Ruptured syphilitic ascending aortic aneurysm; report of a case

Syphilitic cardiovascular disease has become a rarity today. It most commonly affects the ascending aorta and aortic arch. A case is reported of a 50-year-old female with a ruptured syphilitic ascending aortic aneurysm who underwent an emergency operation. The patient was emergently admitted with complaint of severe dyspnea, circulatory shock due to cardiac tamponade was observed in the emergency room. Bentall's procedure was performed. Intraoperative findings showed multi-cystic dilatation of an aortic root. Penetration was existed on right side posterior wall of an aortic root. Postoperative pathological examination of the aneurysmal wall revealed the characteristic finding of syphilitic aortitis. The postoperative course was uneventful and the patient has been doing well at period of 3 years after operation.     

Ruptured thoracic aortic aneurysm complicated by acute aortic dissection and aortic valve regurgitation; report of a case

An 87-year-old man was found loss of consciousness after falling. He was found in a state of shock. Computed tomography showed rupture of aneurysm of the ascending aorta and aortic arch with acute aortic dissection. Echocardiography revealed aortic valve regurgitation and cardiac tamponade. As the result of emergency operation, a large hematoma in the mediastinum and pleural cavity as well as massive serous pericardial effusion were found. The dissection was seen in aneurysm of the ascending aorta and aortic arch with an intimal tear located in the aortic arch. After aortic valve replacement was performed, the ascending aorta and aortic arch were replaced, and reconstruction of 3 cervical vessel branches was performed under deep hypothermic circulatory arrest with selective cerebral perfusion. Despite the complex clinical state and serious condition in the elderly patient, emergency surgery saved the life of the patient without complications.     

A case of coexisting descending thoracic aortic aneurysm and atypical aortic coarctation treated successfully by surgery using the thromboexclusion method

The thromboexclusion method was successfully applied to a 43-year-old male with aortitis syndrome. Preoperative aortogram showed a fusiform aneurysm of the descending aorta just below the left subclavian artery and atypical coarctation of the descending aorta distal to this aneurysm. Pressure gradient across the stenosis was about 70 mmHg. The technique of flow reversal and thromboexclusion was performed in this patient because of severe calcification in the aortic arch and the entire descending aorta. A long extra-anatomical bypass between the ascending aorta and the infrarenal abdominal aorta was made, and a permanent aortic clamp was placed across the aorta at the left subclavian artery. Hypertension in the arm disappeared immediately after the operation, and postoperative catheterization revealed no pressure gradient between the ascending and the abdominal aorta. Computed tomogram performed 18 days after the operation and aortogram done 44 days postoperatively disclosed thrombi formation in the aneurysm.     

Ruptured aortic arch aneurysm with hemorrhagic cardiac tamponade; report of a case

The ruptured aortic arch aneurysm with cardiac tamponade is rare and has severely high mortality. We report a case of ruptured aortic arch aneurysm with cardiac tamponade. A 66-year-old man who had syncope attack was transferred to city hospital. Brain computed tomography (CT) showed no significant lesion and he admitted to our hospital for suspecting of aortic dissection. Chest CT showed ruptured aortic arch aneurysm and pericardial effusion. Emergent operation was done on the same day. It was found that the hematoma beneath the tunica adventitia existed at the distal arch and extended to the ascending aorta. Cardiac tamponade was caused by rupture of subadventitial hematoma in pericardial space. Aortic arch replacement was performed using selective cerebral perfusion under deep hypothermia. Postoperatively, he had no cerebral complication and was discharged uneventfully.     

Ruptured thoracic aortic aneurysm presenting as massive epistaxis; report of a case

An 80-year-old woman was transported to the emergency room at our hospital by the ambulance, suffering from massive epistaxis. As the patient was hemodynamically stable, otolaryngologist attempted to perform tamponade using nasal packing. However, the patient's condition deteriorated, with the development of dyspnea and a reduction in oxygen saturation to 90%. A chest X-ray performed at this point revealed left lung consolidation and pleural effusion while chest computed tomography (CT) demonstrated that rupture of a descending aortic aneurysm with periaortic hematoma and extension of hemorrhage into the left lower lobe of the lung. Emergency surgery was performed under partial extracorporeal circulation, established by cannulation of the right femoral artery and vein. In addition to the replacement of the descending aorta with a prosthetic conduit, left lower lobectomy was necessary because of severe adhesion to the descending aorta. The postoperative course was largely uncomplicated apart from development of chylothorax, which resolved with a short period of total parenteral nutrition and she was discharged 50 days after surgery.     

