Willis covered stent in patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection: an application and follow-up study / 中华神经医学杂志

Objective:To investigate the safety and effectiveness of Willis covered stent in patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection.Methods:A retrospective analysis was performed. Six patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection admitted to the 3 hospitals from May 2016 to December 2019 were chosen; their clinical data were collected. The surgical processes and complications were concluded, and the prognoses were evaluated by modified Rankin scale (mRS).Results:One patient was treated with intraoperative simple tamponade compression for hemostasis, and died for massive intracranial hemorrhage 2 weeks after surgery. Five patients were occluded by Willis covered stents; the occluded success rate was 100% but ophthalmic arteries were blocked in all. During the perioperative period, diabetes insipidus occurred in one patient and incomplete oculomotor paralysis occurred in one patient; 5 patients were followed up for 3-12 months: MRI indicated subtotal resection of tumor in 4 patients and total resection in one patient, no new bleeding or ischemic stroke events occurred in these 5 patients, and the prognosis was good.Conclusion:Willis covered stent is safe and effective in patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection.

Current Use of the Pulmonary Artery Catheter and Related Complications during Cardiac Surgery in Japan : a Questionnaire Survey / 日本心臓血管外科学会雑誌

A recent fatal accident related to the use of the pulmonary artery catheter (PAC) promoted us to conduct a questionnaire survey to assess the current use of the PAC and its complications during cardiac surgery. Methods : A 10-item questionnaire was distributed to all board-certified cardiovascular surgery centers in Japan. Five hundred thirty-two questionnaires were distributed and 325 (61.1%) were returned. Results : Seventy-two percents of hospitals used the PAC in more than 90% of cases, while only 17% used it less than 50% of the time. Indication of its use was not clearly determined in 52% of hospitals. Entrapment of the PAC was experienced in 28% of centers in the last 10 years, and its incidence was calculated as 0.07%. At a quarter of hospitals, checking for PAC to confirm absence of entrapment was not performed during the operation. Pulmonary artery rupture occurred at 22% of hospitals, and its incidence was 0.05%. Agreements on handling PAC to prevent cardiac injury or pulmonary artery rupture were not made in 24 and 56% of hospitals respectively. Conclusion : These data demonstrate that in many of the cardiac surgery centers in Japan, the PAC is still routinely used. Serious complications including catheter entrapment and pulmonary artery injury were encountered in a substantial number of patients. Development of guidelines for PAC during cardiac surgery to limit its use to patients with clear benefits and prevent related complications is warranted.

A Case of Stanford Type A Acute Aortic Dissection with an Innominate Artery Rupture / 日本心臓血管外科学会雑誌

We recorded a case of a 58-year-old man who presented with swelling of the right neck after sudden chest pain. He was diagnosed with Stanford type A aortic dissection. Computed tomography revealed an aneurysm in the innominate artery surrounded by a hematoma. We therefore suspected a rupture of the innominate artery. In addition, the right common carotid artery was almost completely obstructed due to dissection. An emergency partial arch replacement was performed. Cardiopulmonary bypass (CPB) was established with two blood supplies : the right axillary and left common femoral arteries. When CPB was started, the innominate artery ruptured and could no longer be used for cerebral perfusion or as an anastomotic site. The right side of the neck was opened, and a synthetic graft was anastomosed to the right common carotid artery for cerebral perfusion. Finally, the graft was anastomosed with a branch of the main trunk. The right subclavian artery was also reconstructed using a graft that was anastomosed to the axillary artery for blood supply. The postoperative course was favorable, and no cerebral complications were observed.

Clinical analysis of 5 cases of infectious renal artery rupture after renal transplantation / 中华器官移植杂志

