Cases reported "Aneurysm, Ruptured"

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1/83. Transcatheter arterial embolization for impending rupture of an isolated internal iliac artery aneurysm complicated with disseminated intravascular coagulation.

    A 90-year-old male, with impending rupture of an isolated internal iliac artery aneurysm (IIAA) complicated with disseminated intravascular coagulation (DIC) was successfully treated with transcatheter arterial embolization (TAE). After TAE, enlargement of the aneurysm was arrested and coagulation-fibrinolytic abnormalities induced by DIC improved without severe complications. Although IIAA is relatively rare, the post-operative mortality of patients with ruptures is reportedly high. We assessed the usefulness of this procedure for impending rupture of IIAA, especially for patients in high risk groups.
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2/83. Ruptured mycotic pulmonary artery aneurysm: an unusual complication of right-sided endocarditis.

    Mycotic pulmonary aneurysm is an infrequently diagnosed complication of endocarditis. We report here a case of mycotic pulmonary aneurysm and a review of 25 cases from the literature. The mortality rate is greater than 50%. Prompt diagnosis is necessary because early intrasaccular embolization and/or surgical repair is essential to avoid death from rupture of the aneurysm.
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3/83. Isolated hypogastric artery aneurysms.

    iliac artery aneurysms are rare in the absence of concomitant abdominal aortic aneurysm (AAA), and isolated internal iliac (hypogastric) aneurysms in particular are extremely rare. From 1986 to 1997 we repaired 572 aortic and/or iliac artery aneurysms in 440 patients. Among these there were only seven hypogastric aneurysms and three of these occurred in the absence of, or remote to, AAA. Hypogastric aneurysms are difficult to diagnose, and large aneurysms are associated with significant morbidity and mortality due to compression of adjacent structures and a high rate of rupture. They pose technical challenges in repair because of their location deep in the pelvis and because it is difficult to gain distal control of the hypogastric artery and its branches. However, the technique of obliterative endoaneurysmorrhaphy has made repair of these aneurysms safe and straightforward. Moreover, this method, unlike percutaneous endovascular techniques, eliminates the compressive mass that is often associated with significant symptomatology. We report three isolated hypogastric aneurysms repaired over an 11-year period, illustrating the technique of proximal ligation and obliterative endoaneurysmorrhaphy, and review the literature on the topic.
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4/83. Cerebral aneurysm rupture after r-TPA thrombolysis for acute myocardial infarction.

    BACKGROUND: Intracranial hemorrhage is the most dreaded risk of thrombolytic therapy for acute myocardial infarction because of the high mortality and disability rates associated with this complication. brain structural lesions may predispose a patient to bleeding. To date, aneurysm rupture has not been described as a complication of such therapy. CASE DESCRIPTION: A 66-year-old hypertensive woman was admitted because of chest pain. myocardial infarction was diagnosed and fibrinolytic therapy with recombinant tissue plasminogen activator (r-TPA) was initiated. Eight hours after admission she became unconscious. brain computed tomography scan showed subarachnoid hemorrhage, and a cerebral arteriography showed an anterior communicating artery aneurysm. Because of her poor clinical condition treatment was postponed. death occurred 7 days later because of multiorgan failure. CONCLUSIONS: Cerebral aneurysms should be considered as a possible contributing factor to intracranial bleeding after thrombolytic therapy.
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5/83. Ruptured adrenal artery aneurysm: a case report.

    A case of ruptured adrenal artery aneurysm is presented. The ultrasound, computed tomography and selective renal angiography findings are described in detail. Aneurysms of adrenal arteries are particularly rare. early diagnosis is important because of their tendency towards rupture and subsequent high mortality rate.
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6/83. Endoluminal embolization of bilateral atherosclerotic common iliac aneurysms with fibrin tissue glue (Beriplast).

