Aneurisma de arteria iliaca: una causa de dolor abdominal agudo de alto riesgo

El dolor abdominal de alto riesgo es una condición común en los servicios de emergencia y está asociado a una alta morbilidad y mortalidad, si no se diagnostica y trata de manera rápida y precisa. Un hombre con síntomas de cólico nefrítico se presentó en emergencia con dolor abdominal intenso y deterioro clínico. Después de una tomografía, se encontró una imagen aneurismática en la arteria iliaca común primitiva izquierda. El paciente fue trasladado a sala de operaciones para una reparación quirúrgica, pero falleció. El dolor abdominal de alto riesgo requiere un abordaje diagnóstico integral y tratamiento individualizado para prevenir complicaciones graves. El aneurisma de la arteria iliaca complicado es una causa potencialmente grave de dolor abdominal en hombres fumadores de edad avanzada con antecedentes de hipertensión y aterosclerosis.

Life-Threatening abdominal pain is a common condition in emergency departments and it is associated with high morbidity and mortality, if not promptly and accurately diagnosed and treated. A man with symptoms of renal colic presented to the emergency room with severe abdominal pain and clinical deterioration. After a CT scan, an aneurysmatic image was found in the left primitive iliac artery. The patient was taken to an operating room for surgical repair but died. Life-Threatening abdominal pain requires a comprehensive diagnostic approach and individualized treatment to prevent serious complications. The complicated iliac artery aneurysm is a potentially serious cause of abdominal pain in elderly male smokers with a history of hypertension and atherosclerosis.

Manejo ultra temprano del aneurisma cerebral roto. Reporte de caso y revisión de la literatura / Ultra-early management of ruptured brain aneurysm. A case report and literature review

Introducción : Los aneurismas intracraneales representan el 85% de casos de hemorragias subaracnoideas, dentro de las cuales las no traumáticas tienen una alta tasa de mortalidad (40-60%). En el manejo endovascular y microquirúrgico de esta enfermedad, el debate ha sido siempre intenso respecto a si el tratamiento temprano produce un beneficioso resultado funcional y reduce la morbi-mortalidad del paciente. Caso Clínico : Paciente mujer de 54 años, admitida con cefalea súbita y cuadro neurológico que cursó con rápido deterioro. La tomografía mostró hemorragia subaracnoidea por ruptura aneurísmica del complejo comunicante anterior; fue sometida a microcirugía dentro de las primeras 24 horas y transferida luego a UCI, sin complicaciones. Discusión : El tiempo de resolución, sea mediante clipaje microquirúrgico o tratamiento endovascular es tema de intensos debates. Las guías actuales señalan la necesidad del manejo más temprano posible de la patología. Conclusión : En nuestro caso, se obtuvo un buen resultado funcional debido a varios factores uno de ellos el ingreso precoz a cirugía. La actualización de las guías y nuevos estudios ayudarán a mejorar el conocimiento de la enfermedad y protocolos hospitalarios adecuados a la realidad clínica ayudarán a reducir su tiempo de resolución.

SUMMARY Introduction : Intracranial aneurysms account for 85% of all subarachnoid hemorrhages. Non-traumatic SAH has a high mortality rate (40-60%). Regarding the microsurgical and endovascular management for this pathology, there has been intense debate on whether early action is beneficial in terms of functional outcome and reduction of morbi-mortality. Clinical case : A 54-year-old woman admitted with a sudden, severe headache and a rapidly deteriorating neurological state at baseline, and with deterioration at the next hour. Tomography showed a subarachnoid hemorrhage due to ruptured aneurysm of the anterior communicating artery; the patient underwent surgery within the first 24 hours, with subsequent ICU management without complications. Discussion : The resolution time of this condition, either by micosurgery or endovascular management is a matter of intense debate. International guidelines point out the need of an earliest possible treatment. Conclusion : In our case, a good functional result was obtained due to several factors, one of which was early admission to surgery. The updating of guidelines and new studies will help to better understand the pathophysiology of SAH, and the creation of hospital protocols adapted to clinical realities will assist to reduce the resolution time of this pathology.

