Manejo anestésico durante la cirugía para pseudoaneurisma ventricular izquierdo / Anesthetic management during surgery for left ventricular pseudoaneurysm

Resumen: Se informa la conducta anestésica de un caso de pseudoaneurisma ventricular izquierdo crónico secundario a complicación de infarto de miocardio transmural, complicación rara y casi siempre mortal. En este informe se describe el caso de una mujer de 60 años con insuficiencia cardíaca aguda a consecuencia de un infarto cardíaco ocurrido cinco meses atrás, que generó la complicación de la cual damos referencia. El manejo anestésico perioperatorio se logró al enfocarse en mantener una presión arterial estable para garantizar la perfusión cerebral y reducir el riesgo de ruptura completa del aneurisma hacia el espacio mediastinal.

Abstract: The anesthetic behavior of a case of chronic left ventricular pseudoaneurysm secondary to a complication of transmural myocardial infarction, a rare and almost always fatal complication, is reported. This report describes the case of a 60-year-old woman with acute heart failure, this is a consequence of a heart attack that occurred 5 months ago, which generated the complication of which we refer. Perioperative anesthetic management was achieved by focusing on maintaining a stable blood pressure to ensure cerebral perfusion and reduce the risk of complete rupture of the aneurysm into the mediastinal space.

Left Ventricular Pseudo-False Aneurysm Perforating into the Right Ventricle / 日本心臓血管外科学会雑誌

We report the case of a 52-year-old man who presented with a 2-week history of exertional dyspnea and was admitted to our hospital with heart failure. Coronary angiography showed severe three-vessel disease ; left ventriculography revealed an aneurysm in the inferior left ventricular (LV) wall perforating into the right ventricle. We suspected the LV aneurysm was from a previous myocardial infarction (MI) that had perforated into the right ventricle, although the time of MI was unclear. The patient was treated with medications initially. We subsequently treated the patient by LV aneurysm closure using a patch and direct closure of the perforation by incising the aneurysm. Coronary artery bypass grafting was performed in the left anterior descending artery, the diagonal artery, and the right coronary artery simultaneously. After having an uneventful postoperative course, he was discharged from the hospital in a stable condition. A pathology examination confirmed a diagnosis of LV pseudo-false aneurysm.

Pseudoaneurisma humeral secundario a punción arterial inadvertida / Brachial artery pseudoaneurysm secondary to inadvertent arterial puncture

RESUMEN Los pseudoaneurismas de la arteria humeral son infrecuentes, pero pueden asociarse a complicaciones de alta morbilidad como la isquemia de miembro superior. Comunicamos un caso de pseudoaneurisma humeral en el pliegue del codo, que se presentó como tumor pulsátil con leve disminución de la temperatura y parestesias en la mano homolateral de un año de evolución, debido a una punción arterial inadvertida durante la venopunción para extracción de sangre. Se trató con éxito mediante resección quirúrgica más reconstrucción vascular con bypass húmero-cubital y bypass húmero-radial ambos con vena safena. Se discuten las diversas opciones terapéuticas disponibles para los pseudoaneurismas humerales considerando las características anatómicas y la sintomatología del paciente.

ABSTRACT Brachial artery pseudoaneurysms are rare but can be associated with severe complications as ischemia of the upper extremity. We report a case of a brachial artery pseudoaneurysm in the crease of the elbow presenting as a pulsating mass with progressive growth over the past year. The ipsilateral hand was sightly cold and presented paresthesia. The lesion was due to inadvertent arterial puncture during venipuncture. The pseudoaneurysm was successfully treated with surgical resection and vascular reconstruction with a brachial to ulnar artery bypass and brachial to radial artery bypass with saphenous vein graft. The different therapeutic options available for brachial artery pseudoaneurysms are discussed, considering the anatomic characteristics and patients' symptoms.

