A case report of an intracranial giant aneurysm in a 10-year-old female

@#Pediatric intracranial aneurysms are rare and differ from aneurysms in adults in terms of location, etiology, natural history and management. This is a case report of giant aneurysm in a 10-year old patient presenting with symptoms of headache and vomiting. Cerebral catheter angiogram revealed a large aneurysm in the left middle cerebral artery, M1 segment. The patient underwent left pterional craniotomy, clip reconstruction of the patent artery, and aneurysmectomy. Post operatively the patient had an unremarkable course and was discharged improved after 1 week. Cerebral catheter angiogram was performed after 2 months and revealed no residual aneurysm.

Aneurisma aislado y asintomático en la arteria ilíaca común derecha / Isolated and asymptomatic aneurysm in the right common iliac artery

Los aneurismas de la arteria ilíaca aislados son extremadamente raros y representan solo entre el 2 por ciento y el 7 por ciento de todos los aneurismas intraabdominales. Este artículo tuvo como objetivo asociar los criterios actuales para el tratamiento quirúrgico en los aneurismas aislados y asintomáticos en la arteria ilíaca común. Se presenta un paciente masculino de 62 años, fumador, remitido del departamento de radiología, porque se observó en el ultrasonido abdominal dilatación aneurismática en arteria ilíaca común derecha. En la tomografía computarizada contrastada se confirmó aneurisma aislado con diámetros quirúrgicos. Se decidió operar y se realizó aneurismectomía más injerto por sustitución protésica con dacrón ilio-ilíaco, con una evolución clínica posoperatoria inmediata y tardía satisfactoria. El tratamiento de referencia para el aneurisma de la arteria ilíaca común ha sido la reparación quirúrgica abierta con injertos protésicos. El algoritmo de decisión se basó en el riesgo de ruptura, que depende a su vez del diámetro aneurismático y del ritmo de crecimiento. Actualmente, el umbral para la reparación electiva de la arteria ilíaca aislada puede considerarse con un mínimo de 3,5 cm de diámetro, pero existe nueva evidencia científica de que muchos pacientes pueden someterse a un tratamiento innecesario si se utiliza este diámetro. Esta es una entidad especial, no solo por su infrecuencia sino también por la mayor complejidad de su reparación(AU)

Isolated iliac artery aneurysms are extremely rare and account for only 2 percent to 7 percent of all intra-abdominal aneurysms. This article aimed to associate current criteria for surgical treatment in isolated and asymptomatic aneurysms in the common iliac artery. A 62-year-old male patient, smoker, referred from the radiology department, is presented because aneurysmal dilation was observed in the abdominal ultrasound in the right common iliac artery. The contrasted computed tomography confirmed an isolated aneurysm with surgical diameters. It was decided to operate and aneurysmectomy plus grafting was performed by prosthetic replacement with ilio-iliac dacron, with a satisfactory immediate and late postoperative clinical evolution. The reference treatment for common iliac artery aneurysm has been open surgical repair with prosthetic grafts. The decision algorithm was based on the risk of rupture, which in turn depends on the aneurysmal diameter and the rate of growth. Currently, the threshold for elective repair of the isolated iliac artery can be considered to be a minimum of 3.5 cm in diameter, but there is new scientific evidence that many patients may undergo unnecessary treatment if this diameter is used. This is a special entity, not only because of its infrequency but also because of the higher complexity of its repair(AU)

A Surgical Experience of Popliteal Venous Aneurysm Associated with Acute Pulmonary Thromboembolism / 日本心臓血管外科学会雑誌

Popliteal venous aneurysm (PVA) is recognized as source of fatal pulmonary embolism ; surgical treatment is indicated. A 79-year-old woman presented with acute shortness of breath. A cardiac ultrasound echography showed right heart overload and pulmonary hypertension. A contrast enhanced CT revealed multiple pulmonary artery emboli and right popliteal venous aneurysm. She was immediately started anticoagulation therapy with oral factor Xa inhibitor and her dyspnea improved. As thrombus in venous aneurysm was considered the cause of the pulmonary embolism, we recommended surgical treatment. Tangential aneurysmectomy with lateral venorrhaphy for the saccular venous aneurysm was performed. Postoperative contrast enhanced CT showed good morphology and she was discharged without complication. Surgical treatment of symptomatic popliteal venous aneurysm is considered useful strategy.