Fístula arteriovenosa ilíaca à direita por rotura de aneurisma e aneurisma de artéria ilíaca esquerda: tratamento híbrido / Right iliac arteriovenous fistula due to aneurysm rupture and left iliac artery aneurysm: hybrid treatment

Resumo A fístula arteriovenosa (FAV) é uma sequela incomum de rotura espontânea de aneurisma arterial dentro do sistema venoso adjacente. Descrevemos, em um paciente de 74 anos, o tratamento endovascular de FAV ilíaca à direita por aneurisma de artéria ilíaca comum (AIC) roto associado a aneurisma de AIC distal à esquerda, em cuja cirurgia foram preservadas as artérias lombares e mesentérica inferior por necessidade de excluir simultaneamente as artérias hipogástricas. Foram demonstrados os fenômenos na dinâmica do balanço hídrico ocorridos em decorrência da interrupção da FAV. A evolução do paciente foi benigna, com normalização das graves alterações hemodinâmicas que apresentava e com desaparecimento dos sintomas respiratórios atribuídos à hipertensão arterial pulmonar.

Abstract An arteriovenous fistula (AVF) is an uncommon sequela of spontaneous arterial aneurysm rupture into the adjacent venous system. We describe the case of a 74-year-old patient who underwent endovascular treatment of a right iliac AVF caused by a ruptured common iliac artery (CIA) aneurysm and a distal left CIA aneurysm. Surgery preserved the lumbar and inferior mesenteric arteries because of the need to simultaneously exclude the hypogastric arteries. Dynamic fluid balance phenomena provoked by closure of the AVF are described. The patient had a benign postoperative course with normalization of the severe hemodynamic changes presented prior to the intervention and resolution of respiratory symptoms attributed to pulmonary arterial hypertension.

A novel balloon-assisted technique to secure visceral catheterization during a chimney endovascular repair of a ruptured abdominal aortic aneurysm in a centenarian patient / Uma nova técnica assistida por balão para assegurar a cateterização visceral durante o reparo endovascular, com a técnica de chaminé, de um aneurisma de aorta roto em um paciente centenário

Abstract A 100-year-old male patient was admitted with a ruptured abdominal aortic aneurysm due to type IA endoleak. Given the proximity of the ruptured site to the superior mesenteric artery (SMA) and renal arteries, a ChEVAR was indicated. Catheterization of the target visceral vessels was a challenging procedural step because of an intensely tortuous thoracic aorta. This hostile aortic anatomy also inhibited exchange for a super stiff guide-wire and selective cannulation with the diagnostic catheter was repeatedly lost when guidewire exchange was attempted. To overcome this issue, a 5 x 40 mm balloon catheter was placed 3cm into the target arteries. The balloon was then inflated below the nominal pressure limit enabling safe exchange for a super stiff guidewire and placement of three 90-cm long 7Fr guiding sheaths. The procedure was thus safely performed with deployment of an aortic extension and the bridging stents.

Resumo Um paciente de 100 anos foi diagnosticado com um aneurisma de aorta abdominal roto por um endoleak 1A. Pela proximidade do ponto de ruptura com a artéria mesentérica superior (AMS) e as artérias renais, um ChEVAR foi indicado. A cateterização das artérias-alvo foi um passo desafiador pela intensa tortuosidade da aorta torácica. Essa anatomia aórtica hostil também impediu a troca por um fio-guia extra-rígido, e a cateterização seletiva foi repetidamente perdida quando a troca de fio-guia foi tentada. Para superar essa dificuldade, um cateter balão 5mm x 40mm foi posicionado nas artérias-alvo. O balão foi, então, insuflado abaixo da pressão nominal, permitindo uma troca segura do fio-guia por um fio-guia extra-rígido e o posicionamento de três bainhas longas 7Frx 90cm. Assim, o procedimento foi executado de forma segura, com o implante de uma extensão aórtica e dos stents recobertos.

