Cases reported "Aneurysm"

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1/138. The use of an external-internal shunt in the treatment of extracranial internal carotid artery saccular aneurysms: technical case report.

    BACKGROUND: Extracranial internal carotid artery aneurysms (EICAA) are rare lesions. Resection and grafting is the preferred method of management. However, the details of shunt use in surgery for this type of aneurysm has been described in few articles. We describe an external-internal shunt with intra-aneurysmal trans-orifice insertion. CASE REPORT: A 55-year-old woman presented with a 5-year history of a progressively enlarging pulsatile neck mass. An examination revealed no neurological deficit. Right carotid angiogram showed a saccular EICAA involving the ICA distal to the bifurcation, with kinking of the internal carotid artery (ICA). The dome of the EICAA extended from the upper border of C4 to the midportion of C2 and the maximum diameter was 4 cm. RESULTS: Using the shunt technique, we successfully removed the aneurysm and reconstructed the ICA. The end-to-end anastomosis was easy because the shunt was involved only in the distal free end of the ICA, but not in the proximal free end of the ICA. CONCLUSION: This technique could be an option for the treatment of EICCA when a shunt is needed to maintain the cerebral circulation.
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keywords = neck
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2/138. Popliteal venous aneurysms. Report of a case and review of the literature.

    Venous aneurysms are uncommon in the vascular pathology of the lower limb. They are more commonly encountered in the neck, thoracic veins and visceral veins. Involvement of the popliteal veins is not often encountered. These aneurysms often cause thrombosis and subsequently pulmonary embolism. phlebography and duplex scanning give the most accurate diagnosis. As the risk of associated pulmonary embolism is high, elective surgery is recommended since it has been proven that proper anticoagulation treatment does not prevent the risk of pulmonary embolism.
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keywords = neck
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3/138. Use of microvascular Doppler sonography in aneurysm surgery on the anterior choroidal artery.

    Anterior choroidal artery (AChA) syndrome is still one of the most serious complications of the clipping of internal carotid artery aneurysms. No monitoring method can detect ischemia in the area of the AChA during surgery. This artery may be obstructed when a clip is applied to the neck of the aneurysm, and patency is sometimes difficult to confirm by microscopy because of the artery's small size and site of origin (usually behind the internal carotid artery as viewed surgically). However, microvascular Doppler sonography (MVDS) can detect flow instantaneously even in such a small vessel. In our series, AChA syndrome occurred in three of 19 patients treated for AChA aneurysm before the introduction of MVDS, but only one of 19 patients treated with the aid of this device. In that patient, one of the two AChA branches was intentionally sacrificed by applying a clip to the prematurely ruptured aneurysm. MVDS detected hypoperfusion of the AChA after clipping in five other patients, and so the clip was readjusted to preserve AChA flow. Use of MVDS is very effective to prevent inadvertent injury to the AChA during aneurysm surgery on this artery.
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keywords = neck
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4/138. Asymptomatic aneurysm of the proximal right subclavian artery: a rare ultrasound diagnosis.

    True aneurysms of otherwise normal subclavian arteries are uncommon peripheral vascular anomalies. Most patients with subclavian artery aneurysms are symptomatic by presenting neurologic signs. We report a young woman who had an asymptomatic true aneurysm of the right subclavian artery assumed to be of congenital origin. This case is unique in that the aneurysm was in the extremely rare anatomic location of the right supraclavicular fossa between the origins of the right subclavian artery and the vertebral artery. Aneurysms of the right subclavian artery may represent a potential pitfall in conventional gray-scale ultrasound of the neck particularly the supraclavicular fossa. Differential diagnosis includes cervical cyst, pharyngo-esophageal diverticulum, vascular anomalies, struma, enlarged lymph node, as well benign or malignant neoplasms. color duplex ultrasound should be performed as the method of choice for further analysis of suspected aneurysms. In this report the role of B-mode ultrasound and color duplex ultrasound is discussed in relation to digital subtraction- and MR angiography in confirmation of the diagnosis.
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keywords = neck
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5/138. Endovascular treatment of a ruptured paraclinoid aneurysm of the carotid syphon achieved using endovascular stent and endosaccular coil placement.

    We herein report a case of a ruptured superior hypophyseal aneurysm of the left supraclinoid carotid artery that could not be treated with a Guglielmi detachable coil (GDC), even in combination with a supporting nondetachable balloon. After an unsuccessful attempt at surgical clipping, treatment consisted of the placement of a stent over the neck of the aneurysm, advancement of a microcatheter through the stent mesh, and endosaccular embolization with a GDC. The late clinical outcome was excellent.
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keywords = neck
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6/138. Balloon-assisted coil embolization for large-necked renal artery aneurysms.

