Pseudoaneurysm

The formation of external carotid artery (ECA) pseudoaneurysms caused by stab wounds is a rare vascular anomaly. Although the surgical exploration of the ECA segment is the standard treatment, endovascular treatment (EVT) can be considered if there is difficulty in identifying the source of bleeding in the injured regions that are difficult to operatively access. Here we treated a young patient who had hemorrhagic instability with hemorrhage-induced coagulopathy caused by a zone III cervical stab wound with a pseudoaneurysm from the main trunk of the ECA; the patient underwent EVT and successful hemostasis...

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Secondary postpartum hemorrhage (PPH) and postabortion hemorrhage are rare complications. Retained products of conception (RPOC) is among the most common causes of both secondary PPH and postabortion hemorrhage. Other less common causes of secondary PPH are uterine vascular abnormalities such as arteriovenous malformations and pseudoaneurysms. These are usually related to a history of a procedure such as dilation and curettage or cesarean delivery. Subinvolution of the placental site is an idiopathic cause of secondary PPH; this condition may be underrecognized and therefore could have a higher incidence than currently reported...

A 80-year-old man was admitted to catheterization room for an acute infero-lateral ST-elevation myocardial infarction (STEMI). Coronary angiography showed a thrombotic occlusion of the second left marginal branch, and normal other coronary arteries. The thrombo-embolic mechanism of the STEMI, and the infectious context in this patient who had had a transcatheter aortic valve implantation (TAVI) two months earlier, led us to suspect a bioprosthesis endocarditis. It was confirmed by transthoracic and transoesophageal echocardiography, which showed an aortic-mitral curtain abscess and aortic bioprosthesis vegetations, associated to Enterococcus faecalis bacteriemia...

Pseudoaneurysms of the internal mammary artery are a rare complication of median sternotomy. They may clinically present as a pulsatile mass or with signs of rupture and haemodynamic instability. In stable patients, percutaneous thrombin injection of the pseudoaneurysm is a safe and minimally invasive procedure to treat the pseudoaneurysm and avoid further surgery. We present a case of a pseudoaneurysm of a branch of the right internal mammary artery post-median sternotomy with no signs or symptoms of haemodynamic instability...

Oesophageal foreign body is an emergency situation. Once oesophageal perforation occurs, damage and subsequent infection involving surrounding tissue or organs may ensue. We present here a rare case of aorto-oesophageal fistula which was treated with challenges. An old lady with fishbone induced oesophageal perforation, aortic pseudoaneurysm and mediastinal haematoma was treated with great vessel stent-graft placed in aortic arch, and the fish bone was removed under endoscopy thereafter. During the early follow-up period, part of the graft stent was discovered in the oesophageal perforation with no haemorrhage...

Delayed gastrointestinal bleeding in the context of a gastric fistula is a very rare complication of longitudinal sleeve gastrectomy. We report the case of a patient who presented with massive gastrointestinal bleeding from a pseudoaneurysm arising from the splenic artery following complications after a longitudinal sleeve gastrectomy several months previously. The case was successfully managed with angiographic embolisation and we present our experience with recommendations for managing this rare but life-threatening complication...

A 53-year-old woman was referred to us for reoperation of aortic root. Twenty-three years ago, she was diagnosed with aortitis and suffered from annuloaortic ectasia, aortic regurgitation, severe stenosis of left carotid and subclavian arteries and occulusion of the main trunk of left coronary artery. The left coronary system was perfused by collateral arteries from right coronary artery. She had undergone original Bentall procedure( Cooley graft 26 mm+SJM valve 25 mm) with coronary artery bypass grafting (CABG)[saphenous vein graft (SVG)-left anterior descending artery (LAD)]...

Aerococcus viridans is a gram positive microaerophilic lactic acid coccus which is known to cause an infection in lobsters called Gaffkaemia. Consumption of gaffekaemia affected lobsters is considered to be safe if properly cooked even though there hasn't been any research on potential transmission by this route. Though uncommon, A. viridans is capable of causing a virulent endocarditis associated with aortic valve destruction and abscess. There have been 11 worldwide reported cases of infective endocarditis, of which 6 were aortic and only one of them had aortic pseudoaneurysm (APA)...

Endocarditis of a prosthetic heart valve is a life-threatening condition that is associated with high morbidity and mortality. Perivalvular extension in infective endocarditis includes complications such as periannular or intramyocardial abscesses, pseudoaneurysms and fistulae. The incidence of perivalvular extension ranges from 10 to 30% in native valve endocarditis and 30 to 55% in prosthetic aortic-valve endocarditis. Herein, we describe a case of a 66-year-old man who presented endocarditis of a prosthetic aortic valve complicated by infective pseudoaneurysm with localization next to the right coronary sinus of Valsalva...