Fast-track protocol of endovascular aneurysm repair for ruptured abdominal aortic aneurysm / 中国医师进修杂志

Objective:To analyze the effective and safety of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (RAAA) at one tertiary center, and to improve the outcomes of RAAA under fast-track protocol.Methods:Nineteen cases of RAAA in the 940th Hospital of Joint Logistic Support Force of PLA from January 2014 to December 2020 were reviewed retrospectively. EVAR-fist strategy was employed from the emergency room to the operating room by using fast-track protocol. Preoperative management, anatomic characteristics, choice of anesthesia, operative procedures and postoperative complications were collected and analyzed. Abdominal compartment syndrome (ACS) and hospital mortality were paid special attention.Results:Nineteen cases were undergone EVAR procedures. The age was (73.4 ± 7.4) years old, and the AAA size was (67.8 ± 13.6) mm. Two cases underwent cardiopulmonary resuscitation at emergency department. General anesthesia was used in 13 patients and local anaesthesia in 6 patients. Successful stent graft deployment was achieved in all cases. The duration from emergency room to operating room was (84.8 ± 22.4) min. The hospital stay time was (9.7 ± 5.7) d. The hospital mortality was 5/19. The 5 deaths were reviewed: 3 died for multiple organ failure, 1 for irreversible shock, and 1 for ongoing bleeding.Conclusions:Excellent results were confirmed by using EVAR-first strategy for RAAA. The management of hemodynamically unstable state, standardized endovascular procedure, fast-track program and multidiscipline team collaboration were the very important determining factors for the implementation of EVAR. Focused efforts to reduce RAAA mortality are warranted.

Endovascular treatment of ruptured lobulated anterior communicating artery aneurysms: A retrospective case series study of 24 patients / 国际脑血管病杂志

Objective:To investigate the efficacy and safety of endovascular treatment for ruptured lobulated anterior communicating artery aneurysm (ACoAA).Methods:Patients with ruptured lobulated ACoAA received endovascular treatment in Sanming First Hospital Affiliated to Fujian Medical University from June 2020 to June 2022 were retrospectively included. Their demographic, clinical and imaging characteristics, endovascular treatment methods and follow-up results were collected.Results:A total of 24 patients with ruptured lobulated ACoAA were included, including 9 males (37.5%) and 15 females (62.5%). Their age was 56.2±8.9 years old (range 39-74). The time from rupture to endovascular treatment was 10.9±12.5 h. The maximum diameter of the aneurysms was 5.1±1.0 mm and neck width was 3.0±0.7 mm. Nineteen patients (79.2%) were double-lobed and 5 (20.8%) were multilobed. Fisher's grade: grade 2 in 16 cases (66.7%), grade 3 in 6 cases (25%), and grade 4 in 2 cases (8.3%). Hunt-Hess grade: grade 0-2 in 5 cases (20.8%), grade 3-5 in 19 cases (79.2%). Glasgow Coma Scale score: 9-12 in 14 cases (58.3%), 13-15 in 10 cases (41.7%). Immediately postprocedural Raymond-Roy grade: grade 1 in 23 cases (95.8%), grade 2 in 1 case (4.2%). Raymond-Roy grade in imaging follow-up for 2 weeks to 3 months: grade 1 in 23 cases (95.8%), grade 2 in 1 case (4.2%). Follow-up for 2 to 12 months showed that 21 patients (87.5%) had good functional outcomes (modified Rankin Scale score ≤2), and there were no deaths.Conclusion:Endovascular treatment is a safe and effective treatment for ruptured lobulated AcoAA.

