Massive inferior wall aneurysm presenting with ventricular tachycardia and refractory cardiomyopathy requiring multiple interventions: A case report.

BACKGROUND: Inferior wall left ventricular aneurysms are rare, they develop after transmural myocardial infarction (MI) and may be associated with poorer prognosis. We present a unique case of a large aneurysm of the inferior wall complicated by ventricular tachycardia (VT) and requiring surgical resection and mitral valve replacement. CASE SUMMARY: A 59-year-old male was admitted for VT one month after he had a delayed presentation for an inferior ST-segment elevation MI and was discovered to have a large true inferior wall aneurysm on echocardiography and confirmed on coronary computed tomography (CT) angiography. Due to the sustained VT, concern for aneurysm expansion, and persistent heart failure symptoms, the patient was referred for surgical resection of the aneurysm with patch repair, mitral valve replacement, and automated implantable cardioverter defibrillator insertion with significant improvement in functional and clinical status. CONCLUSION: Inferior wall aneurysms are rare and require close monitoring to identify electrical or contractile sequelae. Coronary CT angiography can outline anatomic details and guide surgical intervention to ameliorate life-threatening complications and improve performance status.

Endovascular Coil Embolization of a Large Ruptured Splenic Artery Aneurysm: A Case Report.

This case report aims to elucidate the current practices and efficacy of endovascular repair in managing splenic artery aneurysms (SAAs), particularly focusing on a case of a large, partially ruptured SAA. A 66-year-old female presented with severe abdominal pain and was later diagnosed with a 53mm saccular, degenerative SAA showing signs of partial rupture. The patient underwent successful endovascular repair using a combination of interlocking detachable coils and fibered coils. Despite the initial success, a follow-up CT angiogram revealed residual issues, necessitating additional embolization. The patient recovered well, with subsequent follow-ups indicating complete aneurysm closure and no complications. The successful management of this case aligns with current trends in SAA treatment, emphasizing the shift towards endovascular repair methods. This approach, highlighted in the literature, offers a minimally invasive alternative to open surgery, with lower morbidity and mortality rates. This case underscores the importance of individualized treatment planning and vigilant follow-up, particularly in light of the potential need for secondary interventions. This report contributes to the growing body of evidence supporting endovascular repair as a safe and effective treatment for SAAs, advocating for continued research into long-term outcomes and the development of advanced endovascular technologies.

Idiopathic true aneurysm of the proximal radial artery with the appearance of an enlarging mass: A case report.

INTRODUCTION AND IMPORTANCE: Aneurysm of the radial artery is one of the rare cases in the field of vascular surgery, and its diagnosis and management is one of the challenges in this era. Without proper diagnosis and treatment, it may affect the patient's lifestyle and reduce the quality of life because of pain and limitation in activity. Importantly, it may cause limb or life threatening complications including arterial thromboembolism and aneurysm rupture. CASE PRESENTATION: A 50-year-old woman was presented with a true proximal right radial artery aneurysm with the manifestation of an enlarging mass since 2 years ago, which had gradually become painful. The radiologic investigations revealed the presence of an aneurysm in the proximal radial artery. The patient underwent surgery consisting of ligation of the radial artery proximal and distal to the aneurysm and excision of the aneurysm sac. Pathologic examination confirmed the diagnosis. CLINICAL DISCUSSION: Any enlarging mass in the pathways of arterial branches can be arterial aneurysm, even if not pulsatile. Prompt physical examination and imaging modalities can help for diagnosis and decision making for either segmental arterial resection or vascular reconstruction. CONCLUSION: Radial artery aneurysm, as a rare but potentially devastating arterial disease should be in differential diagnosis of any forearm mass and managed promptly.

Successful treatment of a rare 6.5-cm true profunda femoris artery aneurysm with aneurysmectomy and interposition bypass.

Profunda femoris artery aneurysms (PFAAs) are rare and account for only 0.5% of all peripheral artery aneurysms. Potential complications include compression of surrounding nerves and veins, limb ischemia, and rupture. Currently there are no guidelines on the management of true PFAAs, and suggested treatment modalities include endovascular, open, and hybrid approaches. We report a case of an 82-year-old male with a history of aneurysmal disease who presented with a symptomatic 6.5-cm PFAA. He underwent successful aneurysmectomy and interposition bypass, which remains an effective method for treatment of this rare pathology.

Diagnostic dilemma of proximal ulnar artery aneurysm.

A 67-year-old lady presented to the vascular clinic with (8 × 4) cm pulsatile swelling in her right medial forearm and had congenital high-flow AV fistula in the same arm ligated in the antecubital fossa 2 years earlier. MR angiogram failed to make a definitive diagnosis and conventional angiogram was also inconclusive. As she became more symptomatic consequently, underwent surgical procedures. The finding was a large proximal ulnar artery aneurysm. The aneurysm was excised and artery was ligated. Proximal ulnar artery aneurysms are rarely reported in the literature. Thus, this case presents a diagnostic challenge in persistent flow despite the large thrombus.