Aneurisma venoso como complicación de una fistula arterio-venosa interna para hemodiálisis / Venous aneurysm as a complication of an internal arteriovenous fistula for hemodialysis: a case report

RESUMEN Introducción: dos complicaciones frecuentes que presentan mal función de las fístulas arteriovenosas internas son la trombosis y la estenosis. Otras complicaciones como los aneurismas, aunque de menor frecuencia, no dejan de ser importantes. Estas requieren una intervención a tiempo para evitar el fracaso de dicho acceso. Presentación del caso: paciente que es intervenido por aneurisma venoso de fístula arteriovenosa interna y tratado con aneurismectomía total. No se preservó el acceso vascular. Se colocó catéter temporal en yugular interna derecha en espera de la realización de un nuevo acceso vascular, sin complicaciones. Conclusiones: el tratamiento es a criterio del cirujano vascular debido a los elementos clínicos encontrados, así como a los cambios degenerativos a consecuencia del proceso inflamatorio local. Los aneurismas de las fístulas arteriovenosas constituyen una complicación con frecuencia baja, pero que no están exentos de la ruptura. Se observa tanto en fístulas arteriovenosas autólogas como en injertos autólogos y heterólogos. El peligro de rotura espontánea en un sitio de afinamiento marcado de la piel a consecuencia de punciones repetidas, constituye una indicación para tomar una conducta quirúrgica con prontitud. Además, es importante que el equipo multidisciplinario esté al cuidado de la fistula durante todo el tiempo de vida útil.

ABSTRACT Introduction: two frequent complications that present a poor function of the internal arteriovenous fistulas are thrombosis and stenosis. Other complications such as aneurysms, although less frequent, are not unimportant; they require a timely intervention to avoid the failure of such approach. Case report: a patient who is intervened due to a venous aneurysm of internal arteriovenous fistula and treated with total aneurysmectomy. Vascular approach was not preserved; a temporary catheter was placed in the right internal jugular vein while waiting for a new vascular approach to be made, and there were no complications. Conclusions: the treatment is at the discretion of the vascular surgeon; due to the clinical elements found, as well as the degenerative changes as a result of the local inflammatory process. The aneurysms of the arteriovenous fistulas constitute a complication of low frequency, but they are not exempt from rupture. It is observed both in autologous arteriovenous fistulas and in autologous and heterologous grafts. The danger of spontaneous rupture at a marked skin-toning site as a result of repeated punctures is an indication for prompt surgical procedure. The treatment is at the discretion of the vascular surgeon and it is important the multidisciplinary team cares for the fistula during its projected lifespan.

Aneurisma de la arteria carótida interna derecha / Aneurysm of the right internal carotid artery

Introducción: El aneurisma de la arteria carótida interna es una enfermedad muy poco frecuente. Sus complicaciones son muy graves si se tiene en cuenta la zona que irrigan estas arterias. Su incidencia es baja Objetivo: Presentar las manifestaciones clínicas de esta enfermedad y el tratamiento realizado en el paciente. Presentación del caso: paciente masculino de 58 años de edad con antecedentes de hipertensión arterial y un aneurisma de la arteria carótida interna derecha desde hace cinco años; el cual aumentó su tamaño en los últimos seis meses. El diagnóstico fue confirmado por ecodoppler y angiotomografía. Se empleó el tratamiento quirúrgico convencional, la aneurismectomía e injerto por sustitución, con prótesis de politetrafluroetileno sin complicaciones. Conclusiones: El paciente evolucionó satisfactoriamente después de la cirugía, en la actualidad lleva tres meses intervenido sin complicaciones y mantiene el tratamiento con antiagregantes plaquetarios(AU)

