1/93. Embolic bacterial aneurysm of the basilar artery: case report.A patient with basilar artery rupture caused by a septic embolus originating from a mitral valve vegetation is reported. The pathogenesis, investigation and management of infected cerebral aneurysms are reviewed.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
2/93. Fatal late multiple emboli after endovascular treatment of abdominal aortic aneurysm. Case report.BACKGROUND: The short term experience of endovascular treatment of abdominal aortic aneurysms (AAA) seems promising but long term randomised data are lacking. Consequently, cases treated by endovascular procedures need to be closely followed for potential risks and benefits. CASE REPORT: A 70 year-old mildly hypertensive male without previous or present arteriosclerotic, pulmonary, or urological manifestations was subjected to endovascular treatment after his mass-screening diagnosed abdominal aortic aneurysm had expanded to above 5 cm in diameter, the aneurysm having been found by CT-scanning and arteriography to be endovascularly treatable. A Vanguard bifurcated aortic stent graft was implanted under epidural/spinal anaesthesia and covered by cephalosporine and heparin (8000 IE) protection. Apart from treatment of a groin haematoma and stenosis of the left superficial femoral artery, the postoperative period presented no problems. A few days before the monthly follow-up visit, the patient developed uraemia, gangrene of one foot and dyspnoea. blood glucose and LDH was elevated. Deterioration led to death a month and a half after stent implantation. autopsy showed extraordinary large, extensive soft, brown vegetations in the lower part of the thoracic aorta above the properly infrarenally-placed stent. Microscopic examination revealed multiple microemboli in the liver, spleen, pancreas, intestines, testes, and especially the kidneys. DISCUSSION: Early death from microemboli after aortic stent implantation has been reported. However, the present case developed fatal multiple microemboli so late that they could not have originated from the excluded mural thrombus. The sudden death of an otherwise healthy man of extensive microemboli is difficult to explain. The stent application may have altered the proximal flow and wall movements disposing to microemboli in the case of vegetations.- - - - - - - - - - ranking = 1.4keywords = aneurysm (Clic here for more details about this article) |
3/93. Internal carotid artery aneurysm visualized during successful endovascular treatment of carotid embolism.We herein present a case of an internal carotid artery embolism associated with a hidden internal carotid artery aneurysm. The aneurysm was visualized during successful endovascular treatment of the carotid embolism. In retrospect, the aneurysm was at risk of rupture during the procedure. In the endovascular treatment of cerebral embolism, the possibility that aneurysms are hidden by emboli must be borne in mind. Care should be taken not to injure unidentified arterial walls while advancing a catheter blindly.- - - - - - - - - - ranking = 1.6keywords = aneurysm (Clic here for more details about this article) |
4/93. Staged thoracic and abdominal aortic aneurysm repair using stent graft technology and surgery in a patient with acute renal failure.A 52-year-old male presented with severe hypertension and acute renal failure. carbon dioxide (CO(2)) angiography identified a saccular thoracic aortic aneurysm, right renal artery stenosis, left renal artery occlusion, an infrarenal aortic aneurysm, celiac artery, and inferior mesenteric artery (IMA) orificial stenoses. Via an anterior retroperitoneal approach, bilateral renal artery thromboendarterectomy, infrarenal aortic aneurysmectomy, and IMA reimplantation were performed. The patient's tortuous iliac arteries were straightened to permit future passage of a thoracic stent graft by mobilizing the aortic bifurcation and anastomosing it to a Dacron graft within 4 cm of the renal vessels. Two weeks later, a stent graft was placed via a femoral incision utilizing CO(2) angiography, successfully excluding the saccular thoracic aneurysm. Recovery from both procedures was quick, with rapid return of renal function, and alleviation of the hypertension. At 8 months follow-up, his renal arteries and aorta are patent.- - - - - - - - - - ranking = 1.6keywords = aneurysm (Clic here for more details about this article) |
5/93. Intraoperative acute occlusion of aortic bifurcation during extracorporeal circulation.A 36-year-old male patient showed a significant decrease of arterial pressure in the lower extremities during coronary artery bypass grafting (CABG) with extracorporeal circulation (ECC). arterial pressure measured in the femoral artery fell to 10-20 mmHg at the end of ECC, whereas in the upper extremities arterial pressure levels were normal. At the end of the surgery a complete ischemia of both lower extremities was observed. We suspected Leriche's syndrome and performed a successful aortic embolectomy through bilateral femoral arteriotomies immediately. An insufficient anticoagulation could be excluded by prolonged "activated clotting time" (ACT), therefore we presumed that the source of embolus was a small aneurysm of the left ventricle. The shape and superficial structure of the extracted embolus, which was partly covered with endocardium, confirmed our suspicion. No complications occurred throughout the postoperative period. On the 10th postoperative day, the patient left our department for postoperative rehabilitation with a normal perfusion of the lower extremities.- - - - - - - - - - ranking = 0.2keywords = aneurysm (Clic here for more details about this article) |