    The standard surgical approach to nonleaking iliac aneurysms found at repair of a leaking abdominal aortic aneurysm is to minimize the operative risk by repairing the abdominal aorta only. This means that the bypassed iliac aneurysms may have to be repaired later. As this population of patients are usually elderly with coexisting medical problems, interventional radiology is being used to embolize these aneurysms, thus avoiding the morbidity and mortality associated with further general anesthesia and surgery. Various materials and stents have been reported to be effective in the treatment of iliac aneurysms. We report the successful use of endoluminal fibrin tissue glue (Beriplast) to treat two large iliac aneurysms in a patient who had had a previous abdominal aortic aneurysm repair. We discuss the technique involved and the reasons why we used tissue glue in this patient.
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7/83. Balloon-assist technique for endovascular coil embolization of geometrically difficult intracranial aneurysms.

    OBJECTIVE: The balloon-assist or neck-remodeling technique is an adjunctive method devised for the endovascular coil embolization of aneurysms characterized by a wide neck or unfavorable geometric features. Since its initial description, there have been few data to corroborate its utility, efficacy, and safety in aneurysm embolization. methods: Twenty patients (19 female patients and 1 male patient) with 22 aneurysms (19 unruptured aneurysms and 3 ruptured aneurysms) underwent balloon-assisted coil embolization. The balloon-assist technique was performed in the same treatment session after conventional coil embolization had failed in 55% of cases (12 of 22 cases) and was the primary treatment in 45% of cases. The majority of aneurysms were located in the supraclinoid carotid artery (13 paraophthalmic and 3 superior hypophyseal aneurysms). The mean angiographic measurements included a fundus of 8.7 /- 3.7 mm, a neck of 5.3 /- 2.2 mm, and a comparatively unfavorable fundus/neck ratio of 1.33 /- 0.23. RESULTS: Technical success was achieved in 77% of cases (17 of 22). The rate of aneurysm obliteration at the end of the procedures was 97 /- 3.8%. Angiographic follow-up data (mean follow-up period, 10.3 mo) obtained for 89% of the treated aneurysms (15 of 17) confirmed stable mean occlusion of 97.8 /- 3.8%. Technical complications included two cases of asymptomatic distal vessel thromboembolism, which resolved angiographically within 24 hours, and one case of intraprocedural rupture of an arteriovenous malformation-related feeder artery aneurysm, which resulted in no neurological deficits and required no further treatment (transient complication rate, 13.6%; 3 of 22 cases). There were no deaths and no procedure-related 30-day or permanent morbidity. CONCLUSION: The balloon-assist method of coil embolization is characterized by promising intermediate-term angiographic and clinical outcomes and acceptable morbidity and mortality rates. Although this adjunctive method requires the use of an additional microcatheter and consequently involves a higher level of technical complexity, it extends the range of aneurysms that can be successfully treated with electrolytically detachable coils via an endovascular approach.
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8/83. Post partum splenic artery aneurysm rupture.

    Ruptured splenic artery aneurysm during pregnancy is a rare event with high maternal and fetal mortality rate. A case of ruptured splenic artery aneurysm in the post partum period is presented. The literature is reviewed on pathophysiology, clinical presentation and management of this rare and potentially fatal entity.
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9/83. Repair of iliac artery aneurysms by endoluminal grafting: the systematic approach of one institution.

    Isolated iliac artery aneurysms are rare lesions that are difficult to detect and treat. Prompt diagnosis and timely intervention are essential, because the incidence of rupture is as high as 50%. The reported mortality rate for patients who undergo surgery for ruptured iliac artery aneurysm ranges from 50% to 70%. The recommended therapy remains surgical excision, although percutaneous techniques are effective alternatives in selected cases. Early intervention, carried out in a systematic fashion, can reduce the high morbidity and mortality. We report 4 cases of isolated iliac artery aneurysms managed over a period of 8 years by means of endoluminal grafting, with only 1 death. In our experience, prompt diagnosis by use of less invasive methods, such as duplex Doppler imaging, and timely intervention led to a reduction in the overall mortality.
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keywords = mortality
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10/83. Ruptured renal artery aneurysm during pregnancy: successful ex situ repair and autotransplantation.

    rupture of a renal artery aneurysm during pregnancy is a rare event, with a high mortality rate for both mother and fetus. Until now, 25 cases have been reported in the English medical literature. Renal salvage with in situ repair of the renal artery has been documented in only four cases, and successful ex situ repair and autotransplantation in only one case. We report the case of a mother and fetus who both survived acute rupture of a renal artery aneurysm after treatment with ex situ repair and autotransplantation.
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