Objective To explore the prevention and treatment strategies for the infectious renal artery rupture after renal transplantation of organ donation after citizens death (DCD).Methods The clinical data of 5 donors and their corresponding recipients with infectious renal artery rupture after renal transplantation were retrospectively analyzed with review of the literature.Results The corresponding donors of 5 recipients had the potential risk factors for donor-transmitted infection (DTI):1 case of traumatic rupture of small intestine,2 cases of digestive tract injury when resecting the donor kidney from DCD donors,1 case of severe pneumonia and 1 case of multiple renal contusion.The pathogenic microorganisms were found in the culture of kidney preservation solution,including klebsiella pneumoniae in 1 case,candida albicans in i case,enterococcus.No pathogens were detected in 1 case,and kidney preservation solution taken from the external hospital was not cultured in 1 case.The pathological examination on the resected renal grafts revealed the necrosis of the arteries and the infiltration of lymphocytes.The culture of bacteria and fungi in the removed vessel walls of renal grafts and the iliac tissues showed there were 2 cases positive for candida albicans (case 2 and case 4),1 case for cryptococcus neoformans (case 1),1 case for klebsiella pneumonia (case 5).No pathogenic bacteria were detected in 1 case,but the possibility of fungal infection was more likely.In case 1,the second kidney transplantation was performed 10 months later after artery re-transplantation,and the kidney function was normal during the follow-up period.In case 4,the second kidney transplantation was performed 2 months later after transplant nephrectomy due to the refractory rejection,the transplanted kidney experienced a rapid loss of graft function,and the blood dialysis was given continuously.The remaining 3 patients survived so far,waiting for re-transplantation.No case of bleeding occurred again in the 5 recipients.Conclusion Renal graft artery rupture is one of most severe complications after renal transplantation.It is the key for preventing infectious renal artery rupture to screen strictly infection of donors and recipients,and to use sensitive and wide coverage antimicrobial to the donors before the removal of donor kidney and during the perioperative period after renal transplantation.Early detection and operation as soon as possible is the only treatment to save the lives of the recipients.

Rupture of the Deep Femoral Artery during Proximal Femoral Nailing Following an Intertrochanteric Fracture: A Case Report / 대한고관절학회지

Recently, we experienced a case where the diagnosis and management of a deep femoral artery rupture was delayed. This vascular complication occurred during the insertion of a distal interlocking screw of a proximal femoral nail for the fixation of an intertrochanteric femur fracture. A 79-year-old male patient was diagnosed with a right intertrochanteric fracture after a fall. We fixed the fracture with a proximal femoral nail (Zimmer® Natural Nail™ System). One day after the procedure, the patient complained of pain and swelling on the anteromedial side of his middle thigh followed by hypotension, anemia and prolonged thigh swelling. Computed tomography angiography was performed 7 days after the procedure. We found a pseudoaneurysm of the perforating artery caused by injury to the deep femoral artery and an intramuscular hematoma in the anterior thigh muscle. We successfully treated the pseudoaneurysm using coil embolization. Throughout the management of intertrochanteric femoral fractures, it is important to be aware and monitor signs and symptoms related to the possibility of blood vessel damage. When a patient presents with swelling and pain on the middle thigh and/or unexplained anemia postoperatively, the possibility that these symptoms are caused by an injury to the femoral artery must be considered.

High-resolution MR imaging for diagnosis and follow-up study in 4 patients with extracranial internal carotid artery dissection / 中国脑血管病杂志

Objective: To investigate the characteristics of extracranial internal carotid artery dissection (ICAD) and the application value of high-resolution MR imaging (HR-MRI) in the diagnosis and follow-up study. Methods: Four patients with extracranial ICAD were diagnosed by clinical and imaging and confirmed by 3D-HR-MRI. They received anticoagulant or antiplatelet therapies for 2 to 9 months and their clinical manifestations were followed up. Their prognostic evaluation was conducted using the National Institutes of Health Stroke Scale (NIHSS), and reexamined with 3D-HR-MRI for observing the changes of hematoma in the vascular walls. Results: Circled digit oneAll the 4 patients was detected by 3D-HR-MRI. The "double-lumen sign" and the "half-moon" shaped intramural hematoma with uniform strength and slightly higher signal could be seen on each axial sequence. Circled digit twoThe clinical prognosis of the 4 patients were good. Circled digit threeThe intramural hematomas were reexamined in 3 patients, their hematomas were significantly reduced or completely disappeared. One patient with true lumen thrombosis caused arterial occlusion had distal recanalization during the reexamination. Conclusion: HR-MRI may conducts the diagnosis and follow-up study of the extracranial ICAD. The prognosis of the extracranial ICAD may be good if it is diagnosed and treated promptly.

