Pseudoaneurysm in the hand of a three-year-old boy: a case report.

BACKGROUND: Post-traumatic, true aneurysm of the hand is a well-documented phenomenon. Hypothenar hammer syndrome is often a consequence of repeated blunt trauma to the palm, but a false aneurysm, or pseudoaneurysm, of the palm is much rarer. A pseudoaneurysm is often the result of focal penetrating trauma. OBJECTIVES: The goal of this article is to describe a rare case of a child with a pseudoaneurysm of the superficial palmar arch and his subsequent surgical treatment. CASE REPORT: A 3-year-old boy sustained an accidental laceration to his palm while picking up a knife from a counter. The child was initially treated in a local Emergency Department (ED) with local wound care and Dermabond (Ethicon, Inc., Somerville, NJ). No imaging was undertaken at that time. The boy subsequently developed a large, pulsatile, painful mass in his palm near the site of injury, and he presented to our ED for evaluation. Using a combination of imaging modalities and a careful history, the boy was accurately diagnosed with a pseudoaneurysm of the superficial palmar arch. This lesion was subsequently successfully resected and repaired. The child has healed well after surgery, with no lasting sensory or motor deficits to the hand. To date, this is one of only two reported post-traumatic pseudoaneurysms of the palmar arch in a child in North America. CONCLUSION: Although a rare phenomenon, pseudoaneurysm of the superficial palmar arch after local penetrating trauma remains an important item on the differential for patients presenting with palmar masses. Pseudoaneurysm can be effectively diagnosed and treated with excellent results.

Obesity is not an independent risk factor for adverse perioperative and long-term clinical outcomes following open AAA repair or EVAR.

OBJECTIVES: Moderate (body mass index [BMI] ≥30) and morbid obesity (BMI ≥35) is increasing at an alarming rate in vascular surgery patients. The objective of this study was to determine the impact of obesity on perioperative and long-term clinical outcomes following open abdominal aortic aneurysm (AAA) repair or endovascular aneurysm repair (EVAR). METHODS: This review includes patients that underwent open AAA repair (n = 403) or EVAR (n = 223) from 1999 to 2009. Specific patient characteristics such as comorbid diseases, medications, and body mass index (BMI) were assessed. Specific perioperative outcomes such as length of stay, myocardial infarctions, and mortality were reviewed. In addition, long-term outcomes such as rates of reintervention, permanent renal dysfunction, and mortality beyond 30 days were also assessed. RESULTS: The incidence of obesity in open AAA patients was 25.3% (documented incidence 1.5%) and for EVAR was 24.6% (documented incidence 4%). Moderate and morbid obesity was associated with longer intensive care unit (ICU) admissions for both open AAA or EVAR patients (P < .05). However, no significant differences in perioperative outcomes in terms of overall length of stay, myocardial infarction, acute renal failure, wound infections, or mortality were noted between obese and nonobese patients underoing open AAA repair or EVAR (P > .05). Similarly, moderate and morbid obesity was not associated with significant differences in rates of reintervention, permanent renal dysfunction, and mortality beyond 30 days for patients undergoing open AAA repair or EVAR (P > .05). CONCLUSIONS: The results of this study indicate that moderate and morbid obesity are not independently associated with adverse perioperative and long-term clinical outcomes for patients undergoing open AAA repair or EVAR. Therefore, either open AAA repair or EVAR can be accomplished safely in moderately obese and morbidly obese patients.