Introduction: The aneurysm of the right internal carotid artery is a very rare disease. Its complications are very serious if we take into account the area that irrigates these arteries. The incidence of this disease is low. Objective: To present the clinical manifestations of this disease and the surgical treatment used in this patient. Presentation of the case: Male patient, 58 years old, with a history of arterial hypertension and presenting an aneurysm of the right internal carotid artery with five years of evolution. Such lump increased its size in the last six months; this was confirmed by ecodoppler and angiotomography, so he came to the consultation. The conventional surgical treatment was used: aneurysmectomy and grafting by substitution with polytetrafluroethylene prosthesis without complications. Conclusions: The patient developed successfully after surgery; he is currently evolving after three months of being operated on without complications and he keeps the treatment with antiplatelet agents(AU)

Tangential Resection of a Popliteal Vein Aneurysm in a Patient Complaining of Localized Popliteal Pain

A 48-year old man presented with left popliteal pain. A 2.2×1.6 cm sized saccular aneurysm at the level of the left popliteal fossa was diagnosed by ultrasonography. Tangential aneurysmectomy and popliteal vein repair was performed uneventfully. The patient fared well for a year without symptoms. Popliteal vein aneurysms are rare and typically found in patients with fatal thromboembolic features without warning symptoms. Fortunately, our patient had localized pain which was helpful in its early diagnosis and treatment.

Aneurisma del tronco tirocervical / Thyrocervical trunk aneurysm

El aneurisma de la arteria subclavia es una entidad extremadamente rara que no sobrepasa el 1 % del total de los aneurismas periféricos y pueden situarse en diferentes sectores de la arteria. El objetivo de este trabajo es describir el diagnóstico y tratamiento empleado en un paciente portador de un aneurisma verdadero del tronco tirocervical derecho, rama de la arteria subclavia, considerado como infrecuente. Se trata de una paciente femenina de 48 años de edad, con antecedentes de aumento de volumen en la zona supraclavicular derecha, tumoración que late y se expande sin trauma previo en dicha zona. Las manifestaciones clínicas consistieron en dolor y parestesias que se irradiaban al miembro superior derecho. A través de estudios ultrasonográficos (ecodoppler y angioTac) se le diagnosticó un aneurisma del tronco tirocervical derecho, rama de la primera porción de la arteria subclavia. Fue intervenida quirúrgicamente en el Instituto Nacional de Angiología y Cirugía Vascular. Se realizó una aneurismectomía y ligadura proximal y distal utilizando un abordaje supraclavicular. Se encontró un aneurisma verdadero de la arteria señalada. Los estudios ultrasonográficos permitieron un diagnóstico certero del problema. La técnica quirúrgica utilizada fue exitosa y la paciente mostró una evolución satisfactoria, sin complicaciones hasta el momento actual con regresión de sus síntomas clínicos(AU)

The subclavian artery aneurysm is an extremely rare disease that barely accounts for 1 % of all peripheral aneurysms and may be located in different sectors of the aorta. The objective of this paper was to describe the diagnosis and treatment used in a patient carrying an unusual true aneurysm of the right thyrocervical trunk, the subclavian artery branch. The case of 48 years-old woman, with a history of raised volume of the right supraclavicular area, beating tumor that expands, and no previous trauma in the area. The clinical symptoms were pain and parestesias irradiating to the right upper member. Through the ultrasonographic studies (Ecodoppler and AngioTac), she was diagnosed a right thyrocervical trunk aneurysm, branch of the first portion of the subclavian artery. She was operated on at the National Institute of Angiology and Vascular Surgery. She underwent aneurysmectomy and proximal and distal ligature by using supraclavicular approach. A true aneurysm of the referred artery was found. The ultrasonographic studies allowed a precise diagnosis of the problem and the surgical procedure was successful. The patient recovered satisfactorily with no complications up to the present and regression of her clinical symptoms(AU)

Efficacy of aneurysmectomy in patients with severe left ventricular dysfunction: favorable short-and long-term results in ischemic cardiomyopathy

