Cases reported "Aneurysm, False"

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11/102. thrombin injection for treatment of brachial artery pseudoaneurysm at the site of a hemodialysis fistula: report of two patients.

    We report two patients with arteriovenous hemodialysis fistulas that were complicated by brachial artery pseudoaneurysms. Each pseudoaneurysm was percutaneously thrombosed with an injection of thrombin, using techniques to prevent escape of thrombin into the native brachial artery. In one patient, an angioplasty balloon was inflated across the neck of the aneurysm during thrombin injection. In the second patient, thrombin was injected during ultrasound-guided compression of the neck of the pseudoaneurysm. Complete thrombosis of each pseudoaneurysm was achieved within 30 sec. No ischemic or embolic events occurred. This technique may be useful in treating pseudoaneurysms of smaller peripheral arteries.
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12/102. Unusual occurrence of a pseudo-aneurysm of the middle cerebral artery in a patient with fibromuscular dysplasia.

    Our patient is the first reported case of pseudo-aneurysm due to the rupture of an intracranial artery in the context of fibromuscular dysplasia (FMD). As we assume that our case is probably not unique, we conclude that this diagnosis may be sometimes overlooked for lack of confirmation either by surgery or autopsy. The retrospective study of the arteriograms suggests some clues that should be taken into account to foresee the existence of an intracranial pseudo-aneurysm in order to avoid unexpected peroperative difficulties: 1.) the rapid growth of the lesion within a few weeks and 2.) the unusual location of the aneurysmal neck at some distance from a arterial bifurcation.
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13/102. Horner's syndrome after carotid artery stenting: case report.

    BACKGROUND: angioplasty and stenting of various lesions of the carotid artery is gaining in popularity. Our knowledge of the efficacy and limitations of this promising technology is incomplete. Although Horner's syndrome and its variants have been described after traumatic, spontaneous, or surgical carotid dissection, it has not been reported after carotid artery stenting. CASE DESCRIPTION: A 36-year-old woman presented with left neck and ear pain and a 3-year history of rushing noises in her left ear. angiography demonstrated evidence of dissection of the left internal carotid artery at the skull base with a pseudoaneurysm.The pseudoaneurysm was treated with a 6-mm diameter self-expanding stent in a 4-mm diameter left internal carotid artery. A few hours later, she developed partial Horner's syndrome with a subtle ipsilateral ptosis and miosis without anhidrosis. angiography performed on the next day did not demonstrate further dissection or aneurysm growth but did show distention of the artery wall because of the stent. She did not develop any further sequelae. CONCLUSION: This case suggests that stretching of the artery wall may result in stretching of surrounding structures. The sympathetic fibers surrounding the internal carotid artery are clearly sensitive to this degree of stretch. Possible complications associated with stretch injury must be considered when choosing the stent diameter.
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14/102. Echocardiographical demonstration of a progressively expanding left ventricular aneurysm preceded by endomyocardial tearing.

    A 70-year-old woman with acute myocardial infarction (AMI) had a narrow necked left ventricular (LV) aneurysm and pericardial effusion. Although there had been no obvious sign of pseudoaneurysm at the first operation on the 13th day after onset, LV volume increased so dramatically that dyspnea on mild exertion was induced only 2 months after the onset of AMI. She underwent Dor's operation for the expanded LV aneurysm. The histological findings of the resected tissue, which were fibrotic epicardial lesion with small myocyte islands, indicated a true aneurysm. The ultrasound manifestation of a narrow necked aneurysm with abrupt thinning of the myocardium at the hinge point may be a valuable predictor of free wall rupture in the early phase and severely progressive LV remodeling in the late phase. Such aneurysms need to be considered as high risk.
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keywords = neck
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15/102. Traumatic pseudoaneurysm of the thyrocervical trunk.

    A case of a pseudoaneurysm of the thyrocervical trunk after a pocketknife stab wound to zone I of the neck is reported. The patient was evaluated and treated in an emergency department with irrigation of the wound, bandage, and oral antibiotics. A large pseudoaneurysm slowly developed over the next 2 months. When the patient arrived at our hospital, he was immediately admitted and arteriograms were obtained. Arteriograms revealed an active leak of blood into a pseudoaneurysm from the thyrocervical trunk. Surgical treatment consisted of proximal and distal ligation of the thyrocervical trunk. This is the first case of a pseudoaneurysm developing only from the thyrocervical trunk due to a stab wound to zone I of the neck. This case and its complication serve to illustrate and emphasize the rationale for routinely imaging the great vessels after all penetrating trauma to zone I of the neck.
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ranking = 1.5
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16/102. Mycotic aneurysm of the carotid bifurcation in the neck: case report and review of the literature.

    OBJECTIVE AND IMPORTANCE: Mycotic aneurysms of the extracranial carotid artery are rare and difficult to diagnose. A search of the world literature published since 1966 reveals at least six cases of mycotic carotid aneurysms due to a salmonella septicemia. We present an exceptional case of mycotic pseudoaneurysm of the bifurcation of the carotid artery due to salmonella septicemia and discuss the pathogenesis as well as various aspects of the diagnosis and surgical management. CLINICAL PRESENTATION: A 68-year-old man presented in poland with salmonella sepsis; 1 month later, he was admitted to the emergency department of the Sir Mortimer B. Davis-Jewish General Hospital in Montreal with a bulky and pulsatile right cervical mass. An angiogram and a computed tomographic scan revealed a voluminous and partially thrombosed aneurysm the size of a tangerine originating from the posterior aspect of the carotid junction. INTERVENTION: Balloon trapping was attempted at the Montreal Neurological Hospital. Subsequently, the patient developed a significant neurological deficit, which was quickly reversed by the administration of hypertensive, hypervolemic, and hemodilution therapy. Thereafter, the pseudoaneurysm was resected surgically, and the internal and external carotid arteries were sacrificed. Pathological examination of the excised specimen of the carotid junction revealed a pseudoaneurysm. Bacterial culture of the lesion showed growth of salmonella. CONCLUSION: The postoperative course was satisfactory except for laryngeal paralysis due to involvement of the vagus nerve. Four months later, a computed tomographic scan showed only small lacunae in both centra semiovale.
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17/102. Endovascular repair of traumatic pseudoaneurysm by uncovered self-expandable stenting with or without transstent coiling of the aneurysm cavity.