Embolization of an Atraumatic Rupture Occurring in the Internal Thoracic Artery / 日本心臓血管外科学会雑誌

We report the findings in a 75-year-old woman who was given diagnosis of rupture of the internal thoracic artery (ITA) and was successfully treated by coil embolization. The patient suddenly felt chest pain, and a chest CT revealed a mediastinal hematoma. She was suspected to have an acute aortic dissection, and therefore transferred to our hospital. Upon careful examination, a CT showed a hematoma in the superior mediastunum and the extravasation of the left internal thoracic artery. Emergency coil embolization was thus performed to stop the bleeding. After the embolization, no further hemorrhaging was observed. The patient was uneventfully discharged in a healthy state 2 weeks later. Rupture of the internal thoracic artery is rare. However, it is important to include this potential disease in the differential diagnosis when encountering a patient presenting with an atraumatic mediastinal hematoma.

Combined open surgical and endovascular management of ruptured femoral artery from recurrent vulvar cancer / 부인종양

We report on the case of a 50-year-old woman with exsanguinating haemorrhage from the common femoral artery as a complication of recurrent vulvar cancer in the groin which was managed successfully with combined open surgical and endovascular intervention. She survived another three months and died from progressive disease without further episodes of bleeding. This complication is rare, presents dramatically, and is usually a terminal event. For those cases where intervention is considered appropriate, the option of combined open surgical and endovascular repair should be kept in mind.

Life-threatening transplant renal artery rupture after cadaveric kidney transplantation in China / 대한내과학회지

Surgical complications are still an important cause of graft loss after kidney transplantation. The most serious of these complications is arterial anastomosis rupture, which may cause not only graft loss and lower limb ischemia but can also be fatal. This paper presents a case of life-threatening transplant renal artery rupture after cadaveric kidney transplantation in China. With regard to cadaveric kidney transplantation in China, the shortage of donor information and operative findings is an obstacle to the post-transplant evaluation and management of overseas transplant recipients. Moreover, a high incidence of surgical complications and infection are present in this population of patients;therefore, these patients should be monitored more closely.

Life-threatening transplant renal artery rupture after cadaveric kidney transplantation in China / 대한내과학회지

Surgical complications are still an important cause of graft loss after kidney transplantation. The most serious of these complications is arterial anastomosis rupture, which may cause not only graft loss and lower limb ischemia but can also be fatal. This paper presents a case of life-threatening transplant renal artery rupture after cadaveric kidney transplantation in China. With regard to cadaveric kidney transplantation in China, the shortage of donor information and operative findings is an obstacle to the post-transplant evaluation and management of overseas transplant recipients. Moreover, a high incidence of surgical complications and infection are present in this population of patients;therefore, these patients should be monitored more closely.

A case of postpartum spontaneous ovarian artery rupture in patient with preeclampsia / 대한산부인과학회지

Spontaneous ovarian artery rupture is exceedingly rare case that occur in the postpartum period. There were the cases that occurred aneurysmal rupture of ovarian artery and the coronary artery rupture in the women postpartum period without preeclampsia. There were the cases that occurred the cerebral artery rupture or retinal artery rupture in preeclampsia, but ovarian artery rupture is unreported. The cause of ovarian artery rupture in the postpartum period is unknown, but we thought that thinned arterial wall may be the cause during this period. The women in preeclampsia have high risk factors such as hypertension and pathologic disorder of the vessel. The retroperitoneal hemorrhage due to ovarian artery rupture cause hypovolemic shock, eventually death, therefore, it is necessary to immediate diagnosis and treatment. We described a case of spontaneous right ovarian artery rupture that occurred 2 days after vaginal delivery in preeclampsia including a review of the literature.

A Case of Hypovolemic Shock Associated with Superior Gluteal Artery Rupture Without Pelvic Fracture in Blunt Trauma

Superior gluteal artery rupture without pelvic fracture is extremely rare, but the rupture of this vessel is a well-known complication of pelvic fractures. This vessel appears to be at risk at the time of pelvic fracture because of its vulnerable anatomical position in the sacrosciatic notch. The rupture of this vessel causes profound hypotension and compartment syndrome of the gluteal or thigh region. Embolization is the most effective treatment. We report an unusual case of a superior gluteal artery rupture without pelvic fracture in blunt trauma.

