Successfully-treated asymptomatic celiac artery aneurysm: A case report

BackgroundCeliac artery aneurysm is a rare vascular lesion. It is frequently discovered after rupture, which leads to death in most cases. We present a case of an asymptomatic celiac artery aneurysm discovered in a 72-year-old female during an evaluation for high grade fever and general fatigue.Case presentationThe patient visited our department with complaints of fever and general fatigue. The patient’s medical history included type 2 diabetes mellitus with poor control and hypertension. Blood culture and urine culture that were submitted at arrival presented E. Coli. Then, she was diagnosed with bacteremia by urinary tract infection. Transesophageal echocardiography revealed no vegetation at her valves. Computed tomography was performed for investigating her urological abnormalities, revealing a 28 × 30 mm aneurysm at the trunk of the celiac artery. Blood and urine cultures submitted at arrival were positive for E. coli. Surgical repair performed after the improvement of her urinary tract infection revealed a non-infective aneurysm; thus, aneurysm closure and prosthetic grafting were conducted.ConclusionClinician awareness regarding this rare entity and discovery efforts to discover the splanchnic aneurysm before rupturing are imperative.     

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.     

Surgical treatment of celiac artery aneurysm: in situ aortoceliac artery reanastomosis: a case report

The authors present a rare case of celiac artery aneurysm treated by aneurysmectomy and vascular reconstruction, and they review the past literature. A 57-year-old man was referred to their hospital with a complaint of epigastric discomfort. Abdominal echography, 3-dimensional computed tomography, and selective angiography showed a sole celiac artery aneurysm. At operation, the origin of the celiac artery and adjacent aorta was exposed through a midline transperitoneal approach alone. A 25 x 20 x 25 mm fusiform aneurysm of the celiac artery was found 5 mm distal from its origin. Aneurysmectomy and in situ aortoceliac artery reanastomosis was performed buttressed with a doughnut-shaped Teflon felt under the partial clamp of the abdominal aorta. The left gastric artery arising from the aneurysm was ligated. Postoperative angiography showed good patency of the splenic and common hepatic arteries. He had an uneventful postoperative course with no aggravation of the liver function and was discharged 11 days after operation. Pathological examination of the aneurysmal wall revealed medial degeneration with a tear of the internal elastic lamina and intimal edema. In situ aortoceliac artery reanastomosis after aneurysmectomy, as was done in this case, has not been previously documented in the past literature.     

Treatment of a giant vertebrobasilar artery aneurysm using stent grafts. Case report

This 65-year-old man presented to the authors' institution reporting neck swelling. Stage IIIA Hodgkin disease was diagnosed, and a computed tomography scan of the neck revealed a vertebrobasilar artery aneurysm. His medical history was significant for subarachnoid hemorrhage and coma 2 years earlier. Subsequent digital subtraction angiography demonstrated a giant fusiform vertebrobasilar junction aneurysm with associated basilar artery (BA) fenestration. Endovascular treatment of the giant aneurysm was performed by left vertebral artery (VA) occlusion and placement of two Jo-stent coronary stent grafts from the right VA to the BA. The postprocedure course was uneventful. Follow-up angiography performed 1 week postoperatively demonstrated complete exclusion of the aneurysm. This unique case is described and a review of the relevant literature is presented.     

Combined open and endovascular treatment of a right subclavian artery aneurysm: a case report

A 69-year-old man with previous ascending aortic repair combined with valve replacement for an ascending aortic aneurysm presented with a type 2 thoracoabdominal aneurysm and a 4.4-cm aneurysm of the right subclavian artery. Because of the anatomic location of the aneurysm and his previous operation, an innominate to carotid artery stent graft and a carotid-subclavian bypass and vertebral artery bypass were performed. Postoperative computed tomographic angiography confirmed good flow in the right carotid and vertebral artery, and the patient recovered without complication.     

