Surgical treatment of right subclavian aneurysm--a case report

A case of arteriosclerotic aneurysm of right subclavian artery is reported. The patient was 74 years old male. A huge arteriosclerotic aneurysm was found at the origin of right subclavian artery. Calcification of thoracic aorta and arch vessels was prominent. Under the temporary bypass between brachiocephalic artery and right common carotid artery, replacement of the aneurysm with 8 mm Dacron graft was successfully performed. To avoid the systemic embolism, partial clamp was applied to intact arteries. As the perfusion of the brain was maintained through the temporary bypass during the reconstruction of right common carotid and subclavian arteries, intracranial complication was prevented.     

A true posterior tibial artery aneurysm--a case report

Aneurysms of infrapopliteal arteries are rare. The etiology is usually traumatic, and most aneurysms are false. The English-language literature reports only 33 cases of infrapopliteal arterial true aneurysms, of which 8 involve the posterior tibial artery. The etiology of these lesions is unclear; a fibromuscular fibrodysplasia similar to ulnar aneurysm may be hypothesized, but traumatic, atherosclerotic, inflammatory, and other pathological processes are also probably involved. The natural history seems to be related to thrombosis and distal embolism more than to rupture. Surgical indications are debated. Aneurysm repair with a complete restoration of the blood flow through the affected artery is particularly challenging owing to the small size of the vessels, and ligation may be required. We report, to the best of our knowledge, the first case of an atherosclerotic posterior tibial artery true aneurysm successfully treated with aneurysmectomy and end-to-end direct reconstruction with a documented good long-term patency. Clinical features, imaging findings, and surgical management are described; indications and treatments (open or endovascular) are discussed.     

Laparoscopic exclusion of a splenic artery aneurysm--a case report

Splenic artery aneurysm is a rare but serious vascular disease. The mortality risk is 36% when one is ruptured. Surgical therapy has traditionally consisted in resection through a laparotomy. The authors' experience of a case of laparoscopic exclusion of a splenic artery aneurysm is reported. This surgical approach is simple, safe, and minimally invasive. This procedure should increase the indication for surgical treatment of a splenic artery aneurysm.     

Giant basilar aneurysm--a case report (author's transl)]

A case of a giant aneurysm arising from the basilar artery is presented. The patient a 41--year-old female, had recent memory disturbance, miscalculations and hemiparesis on admission. Vertebral angiograms displayed a giant aneurysm measuring approximately 66 mm in diameter arising from the basilar artery, a tortuous vertebral artery, an extremely dilated basilar artery and an agenesis of the left carotid artery. Due to the enormous size of the aneurysm and its location in the deep intracranial portion, radical surgery was abandoned. Six months following her discharge, she died. At autopsy, the giant aneurysm arising from the top of the basilar artery was found, existing just beneath the third ventricle and extending to the left basal ganglia. The lateral ventricle, the third ventricle and the Sylvian fissure were filled by hematoma resulting from the rupture of the aneurysm. It is possible that this giant aneurysm could be considered a vascular anomaly, and hence be distinguished from saccular aneurysms.     

Endovascular management of isolated axillary artery aneurysm--a case report

The purpose of this paper is to report a case of axillary artery aneurysm, successfully treated by percutaneous transfemoral self-expandable polytetrafluoroethylene (PTFE) covered Wallgraft stent. A 20-year-old man presented with sudden-onset, severe aching pain of left upper limb that occurred while doing isometric exercise. He had feeble left brachial and radial pulses. Angiography revealed a 21 x 14 mm left axillary artery aneurysm with a 15 mm neck. There was an organized clot in the midpart of the left brachial artery. The aneurysm was successfully closed with a self-expandable 10 x 30 mm Wallgraft endoprosthesis PTFE graft stent, via the right femoral route. A check angiogram at 6 weeks of follow-up showed a patent stent with no endovascular leak. At 1 year of follow-up, the patient was asymptomatic with normal upper limbs pulsations. Axillary artery aneurysm may be treated with a stent graft, which is an effective, rapid, and definite treatment and is an acceptable alternative to standard open surgical repair.     