Contained Left Ventricular Free Wall Rupture Following a Silent Myocardial Infarction.

A left ventricular pseudoaneurysm (LVP) is defined as an outpouching contained by the surrounding pericardium. Clinical presentation is often unspecific with patients presenting with chest pain, dyspnea, symptoms consistent with heart failure, and post-myocardial infarction. Cardiac magnetic resonance imaging represents an important tool for differentiating a pseudoaneurysm from a true aneurysm. Furthermore, multiple imagining modalities are available, including transesophageal and transthoracic echocardiogram and contrast ventriculography, which remains the gold standard diagnostic technique. Early recognition and prompt surgical management are of utmost importance in patients with acute and symptomatic LVP. On the other hand, medical management may be considered in patients with chronic and small pseudoaneurysms. Here, we are presenting a 74-year-old lady who presented with chest pain and was found to have a chronic and small LVP which was managed conservatively.

Myocardial Infarction With Ventricular Wall Aneurysm: A Case Report.

A ventricular aneurysm can be pseudo or true; it is a rare complication of myocardial infarction induced by an intra-myocardial dissecting hematoma due to fragile myocardium. Ventricular wall rupture takes place two to four days after myocardial infarction when coagulative necrosis and inflammatory infiltrate and lysis of myocardial connective tissue results in weakening of infarcted myocardium. Acute cardiac wall ruptures are mostly fatal; an unwittingly located pericardial adhesion can abort a rupture resulting in a false aneurysm. The wall of a false aneurysm consists of the epicardium in contrast to a true aneurysm, which is composed of the myocardium. True aneurysms are complications seen in transmural infarcts. Thinned-out scar tissue paradoxically bulged during systole, and toughened fibrotic wall rupture doesn't usually occur. Deaths in subjects with true ventricular aneurysms occur due to mural thrombus, arrhythmias, and heart failure. We encountered a case of a true aneurysm, as reported below.

The oldest patient in literature of spontaneous true giant superficial temporal artery aneurysm.

Background: Superficial temporal artery (STA) aneurysms are very rare compared to vascular aneurysms of other regions. They are divided into two as true and pseudo. Pseudoaneurysm were much more common and often depend on an etiological factor but spontaneous true aneurysms are extremely uncommon and the etiologic causes are not clear yet. Case presentation: We present a 91-year-old female patient who consulted to us with swelling in front of the ear; there was no history of previous surgery or any trauma. The patient had a pulsatile mass in the preauricular region, which started 4 years ago and growed faster for the last 2 months. Conclusion: There was a mass consistent with a saccular type aneurysm whose continuity was observed with the temporal artery in imaging studies. The mass was excised under general anesthesia. The patient whose pathological examination was a true STA aneurysm was discussed in the light of the literature.

Spontaneous Isolated Thrombosed True Popliteal Aneurysm in an Eight-Year-Old Child: A Rare Case Report With Literature Review.

Spontaneous aneurysms are rare in the pediatric age group. Aneurysms of peripheral arteries are even rarer. The diagnosis should not be missed to prevent distal limb ischemia and life-threatening complications. Hence, timely surgery to save the affected limb is advised. There is an increasing number of reported cases of such aneurysms in the English scientific literature. We present a rare case of pediatric idiopathic popliteal artery aneurysm (PAA), with no known risk factors. This scientific writing is unique in its way of reporting an idiopathic aneurysm with spontaneous onset. However, we have successfully investigated and managed the patient considering the established guidelines on aneurysmal surgery.

True Aneurysm on Posterior Tibial Artery as Late Complication of SARS-CoV-2.

We describe the story of a 70- year-old Italian male that almost 4 months later respiratory infection by SARS-CoV-2 presented a rapid evolution of a true aneurism of the right posterior tibial artery (PTA).

True Saccular Aneurysm at the Iliac Bifurcation in an Adolescent: Case Report and Review of Lower Limb Vascular Embryology.

INTRODUCTION: Isolated iliac artery aneurysms are an uncommon occurrence in the absence of concurrent aortic disease in the adult population and are a rare entity in children and adolescents. Paediatric patients may present with false aneurysms less frequently but true aneurysms are exceptional. In this report, the case of an iliac bifurcation true saccular aneurysm is described. REPORT: An 18 year old woman without history of infection, trauma, connective tissue disorders, or vasculitis, was referred with an incidental left iliac bifurcation saccular aneurysm. She underwent open surgical resection of the aneurysm with primary re-anastomosis of the common to external iliac arteries and ligation of the internal iliac artery. Histopathological assessment did not show any inflammatory or other underlying disease process. DISCUSSION: A case is presented of an isolated iliac bifurcation true aneurysm in an adolescent and its successful treatment. It is plausible that incomplete involution of the embryologically dominant sciatic artery may have been the cause for this presentation and for other congenital iliac artery aneurysms. Literature review of other paediatric iliac aneurysms shows an array of postulated underlying causes and treatment strategies.

