates a variable latency period, pseudoaneurysm is often a clinical challenge. Optimal management for this diseases demands rapid recognition and treatment to give the best functional outcome. The authors have experienced three cases of traumatic pseudoaneurysm of the carotid artery resulting in massive epistaxis and showing unusual clinical course that were successfully treated with endovascular techniques. In two patients, pseudoaneurysm formation resulted from hemorrhage of the internal carotid artery (ICA). The other one case resulted from the external carotid artery (ECA).

A Case of Internal Carotid Artery Traumatic Pseudoaneurysm with Epistaxis: Treated with Detachable Balloon Occlusion (DBO) and Detachable Coil / 대한이비인후과학회지

Traumatic pseudoaneurysm of the intracavernous internal carotid artery (ICA) is rare, but it is life threatening because of massive epistaxis. Unfortunately, the prompt diagnosis and treatment of this desease are frequently delayed due to its rarity and latent period. Optimal therapy for this diseases is essential in order to minimize its morbidity and mortality. The authors present a case of male patient with traumatic pseudoaneurysm of ICA. This patient was a 24-year-old male with a multiple facial bone fracture, with unilateral blindness and recurrent massive epistaxis after suffering a head trauma. Computed tomography, MRI and carotid artery angiogram showed intracavernous pseudoaneurysm. The patient was effectively treated with occlusion of the ICA circulation by endovascular treatment utilizing detachable balloon occlusion (DBO) and mechanically detachable tungsten coils.

Interventional therapy of traumatic pseudoaneurysm / 介入放射学杂志

Objective To introduce the different therapeutic methods for the different types of traumatic pseudoaneurysms. Methods Traumatic pseudoaneurysm was treated in 8 patients. Intraarterial embolization was performed with gelfoam in 3 patients for terminal type. Endovascular covered stent graft was inserted in 2 patients with trunk type. One patient with branch type, we used metallic coils to embolize both broken ends. One patient with perforation in femoral artery was treated with compression. For 1 patient with huge haematoma and pseudoaneurysm, operation for elimination the haematoma was performed after embolization. Results Pseudo- aneurysm kept closed after treatment achieved in all 8 patients. Distal arterial pulse was normal in 2 patients treated with stent graft. A new pseudoaneurysm presented as a complication at puncture site in 1 patient due to other factors. There were no other symptomatic complications. Conclusions Pseudo- aneurysms can be treated effectively with interventional techniques instead of surgical operation.