6/93. Hypothenar hammer syndrome: management of distal embolization by intra-arterial fibrinolytics.We report a case of hypothenar hammer syndrome. The ulnar artery aneurysm was resected and a complete thrombectomy of the superficial palmar arch, the common digital and the proximal part of the collateral digital arteries was carried out. The arterial defect of the ulnar artery was repaired by a vein graft. Post-operatively, no clinical improvement was observed on the vascularisation of the second and third fingers. The arteriogram confirmed the presence of arterial obstruction on the distal part of the digital collateral arteries of this two fingers. The finger pulp started to show areas of skin gangrene and in view of the risk of finger necrosis, we decided to use fibrinolytics. This embolic events was dissolved by continuous fibrinolytic and anticoagulant intra-arterial infusion. The treatment was maintained for ten days restoring a normal digital vascularisation.- - - - - - - - - - ranking = 0.2keywords = aneurysm (Clic here for more details about this article) |
7/93. lower extremity paraparesis or paraplegia subsequent to endovascular management of abdominal aortic aneurysms.lower extremity paraplegia or paraparesis is an extremely rare event after operative repair of infrarenal abdominal aortic aneurysms (AAAS). We report two such cases that occurred after endovascular repair or attempted endovascular repair of routine AAAS. To our knowledge, these are the first two cases reported specifically in the literature. These cases may have significant implications with regard to the endovascular management of AAAS, because atheroembolization to the spinal cord appears to be the underlying cause.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
8/93. Septic embolization arising from infected pseudoaneurysms following percutaneous transluminal coronary angioplasty: a report of 2 cases and review of the literature.Septic embolization arising from infected pseudoaneurysms following percutaneous transluminal coronary angioplasty (PTCA) constitutes a distinct clinical and histopathologic entity. Pseudoaneurysms are a potential complication of both cardiac catheterization and PTCA. Repeated or prolonged catheterization increases the risk of bacterial seeding of these sites, resulting in septic embolization. Characteristic clinical features include fever within 2 to 5 days, unilateral embolic disease, and staphylococcus aureus septicemia. culture and examination of biopsy specimens of the embolic lesions typically demonstrate gram-positive microorganisms. We describe 2 patients presenting with ipsilateral palpable purpura, petechiae, and livedo reticularis caused by septic emboli from infected pseudoaneurysms. The recommended treatment includes administration of appropriate systemic antibiotics and surgical resection of the infected pseudoaneurysm. Both cholesterol and septic emboli should be considered in the differential diagnosis of ipsilateral embolic disease induced by invasive vascular procedures.- - - - - - - - - - ranking = 2.2823840878206keywords = aneurysm, pseudoaneurysm (Clic here for more details about this article) |
9/93. Penetrating ulceration of the infrarenal aorta: case reports of an embolic and an asymptomatic lesion.Penetrating aortic ulceration is uncommon in the infrarenal aorta. We describe a patient with a penetrating infrarenal aortic ulcer manifesting as blue toe syndrome, and a second patient with a similar lesion identified as an incidental finding. These two patients were treated for penetrating infrarenal aortic ulceration within the past 9 months at two university-affiliated hospitals, a regional veterans Administration Medical Center, and a County Medical Center. Both lesions demonstrated aneurysm changes with varying degrees of mural thrombus. The lesion filled with fresh thrombus proved labile, with embolization manifesting as blue toe syndrome. We support the aggressive treatment of aneurysmal penetrating aortic ulcer with aortic graft replacement to eliminate the potential for distal embolization and to obviate the risk of rupture and death.- - - - - - - - - - ranking = 0.4keywords = aneurysm (Clic here for more details about this article) |
10/93. Fatal diffuse atheromatous embolization following endovascular grafting for an abdominal aortic aneurysm: report of a case.A 78-year-old woman with an abdominal aortic aneurysm, 57 mm in diameter, was admitted to our hospital for endovascular grafting. Preoperative computed tomography and angiography showed friable mural thrombus in the suprarenal and infrarenal aorta, and a diagnosis of shaggy aorta was made. Postoperatively, the patient suffered cerebral infarction, and disseminated intravascular coagulopathy with multiple organ failure developed, resulting in early death on the third day after surgery. An autopsy revealed diffuse atheromatous embolization into the celiac, superior mesenteric, bilateral renal, bilateral hypogastric (trash buttock), and peripheral arteries. This case report serves to demonstrate that an abdominal aortic aneurysm with a shaggy aorta in the proximal neck is a contraindication to endovascular grafting, and that predicting the possibility of diffuse atheromatous embolization by detecting a shaggy aorta is the best way to prevent this catastrophic complication.- - - - - - - - - - ranking = 1.2keywords = aneurysm (Clic here for more details about this article) |
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