Osler-Weber-Rendu disease--unexpected complication following excision of splenic aneurysm--a case report

Osler-Weber-Rendu disease is an autosomal dominant disease, sometimes known as hereditary hemorrhagic telangiectasia (HHT) with a family history. It is a rare disease and there are no records of families with inheritance lineage in Riyadh. We experienced an anesthetic management of a 28-yr-old woman with Osler-Weber-Rendu disease. She was diagnosed to have splenic aneurysm and was scheduled for excision of splenic aneurysm. A chest X-ray revealed pulmonary arterio-venous malformation all over the lungs. The anesthesia and surgery went deliberately smooth with selective period of Intensive Care admission. In the intermediate post operative period, however, she was diagnosed as having pleural effusion. A chest drain was inserted as an emergency, but the patient developed tension pneumothorax, which necessitated resuscitation and readmission to Intensive Care Unit. Lung atelactasis was diagnosed. Attendance by qualified surgical night staff, communication, vigilance and consultations are as important as the proper management of such rare cases.     

Surgical treatment of a huge hepatic artery aneurysm--a case report.

A debilitated 68 year old woman with an epigastric mass previously identified as a hepatic artery aneurysm (HAA) by selective angiography, developed acute epigastric pain radiating to her back. Impending rupture was diagnosed, and the patient successfully underwent surgical repair using a prosthetic patch to close the orifice of the aneurysm. HAA is uncommon, but the risk of rupture is great, being 44 per cent and the mortality rate high, being 35 per cent. Abnormal ultrasonography and CT may suggest the diagnosis, but selective arteriography is definitive. Surgical treatment is indicated in most patients, although embolization is appropriate for intrahepatic aneurysm and extremely poor risk patients.     

Visceral patch rupture after repair of thoracoabdominal aortic aneurysm--a case report

This is a unique case of a visceral patch rupture in a Marfan patient after a repair of a thoracoabdominal aneurysm. The patient presented with abdominal pain and in shock 6 years after repair. The retained aortic wall containing the origins of the celiac, mesenteric, and renal arteries was aneurysmal and had ruptured. Clinical presentation, diagnosis, and operative modalities are discussed.     

Abdominal pain caused by thrombosis of a gastroepiploic artery aneurysm--a case report

Symptomatic visceral aneurysms usually present with abdominal pain and shock, gastrointestinal bleeding, or hemobilia when the aneurysm ruptures. Less frequently, visceral aneurysms are found incidentally during abdominal computed tomography or angiography. Thrombosis is a frequent complication of popliteal and femoral aneurysms but is rarely seen with a visceral aneurysm. The author believes this is the first report of complete thrombosis of a gastroepiploic artery aneurysm. The patient, who was seen for abdominal pain, had a previously unrecognized aneurysm.     

Transplanting a kidney with a renal artery aneurysm--a case report and literature review

As a rare postoperative complication, renal artery aneurysm has been reported in 0.95% of kidney transplants. A renal artery aneurysm was repaired prior to transplantation of the kidney.     

Spontaneous coronary artery dissection with left ventricular aneurysm--a case report of successful surgical repair

Spontaneous coronary artery dissection is a rare entity. To our knowledge, 86 cases have been reported, and there are 7 operative treatment. The patient was 56 year-old male with a history of the previous myocardial infarction. A selective coronary angiography demonstrated marked dilatation of both coronary arteries. The thin radiolucent lines were shown within the LAD and first diagonal branch as a result of partial separation of the intima. A very large left ventricular myocardial aneurysm was also demonstrated within anteroapical walls, he underwent open heart surgery with left ventricular myocardial aneurysmectomy and aorto-first diagonal branch saphenous vein graft. This present case is the second report which describe a successful surgical treatment for the spontaneous coronary artery dissection with left ventricular aneurysm.     

Splenic artery aneurysm--a rare cause for extrahepatic portal venous obstruction: a case report

Splenic artery aneurysm is a rare yet very important clinical entity because of its potential for rupture with fatal consequences. Most of the splenic artery aneurysms are found in the middle and distal third of the splenic artery and are usually small (< or = 2 cm) at the time of diagnosis. We describe a rare case of large (5x4 cm) juxta-ostial splenic artery aneurysm causing compression of the splenoportal confluence and adjoining proximal portal vein in a 40-year-old woman.     