Mycotic aneurysm of the aorta is a rare, but life-threatening pathology. In recent years, endovascular stent graft placement has been introduced as an effective alternative for treating infected aortic aneurysms. A 64-year-old woman with a history of paraplegia due to spinal cord injury was referred to our institute with fever and blood-tinged sputum. Computed tomography (CT) scan showed an 11-cm pseudoaneurysm arising from the proximal descending aorta, which was normal 1 month ago at the previous CT scan...

We report successful thoracic endovascular repair of a pseudoaneurysm rupture in the ascending aorta using infrarenal endovascular devices after an aortic valve replacement. Complete exclusion of the pseudoaneurysm was achieved with no endoleak or postoperative complications. Despite limitations of the current technology, this endovascular technique was a relatively less invasive, feasible lifesaving surgical option for the repair of a pseudoaneurysm of the ascending aorta with a diameter ≤32 mm.

A 78-year-old woman was admitted with benign biliary stenosis. A plastic stent was placed at the left branch to prevent obstructive cholangitis. Two weeks after the procedure, the patient was readmitted with cholangitis caused by hemobilia. However, computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), peroral cholangioscopy, and abdominal angiography failed to establish the bleeding source. At the seventh bleeding, CT revealed a hepatic artery pseudoaneurysm for which coil embolization was successfully performed...

A 33-year-old man presented with aneurysmal subarachnoid hemorrhage from a ruptured, blister-type sidewall internal carotid artery (ICA) aneurysm. Balloon-assisted coiling was performed with residual neck. He subsequently developed severe vasospasm requiring intra-arterial therapies on multiple occasions, during which it was noted that despite widespread vasospasm, a focal segment of the ICA at the site of the aneurysm showed no significant spasm, suggesting underlying vessel abnormality. He was discharged without deficit and scheduled for flow diversion given concern over this potentially pathologic segment of vessel...

Endoscopic third ventriculostomy (ETV) is a common treatment for noncommunicating hydrocephalus. Although rare, vascular injury and traumatic pseudoaneurysm development during ETV have been reported. The authors present the case of a 13-year-old boy who underwent repeat ETV (rETV) for shunt and ETV failure, and who suffered an intraoperative subarachnoid hemorrhage due to iatrogenic injury to the basilar tip, with subsequent development of a pseudoaneurysm. Despite initial primary coil embolization, the aneurysm recurred and was definitively treated with flow diversion...

The cases of two patients who developed myometrial vascularization following dilatation and curettage are described. In case 1, pathological diagnosis was possible with the resected specimens. This patient had hypervascular retained products of conception (RPOC). In case 2, the natural course of this pathological condition was observed, confirming a process of regression during repeated withdrawal bleeding. The three principal magnetic resonance imaging (MRI) findings in these cases were: (i) presence of a remnant; (ii) breaking of the junctional zone in contact with the remnant; and (iii) vascularization/flow voids infiltrating into the myometrium from the broken junctional zone...

Ruptured pseudoaneurysm following pelvic surgery is a rare and fatal complication. Because of its rarity, existing evidence is limited to a small case series. A 60-year-old woman underwent staging laparotomy, including pelvic and para-aortic lymphadenectomy, for ovarian cancer. On the 11th day, the patient developed a sudden lumbar pain and loss of consciousness, which resulted in a state of shock. She was diagnosed as having a pelvic abscess and ruptured external iliac artery pseudoaneurysm. We performed ligation of the external iliac artery to restrain hemorrhage and femoro-femoral artery bypass to prevent infection, which saved the patient's life...

The authors present a case of a 39-year-old man with alcoholic chronic pancreatitis that was admitted in the emergency department after a car accident, complaining of abdominal pain and looking pale. The patient was hemodinamically unstable, requiring blood transfusions. He underwent computed tomography angiogram of the abdomen and pelvis, showing a pseudoaneurysm of the gastroduodenal artery and a hemoperitoneum. He was referred to our interventional radiology unit and submitted to endovascular treatment, consisting of 'backdoor' and 'frontdoor' embolization of the gastroduodenal artery and pseudoaneurysm neck with coils, with total exclusion in control angiography...

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Objectives To investigate the feasibility and the mid-term outcomes of the chimney-graft technique for the revascularization of supra-aortic branches in patients with thoracic aortic pathologies involving the aortic arch. Methods A retrospective analysis of a prospectively maintained database between January 2010 and July 2016 was performed. Primary endpoints were 30-day and overall mortality. Secondary endpoints were technical success, target vessel patency, stroke/transitory ischemic attack and type I/III endoleak rate...