Cases reported "Aneurysm, Ruptured"

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1/205. 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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keywords = operative
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2/205. Ruptured aneurysm of the orbitofrontal artery associated with dural arteriovenous malformation in the anterior cranial fossa--case report.

    A 27-year-old male presented with a rare association of a ruptured orbitofrontal artery aneurysm and a dural arteriovenous malformation (DAVM) fed by both ethmoidal arteries, manifestation as severe headache, nausea, and vomiting. Computed tomography revealed a hematoma within the right frontal lobe and diffuse subarachnoid hemorrhage. The aneurysm was clipped successfully and the hematoma was evacuated. After an uneventful postoperative course, the patient was referred for gamma knife radiosurgery to treat the DAVM. In this case, the DAVM was asymptomatic and pathogenetically unrelated to the aneurysm, which demanded urgent treatment.
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ranking = 1
keywords = operative
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3/205. Spinal dural arteriovenous fistula with an associated feeding artery aneurysm: case report.

    OBJECTIVE AND IMPORTANCE: A case of a spinal dural arteriovenous fistula (DAVF) with two associated feeding artery aneurysms is reported. Intradural spinal arteriovenous malformations have been associated with aneurysms that present with subarachnoid hemorrhage and with venous varices that produce mass effect, but spinal DAVFs have not previously been described in association with feeding artery aneurysms. CLINICAL PRESENTATION: A 71-year-old man presented with progressive spastic paraparesis, constipation, and overflow incontinence. magnetic resonance imaging demonstrated a spinal vascular lesion and venous ischemia in the lower spinal cord. Diagnostic spinal angiography revealed a DAVF originating from the left T11 radicular artery and having the unusual feature of two proximal feeding artery aneurysms. INTERVENTION: The patient deteriorated neurologically after undergoing angiography, prompting emergent surgery. The DAVF was resected through a T11 transpedicular approach. One aneurysm was dolichoectatic and therefore unclippable, requiring proximal occlusion of the parent artery after establishing tolerance of test occlusion using somatosensory evoked potentials; the second aneurysm was adjacent to the fistula and was resected with the DAVF. CONCLUSION: Feeding artery aneurysms in association with spinal DAVFs have not been previously reported. They present additional risk to patients and, with simple modifications of the standard operative approaches, can easily be treated as part of the surgery for the DAVF.
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ranking = 1
keywords = operative
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4/205. Intraoperative use of nitric oxide during intracranial aneurysm clipping in a patient with acute respiratory distress syndrome.

    We describe a case of subarachnoid hemorrhage (SAH) complicated by acute respiratory distress syndrome (ARDS) and cerebral vasospasm. Inhaled nitric oxide (NO) was used to improve oxygenation, thereby facilitating cerebral aneurysm clipping.
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ranking = 4
keywords = operative
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5/205. Abdominal aortic aneurysm rupture in systemic lupus erythematosus.

    Many cardiovascular complications have been described in systemic lupus erythematosus (SLE), however, aortic involvement is very rare. We are reporting abdominal aortic aneurysm rupture in a 47-year old woman with SLE. The patient was admitted to our hospital with severe abdominal pain. Emergency computed tomography of the abdomen demonstrated ruptured abdominal aortic aneurysm. The restoration of aortic flow with vascular prosthesis was performed in emergency. Postoperative course was uneventful.
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ranking = 1
keywords = operative
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6/205. Surgical treatment for ruptured vertebral artery dissecting aneurysms.