Concentración de la cirugía de aneurisma de aorta abdominal roto en centros especializados calificados / Concentrating ruptured abdominal aortic aneurysm surgery in specialized centers

Ruptured abdominal aortic aneurysm (RAAA) is an arterial emergency with an overall mortality of 80%-90% secondary to massive hemorrhage. If a patient with RAAA presents in a primary hospital without resolution capacity, survival will depend on early transfer to a center with adequately trained specialists. This article reviews the evidence supporting the centralization of AAAR treatment in qualified centers, specifying the criteria used for the selection of referral centers and the role of a coordinating unit. Our current referral system, which is based primarily on costs, is also described. Patients with AAAR who consult in non-resolving centers should be rapidly transferred to a qualified referral center, following a transfer protocol, and guided by a coordinating unit acting according to technical and established criteria based on results, quality, and costs. Qualified referral centers should have an accredited vascular surgeon and a high institutional aortic surgery volume, adequate infrastructure, endovascular resolution capacity, support services (intensive care, hemodialysis, etc.) and specialized personnel permanently available.

Iatrogenic Isolated Ruptured Dorsalis Pedis Artery Pseudo Aneurysm : A Rare Case Report

A Dorsalis Pedis Artery (DPA) pseudo aneurysm is one of the most uncommon peripheral arterial aneurysms. These aneurysms can cause distal embolization and thrombosis, leading to limb loss. However, their rupture is unusual1. Any type of injury or perhaps an iatrogenic intervention can cause a pseudo localized swelling of the dorsalis pedis artery, which is a relatively unusual condition. Whenever it presents as a non-pulsatile soft tissue mass in the presence or absence of a specific predeceasing event, it can lead to a difficult diagnostic dilemma2. The rare instance of an iatrogenic pseudo aneurysm of the dorsalis pedis artery which mimicked cellulitis of the right foot is discussed in this case report. Coil embolization of the proximal artery, and the aneurysm was successfully done by the intervention radiologist. After the procedure, collateral circulation was maintained. No ischemic symptoms such as intermittent claudication or pain at rest were observed. This approach may be useful in treating similar cases

Application and evaluation of ultrasound critical value in ruptured tubal pregnancy / 中华超声影像学杂志

Objective:To evaluate the diagnosis and critical value reporting of ruptured tubal pregnancy by ultrasound.Methods:The clinical and ultrasound data of 70 patients with ruptured tubal pregnancy diagnosed by surgery in Peking Union Medical College Hospital from August 2017 to May 2021 were retrospectively analyzed to evaluate the diagnosis and critical value reporting of ruptured tubal pregnancy by ultrasound.Results:Among the 70 patients, 68 patients underwent gynecological ultrasonography and two patients did not. Sixty-three cases (92.6%, 63/68) were accurately diagnosed as adnexal ectopic pregnancy mass, abdominal and pelvic effusion/blood clot, and 5 adnexal ectopic pregnancy masses (7.4%, 5/68) were missed.Among the 5 missed cases, 4 cases (80%, 4/5) were heterotopic pregnancy (2 cases of IVF-ET 2 embryos, 1 case of patient taking ovulation induction drugs, 1 case of gravida with twin family history) and 1 case (20%, 1/5) of single tubal pregnancy. Critical values were reported in the all 63 cases of ruptured tubal pregnancy diagnosed by preoperative ultrasound.Conclusions:Ultrasound could accurately diagnose tubal pregnancy and assess its rupture, and timely report the critical value, effectively guarantee the medical safety. The particularity and complexity of ultrasound diagnosis in early pregnancy with assisted reproductive technique deserve more attention.