A Case of Death Due to Spontaneous Intraperitoneal Bleeding in P-ANCA Positive Small Vessel Vasculitis / 대한신장학회잡지

P-ANCA small vessel vasculitis is multisystemic disease, especially frequently involving the kidney. Diagnosis is delayed because it's non-specific clinical manifestation. Recently ANCA becomes available tools for diagnosis of vasculitis. Infection and gastrointestinal complications are relatively common in vasculitis. But spontaneous rupture of gastrointestinal artery is a rare complication. A 61-year-old housewife was admitted due to poor oral intake, weight loss and microscopic hematuria. Renal biopsy showed an extensive necrotizing glomerulonephritis, consistent with Wegener's granulomatosis or microscopic polyangitis. Serum test showed positive for P-ANCA. Despite steroid therapy, she expired due to spontaneous rupture of right gastroepiploic artery.

A Case of Management of Carotid Artery Rupture by Detachable Balloon Embolization / 대한이비인후과학회지

Carotid artery rupture ranks as the most dreaded among the head and neck surgery complications. Despite the well-documented risk of cerebral ischemia, operative carotid ligation has been the traditional management of last resort for carotid artery rupture. Over the past several years, however, the technique of endovascular occlusion of blood vessels has demonstated considerable promise in the management of carotid artery rupture. With the help of endovascular balloon occlusion, the authors managed a case of carotid artery rupture developed after the radiation therapy of laryngeal carcinoma and the salvage laryngectomy with neck dissection. Embolization on the right carotid artery was performed with detachable balloons and spiral coils after the carotid artery occlusion test. The patient did not show any complications of neurological function. The pharyngocutaneous fistula and skin defects were reconstructed with the use of pectoralis muscuocutaneous flap.

Pulmanary Artery Rupture with Pulmoanry Artery Catheter / 대한마취과학회지

Pulmonary artery rupture with a flow-directed balloon tipped pulmonary artery catheter (Swan-Ganz catheter)is a rare complication with high mortality. This report concerns a case of this complication with hemothorax leading to fatal exsanguination. Emphasis is placed on the safety guidelines to prevent this. Also, possible causes and managements are presented. A high index of suspicion is necessary whenever a patient with the catheter has hemoptysis or unexplained hemodynamic or respiratory changes.

Pulmanary Artery Rupture with Pulmoanry Artery Catheter / 대한마취과학회지

Pulmonary artery rupture with a flow-directed balloon tipped pulmonary artery catheter (Swan-Ganz catheter)is a rare complication with high mortality. This report concerns a case of this complication with hemothorax leading to fatal exsanguination. Emphasis is placed on the safety guidelines to prevent this. Also, possible causes and managements are presented. A high index of suspicion is necessary whenever a patient with the catheter has hemoptysis or unexplained hemodynamic or respiratory changes.

Insertion Length of Pulmonary Artery Catheter and its Migration During Extracorporeal Circulation / 대한마취과학회지

Proper positioning of pulmonary artery catheter and predicting distal migration of it during cardiopulmonary bypass is important for the prevention of perioperative complication of pulmonary artery rupture. The authors therefore examined the insertion length of pulmonary artery catheter via right internal jugular vein at which catheter tip was advanced to the most proximal position where pulmonary capillary wedge pressure could be obtained. And also the distal migration is measured by comparing the difference between prebypass and postbypass corrected length. Just before bypass, pulmonary artery catheter was arbitrarily receded 5cm for the prevention of spontaneous distal migration and wedging. The subjects were 47 patients who underwent open heart surgery (valve replacement, coronary artery bypass graft) during the period of November, 1992 through April, 1993. The results were as follows. 1) The insertion length of pulmonary artery catheter from skin to the right ventricle inlet, pulmonary artery inlet and pulmonary capillary wedge position were 26.5+/-3.0 cm, 36.8+/-4.9 cm and 46.1+/-5.7 cm respectively. 2) There were no significant statistical correlations between insertion lengths and patient constitutions such as body weight and height(r=0.144, r=0.032). 3) Locations of catheter tips were distributed to the 0.9+/-3.1 cm left to the spinous process, 1.9+/-1.6 cm inferior to the carina ; mostly LLQ of the lung field(51%). 4) During cardiopulmonary bypass, pulmonary artery catheter tips were migrated distally in 93.6% of the cases and the migration lengths were 2.7+/-2.0 cm. 5) There were no major perioperative complications caused by pulmonary artery catheterization. These results suggest that 5 cm withdrawal of pulmonary axtery catheter just before cardiopulmonary bypass can prevent the fatal complication of pulmonary artery rupture owing to its spontaneous distal migration.