Ruptured bronchial artery aneurysm; report of a case

A 74-year-old man who went into shock following an acute hemomediastinum and left hemothorax was operated on. Postoperative angiographies revealed a saccular aneurysm of the left bronchial artery of 2.0 cm in diameter. Sixty days after the initial operation, the aneurysm was resected under F-F bypass. A saccular aneurysm was found at the root of the left bronchial artery, which had a very short segment between the aneurysm and the aorta. Pathological study of aneurysm revealed thinning of the wall and lack of tunica media.     

Operation for an infected thoracoabdominal aneurysm in a patient previously treated with an axillobifemoral bypass for an infected abdominal aortic prosthesis: a case report

High operative mortality of infected thoracoabdominal aortic aneurysms (ITAA) is partly attributable to ischemic injury during aortic clamping. A case is presented of an 88-year old man who was admitted with imminent rupture of an ITAA. Axillobifemoral bypass grafting had been performed after removal of an infected abdominal aortic prosthesis six years earlier. In situ graft replacement was performed during 70 minutes of aortic clamping just below the pulmonary hilum without causing any but transient renal ischemic injury. Since the infrarenal aorta was absent after previous removal of an infected aortic prosthesis, the axillobifemoral bypass provided sufficient blood supply to intestines, kidneys and spinal medulla via arterial collaterals. Blood supply was sufficient, although a previous rectosigmoid resection must have destroyed some of the collaterals and one iliac artery was chronically occluded. The most important message from this case is that an axillobifemoral bypass may prevent ischemic injury during operations for ITAA even when collateral circulation is reduced, possibly on the condition that backbleeding from end-organ arteries is prevented, and there is a pressurized aortic segment that can redistribute blood that arrives via arterial collaterals.     

Mycotic descending thoracic aortic aneurysm complicated by pyothorax postoperatively: report of a case

We experienced with a case of mycotic descending thoracic aortic aneurysm (MTAA) complicated by pyothorax postoperatively. The graft replacement accompanied with wrapping by omental pedicle flap (OPF) was performed in this case. We considered that causative organism for MTAA was Salmonella species, and discussed effectiveness of the application of OPF to MTAA.     

Ruptured abdominal aortic aneurysm and horseshoe kidney. A case report

A patient with a ruptured abdominal aortic aneurysm associated with a horseshoe kidney is reported on. The treatment included aneurysmectomy and insertion of an aortic Dacron prosthesis without division of the isthmus of the kidney. The postoperative course was complicated by a stroke and mild renal failure, but the patient made excellent progress and was discharged from hospital 1 month after admission.     

Ruptured aortic arch aneurysm with hemorrhagic cardiac tamponade: report of a case

A 67-year-old female was sent into our hospital for ruptured thoracic aneurysm with hemorrhagic cardiac tamponade. Computed tomography (CT) showed pericardial effusion and ruptured aortic arch aneurysm. We performed urgent graft replacement of the aortic arch using selective cerebral perfusion under mild hypothermia. Postoperative course was uneventful.     

Ruptured middle cerebral artery aneurysm successfully treated by intra-aneurysmal GDC embolization in a patient with idiopathic thrombocytopenic purpura: a case report]

We report a case of a ruptured middle cerebral artery (MCA) aneurysm treated by an intra-aneurysmal Guglielmi detachable coil (GDC) embolization in a patient with idiopathic thrombocytopenic purpura (ITP). A 57-year-old female, who had been suffering from ITP for 4 years, experienced sudden severe headache. She was diagnosed as having subarachnoid hemorrhage due to a ruptured MCA aneurysm and the hematological examination showed moderate thrombocytopenia. Considering the risk of open surgery, we treated the aneurysm by intra-aneurysmal GDC embolization in the acute stage and platelet transfusion was carried out after the therapy. She had a good clinical course and recovered without any complications or neurological symptoms. The follow-up cerebral angiogram at 1 week and 2 years after the treatment showed complete obliteration of the aneurysm. Recently, endovascular treatment tends to be applied to surgically high-risk patients. A GDC embolization for a patient with thrombocytopenia has rarely been reported and the risk and efficacy is unknown. So, we conclude that for a patient with thrombocytopenia, intra-aneurysmal GDC embolization could be adopted as one of the less invasive treatment for ruptured aneurysm.     