Pseudoaneurisma para-anastomótico gigante tras revascularización por baipás aorto-bifemoral: Informe de un caso / Giant para-anastomotic pseudoaneurysm after revascularization though aorto-bifemoral bypass grafting: Case report

RESUMEN El pseudoaneurisma es aquel hematoma pulsátil y encapsulado producido tras la rotura de todas las túnicas del vaso y contenido por tejidos vecinos circundantes. Es considerado una complicación tardía en la cirugía protésica aorto-ilíaca. Se presenta un paciente de 72 años al que se le realizó un baipás aorto-bifemoral 13 años atrás, y que posteriormente se le diagnosticó un pseudoaneurisma para-anastomótico que se dejó evolucionar por presentar varias comorbilidades asociadas. Transcurridos 2 años fue necesario realizarle una intervención quirúrgica por presentar crecimiento excesivo de la tumefacción y complicación isquémica con necrosis cutánea. La aparición de un pseudoaneurisma está relacionada con el sexo, el material protésico y con el tiempo que transcurre desde la cirugía. El seguimiento ultrasonográfico durante el postoperatorio es primordial para identificar tempranamente esta complicación.

ABSTRACT Pseudoaneurysm is that pulsatile and encapsulated hematoma produced after the rupture of all vessel layers and contained by surrounding neighboring tissues. It is considered a late complication in aorto-iliac prosthetic surgery. We present a 72-year-old patient who underwent an aorto-bifemoral bypass grafting 13 years ago, and who was subsequently diagnosed with a para-anastomotic pseudoaneurysm that was allowed to evolve due to presenting several associated comorbidities. After two years, it was necessary to perform a surgical intervention due to the excessive growth of the swelling, and ischemic complication with skin necrosis. The appearance of a pseudoaneurysm is related to sex, prosthetic material as well as the time that elapses since the surgery. Ultrasound follow-up during the postoperative period is essential for an early identification of this complication.

Pseudoaneurisma micótico por embolismo séptico en paciente pediátrico con leucemia linfoblástica aguda / Mycotic aneurism for septic embolism in a pediatric patient with acute linfoblastic leukemia

Resumen Los aneurismas pediátricos son raros y pueden se causados por infección al dañar la pared arterial formando una saculación ciega contigua a su lumen denominada pseudoaneurisma micótico. La mayoría de los casos reportados son de pacientes ancianos con comorbilidades y los agentes causantes más frecuentes son Staphylococcus spp, Salmonella spp, Streptococcus spp y raramente hongos. Se presenta el caso de un niño de 3 años con: diagnóstico reciente de leucemia linfoblástica aguda de precursores B en remisión; alto riesgo de recaída por tratamiento incompleto y antecedente de bacteremia por Staphylococcus epidermidis y fungemia por Cándida tropicalis; vegetaciones cardiacas que hacen embolismo a hígado, bazo, pulmón y cerebro, y pseudoaneurisma micótico parcialmente trombosado de la arteria ilíaca común y externa. El diagnóstico temprano de esta entidad es de vital importancia por el riesgo de ruptura y el manejo quirúrgico dependerá de la localización, el tamaño y las complicaciones asociadas.

Abstract Pediatric aneurysms are rare and can be caused for damaging of the arterial wall secondary to an infection, forming a blind sacculation contiguous to its lumen called mycotic pseudoaneurysm. The majority of reported cases are from elderly patients with comorbidities. The most frequent involucre microorganisms are Staphylococcus spp, Salmonella spp, Streptococcus spp and rarely fungi. We present the case of a 3-year-old boy, with a recent diagnosis of acute lymphoblastic leukemia of B precursors in remission, with a high risk of relapse due to incomplete treatment and a history of bacteremia due to Staphylococcus epidermidis and fungemia due to Candida tropicalis; with cardiac vegetations that produce liver, spleen, lung and brain embolism, in whom a partially thrombosed mycotic pseudoaneurysm of the common and external iliac artery is found. The early diagnosis of this entity is of vital importance because of the risk of rupture. Surgical management will depend on the location, size and associated complications.

