Iliac artery pseudoaneurysm rupture following excision of an infected hip prosthesis

We report a case of external iliac artery aneurysm rupture during removal of the acetabular component for septic loosening. Potentially fatal hemorrhage would have occurred if the risk had not been recognized, and the external iliac vessels exposed to gain vascular control before proceeding with implant removal. A review of the literature on vascular injury at revision hip surgery is presented.     

An infected pseudoaneurysm following a modified Blalock-Taussig shunt

A two-month-old male infant with tetralogy of Fallot underwent a right-sided modified Blalock-Taussig shunt using a 4 mm expanded polytetrafluoroethylene graft through a right thoracotomy. Five months later, the patient developed otitis media, followed by repeated relapses of pneumonia and fever of unknown origin. Multidetector-row computed tomography and angiography, performed at 12 months of age, revealed a pseudoaneurysm of the subclavian artery at the insertion of the modified Blalock-Taussig shunt. After 20 days of antibiotic therapy, the pseudoaneurysm and infected graft were successfully resected through a median sternotomy approach. This report describes the treatment strategy of this rare but potentially fatal complication after a modified Blalock-Taussig shunt operation.     

Endovascular repair of an infected carotid artery pseudoaneurysm

Pseudoaneurysm formation after carotid endarterectomy is a rare but potentially lethal complication. The risks for embolization and continued expansion necessitate repair. Traditional surgical repair of carotid pseudoaneurysms is often technically demanding, and is associated with relatively high morbidity and mortality. Endovascular stent grafts have been used to treat both posttraumatic and postoperative carotid pseudoaneurysms. An endovascular approach to these pseudoaneurysms limits the risks for operative damage to surrounding structures and the potential for substantial blood loss. We present the case of an infected carotid pseudoaneurysm that was successfully treated with a covered stent graft.     

Traumatic infected pseudoaneurysm of the hand

A rare case of ruptured infected pseudoaneurysm of the hand resulting from penetrating trauma is reported. The patient was seen initially with an acute infection of the hand associated with pulsatile bleeding. Diagnostic evaluation should include arteriography as a guide for the operative plan.     

Ascending aortic infected pseudoaneurysm with aortic insufficiency following cardiac operation for infective endocarditis.

An infected pseudoaneurysm of the ascending aorta after heart surgery is a fatal disease due to its rapid progress, worsening of the systemic condition and a tendency of recurrence. We report a 53-year-old man with this condition who presented with fever and an aortic regurgitation due to compression of the ascending aortic root 2 months after mitral valve replacement for infective endocarditis. We performed an aneurysmectomy with a cardiopulmonary bypass using groin cannulation and moderate systemic hypothermia. A pseudoaneurysm developed 5 mm proximally of the previous aortotomy. There was no dehiscence of the former aortic suture line. After debridement of the ascending aorta involving the previous aortotomy and pseudoaneurysm, we elected to directly close the aortic defect using Teflon felt strips to avoid a prosthetic graft. The aortic valve had no infective endocarditis and other abnormality. Postoperatively, there was no aortic regurgitation, and the cause of the previous aortic regurgitation was believed to be due to a compression of the aortic root from outside. The postoperative course has been good.     

主动脉感染性假性动脉瘤的腔内治疗

目的:探讨使用腔内修复术治疗主动脉感染性假性动脉瘤的有效性。方法:回顾性分析2007年1月到2010年1月期间的主动脉感染性假性动脉瘤病人的临床资料,包括临床表现、治疗方式、治疗效果及预后。结果:6例病人(平均年龄53岁)均行腔内修复术。1例病人并发主动脉支气管瘘,1例病人并发主动脉十二指肠瘘,4例为肾下腹主动脉假性动脉瘤(其中1例于麻醉后出现包裹性破裂)。所有病人于术中均行隔绝成功,静脉使用抗生素1~4周伴随终身口服抗生素,平均住院22 d。围手术期无死亡及并发症。2例主动脉瘘的病人在随访期中死亡。1例病人术后随访发现并发腰大肌脓肿;其余病人在术后随访期间恢复良好。结论:腔内修复术可作为主动脉感染性假性动脉瘤病人挽救生命的良好选择,但主动脉支气管瘘或主动脉肠瘘等意味着持续性感染存在的可能,必须于术后严密随访,必要时需行进一步外科手术治疗。     

Popliteal artery pseudoaneurysm following arthroscopy

An 18-year-old male presented with left foot ischemia secondary to emboli from a pseudoaneurysm of the left popliteal artery. His past history was significant only for two arthroscopies of his left knee. After evaluation, the patient was successfully treated with obliteration of the aneurysm and a reverse saphenous vein bypass graft.     