    An aneurysm of the right renal artery was discovered in a patient suffering from cerebral arterial angiodysplasia and arterial hypertension. The aneurysm was large necked, which made selective endovascular treatment very difficult. To perform the embolization of the aneurysm, a balloon remodelling technique was used. This prevented migration of coils within the arterial lumen.
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keywords = neck
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7/138. Stent-supported coil embolization: the treatment of fusiform and wide-neck aneurysms and pseudoaneurysms.

    OBJECTIVE: We describe a consecutive series of patients treated with endovascular stent-supported coil embolization for symptomatic or enlarging wide-neck and fusiform aneurysms and pseudoaneurysms of the carotid and vertebrobasilar arteries. methods: Seven stent-supported coil embolization procedures were performed for seven aneurysms in seven consecutive patients. There were five pseudoaneurysms, one dissecting aneurysm, and one berry aneurysm. Four aneurysms were located in the carotid artery, and three were located in the vertebrobasilar system. Three aneurysms were intracranial. Four patients were symptomatic, and three had angiographic evidence of increasing aneurysm size. RESULTS: Technical success was achieved in six (86%) of seven patients. Entanglement of a coil with the stent struts necessitated partial coil delivery into the parent artery in one patient, but there were no neurological or other adverse sequelae. The 30-day rate of periprocedural stroke or mortality was 0%. At a mean clinical follow-up of 14.5 months, neurological status was at baseline or better in all patients. To date, all treated patients remain clinically asymptomatic with oral administration of aspirin only. CONCLUSION: Stent-supported coil embolization represents an emerging therapeutic alternative to surgery for the treatment of symptomatic or enlarging wide-neck and fusiform aneurysms and pseudoaneurysms of the cervical and vertebrobasilar arteries, which are not amenable to conventional unsupported coil embolization. Experience with greater numbers of patients and long-term follow-up are required to further validate this technique.
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ranking = 6
keywords = neck
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8/138. Surgical repair of clinoidal segment carotid artery aneurysms unsuitable for endovascular treatment.

    OBJECTIVE: Clinoidal segment carotid artery aneurysms are surgically challenging lesions. The aneurysm neck originates proximal to the distal dural ring, and the aneurysms typically are larger. Therefore, endovascular techniques are often considered to be the primary treatment option. Treatment techniques and results for 40 clinoidal segment carotid artery aneurysms that were considered unsuitable for contemporary endovascular intervention are analyzed in this report. methods: Forty aneurysms in 33 female and 3 male patients were treated surgically. Fifteen patients had bilateral aneurysms; of these patients, four underwent bilateral craniotomies. Twenty-seven aneurysms were 10 to 14 mm in size, eight were 15 to 24 mm, and five were more than 25 mm. The most common presentation was visual loss, which occurred in 13 patients. Seven patients presented with subarachnoid hemorrhage. RESULTS: Thirty-seven aneurysms were directly repaired with clipping, two were trapped with bypass, and one was trapped without bypass. The complication rate was 10%, with one major stroke, two minor strokes, and one successfully treated brain abscess. CONCLUSION: Surgical treatment of clinoidal segment carotid artery aneurysms can produce acceptable outcomes. Specific preoperative and intraoperative techniques facilitate improved surgical results for aneurysms that are not treatable with contemporary endovascular techniques.
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ranking = 1
keywords = neck
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9/138. Fusiform aneurysm of the internal jugular vein: an unusual cause of neck swelling.

    Aneurysmal anomalies of the internal jugular vein are very uncommon. We report two cases of internal jugular vein aneurysm and discuss the clinical pattern, pathology, aetiology and management.
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ranking = 4
keywords = neck
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10/138. Carotid artery aneurysm secondary to cystic medial necrosis.

    Carotid artery aneurysm secondary to cystic medial necrosis is a rare clinical entity. We report a 59-year-old Chinese male patient who presented with a pulsatile right neck swelling for 2 months. Partial resection of the aneurysm with primary anastomosis of the internal carotid artery was performed. Histopathological examination of the aneurysmal wall demonstrated cystic degeneration of the media with accumulation of glycosaminoglycan material, consistent with the features of cystic medial necrosis. The pathogenesis of carotid artery aneurysm secondary to cystic medial necrosis is discussed.
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ranking = 1
keywords = neck
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