Falso aneurisma del sitio de canulación aórtico después de cirugía cardíaca: Informe de un caso y revisión de la literatura / False aneurysm of ascending aortic cannulation site after cardiac surgery. Case report and literature review

RESUMEN El pseudoaneurisma de aorta ascendente, como complicación en cirugía cardíaca, tiene una incidencia menor del 0,5%, pero una mortalidad que varía del 6,7 al 60%. La manipulación aórtica y la infección son los principales factores predisponentes. Su clínica puede ser variada y constituir un hallazgo casual en controles posteriores. Se presenta el caso de una paciente operada de cirugía valvular mitral que a los 11 meses del postoperatorio se le diagnostica un pseudoaneurisma de aorta ascendente, que requirió tratamiento quirúrgico de emergencia. La cirugía fue llevada a cabo con la utilización de canulación periférica extramediastínica, sin requerir parada circulatoria, ni hipotermia para su correcta disección. El caso muestra una variante técnica para enfrentar una enfermedad poco frecuente, pero altamente desafiante, por la necesidad de reintervención y una correcta estrategia quirúrgica.

ABSTRACT False ascending aortic aneurysm, as a complication in cardiac surgery, has an incidence of less than 0.5%, but a mortality that ranges from 6.7% to 60%. Aortic manipulation and infection are the main predisposing factors. Its clinical presentation is non-specific and may be found incidentally on subsequent check-ups. The case of a patient undergoing mitral valve surgery who was diagnosed with ascending aortic false aneurysm, eleven months after postoperative period, requiring emergency surgical treatment is presented. The surgery was performed using extra-mediastinal peripheral cannulation, without induced circulatory arrest or hypothermia for proper dissection. The case shows a technical version to face an uncommon but highly challenging disease as it needs re-interventions and successful surgical strategies.

Pseudoaneurisma como complicação de fratura de côndilo mandibular / Pseudoaneuriysm as complication of mandibular côdilo fracture

INTRODUÇÃO: Pseudoaneurismas são geralmente resultantes de trauma sem corte levando provocando a laceração de parte da parede do vaso promovendo o extravasamento de sangue para os tecidos circundantes, seguidos por tamponamento e formação do coágulo. OBJETIVO: Apresentar um caso de pseudoaneurisma em artéria carótida externa como complicação de fratura de côndilo mandibular. RELATO DE CASO: Paciente de 18 anos de idade, vítima de acidente motociclístico compareceu à emergência do Hospital Regional do Cariri com fratura de côndilo mandibular associada à fratura de coronoide e parassínfise, evoluindo com pseudoaneurisma de artéria carótida externa e submetido à embolização seletiva. CONCLUSÃO: Ressaltamos que pseudoaneurismas da artéria carótida externa apresentam as fraturas de côndilo mandibular como fatores etiológicos raros, no entanto uma cuidadosa análise das suas características anatômicas assim como o diagnóstico precoce concorrem para a prevenção de acidentes e complicações graves nas abordagens dos traumas de face... (AU)

Introduction: Pseudoaneurysms are usually the result of blunt trauma leading to laceration of part of the vessel wall promoting extravasation of blood into surrounding tissues followed by tamponade and clot formation. Purpose: To present a case of external carotid artery pseudoaneurysm as a complication of mandibular condyle fracture. Case report: An 18-year-old patient, a motorcycle accident victim, attended the emergency of the Cariri Regional Hospital with a mandibular condyle fracture associated with a coronoid fracture and a parasymphysis, evolving with external carotid artery pseudoaneurysm and submitted to selective embolization. Conclusion: We emphasize that pseudoaneurysms of the external carotid artery present mandibular condyle fractures as rare etiological factors, however a careful analysis of their anatomical characteristics as well as early diagnosis contributes to the prevention of accidents and serious complications in the face trauma approaches... (AU)

Ruptured Suprarenal Abdominal Aortic Pseudoaneurysm with Superior Mesenteric and Celiac Arteries Occlusion, Revealing Behçet’s Disease: A Case Report

Behçet’s disease (BD) is a multisystemic, chronic autoimmune inflammatory vasculitic disease with an unknown etiology. Although the literature reports that vascular involvement occurs in 7% to 38% of all BD cases, the arteries are rarely involved; however, arterial involvement is usually associated with significant mortality and morbidity. We report the case of a young female patient who presented to the emergency department with severe abdominal pain and a history of weight loss. The patient was evaluated using computed tomography angiography, which revealed a ruptured suprarenal aortic pseudoaneurysm with occlusion of both the superior mesenteric and celiac arteries. Urgent surgery was performed with aortic repair with an interposition graft and superior mesenteric artery embolectomy. The patient’s clinical history and radiological imaging findings were strongly suggestive of the diagnosis of BD with vascular involvement.