A Growing Two-Decade-Old True Left Ventricular Aneurysm: A Case Report.

Left ventricular aneurysms (LVA) occur after an infarcted area of the myocardium necrotizes, fibroses, and expands, forming a dyskinetic cavity. Most ventricular aneurysms are asymptomatic and go unrecognized unless found incidentally. Symptoms commonly reported include angina, heart failure, syncope, and even sudden cardiac death. Late complications from left ventricular aneurysms are infrequently reported. This case reports an elderly woman who presented with new-onset angina from an expanding 18-year-old true left ventricular aneurysm that was successfully treated with surgical repair.

Profunda femoris mycotic aneurysm as a complication of bacterial endocarditis: a case report and review of the literature.

Profunda femoris aneurysms account for only 0.5% of all peripheral artery aneurysms. This case documents a profunda femoris mycotic aneurysm (MA) in a 47-year-old woman, three years post-treatment of bacterial endocarditis. The patient underwent an open surgical excision of the aneurysm with antibiotic cover and made a successful recovery. A literature review was carried out to look at other MA cases to summarise the most common presentations, infective agents and management strategies.

True Aneurysms of Foot Arteries: A Case Report of a Young Patient.

BACKGROUND: Reports of true aneurysms of the lower leg are rare. Among them, cases involving young patients are all the more rare, and there are many unexplored aspects to this pathological condition. CASE PRESENTATION: This is a case of a 30-year-old woman who was referred by an orthopedic surgeon with a chief complaint of severe pain during walking and landing. Angiography revealed multiple aneurysms and arteriovenous fistulas in the posterior tibial artery and lateral plantar artery. We anastomosed the lateral plantar artery and interposed the posterior tibial artery using the great saphenous vein. CONCLUSIONS: Although aneurysms in the arteries of the feet are rare, multiple true arterial aneurysms were observed in the lower leg of a juvenile patient in the present case. Dilation of arteries other than the aneurysm was also observed, suggesting that arteriovenous fistula and arterial occlusion may have been the causes of the true aneurysm of the lower leg. This is a valuable finding, suggesting a cause of aneurysm other than age-related atherosclerotic changes.

Superficial Temporal Artery True Fusiform Aneurysm With Several Lateral Feeding Vessels.

A 49-year-old man flight attendant with a past medical history of Roux-en-Y bypass and massive weight loss 18 months prior was referred for surgical management of a superficial temporal artery aneurysm. Imaging confirmed the diagnosis. Intraoperatively a 1 cm fusiform aneurysm was identified with numerous feeding side branch vessels. The aneurysm was suture ligated and excised in toto with pathologic analysis showing involvement of all vessel layers. This case highlights a rare true aneurysm of the superficial temporal artery and aberrant anatomy of multiple side branches feeding the aneurysm and complicating dissection and excision.

Management of Patients With Aortocoronary Saphenous Vein Graft Aneurysms: JACC State-of-the-Art Review.

Saphenous vein graft aneurysms (SVGAs) following coronary artery bypass grafting (CABG) surgery were first described in 1975. Although rare, in the absence of a prompt diagnosis, SVGAs can be responsible for serious complications and adverse outcomes. The clinical presentation of SVGAs described in the literature can vary from an asymptomatic patient with an incidental radiological finding to a profoundly shocked patient with life-threatening hemorrhage secondary to SVGA rupture. Improvements in diagnostic tools within the last decade, such as multislice computed tomographic scanning, has enabled early detection of SVGAs, and therefore, an expansion of the current management options. In this review, the current data and knowledge about clinical presentation, diagnosis, natural history, and treatment of SVGAs are updated, with a specific emphasis on the evolution of management strategies of this rare complication over the last 45 years. Finally, a clinical algorithm to guide decision-making and management is proposed.

Idiopathic true ulnar artery aneurysm.