Mycotic aneurysm--a rare complication of acute osteomyelitis in a child. A case report

A case of mycotic aneurysm formation of the right iliac artery is described. This unusual complication developed as a result of acute osteitis of the left tibia which was initiated by a kick on the lower leg. One month after treatment for osteitis of the tibia, the patient was readmitted because of unequivocal evidence of ischaemia of the right leg and a large pulsatile mass in the right iliac fossa, confirming the clinical diagnosis of mycotic aneurysm. The aneurysm was excised but because the wall of the artery was extremely friable simultaneous revascularization was deferred for fear of uncontrollable haemorrhage from the anastomotic line.     

A case of persistent primitive proatlantal intersegmental artery (proatlantal artery I) with aneurysm--a case report

A 70-year-old woman was admitted to our hospital with attack of SAH. On admission, she was semi-comatose with no other neurological deficit. Left carotid angiography revealed an aneurysm of the anterior communicating artery and a large abnormal vessel connecting the left external carotid artery and the left vertebral artery. This large anastomotic vessel was thought to be primitive proatlantal intersegmental artery (proatlantal artery I). Right carotid angiography revealed a coiling of the right internal carotid artery and hypoplasia of the right A1 portion. Left retrograde brachial angiography revealed aplasia of the left vertebral artery. After admission her consciousness gradually improved but 17 days after admission she died of rerupture of the aneurysm. Autopsied brain showed that the left vertebral artery, namely proatlantal artery, was almost as large as the basilar artery and its macroscopical appearance was similar to other arteries. It was also obvious that the right vertebral artery was hypoplastic. As the rate of combination of the persistent artery with the intracranial aneurysm is relatively high, the authors think that some congenital factor may affect the occurrence of intracranial aneurysms.     

Endovascular repair of an arteriovenous fistula from a ruptured hypogastric artery aneurysm--a case report

A spontaneous ilioiliac arteriovenous fistula secondary to rupture of a hypogastric artery aneurysm is an unusual occurrence. A case of an endovascular repair of this challenging problem is reported.     

Hemorrhagic gastric ulcer associated with consumption coagulopathy in the dissecting aortic aneurysm--a case report

A case of the hemorrhagic gastric ulcer and post-operative stomal ulcer associated with the consumption coagulopathy in the dissecting aortic aneurysm is presented. A 68 year old man, who had diagnosed as having the dissecting aortic aneurysm (DeBakey III) in 1985 and had been attending to our hospital as an outpatient since then, was admitted to our hospital because of the hemorrhagic gastric ulcer on July 3rd, 1987. Although the wide resection of stomach was performed after the admission, the hemorrhagic stomal ulcer was developed 4 weeks after the operation. The administration of heparin in addition to antacids to improve the consumption coagulopathy, having been caused by thrombus formation in the aneurysm, was effective in control of the hemorrhage and also making the stomal ulcer scarred. It is suggested that ischemia of the stomach mucosa, which seemed to have been induced by the dissecting aortic aneurysm, was responsible for the development of the ulcers in this case and the hemorrhage from them was caused mainly by the consumption coagulopathy derived from thrombus formation in the aneurysm.     

Aorto-caval fistula due to rupture of abdominal aorto-iliac aneurysm--a case report of successful repair

A 62-year-old man who had complained of swelling of bilateral lower extremities, exertional dyspnea and jaundice for 3 months was referred to our hospital with a diagnosis of large abdominal aneurysm and congestive heart failure. His aortography and Doppler echocardiography revealed that he had the aorto-caval fistula due to rupture of abdominal aorto-iliac aneurysm. He underwent a reconstruction of abdominal aorta with woven Dacron bifurcation graft together with a closure of fistula with 3 mattress sutures. The postoperative course was uneventful and he is free from any symptoms. Problems of diagnosis, operative management and results are discussed, reviewing the previously reported cases in Japan.     

Axillary giant lipoma: a case report

Lipoma are the most frequent mesenchymal soft tissue tumours but rarely present huge sizes in their cutaneous localization. Some cases of so-called "giant lipomas" have been reported in the literature and here is presented a giant lipoma of the axillary area which is, to our best knowledge, the second report of such a giant lipoma in this localization.