Giant Dorsalis Pedis Pseudoaneurysm Following Cannulation for Arterial Line in a Patient with Systemic Lupus Erythematosus

Dorsalis pedis artery (DPA) aneurysms are very rare and fewer than 60 cases have been reported in the literature. Most affected patients present with false aneurysms after orthopedic surgery or trauma. Here we report an unusual case of a giant DPA pseudoaneurysm after cannulation for arterial line placement in a patient newly diagnosed with systemic lupus erythematosus (SLE). A diagnostic delay resulted in necrosis of the overlying skin. Excision of the pseudoaneurysm, ligation of the DPA, and debridement of the foot dorsum were performed, followed by a second flap coverage surgery. Although a DPA false aneurysm is rare after arterial line removal, it can cause the serious complications of skin necrosis, rupture and toe necrosis. Arterial puncture sites should be carefully monitored, especially in patients with SLE or other vasculitis.

Access site pseudoaneurysms after endovascular intervention for peripheral arterial diseases

PURPOSE: Pseudoaneurysms after percutaneous vascular access are common and potentially fatal if left untreated. The aim of this study was to determine the incidence and risk factors associated with access site pseudoaneurysms after endovascular intervention for peripheral arterial disease (PAD) under a routine postintervention ultrasound (US) surveillance protocol. METHODS: A total of 254 PAD interventions were performed in a single center between January 2015 and November 2016, and puncture site duplex US surveillance was routinely performed within 48 hours of the procedure. Clinical, procedural and follow-up US data were analyzed. RESULTS: The overall incidence of pseudoaneurysm was 2.75% (6 cases in the femoral artery and 1 in the brachial artery). There was no difference between retrograde and antegrade approach, but there was a higher rate of pseudoaneurysm formation after manual compression compared to arterial closure device (ACD) use (4.3% vs. 0.87%). Manual compression was more commonly used for antegrade punctures (79.0%) and ACD for retrograde punctures (67.7%). Calcification was more frequently found in antegrade approach cases (46.8% vs. 16.9% for retrograde cases) and manual compression was preferred in its presence. All pseudoaneurysms were treated successfully at the time of diagnosis by US-guided compression repair and there were no cases of rupture. CONCLUSION: Pseudoaneurysm rates after therapeutic endovascular intervention for PAD were comparable to other cardiologic or interventional radiologic procedures despite the higher possibility of having a diseased access vessel. Routine US surveillance of access sites allowed for early diagnosis and noninvasive treatment of pseudoaneurysms, preventing potentially fatal complications.

A Case of Left Ventricular Pseudo-false Aneurysm / 日本心臓血管外科学会雑誌

<p>A 66-year-old man presented to a local doctor with a chief complaints of episodes of dizziness lasting several seconds. Electrocardiographic findings were suggestive of arrhythmia and old myocardial infarction, and the patient was therefore referred to our hospital. Left ventriculography showed an aneurysm at the posteroinferior wall of the left ventricle, while coronary angiography showed chronic total occlusion of the left circumflex branch (segment 13) and a coronary-pulmonary artery fistula with a coronary aneurysm. On computed tomography, the orifice of the ventricular aneurysm was small, measuring approximately 10 mm. Magnetic resonance imaging showed wall thinning and mural thrombus in the ventricular aneurysm, with aneurysmal dilatation during systole. Suspecting a ventricular false aneurysm resulting from old myocardial infarction, left ventricular reconstructive surgery and resection of the coronary artery aneurysm were performed. Intraoperatively, myocardial necrosis of the posteroinferior wall accompanied by the ventricular aneurysm was seen. There was no pericardial adhesion to the ventricular aneurysm, and the diameter of the orifice of the aneurysm was approximately 10 mm. The ventricular aneurysm was cut open and then closed using a direct suture combined with patch repair. As for the coronary artery aneurysm, the inflow and outflow arteries were each clipped before the wound was closed. The patient had a favorable postoperative course and was discharged from the hospital on the 15th day after surgery. The pathological examination showed residual cardiomyocytes within the aneurysmal wall, thereby establishing the diagnosis of a pseudo-false aneurysm. Our experience with this rare case is reported.</p>