Evidence summary of blood pressure management strategies in patients with ruptured intracranial aneurysm bleeding / 中国实用护理杂志

Objective:To estimate and summarize the evidence for the blood pressure in patients with ruptured intracranial aneurysm bleeding, to provide valuable reference for clinical care and improve the prognosis of patients.Methods:BMJ Best Practice, UpToDate, Chinese Guideline Website, Cochrane Library, PubMed, American Stroke Association, Chinese National Knowledge Infrastructure, Wanfang Database and VIP Database were utilized for screening out evidences of blood pressure management strategies for patients with ruptured intracranial aneurysm bleeding from database establishment to December 8, 2020. The source of evidences included guidelines, evidence summarization, information brochure of optimal clinical practice, recommended practice, systematic review and original research. Upon the assessment of the included literature, the evidences meeting the enrollment criterion would be identified and extracted.Results:There were 9 articles involved in this research and 20 evidences possessing clinical applicability were extracted. The evidences involved in clinical assessment, regulation tenets, intervention protocol, and nursing to prevent complications in patients with ruptured intracranial aneurysm bleeding.Conclusions:To summarize, we suggested strongly to evaluate the individual differences in age, underlying diseases and pharmacological tolerance, and to effectivelly control blood pressure in patients with ruptured intracranial aneurysm bleeding through scientific nursing methods, which could improve the nursing qualification.

Surgical clipping of ruptured posterior communicating artery aneurysms originating from fetal-type posterior cerebral artery via lateral supraorbital approach / 国际脑血管病杂志

Objective:To investigate the therapeutic effect of surgical clipping ruptured posterior communicating artery aneurysms (PCoAA) originating from fetal-type posterior cerebral artery (FPCA) via lateral supraorbital approach and the influencing factors of the outcomes.Methods:Patients with ruptured PCoAA originating from FPCA underwent surgical clipping via lateral supraorbital approach in the Cerebrovascular Center of Foshan Hospital of Traditional Chinese Medicine from January 2017 to May 2020 were retrospectively enrolled. The Glasgow Outcome Scale was used to evaluate the outcomes of patients at 6 months after operation. 4-5 points were defined as good outcome, and 1-3 points were defined as poor outcome. Multivariable logistic regression analysis was used to determine the risk factors for poor outcomes. Results:A total of 119 patients were enrolled, including 98 females (82.35%), aged 61.59±11.52 years old (range 32-78 years). Thirty patients (25.21%) had poor outcomes. Multivariable logistic regression analysis showed that age (odds ratio [ OR] 2.935, 95% confidence interval [ CI] 2.117-5.391; P=0.012), hypertension ( OR 2.016, 95% CI 1.568-4.335; P=0.023), Hunt-Hess grade ( OR 2.408, 95% CI 1.326-5.068; P<0.001), modified Fisher grade ( OR 3.034, 95% CI 2.201-5.517; P<0.001), aneurysm size ( OR 1.793, 95% CI 1.427-2.622; P=0.009), preoperative intracranial hematoma volume ( OR 1.246, 95% CI 1.055-2.153; P=0.011) and surgical timing ( OR 2.152, 95% CI 1.316-3.240; P=0.006) were the independent risk factors for poor outcomes of the patients. Conclusions:Surgical clipping via lateral supraorbital approach can effectively treat the ruptured PcoAA with FPCA. Patients with age >65 years, with a history of hypertension, high Hunt-Hess grade, high modified Fisher grade, aneurysms >7.65 mm, preoperative intracranial hematoma volume >19.02 ml, and late surgery need to strengthen postoperative management to improve outcomes.

Aneurisma infeccioso primário da aorta: série de casos e revisão da literatura / Primary infectious aortic aneurysm: a case series and review of the literature

Resumo Aneurismas infecciosos, anteriormente chamados de aneurismas micóticos, são raros; acometem com maior frequência a aorta de pacientes jovens e apresentam maior tendência à rotura do que aneurismas de outras etiologias. O formato sacular é o mais característico, e os agentes etiológicos mais comuns são Staphylococcus sp e Salmonella sp. A literatura fornece informações limitadas e imprecisas sobre a correta nomenclatura, diagnóstico e tratamento da doença. Os autores reuniram três casos cujos procedimentos diagnósticos e terapêuticos foram documentados. Além de relatar essa série de casos, realiza-se uma revisão sobre o tema, a fim de estabelecer estratégias diagnósticas e terapêuticas pertinentes.