    Various surgical options for internal carotid or subclavian artery pseudoaneurysm repair have been reported; however, in general they have resulted in poor outcomes with high morbidity and mortality rates. Recently, these open surgical procedures have been partly replaced by percutaneous transluminal placement of endovascular devices. We evaluated the potential for using flexible self-expanding uncovered stents with or without coiling to treat extracranial internal carotid, subclavian and other peripheral artery posttraumatic pseudoaneurysm. Three patients with posttraumatic pseudoaneurysm were treated by stent deployment and coiling (two cases) of the aneurysm cavity. In one case, a 5.0 x 47 mm Wallstent (boston Scientific) was positioned to span the neck of the 9 x 5 mm size pseudoaneurysm (left internal carotid artery) and deployed. angiography demonstrated complete occlusion of the pseudoaneurysm without coiling. In the second patient, a 5.0 x 31 mm Wallstent (boston Scientific) was positioned to span the neck of the 9 x 7 mm size pseudoaneurysm (right internal carotid artery) and deployed. A total of six coils (Guglielmi Detachable Coils, boston Scientific) were deployed into the pseudoaneurysm cavity until it was completely obliterated. In the third case, an 8.0 x 80 mm SMART (Cordis) stent was advanced over the wire, positioned to span the neck of the 10 x 7 mm size pseudoaneurysm of the left subclavian artery, and deployed. Fourteen 40 x 0.5 mm Trufill (Cordis) pushable coils were deployed into the pseudoaneurysm cavity until it was completely obliterated. At long-term follow-up (6-9 months), all patients were asymptomatic without flow into the aneurysm cavity by Duplex ultrasound. We conclude that uncovered endovascular flexible self-expanding stent placement with transstent coil embolization of the pseudoaneurysm cavity is a promising new technique to treat posttraumatic pseudoaneurysm vascular disease by minimally invasive methods, while preserving the patency of the vessel and side branches.
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ranking = 1.5
keywords = neck
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18/102. mitral valve replacement and endocavitary patch repair for a giant left ventricular pseudoaneurysm.

    We present a case of a giant inferior left ventricular (LV) wall pseudoaneurysm. The patient had new york Heart association class IV heart failure due to severe mitral valve regurgitation and poor LV function. Our operative approach included right thoracotomy, excision of the mitral valve, and patch repair of the pseudoaneurysm neck from inside of the dilated LV cavity followed by mitral valve replacement. Surgery was performed without aortic cross-clamping on a normothermic perfused beating heart. The patient had an uncomplicated cardiac recovery and is doing well 15 months after surgery.
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ranking = 0.5
keywords = neck
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19/102. Pseudoaneurysm of the proximal facial artery presenting as oropharyngeal hemorrhage.

    BACKGROUND: Penetrating trauma to the neck traversing zones II and III may cause considerable damage to soft tissues and neurovascular structures. Delayed sequelae of vascular injuries, such as pseudoaneurysm (PA), may present weeks to months after the initial injury. methods: We report an unusual case of a traumatic PA of the proximal facial artery that ruptured into the oropharynx. RESULTS: A 30-year-old man presented with oropharyngeal hemorrhage one month after a gunshot wound to the neck. angiography revealed a PA of the proximal facial artery, which was treated with embolization. The arterial injury leading to the pseudoaneurysm had not been detected by arteriography at the time. CONCLUSIONS: PAs are rare complications of penetrating neck trauma. To our knowledge, this is only the second report of PA involving the proximal facial artery, and the first of a facial PA rupture into the pharynx.
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ranking = 1.5
keywords = neck
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20/102. Successful closure of large pseudoaneurysm of peroneal artery using transluminal temporary occlusion of the neck with the catheter.

    Pseudoaneurysm is well-known complication resulting from surgical or interventional vascular procedures. We present the case of a 51-year-old patient with a large iatrogenic pseudoaneurysm of the peroneal artery, a very rare location. The pseudoaneurysm developed after orthopedic surgery of the knee. Swelling and vascular insufficiency of the calf ensued a few days later. The large peroneal pseudoaneurysm and compression of the anterior and posterior tibial arteries were confirmed by ultrasound and angiography. The pseudoaneurysm was too deep for ultrasound-guided compression or percutaneous obliteration and too large to be occluded by coil embolization alone. Because the pseudoaneurysm failed to occlude even after four coils were introduced into the lumen, pseudoaneurysm thrombosis was achieved by temporary occlusion of its neck with the angiographic catheter. During the occlusion of the neck of the pseudoaneurysm, the patency of the crural arteries and the development of the thrombus in the pseudoaneurysm cavity were monitored with color Doppler ultrasonography. Follow-up examinations after 3 and 6 months showed permanent closure of the pseudoaneurysm and patent crural arteries.
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