Pseudoaneurysm of the aortic arch after aortosubclavian bypass treated with endoluminal stent grafting--a case report

This paper describes a case of aortic arch pseudoaneurysm treated with stent graft 2 years after aortosubclavian bypass repair of a subclavian artery aneurysm. An 84-year-old man presented with back pain. Two years before, he had had a left subclavian artery aneurysm repaired with aortosubclavian bypass. Upon examination by computed tomography (CT) scan and angiography he was found to have a bovine arch configuration, a 7-centimeter pseudoaneurysm arising from the stump f the native subclavian artery, a patent aortosubclavian bypass, and a left hemothorax. A 37 mm by 10 mm Gore Excluder thoracic graft was introduced into the right femoral artery cutdown and deployed across the arch, excluding the pseudoaneurysm and preserving the brachiocephalic vessels. Follow up CT scan at 1 year shows exclusion of the pseudoaneurysm. The patient continues to do well 1 year after implantation without evidence of endoleak. In the presence of unusual anatomical characteristics, endoluminal stent graft repair can be successfully performed across the aortic arch.     

Treatment of a middle cerebral artery giant aneurysm using a covered stent. Case report

The authors report the case of a 60-year-old man harboring a wide-necked giant aneurysm of the M1 segment of the left middle cerebral artery (MCA); his symptoms included transient ischemic attacks characterized by right hemiparesis and aphasia. The aneurysm was treated by placing a covered stent across the orifice of the aneurysm. The 18-month follow-up examination showed a very good outcome, with perfect left MCA patency, no new ischemic lesion, and minor residual aphasia and right hemiparesis. This is the first report in the literature of an MCA aneurysm treated using a covered stent.     

Prolonged success with a covered endovascular stent after emergent use in radiation-induced subclavian artery blowout: a case report

Radiation-induced damage to the bone, soft tissues, and vasculature represents the unfortunate consequences of radiation therapy for the treatment of malignant tumors. Complications arising from irradiation are frequently challenging to manage and may be life threatening. A case is presented of a patient with a longstanding clavicular osteoradionecrosis with an acute massive hemorrhage after rupture of the subclavian artery and subsequent management with endovascular stent placement. With over 2 years' follow-up, vascular patency was maintained with no further bleeding episodes in this surgically high-risk patient.     

Celiac artery aneurysm: a case report

The aneurysms of the celiac trunk are extremely rare. The authors describe a case of aneurysm of the celiac trunk dealt with aneu-rysmectomy and reconstruction by means of protesic graft made in Dacron. The patient was asymptomatic, and the aneurysm was discovered accidentally during abdominal computerized tomography (CT) for the stadiation of hepatic cirrhosis. The aneurysmectomy and the reconstruction have been executed by means of a prosthetic graft finish-terminal in Dacron, succeeding in preserving the three arteries originating from the celiac trunk (left gastric, hepatic, splenic). The histologic examination documented the degeneration of the medium trunk with loss of elastic fibers and atherosclerotic lesions. The postoperative course was complicated by hepatic ascites, and severe renal insufficiency. As a result of paracentesis and diuretic dose titration, the blood parameters and the conditions of the patient improved progressively until allowing the discharge on XL postoperative day in good conditions. Six months after, abdomen CT documented the integrity of the prosthetic graft and the absence of perianastomotic leak.     

Coeliac artery aneurysm: a case report

Coeliac artery aneurysm is a rare but potentially fatal disease. In this paper a case of coeliac artery aneurysm is presented which was diagnosed before rupture and treated electively by resection and graft replacement between the aorta, common hepatic artery and superior mesenteric artery. Copyright © 1996 The International Society for Cardiovascular Surgery.     