Abstract Infectious aneurysms, formerly known as mycotic aneurysms, are rare, most often involve the aorta in young patients, and have a greater tendency to rupture than aneurysms of other etiologies. The most characteristic shape is saccular and the most common etiologic agents are Staphylococcus sp. and Salmonella sp. There is scant and imprecise information in the literature about correct nomenclature, diagnosis, and treatment. The authors present three cases in which diagnostic and therapeutic procedures were documented. In addition to reporting this case series, the authors also present a review of the subject, outlining pertinent diagnostic and therapeutic strategies.

Histological Changes in Anterior Cruciate Ligament after Injury

The anterior cruciate ligament (ACL) injury is very common worldwide, frequently associated with sports trauma. Often, ACL tear necessitates reconstruction by replacing the entire ligament. Despite ACL reconstruction being performed widely, there is still lack in restoring the anatomical functions. Histological studies have demonstrated that the injured anterior cruciate ligament has numerous vessels and fibroblasts proliferation potential with continuous collagen turnover after 13–20 weeks of injury. Therefore, the ACL has healing potential and the remnants of injured ACL can be used for repair/reconstruction procedures. A better understanding of histological characteristics of injured ACL ligament will add further knowledge for finding new treatment techniques for ACL repair

Tratamiento endovascular del aneurisma esplénico incidental y en la urgencia / Endovascular treatment of incidental and emergency splenic aneurysm

Resumen Los aneurismas esplénicos verdaderos son dilataciones saculares que involucran todas las capas de la arteria esplénica. Se presentan más frecuentemente en mujeres, en el embarazo y pacientes con hipertensión portal. Son habitualmente asintomáticos y diagnosticados incidentalmente durante el estudio de otra afección abdominal. Hasta un 10% se puede presentar con ruptura, lo que supone un escenario con una alta morbilidad y mortalidad. El tratamiento de los aneurismas esplénicos es aún un tema de controversia y existen variadas modalidades terapéuticas. Presentamos dos casos de pacientes con aneurismas esplénicos: uno de ellos que se manifestó con rotura y el otro por un diagnóstico incidental. Ambos fueron resueltos mediante embolización endovascular con resultados óptimos. Esta modalidad terapéutica poco difundida para el tratamiento de aneurismas esplénicos gigantes o rotos, nos permitió resolver el cuadro de forma segura y efectiva, con mínima morbilidad y mortalidad.

Abstract True splenic aneurysms are saccular dilations of all the layers of the splenic artery, more common in women, pregnancy and portal hypertension. They are usually asymptomatic and diagnosed incidentally during the study of other abdominal diseases. Up to 10% may present with rupture, which implies a high morbidity and mortality. Treatment of splenic aneurysms is still a subject of controversy and there is a great variety of therapeutic modalities. We present two cases of patients with splenic aneurysms: one who presented with rupture and the other one incidentally diagnosed. Both were treated with endovascular embolization achieving optimal results. Although the utility of this therapy has not been assessed for giant or ruptured aneurysms, it allowed us to solve these scenarios in a secure and effective way, with minimum morbidity and mortality.

Abdominal aortic aneurysms ruptured to the vena cava: a case series and literature review / Aneurismas de aorta abdominal rotos para a veia cava: uma série de casos e revisão de literatura

Abstract Ruptured abdominal aortic aneurysms (RAAA) evolving aortocaval fistula (AF) can have catastrophic hemodynamic effects. Surgical repair is imperative, but the optimal technical approach is still under debate. Our objective is to present 3 cases treated with endovascular repair (EVAR) at a University Hospital. Case #1, a 71-year-old man presenting a 7.1cm RAAA with AF, repaired with a monoiliac stent graft and femoral-femoral bypass; Case #2, a 76-year-old man presenting a 9.9cm RAAA with AF, repaired with a bifurcated stent graft; Case #3, a 67-year-old man with previous history of EVAR, presenting a type 3 endoleak with late rupture related to AF, repaired with a tubular stent graft. All cases unfolded with delayed recovery and significant complication rates, although AF symptoms had resolved by hospital discharge. EVAR techniques for AF may require secondary interventions but are feasible, despite the lack of consensus, considering the rarity of this RAAA presentation.