INTRODUCTION: The purpose of this study was to (1) identify the functional results after aneurysm surgery in patients with ischemic cardiomyopathy and (2) identify predictors of favorable outcomes. METHODS AND MATERIAL: Patients (n = 169) with angiographic left ventricular ejection fraction of 22±5 percent underwent aneurysm surgery and were prospectively followed for three years. Prior to surgery, 40 percent and 60 percent of the patients were in congestive heart failure NYHA class I/II and III/IV, respectively. Concomitant revascularization was performed on 95 percent of the patients. RESULTS: Cumulative in-hospital and 36-month mortalities were 7 percent and 15 percent, respectively. These respective rates varied according to preoperative parameters: CHF class I-II, 4 percent and 13 percent; CHF class III-IV, 8 percent and 16 percent; LVEF,20 percent, 12 percent and 26 percent; LVEF 21-30 percent, 2 percent and 6 percent; gated LVEF exercise/rest .5 percent, ,1 percent and 4 percent; and gated LVEF exercise/rest #5 percent, 17 percent and 38 percent. Higher LVEF ex/rest ratio (p = 0.01), male sex (p = 0.05), and a higher number of grafts (p = 0.01) were predictive of improvement in CHF class at follow-up based on the results of a multivariate analysis. After three years of follow-up, 84 percent of the patients were in class I/II, LVEF was 45±7 percent, and gated LVEF ex/rest ratio was 13 percent higher (p,0.01) compared to the beginning of the study. CONCLUSIONS: These data suggest that aneurysmectomy among patients with severe LV dysfunction result in shortand long-term favorable functional outcome and survival. Selection of appropriate surgical candidates may substantially improve survival rates among these patients.

Management of Postinfarct Posterobasal Left Ventricular Aneurysm A Case Report / 대한흉부외과학회지

The surgical treatment of postinfarct aneurysm on the posterobasal aspect of left ventricle is seldom reported compared to apical aneurysm although the actual incidence is higher than expected, partly because of the complexity of the operation and unpredictable postoperative results. Here, we present a case of postinfarct posterobasal left ventricular aneurysm in which endoventricular circular patch plasty technique was applied successfully. The methodology is described with review of the relevant literature.

Técnica de Cooley modificada para a correçäo cirúrgica de aneurismas do ventrículo esquerdo / Modified Cooley technique for surgical repair of left ventricular aneurysms

Avaliar os resultados cirúrgicos imediatos da técnica de endoaneurismorrafia ventricular de Cooley modificada. Oito pacientes, sete homens, com idades de 38 a 67 (m = 51,2 ñ 11,4) anos, portadores de aneurisma do ventrículo esquerdo pós-infarto agudo do miocárdio, submetidos à correçäo do aneurisma pela técnica de endoaneurismorrafia ventricular de Cooley modificada. Todos os pacientes receberam alta hospitalar assintomáticos em período médio de 9,0 ñ 2,3 dias após a cirurgia, näo tendo ocorrido complicaçöes pós-operatórias. O índice cardíaco médio aumentou de 2,1 ñ 0,5 para 3,3 ñ 1,1l/min (p < 0,05), perfazendo aumento médio de 52,8%. Nenhum paciente necessitou de suporte circulatório mecânico e o suporte farmacológico pôde ser interrompido em todos os casos no pós-operatório imediato. A técnica de endoaneurismorrafia ventricular de Cooley modificada tem ostrado resultados iniciais animadores, buscando preservar a anatomia do ventrículo esquerdo o mais próximo do normal

An operative case of aneurysm of peripheral pulmonary artery / 日本心臓血管外科学会雑誌

Aneurysm of peripheral pulmonary artery was rarely reported. A 51-year-old man who was pointed out a coin lesion at the right hilus region on the chest X-ray film complained back chest pain. Selective pulmonary arteriography revealed the peripheral pulmonary aneurysm of saccular dilatation running into the middle lobe. Aneurysmectomy was performed successfully and the patient returned to social work. Pathologic specimen revealed partly necrosis of medial cell. Eleven surgical cases including this case were reported in Japan. A brief review of the literature was made.