Surgical management of a pulsatile chest wall mass secondary to an ascending aortic aneurysm in a patient with bovine arch

Ascending aortic pseudoaneurysms are rare, but life‐threatening conditions, that often require intervention. While endovascular techniques have advanced significantly, the majority of these clinical scenarios preclude endovascular options and the primary treatment modality remains open surgical repair. Repair of an aortic pseudoaneurysm eroding through the sternum resulting in a pulsatile chest wall mass is technically challenging. We report the successful repair of a large ascending aortic pseudoaneurysm in a 62‐year‐old male with bovine arch anatomy and prior Type A dissection repair, presenting with contained rupture and a pulsatile chest wall mass.     

胆胰手术后假性动脉瘤诊断及治疗

胆胰疾病病人经外科手术、介入或内镜治疗后发生迟发性大出血时,救治困难、病死率高,而术后假性动脉瘤形成和破裂是主要原因。胆胰手术后假性动脉瘤成因复杂多样,瘤体破裂出血前临床症状隐匿。从致病机制源头预防假性动脉瘤形成、重视前哨出血等特征性临床症状,将会有效确保胆胰疾病病人围手术期安全性,提高术后迟发性大出血的救治成功率。     

Glue embolization of a ruptured celiac trunk pseudoaneurysm via the gastroduodenal artery

Percutaneous transcatheter embolization of splanchnic artery aneurysms is a minimally invasive and alternative therapy to conventional surgical intervention. Due to a high-grade stenosis at the origin of the celiac trunk, a retrograde approach to the celiac trunk pseudoaneurysm via the gastroduodenal artery was necessary. To prevent undesirable embolization into the peripheral left gastric artery initial occlusion of the central portion of the left gastric artery was performed with microcoils using a Tracker catheter. Complete occlusion of the celiac trunk itself and the short adjacent segments of the celiac artery was achieved by using a mixture of N-butyl-2-cyanoacrylate and ethiodized oil as the embolizing agent. Received: 22 June 1999; Revised: 7 September 1999; Accepted: 1 October 1999     

Isolated temporal infarct due traumatic vertebral artery dissecting pseudo-aneurysm: a rare case report

The authors describe a rare case of traumatic vertebral artery dissecting pseudo-aneurysm with temporal lobe infarct in the pre-foramina segment of the left vertebral artery following knife injury of the left anterolateral neck area. A 40 years old man was admitted to the emergency department after a penetrating injury in the left anterolateral neck. On contrast-enhanced CT and Doppler ultrasonography in the neck, a dissecting pseudo-aneurysm of the vertebral artery was revealed.On day 2, MRI scanning revealed an ischemic infarct in the temporal lobe, which can be attributed to vertebral artery injury. The case was treated conservatively and the patient was discharged on the fourth hospital day. Owing to the position of the artery, traumatic vertebral artery dissections are uncommon, and they are linked with a high mortality rate due to aneurismal rupture and embolic impact of the dissections, culminating in stroke in young people. Our findings demonstrate the necessity of imaging in head and neck traumatic injuries to detect vertebral artery injuries far sooner in order to prevent complications.     

颈动脉损伤的外科治疗(附16例报告)

目的 探讨颈动脉损伤的早期诊断和外科治疗方法。方法 回顾性分析2003年10月至2006年12月哈尔滨医科大学附属第二医院血管外科收治的16例颈动脉损伤的临床资料。颈外动脉损伤4例,颈总动脉损伤3例,颈内动脉损伤1例,颈动脉假性动脉瘤3例,颈动脉血栓形成1例,医源性颈动脉损伤4例。结果行颈外动脉结扎4例,颈总动脉修补2例,自体大隐静脉移植7例,覆膜支架植入2例,抗凝溶栓1例。死亡1例,偏瘫、失语1例．Homer综合征5例,声音嘶哑、饮水呛咳5例,7例痊愈。结论 早期诊断,及时有效的止血,修复血管．尽快恢寅颈动脉血流和必要的脑保护措施是降低病死率,减少神经系统并发症的关键。     

Recurrent peripheral embolism following nonunion of the clavicle

Vascular complications in closed clavicular fractures are uncommon, with an incidence of only 0.4%. Subclavian artery injury can present acutely or can have a delayed presentation with arm ischemia. We report the case of an undetected subclavian pseudoaneurysm in a patient with a nonunion fracture clavicle who was referred with persistent ischemia following attempted brachial embolectomy at another center, along with a review of literature to support the hypothesis that in addition to repair of the aneurysm, treatment of the psuedarthrosis by fixation of the clavicle is essential.     

Acute myocardial infarction as the manifestation of the thoracic aorta pseudoaneurysm

We present the case of the 56-year-old Caucasian man, with the 30 months history of previous Yacoub operation, reported to the complex cardiovascular center as the acute coronary syndrome with new LBBB ECG changes. Coronary angiogram proved the atypical affection of the left main coronary artery, transesophageal echocardiography clarified a large aortic pseudoaneurysm repressed both of coronary arteries, as the cause of symptoms. The surgical correction (Bentall procedure) was successfully performed and the patient was discharged 23 days after redo surgery with no complications.