INTRODUCTION AND IMPORTANCE: True ulnar artery aneurysms are a rare entity, with existing literature suggesting that most of these aneurysms are due to trauma. This case report sheds light on a true ulnar artery aneurysm that was deemed to be idiopathic. CASE PRESENTATION: A 49-year-old lady presented with numbness in the medial 3 fingers of the left hand, tenderness over the medial forearm, and a palpable ulnar artery pulse. There was no history of trauma. An arterial ultrasound, MRI of the forearm, and upper limb angiography confirmed the diagnosis of ulnar artery aneurysm. Surgical repair of the aneurysm was done with excellent immediate post-operative and follow up results. CLINICAL DISCUSSION: Trauma is the most common cause for the development of ulnar artery aneurysms. In this case however, after detailed history taking, physical examination, and thorough investigations, the cause of the patient's aneurysm was deemed to be idiopathic. Treatment of ulnar aneurysms are not well established due to the rarity of the disease. A surgical approach however may be considered depending on the location of the aneurysm along with the patient's symptoms. CONCLUSION: A high index of suspicion, thorough history, physical examination, and appropriate investigations are required to diagnose ulnar artery aneurysms. Surgical intervention is indicated to relieve symptoms of nerve compression and prevent limb threatening ischemia. Regular post-operative follow up is essential to detect potential graft dysfunction and to ensure a good outcome.

True Aneurysm of the Breast After Vacuum-assisted Removal of Benign Masses: A Case Report.

RATIONALE: The most common complications of vacuum-assisted removal (VAR) for benign breast masses are hematoma, infection, and occasionally pseudoaneurysms. To the best of our knowledge, this is the first report of a true aneurysm following VAR for breast fibroadenomas. CASE PRESENTATION: A 50-year-old woman underwent VAR of bilateral benign breast masses under ultrasonic guidance. Routine breast ultrasound examination was performed 3 months later, and no discomfort was observed during follow-up. DIAGNOSES AND INTERVENTIONS: Physical examination revealed a slightly palpable, arterial-like pulsation in the lateral part of the right breast. The two-dimensional ultrasound showed that there was a well-defined anechoic nodule in the right breast at the 9 o'clock position 3 cm from the nipple, measuring 6 mm × 4 mm. Color Doppler sonography demonstrated that it was a localized dilated intramammary arteriole within the colorful flow. Spectral Doppler illustrated a high-velocity turbulent arterial flow component inside. Based on these findings, the patient was diagnosed with an iatrogenic true aneurysm of the breast. Given her overall good condition, conservative treatment with regular imaging surveillance was adopted. OUTCOMES: Up to now, the patient remains asymptomatic, and the size of the aneurysm has not changed. LESSONS: With the increasing use of interventional diagnosis and treatment techniques, iatrogenic vascular complications are likely to occur more frequently. Careful duplex ultrasound examination prior to or following the procedure is strongly recommended. In the absence of risk factors, we recommend a conservative approach to small, stable aneurysms.

Rare case of isolated true aneurysm in the superficial femoral artery treated with endovascular intervention: a case report.

BACKGROUND: Isolated true aneurysms in the superficial femoral artery (SFA) have rarely been reported. Most cases are undiagnosed until rupture or the occurrence of complications. CASE SUMMARY: A 36-year-old woman presented with a palpable, pulsating mass on her right thigh which had increased in size over 2 months. She also had a swollen right leg and mild claudication (Stage II in Rutherford classification). For 2 months, the patient was treated by manual massage, acupuncture, and extracorporeal shock wave therapy in local clinics. Bed-side ultrasonography identified a 3.4-cm sized true aneurysm of the right SFA. There were no other aneurysms in arteries from head to toe. There was no evidence of atherosclerotic risk factors or connective tissue disease. The patient was successfully treated by a covered stent graft implantation without any complications. DISCUSSION: Isolated true aneurysm in the SFA is rare and tends to go undiagnosed especially in young women. Ultrasonography is an easy and useful diagnostic tool for differential diagnosis of thigh mass. In this case, endovascular treatment was safely applied for a true aneurysm without rupture.

True Idiopathic Radial Artery Aneurysm: A Case Report and Review of Current Literature.

INTRODUCTION: True non-traumatic radial artery aneurysms (RAAs) are extremely rare, and few cases have been described. The majority of RAAs are post-traumatic or iatrogenic pseudo-aneurysms following arterial cannulation. However, RAAs due to other causes have also been described. Here a rare case of true idiopathic distal RAA, which was managed by surgical resection and repair with interposition vein graft, is described. REPORT: A 62 year old female with a known medical history of hypertension and hyperlipidaemia presented with left wrist swelling of one year duration, associated with a pulsatile lump that was increasing in size. Duplex ultrasound and computed tomography angiography revealed a distal RAA. She underwent open surgical resection and repair with interposition vein graft using the distal left cephalic vein. Histopathology of the specimen revealed an aneurysm with atherosclerosis. She recovered well post-operatively with no complications. DISCUSSION: True idiopathic RAAs are rare. Surgical treatment is almost always recommended in view of the risk of complications. A case of true idiopathic distal RAA is presented here, which was managed successfully by surgical resection and repair with interposition vein graft.