颈内动脉瘤合并锁骨下动脉瘤1例

患者女,45岁,7天前突然头痛、头晕伴恶心呕吐,既往健康。查体：生命体征平稳。头颅CT平扫双侧裂池、前纵裂略高密度影。DSA（图1～4）：右侧颈内动脉前床突段向后侧方囊状膨突动脉瘤10mm×9mm,可见附壁血栓,外缘不规则。左侧锁骨下动脉、椎动脉开口远端可见向上前方囊状膨突动脉瘤7．0mm×4．2mm,外缘光滑。     

Endovascular repair of a celiac trunk aneurysm with a new multilayer stent

Operative treatment of celiac trunk aneurysms has traditionally involved open repair using simple ligation, interposition graft, resection, and direct repair or antegrade bypass from the aorta; recently, endovascular techniques have been proposed in selected cases. We report a 60-year-old man presenting with a celiac trunk aneurysm that we treated with a new multilayer stent with the aim of preserving the parent vessels arising from the aneurysm. Computed tomography angiography at the 12-month follow-up visit confirmed the patency of the stents, the complete thrombosis of the sac without impairment of the main branches, and the regular perfusion of the liver and spleen.     

Hemodynamic benefits of celiac artery release for ruptured right gastric artery aneurysm associated with median arcuate ligament syndrome: a case report

Background

It has been reported that median arcuate ligament syndrome is closely associated with gastric or pancreaticoduodenal artery aneurysms. Hemodynamic state plays an important role in the formation of the aneurysms. These aneurysms are treated with open resection or endovascular exclusion. However, whether revascularization of the celiac artery can prevent the aneurysm formation is unknown. This report indicated a possibility that prophylactic revascularization for celiac artery stenosis resulted in decreased shear stress on the collaterals, which may otherwise be susceptible to new aneurysms.

Case presentation

This report describes a 51-year-old man who presented with epigastric pain at our hospital. According to contrast enhanced computed tomography (CT), he was diagnosed with a ruptured right gastric artery aneurysm and celiac artery stenosis caused by the median arcuate ligament (MAL). He had a vascular anomaly of the common hepatic artery arising from the superior mesenteric artery (SMA). His vital signs were stable. We informed him of the situation and he chose open surgery rather than endovascular treatment. Following, we resected the aneurysm and transected the MAL. Intraoperative angiography after transection of the MAL showed the antegrade blood flow to the splenic artery instead of the retrograde flow via the prominent collaterals. Follow-up CT confirmed narrowed collateral vessels between the SMA and the celiac artery without de-novo aneurysms.

Conclusion

While the necessity of celiac artery release could be questioned, the present case supports the hemodynamic benefits of MAL transection in terms of de-novo aneurysm prevention.

     

Isolated celiac artery aneurysm with splenic artery stenosis as a rare presentation of polyarteritis nodosum: a case report and review of the literature

Polyarteritis nodosum (PAN) is a vasculitic disease that affects small to medium arteries. It often presents as a systemic and multiorgan disease that affects the skin, joints, gastrointestinal tract, kidneys, and nervous system. Nonspecific signs and symptoms are the hallmarks of PAN. It rarely affects single vessels, although there have been case reports of PAN involving single intra-abdominal vessels. The authors present a case of a 42-year-old white man who presented with mild epigastric pain but was otherwise asymptomatic. The workup ultimately revealed a rare case of an isolated celiac artery aneurysm with a concomitant stenosis of the splenic artery secondary to PAN. The patient was treated with high-dose steroid therapy, with resultant resolution of the vasculitis and a decreased size of the aneurysm.     

Development of a pontine cyst after endovascular coil occlusion of a basilar artery trunk aneurysm: case report