Resumo Aneurismas de aorta abdominal rotos (AAAR) com evolução para fístula aorto-cava (FAC) podem apresentar consequências hemodinâmicas catastróficas. A correção cirúrgica é mandatória, embora não haja consenso sobre a técnica operatória. Apresentamos uma série de três casos operados em hospital universitário pela técnica endovascular. No primeiro caso, um homem de 71 anos apresentou AAAR de 7,1 cm com FAC, submetido a correção por endoprótese monoilíaca e enxerto femoral cruzado. No segundo, um homem de 76 anos apresentou AAAR de 9,9 cm com FAC submetido a colocação de endoprótese bifurcada. O terceiro caso era de um homem de 67 anos com histórico de EVAR e endoleak tipo 3, com ruptura tardia para veia cava, tratado com extensão aórtica. Todos apresentaram evolução pós-operatória prolongada com significativas complicações, entretanto com boa resolução dos sintomas à alta hospitalar. A EVAR é uma técnica promissora para o tratamento de FAC, embora com taxa de reintervenção significativa.

Signs of impending rupture in abdominal aortic and iliac artery aneurysms by computed tomography: Outcomes in 41 patients

OBJECTIVES: This study aimed to determine the prevalence of signs of impending rupture (SIR) in asymptomatic patients with abdominal aortic and iliac artery aneurysms, and to evaluate whether these signs were associated with rupture in asymptomatic patients. METHODS: This was a retrospective study of patients with abdominal aortic and iliac artery aneurysms identified on computed tomography (CT) over a 10-year period in a single center. The CT scans were reviewed by two reviewers, and patients with SIR were assigned to one of three groups: (1) early symptomatic (ES), (2) late symptomatic (LS), and (3) always asymptomatic (AA). The four main SIR described in the literature were investigated: 1) crescent sign, 2) focal wall discontinuity of circumferential calcifications, 3) aortic bulges or blebs, and 4) aortic draping. RESULTS: From a total of 759 aortic and iliac aneurysm reports on 2226 CT scans, we identified 41 patients with at least one SIR, and a prevalence of 4.14% in asymptomatic patients. Focal wall discontinuity of circumferential calcifications was the most common sign, and it was present in 46.3% of these patients (19/41); among these, 26 were repaired (ES: 9, LS: 2, AA: 15). Eleven asymptomatic patients underwent follow-up CT. The aneurysm increased in size in 6 of the 11 (54.5%) patients, and three ruptured (all with discontinuity of calcifications), one of which had no increase in diameter. CONCLUSIONS: The presence of focal wall discontinuity of circumferential calcifications was the most common SIR. There was a prevalence of all signs in less than 5% of asymptomatic patients. In unrepaired patients, the signs could be observed on follow-up CT scans with an increase in aneurysm size, indicating that the presence of SIR alone in the absence of other clinical factors or aneurysm characteristics is an insufficient indication for surgery.

Resultado imediato do tratamento endovascular com stents paralelos do aneurisma roto justarrenal / Immediate outcome of endovascular treatment of ruptured juxtarenal aneurysm with parallel stents

Resumo A ruptura do aneurisma de aorta abdominal é um evento com alta mortalidade, e o seu tratamento nesses casos é uma emergência médica. O tratamento endovascular desses aneurismas tem se estabelecido como uma alternativa minimamente invasiva à cirurgia aberta clássica, tornando-se a opção de primeira escolha. Contudo, 20 a 50% dos pacientes portadores de aneurisma de aorta abdominal não apresentam anatomia favorável para o tratamento endovascular devido à presença de colo curto ou pelo acometimento de ramos viscerais pelo aneurisma. Relatamos um caso de uma paciente de 70 anos submetida à correção endovascular de aneurisma roto justarrenal com implante de stents paralelos para as renais (técnica de chaminé). São apresentados dados clínicos e detalhes do procedimento. O sucesso técnico foi obtido e não houve relato de complicações pós-operatórias.

