ABSTRACT
AIM: To report palliative embolization of a false aneurysm over the distal suture line of an ascending aorta graft replacement. MATERIAL AND METHOD: A 78-year-old male patient was admitted for increasing bleeding of a chronic Manubrium ulceration, 20 months after coronary artery bypass complicated by perioperative ascending aorta dissection requiring prosthetic graft replacement. One month later, he underwent epiploplasty for a mediastinitis followed by long-term antibiotic therapy. Five months later, he presented with a Manubrium ulceration of the sternotomy. Spiral computerized tomography (CT) and aortography revealed a 20 mm anterior peri-prosthetic false aneurysm with a wide neck. Advanced age, active mediastinitis and patient's objection led us to perform percutaneous occlusion according to the Moret remodeling technique while protecting the coils release with balloon catheter inflation. RESULTS: No post-operative complication was observed and at 1-year follow-up the patient was doing well with no recurrent bleeding. Magnetic resonance imaging (MRI) and spiral CT controls confirmed coils stability without any internal flow. CONCLUSION: Percutaneous coils embolization of a large false aneurysm in the ascending aorta can be a palliative treatment in a surgically unsuited patient.
Subject(s)
Aneurysm, False/therapy , Aorta/surgery , Aortic Diseases/etiology , Blood Vessel Prosthesis Implantation/adverse effects , Cutaneous Fistula/etiology , Embolization, Therapeutic , Vascular Fistula/etiology , Aged , Anastomosis, Surgical/adverse effects , Aneurysm, False/diagnostic imaging , Aneurysm, False/etiology , Aortic Aneurysm/surgery , Aortic Diseases/diagnostic imaging , Aortic Diseases/therapy , Aortography , Chronic Disease , Cutaneous Fistula/diagnostic imaging , Cutaneous Fistula/therapy , Embolization, Therapeutic/instrumentation , Humans , Male , Palliative Care , Postoperative Complications , Vascular Fistula/diagnostic imaging , Vascular Fistula/therapyABSTRACT
PURPOSE: To compare the angulation at the origin of dysplastic renal arteries compared to atherosclerotic renal arteries, in order to improve the technique for percutaneous transluminal angioplasty of FMD. MATERIALS AND METHODS: Retrospective analysis of 40 aortograms in patients who underwent renal angioplasty for dysplastic stenosis, with comparison with 45 control aortograms (with or without atherosclerotic lesions of the renal arteries). The angle of implantation of the renal arteries was measured relative to the aortic axis in the frontal plane, taking into account only the angulation of its proximal segment. We identified three types of kidneys with regard to their position relative to the renal artery ostium. RESULTS: The angle of implantation of dysplastic renal arteries is significantly sharper compared with the control group (63.8 degrees vs 80.9 degrees, p = 0.0001), irrespective of the side. The angulation did not correlate with the position of the kidney or the direction of the renal artery, suggesting a congenital origin. CONCLUSION: The angle of implantation of the dysplastic renal arteries relative to the aortic axis in the frontal plane is sharper than the angle measured in non dysplastic renal arteries.