OBJECTIVE AND IMPORTANCE: Cyst formation within the brain parenchyma after endovascular coil occlusion of an intracranial aneurysm is a previously undescribed occurrence. We describe a 70-year-old woman who presented with a symptomatic pontine cyst 1 year after uncomplicated stenting and Guglielmi detachable coil occlusion of an unruptured basilar artery trunk aneurysm. CLINICAL PRESENTATION: A 70-year-old woman presented with an episode of transient dysequilibrium and gait difficulty. Magnetic resonance imaging and cerebral angiography demonstrated a 15-mm distal basilar artery trunk aneurysm. Endovascular stenting and coil occlusion of the aneurysm were performed without technical complications. One year after the initial treatment, the patient developed progressive dysarthria, dysphagia, diplopia, and left hemiparesis. A large pontomesencephalic cyst adjacent to the coiled basilar aneurysm was identified on magnetic resonance imaging scans. INTERVENTION: A subtemporal craniotomy and decompression of the pontomesencephalic cyst were performed. The patient's symptoms of brainstem dysfunction improved temporarily but recurred within 2 months, necessitating reoperation for cyst drainage and placement of a cyst-peritoneal shunt. CONCLUSION: Intra-axial cyst formation after stenting and endovascular occlusion of an intracranial aneurysm is an unusual occurrence and should be considered in the differential diagnosis of new neurological deficits after endovascular treatment. The pathophysiological mechanism of cyst formation in this case is not known.     

Spontaneous dissection of the celiac artery: a case report

Spontaneous dissection of visceral arteries is rare in the absence of concurrent dissection of the aorta, iatrogenic injury from instrumentation, or trauma. We describe a spontaneous dissection of the celiac artery that was identified by computed tomographic scan in an otherwise healthy man with acute onset abdominal pain and no identifiable causes of dissection. The patient was successfully managed medically. Although endovascular treatment or surgical intervention is the procedure of choice for complicated cases, medical management with close observation is an acceptable management strategy for stable, uncomplicated cases of spontaneous celiac artery dissection.     

Combined endovascular stent implantation and coil embolization for the treatment of a vertebro-basilar fusiform aneurysm: technical case report

We describe a case of the combined application of endovascular stent implantation and Guglielmi detachable coil packing for the treatment of a vertebro-basilar fusiform aneurysm and review the literature on stent placement to treat cerebral aneurysms. A 70-year-old female presented with an acute headache from subarachnoid hemorrhage. A fusiform aneurysm with a broad-based neck and dome, measuring 15 mm, involving the union of the vertebral arteries and the proximal basilar artery was demonstrated on cerebral angiography. The aneurysm was judged to be inoperable and treated conservatively. Twelve days later the patient was transferred to our hospital for endovascular therapy. An intravascular stent (MultiLink) was placed across the base of the aneurysm through the right vertebral artery. After this, coil placement in the aneurysm around the stent was performed via a microcatheter guided from the left vertebral artery. After that a microcatheter was guided from the right vertebral artery through the interstices of the stent into the aneurysm, and additional coils were placed. Final angiography showed subtotal occlusion of the aneurysm and excellent blood flow of the parent artery through the stent. There were no new neurological deficits. Neither rerupture nor ischemic event has occurred. The use of stents provides another treatment for managing the difficult entity of intracranial aneurysms.     

Persistent sciatic artery aneurysm: a case report

In early embryologic development the sciatic artery provides the blood supply to the lower limb bud. When the femoral artery develops, the sciatic artery involutes. However, in rare cases, the sciatic artery persists. It can be visualised as a prolongation of the inferior gluteal artery (branch of the internal iliac artery) and it accompanies the sciatic nerve at the posterior side of the hip. We present the case of a 47-year old woman who consulted because of a numb right foot which presented colder and paler than the left foot. She also had a right painful calf, especially after exercise. Upon physical examination and doppler ultrasound there were no popliteal nor pedal artery pulses in the right leg. CT angiography showed bilateral persistent sciatic arteries with aneurysm formation and the presence of an embolus in the popliteal artery at the right side. Treatment involved thrombolysis of the popliteal occlusion, followed by intra-aneurysmatic stent placement and embolectomy of the popliteal artery and its distal branches. Postoperative clinical results were remarkably good and the patients symptoms dissolved. CONCLUSION: A persistent sciatic artery is a rare vascular anomaly. It is more prone to vasculopathies such as aneurysm formation. In cases of acute ischemia, correct diagnosis and treatment of this anomaly can avoid serious medical consequences.