Abstract Rupture of an abdominal aortic aneurysm is an event with a high mortality rate and treatment is a medical emergency. Endovascular treatment of these aneurysms has become established as a minimally invasive alternative to classical open surgery and is now the first-choice option. However, 20 to 50% of patients with abdominal aortic aneurysms do not have anatomy favorable for endovascular treatment because of a short aneurysm neck or because visceral branches are involved by the aneurysm. We report the case of a 70-year-old patient who underwent endovascular repair of a ruptured juxtarenal aneurysm with deployment of parallel stents in the renal arteries (in a chimney technique). Clinical data and details of the procedure are reported. Technical success was achieved and there were no postoperative complications.

Short- and long-term outcomes of emergency resection versus transarterial embolization followed by resection for spontaneous rupture hepatocellular carcinoma: a meta-analysis / 中华肝胆外科杂志

Objective:To study the optimal surgical strategy for patients with hepatocellular carcinoma (HCC) presenting with spontaneous rupture and hemorrhage.Methods:The electronic databases of PubMed, Web of Science, Embase, and Cochrane Library were searched, and studies reporting on survival outcomes comparing emergency resection (ER) and transarterial embolization followed by hepatectomy (SH) were included by using predetermined inclusion and exclusion criteria. The perioperative and survival data were compared using the Review Manager 5.3 software.Results:Eight retrospective studies were included. The total sample size was 556, with 285 (51.3%) in the ER group and 271 (48.7%) in the SH group. Perioperative blood loss ( WMD=683.61, 95% CI: 283.36-1 083.86, P=0.0 008) and blood transfusion volume ( WMD=453.43, 95% CI: 250.27-656.58, P<0.0 001) in the SH group were significantly less than those in the ER group. There were no significant differences in operative time, incidences of complications, mortality and recurrence rates of tumors between the two groups (all P>0.05). The 1-, 2-, 3-year overall survival and 1-, 2-, 3-, 5-year disease-free survival of the ER group were not significantly different from those of the SH group (all P>0.05). The 5-year overall survival rate of the ER group was significantly lower than that of the SH group ( HR=1.52; 95% CI: 1.14-2.03, P=0.005). Conclusions:There was no significant difference in short-term outcomes in treatment of ruptured HCC, SH was superior to ER in long-term survival outcomes.

A life-threatening condition—ruptured ectopic pregnancy with negative urine pregnancy test: A case report

@#Ectopic pregnancy is an extra-uterine pregnancy and is a potentially life-threatening condition that can lead to death from intra-peritoneal hemorrhage. This case reports a rare occurrence of ruptured tubal pregnancy in which the patient presented early with abdominal pain and a negative urine pregnancy test but subsequently presented again with evidence of intra-peritoneal hemorrhage. A negative urine pregnancy test is often used to rule out pregnancy, but it is not 100% sensitive. Complete assessment is critical in this important diagnosis in order to plan for the appropriate emergency management.

Misleading Presentation of a Ruptured Renal Angiomyolipoma

@#We report a case of a 37-year-old pregnant lady at 27 weeks of gestation presented with contraction pain mimicking abruptio placenta. She developed hypovolemic shock six hours following hospital admission. Subsequent emergency caesarian section revealed a viable fetus with retroperitoneal hematoma but no evidence of placenta abruption. Post-operative abdominal CT angiography demonstrated a ruptured and bleeding left renal mass with fatty component consistent with renal angiomyolipoma. In view of the patient’s clinical condition who was persistently critical, an emergency left nephrectomy was proceeded which confirmed the diagnosis of a ruptured left renal angiomyolipoma intraoperatively and histologically