Aortic Injury during Transforaminal Lumbar Interbody Fusion

Aortic injury during transforaminal lumbar interbody fusion (TLIF) is a rare but severe complication. We experienced aortic injury during TLIF at L3–4 with a 59-year-old woman diagnosed with an adjacent segment disease at L3–4. Severe bleeding occurred during disc space expansion, and the blood pressure dropped to 60/40 mmHg. The patient’s vital sign stabilized after compression with gauze and Gelfoam in addition to blood transfusion. The patient was treated with endovascular repair using a percutaneous technique after intertransverse fusion at L3–4 was completed. She recovered and is being followed-up in the outpatient department.

Organizing Thrombus Mimicking a Cardiac Tumor Located at the Mitral-Aortic Intervalvular Fibrosa

Thrombosis at the left ventricular outflow tract occurs without any detectable heart disease or predisposing factors only extremely rarely. A 48-year-old male visited Konkuk University Medical Center with loss of consciousness one month prior to presentation. Before he visited our hospital, he had been diagnosed with a cardiac tumor, which was located between the left atrium and posterior aortic root, and which was adjacent to both the aortic and mitral valves. Cardiac transplantation was recommended at the other hospital because of the high risk of cardiac dysfunction induced by both aortic and mitral valvular dysfunction after surgical resection. Based on preoperative transthoracic echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging, and intra-operative transesophageal echocardiography, we considered it to be a benign tumor. Complete resection was achieved and the pathology confirmed organizing thrombus. We report a case of organizing thrombus mimicking a cardiac tumor, which was located at the mitral-aortic intervalvular fibrosa of the left ventricular outflow tract without any heart disease.

Anesthetic management during surgery for left ventricular aneurysm and false aneurysm occurring in stage: a case report / 대한마취과학회지

Left ventricular aneurysm (LVA) and false aneurysm are complications of acute myocardial infarction, trauma, and cardiac surgery. Left ventricular false aneurysm (LVFA) is a particularly catastrophic complication owing to its high propensity for rupture. Surgical resection should be considered for LVFA occurring within three months after myocardial infarction or development of congestive heart failure. In this report, we describe a case of acute heart failure with LVA and LVFA occurring in stage as a complication of myocardial infarction in a 55-year-old man. The patient was also at risk of brain ischemia due to abnormal vessel status and a previous cerebrovascular accident with left-sided weakness. Successful perioperative anesthetic management was achieved by focusing on maintaining marginal upper normal blood pressure to ensure cerebral perfusion and to reduce the risk of false aneurysm rupture.

Pseudoaneurysm after arthroscopic procedure in the knee / Pseudoaneurisma após procedimento artroscópico no joelho

The aim of this study was to review all cases of pseudoaneurysm in the literature, in predominantly arthroscopic procedures on the knee, and to report on a case of pseudoaneurysm that we treated. A bibliographic search was conducted for scientific articles published in Brazilian and foreign periodicals over the last 23 years. Forty-seven cases were found, in 40 articles. In addition to these 47 cases, there was the case that we treated, which was also included in the data. Among the operations that progressed with formation of a pseudoaneurysm, 60% were cases of meniscal injuries and 23%, anterior cruciate ligament injuries. In 46% of the cases, the artery affected with the popliteal, and in 21%, the inferomedial genicular artery. The commonest clinical symptom was pain (37%), followed by pulsating tumor (31%), edema of the calf (12%) and hemarthrosis (11%). The median time taken to make the diagnosis was 11 days, but it ranged from one day to 10 weeks after the procedure. Although rare, pseudoaneurysms are a risk that is inherent to arthroscopic surgery. All patients should be made aware of the vascular risks, even in small-scale procedures.