    We analyze 20 cases of ruptured vertebral artery dissecting aneurysms and discuss the best choices for the surgical procedure. The preoperative Hunt and Kosnik grade was I in nine cases, Ia in four cases, II in three cases, III in three cases, and IV in one case. Rebleeding occurred in six cases, in four cases within 24 hours after the initial bleeding, and in every case within 6 days. In two cases surgery was performed within 3 days after the initial bleeding, in two cases within 4 to 7 days, in 16 cases after more than 7 days. A total of 22 operations were performed in the 20 patients (coating in 12, trapping in 6, proximal clipping of the vertebral artery in 2, clipping of the bleeding point in 2). A case of proximal clipping rebled 32 days after the operation and subsequently died. Both cases of clipping of the bleeding point were reoperated because of rebleeding and a slipped clip, respectively. All cases in which trapping or coating was performed resulted in a good outcome. Trapping is the most reliable method of preventing rebleeding. Coating or proximal clipping is an optional procedure, but cannot always prevent rebleeding because of the continuing circulation.
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ranking = 1
keywords = operative
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7/205. Aortocaval fistula in ruptured aneurysms.

    OBJECTIVES: to study incidence, clinical presentation and problems in management of aortocaval fistula in our series. DESIGN: retrospective study. MATERIALS: during a seven-year period, 112 patients operated on for abdominal aortic aneurysm, including four patients with aortocaval fistula. methods: standard repair of aortocaval fistula from inside the aneurysmal sac was the preferred operative technique. RESULTS: the incidence of aortocaval fistula was 3.6%. Three cases were found incidentally during emergency surgery for ruptured aneurysms; the fourth case was an isolated aortocaval fistula associated with inferior vena cava thrombosis, diagnosed preoperatively by angiography. In this case, inferior vena cava ligation instead of standard aortocaval repair was performed. CONCLUSIONS: Aortocaval fistulas, although rare, should be kept in mind, because clinical diagnosis is often difficult. Furthermore, unsuspected problems during repair may necessitate appropriate change in operative technique.
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ranking = 3
keywords = operative
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8/205. Pericallosal artery aneurysm originating from a "supreme anterior communicating artery".

    Report on the rare case of a ruptured pericallosal aneurysm originating from an atypic communicating segment between both distal A2 arteries, called the 'supreme anterior communicating artery'. The neurosurgeon should be aware of this rare vascular anomaly that might be angiographically occult and raise unexpected intraoperative difficulties.
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ranking = 1
keywords = operative
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9/205. anesthesia for ruptured cerebral aneurysm surgery associated with chronic renal failure.

    The management of patients with chronic renal failure (CRF) undergoing cerebral aneurysm surgery has been documented on only a few occasions. We report a 58-year-old man with CRF and subarachnoid hemorrhage (SAH) due to aneurysm rupture. We describe the patient's perioperative anesthetic management, discussing the current methods for maintaining an appropriate cerebral perfusion pressure and for preventing rehemorrhage from the aneurysm. We suggest that heparin-aided hemodialysis be avoided in these cases.
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ranking = 1
keywords = operative
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10/205. Pseudoaneurysm of the left ventricle progressing from a subepicardial aneurysm.

    A 56-year-old man presented with an inferior myocardial infarction and a huge pseudoaneurysm below the inferior surface of the left ventricle, which had progressed from a small subepicardial aneurysm over a 6-month period. Transthoracic echocardiography, doppler color flow images, radionuclide angiocardiography, magnetic resonance imaging and contrast ventriculography all revealed an abrupt disruption of the myocardium at the neck of the pseudoaneurysm, where the diameter of the orifice was smaller than the aneurysm itself, and abnormal blood flows from the left ventricle to the cavity through the orifice with an expansion of the cavity in systole and from the cavity to the left ventricle with the deflation of the cavity in diastole. coronary angiography revealed 99% stenosis at the atrioventricular nodal branch of the right coronary artery. At surgery the pericardium was adherent to the aneurysmal wall and a 1.5-cm orifice between the aneurysm and the left ventricle was seen. Pathological examination revealed no myocardial elements in the aneurysmal wall. The orifice was closed and the postoperative course was uneventful. Over-intense physical activity as a construction worker was considered to be the cause of the large pseudoaneurysm developing from the subepicardial aneurysm. These findings indicate that a subepicardial aneurysm may progress to a larger pseudoaneurysm, which has a propensity to rupture, however, it can be surgically repaired.
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ranking = 1
keywords = operative
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