Inflammatory abdominal aortic aneurysm treated by endovascular stent grafting: a case report

Despite complications inherent to open surgical repair of inflammatory abdominal aortic aneurysms, there is expected resolution of the retroperitoneal inflammatory process following graft replacement. An endovascular approach could also exclude the aneurysm while potentially avoiding injury to vital structures in the hostile operative field. However, data are limited regarding the role of endovascular stent grafts in the management of inflammatory abdominal aortic aneurysms. Furthermore, postoperative regression of perianeurysmal inflammation is rarely discussed in the few published accounts of endovascular repair of inflammatory aortic aneurysms. The case presented demonstrates successful endovascular treatment of an infrarenal inflammatory aneurysm with resolution of the retroperitoneal inflammation and hydronephrosis.     

Ruptured popliteal artery aneurysm: a case report

A high index of suspicion for popliteal aneurysms must be present when evaluating a popliteal mass. Though typically pulsatile, in the presence of chronic thrombosis, the absence of a pulse may make the diagnosis even more difficult. A case is presented that illustrates this point, where an 83-year-old man presents following the biopsy of what turned out to be a very large popliteal aneurysm. In the presence of chronic thrombosis and adequate collateral flow, decompression and ligation of any feeding vessels is typically sufficient. These patients must be followed lifelong for the development of other associated aneurysms.     

Ruptured ovarian artery aneurysm: a case report

Ruptured aneurysms of the ovarian artery are exceedingly rare. Five cases have been previously reported in the English-language literature, all occurred in the early postpartum period. The present report details another such case, the first, to my knowledge, to have been demonstrated by angiography or to have been treated nonoperatively.     

Infected thoracoabdominal aortic aneurysm; report of a case

A 54-year-old man complained of pain in the left upper abdomen with fever. His past medical history was significant for non-insulin-dependent diabetes mellitus and hypertension. Leucocytosis and an elevation of CRP levels were detected. Thoracoabdominal aneurysm of 69 mm in diameter was identified by enhanced computed tomography (CT). An infected thoracoabdominal aortic aneurysm was diagnosed and an emergency operation was performed. The aneurysm was treated by debridement of the infected aortic tissue and in situ prosthetic graft replacement followed by antibiotic therapy. The postoperative course was uneventful and there were no adverse neurological symptoms. After surgery, antibiotics were administered for 1 month intravenously and the patient was discharged on oral antibiotics for 2 months after the operation. The patient is doing well 7 months after the operation.     

Combined endovascular treatment of a descending thoracic aortic aneurysm and off-pump myocardial revascularization-a case report

Endovascular intervention is an alternative form of treatment for patients with thoracic aortic aneurysms. Coexistent cardiovascular diseases may adversely influence the postoperative course and affect the long-term prognosis. The case of a 76-year-old man with severe coronary artery disease and a thoracic aortic aneurysm is reported. A single-stage procedure of off-pump coronary artery revascularization and endoluminal exclusion of the descending thoracic aortic aneurysm was performed. The patient was treated first with off-pump coronary artery bypass graft (left internal mammary artery on the left anterior descending coronary artery and two single venous grafts from ascending aorta to obtuse marginal artery and posterior descending artery). After heart revascularization, two Thoracic Excluder endovascular grafts (34 x 100 and 37 x 100 mm) were implanted to treat the descending thoracic aortic aneurysm. Follow-up with computed tomography angiography showed successful exclusion of the thoracic aneurysm 12 months after the procedure. The patient is well and free of symptoms 18 months later.     

Intrameatal aneurysm successfully treated by meatal loop trapping--case report

A 77-year-old female presented with a rare intrameatal aneurysm manifesting as sudden onset of headache, hearing loss, tinnitus, and vertigo associated with subarachnoid hemorrhage. Meatal loop trapping was performed. After surgery, the patient's functions recovered almost completely, probably because of the preservation of the 7th and 8th cranial nerves and the presence of effective collaterals in the area supplied by the anterior inferior cerebellar artery.     

Ruptured aortic dissecting aneurysm in Turner's syndrome: a case report and review of literature.

Cardiovascular malformations are frequently observed in Turner's syndrome. Bicuspid aortic valve and coarctation of the aorta are commonly associated with Turner's syndrome whereas aortic dissection is rare but its rupture results in death. We experienced a case of ruptured dissecting aneurysm (Stanford type A) in a 30-year-old female with Turner's syndrome. Emergent total arch replacement was performed successfully. A literature review revealed 32 cases of aortic dissection in patients with Turner's syndrome, including 15 cases of rupture. However, survival after rupture was reported only two cases. To our knowledge, this report descries the third known case of successful surgical management of ruptured aortic dissection in Turner's syndrome.