O objetivo deste estudo é revisar na literatura todos os casos de pseudoaneurisma em procedimentos predominantemente artroscópicos do joelho e relatar um caso de pseudoaneurisma tratado pelos autores. Foi feita uma pesquisa bibliográfica por meio de artigos científicos publicados em periódicos nacionais e internacionais nos últimos 23 anos. Foram levantados 47 casos, em 40 artigos. Somou-se aos 47 um caso dos autores deste estudo que foi incluído nos dados. Das cirurgias que cursaram com pseudoaneurisma, 60% se tratavam de lesões meniscais e 23% de lesões do ligamento cruzado anterior. Em 46% dos casos a artéria acometida foi poplítea e em 21% a artéria genicular inferomedial. O sintoma clínico mais comum foi dor (37%), seguido de tumor pulsátil (31%), edema de panturrilha (12%) e hemartrose (11%). A mediana do tempo para diagnóstico foi de 11 dias, mas variou de um dia até 10 semanas após o procedimento. Apesar de raro, o pseudoaneurisma é um risco inerente à cirurgia artroscópica. Todo paciente deve ser notificado dos riscos vasculares, mesmo em procedimentos de pequeno porte.

O objetivo deste estudo é revisar na literatura todos os casos de pseudoaneurisma em procedimentos predominantemente artroscópicos do joelho e relatar um caso de pseudoaneurisma tratado pelos autores. Foi feita uma pesquisa bibliográfica por meio de artigos científicos publicados em periódicos nacionais e internacionais nos últimos 23 anos. Foram levantados 47 casos, em 40 artigos. Somou-se aos 47 um caso dos autores deste estudo que foi incluído nos dados. Das cirurgias que cursaram com pseudoaneurisma, 60% se tratavam de lesões meniscais e 23% de lesões do ligamento cruzado anterior. Em 46% dos casos a artéria acometida foi poplítea e em 21% a artéria genicular inferomedial. O sintoma clínico mais comum foi dor (37%), seguido de tumor pulsátil (31%), edema de panturrilha (12%) e hemartrose (11%). A mediana do tempo para diagnóstico foi de 11 dias, mas variou de um dia até 10 semanas após o procedimento. Apesar de raro, o pseudoaneurisma é um risco inerente à cirurgia artroscópica. Todo paciente deve ser notificado dos riscos vasculares, mesmo em procedimentos de pequeno porte.

A Case of Double-Patch Closure for Left Ventricular Pseudo-False Aneurysm Following Subacute Myocardial Infarction / 日本心臓血管外科学会雑誌

A 65-year-old man was admitted with subacute myocardial infarction. During medical treatment, the patient lost consciousness as a result of an atrioventricular block and underwent an operation for an emergency percutaneous coronary intervention in the right coronary artery. In a follow-up examination, transthoracic echocardiography and computed tomography showed a left ventricular pseudo-false aneurysm, and therefore another operation was carried out. The operative findings showed that the heart markedly adhered to the pericardium and the aneurysm at the apex. The patient then underwent a double-patch closure of the ruptured point using an equine pericardial patch and a Dacron patch. No perioperative complication was observed. Left ventricular pseudo-false aneurysm is a rare complication following myocardial infarction. Here, we report a successful case of a double-patch closure of a pseudo-false aneurysm.

Pseudoaneurisma de la vena porta como una complicación hemorrágica de Ia pancreatoduodenectomy: portal vein pseudoaneurysm as an hemorrhagic complication after pancreatoduodenectomy / Case report: portal vein pseudoaneurysm as an hemorrhagic complication after pancreatoduodenectomy

La pancreatoduodenectomía (cirugía de Whipple) es un procedimiento realizado frecuentemente para el manejo de neoplasias pancreáticas. Las complicaciones hemorrágicas de este procedimiento son bien conocidas, sin embargo, existe escasa información sobre el desarrollo de pseudoaneurisma portal como complicación de esta cirugía. Aquí presentamos un caso de pseudoaneurisma portal en una paciente de 76 años que evoluciona con hemorragia tardía post pancreatoduodenectomía. Se realiza una tomografía computada de abdomen que demuestra el pseudoaneurisma de la vena porta, que se corrobora quirúrgicamente como un desgarro de 2 centímetros en esta estructura. El pseudoaneurisma se desarrolla adyacente a un tubo de drenaje abdominal y en el intraoperatorio se evidencia filtración de la anastomosis, hallazgos también descritos en otro caso de pseudoaneurisma portal post pancreatoduodenectomía, situación que sugiere que estas condiciones pudiesen ser factores de riesgo para el desarrollo de esta complicación.

Pancreaticoduodenectomy (Whipple surgery) is a procedure commonly performed for the management of pancreatic neoplasms. Hemorrhagic complications for this procedure are well known, however, there is little information on the development of portal vein pseudoaneurysm as a complication of this surgery. We present a case of a 76 year old patient with portal vein pseudoaneurysm which formed as a result of lateonset bleeding after pancreaticoduodenectomy. Computed tomography of the abdomen was performed showing the portal vein pseudoaneurysm, which was surgically corroborated as a 2cm tear in this structure. The pseudoaneurysm developed adjacent to an abdominal drainage tube and in the intraoperative anastomotic leakage was evident, findings also described in another case of portal vein pseudoaneurysm after pancreaticoduodenectomy, a situation that suggests that these conditions might be risk factors for the development of this complication.

Pulmonary alveolar hemorrhage from a pulmonary artery false aneurysm after Swan-Ganz catheterization in a thoracic aortic aneurysm patient: a case report / 대한마취과학회지

Pulmonary artery (PA) rupture caused by a PA Swan-Ganz catheter is a rare complication but remains fatal in almost 50% of cases. False aneurysm of the PA is a rare presentation of PA rupture and should be considered as a possible diagnosis in a patient with a new lung mass after PA catheterization. We present a case of sudden-onset pulmonary alveolar hemorrhage during cardiovascular surgery due to a traumatic PA false aneurysm. The Swan-Ganz catheter might have been displaced by the thoracic aortic aneurysm with displacement of the catheter causing the false aneurysm and bleeding.

Arterial Pseudoaneurysm in Neonates with Hemophilia: Successful Treatment with Noninvasive Clotting Factor Replacement and Ultrasound-guided Compression

Vascular cannulation is an invasive procedure that carries the risk of complications such as pseudoaneurysms. Hemophilia, the most common severe bleeding disorder of inheritance, increases the risk of such complications through underlying hypocoagulability. Although surgical ligation has been considered the gold standard treatment, less invasive options are currently available. Here we present 2 hemophiliac neonates for whom clotting factor replacement and ultrasound (US)-guided compression were successfully used. A 3-week-old male infant and a 4-week-old male infant presented with masses in the left antecubital area and the radial aspects of both wrists, respectively, after arterial punctures. The US confirmed the presence of pseudoaneurysms located at the left brachial artery and right radial artery. US-guided compressions with clotting factor administration initially attempted while confirming a thrombus inside the pseudoaneurysm sac indicated successful management. Arterial cannulation and other procedures in hemophiliac neonates must be attempted with caution because pseudoaneurysms or uncontrolled bleeding may occur. If laboratory analyses or invasive procedures are needed for neonates with a bleeding tendency or a suspected hemophiliac disorder, arterial or venous cannulation requires more caution or should be avoided if possible. This case report suggests that US-guided compression and clotting factor administration are suitable modalities for the treatment of small pseudoaneurysms in hemophilia patients.

Glued Angiocatheter: A Rare Complication of Intrarenal Pseudoaneurysm Glue Angioembolization

Endovascular management of intraparenchymal renal artery pseudoaneurysms is a reasonable and effective therapeutic technique. Endovascular management preserves the maximum amount of renal tissue and reduces the potential risk of nephrectomy. We present the case of an angiocatheter that became stuck in the renal artery following the injection of cyanoacrylate glue for angioembolization of an intrarenal pseudoaneurysm.