Traumatic pseudoaneurysm following blunt trauma

Traumatic aneurysms of the superficial femoral (SFA) and superior medial geniculate artery (SMGA) demonstrated late expansion of previously well contained hematomas which were pulsatile and remarkable for the presence of bruits. Injury to the SFA resulted in a cool, pulseless distal extremity. Direct exploration of the pseudoaneurysm cavity following proximal and distal control of the main arterial segment resulted in optimal exposure and successful repair of the arterial defect. Blunt trauma may result in pseudoaneurysm formation. Persistent swelling at a focus of injury despite normal distal pulsation is an early indicator of major vascular injury.     

Endovascular treatment of an innominate artery iatrogenic pseudoaneurysm following subclavian vein catheterization

Central venous catheterization is routinely required in a wide range of clinical situations such as hemodynamic monitoring, delivery of blood products and drugs, hemodialysis, total parental nutrition, and management of perioperative fluids. Pseudoaneurysms account for 4% of all innominate artery aneurysms. Clinical presentation may include airway and neurological compression, chest pain, mediastinal syndrome, upper limb ischemia, and hemodynamic instability. We report what we believe is the first documented case of a successful endovascular stent-graft repair of an innominate artery iatrogenic pseudoaneurysm.     

经闭孔旁路术治疗股动脉感染性动脉瘤

目的：探讨采用经闭孔旁路术治疗股动脉感染性动脉瘤的方法和疗效。方法：回顾性分析2004年8月—2014年7月间采用经闭孔旁路术治疗的4例股动脉感染性假性动脉瘤患者的临床资料。结果：患者男3例,女1例,平均年龄26.5（22~31）岁,病因为注射吸毒损伤股动脉3例,下肢动脉栓塞介入治疗穿刺点并发症1例。3例接受单纯股动脉结扎及感染性动脉瘤清创术治疗,术后出现下肢缺血,二期行经闭孔髂动脉到股动脉旁路术,1例行同期股动脉结扎、动脉瘤清创加经闭孔髂外动脉到股浅动脉旁路术治疗。平均随访27（8~60）个月,4例患者术后患肢踝肱指数（ABI）为1.0~1.1,无间歇性跛行及其他不适。结论：同期或分期经闭孔旁路是治疗股动脉感染性假性动脉瘤可避免术后的下肢缺血症状。     

Endoaortic stent grafting of a giant infected hepatic-celiac pseudoaneurysm

A 72-year-old man was admitted because of progressive right upper-abdominal distension and pain as well as concurrent remittent fever for 5 months. He had undergone a radical gastrectomy and catheter intubation in the common hepatic artery for chemotherapy 12 months before admission. The diagnosis of giant infected hepatic-celiac artery pseudoaneurysm was established. Coils embolotherapy was given in another hospital, but it failed. After admission, a computed tomographic aortogram showed a mass 10.3 x 8.5 x 8.1 cm in size in the right upper abdomen that originated from the common hepatic artery and the celiac artery. A celiac-super mesenteric artery (SMA) double catheter simultaneous digital subtraction angiography (DSA) further revealed that the entrance of the aneurysm opened directly from the abdominal aorta, the distance between the orifice of SMA and celiac axis was only 0.5 cm, and the diameter of the celiac trunk had been aneurysmally enlarged to 2.0 cm. A blood culture was positive for Bacillus pyocyaneus. After detailed discussion and preparation, a stent-graft complex was negotiated through the left femoral artery and deployed successfully into the abdominal aorta to seal the orifice of celiac trunk under the dynamic supervision of DSA. Completion angiography revealed that the hepatic-celiac pseudoaneurysm was completely excluded from aortic flow by the endoluminal stent-graft complex, while the SMA and renal arteries remained perfectly patent. The patient recovered uneventfully and was discharged without any residual symptoms. At a 5-year follow-up, the patient remained asymptomatic and was leading a normal life.     

Successful repair of a submitral left ventricular infected pseudoaneurysm

Aneurysms of the left ventricle may be congenital or may occur after a myocardial infarction, trauma, or endocarditis. Infective endocarditis can cause destructive injury to the heart in various ways. This report describes the formation of an aneurysm of the left ventricle from trauma of a bacterial vegetation of the mitral valve. Early recognition by echocardiography and magnetic resonance imaging led to successful repair and prevented a catastrophic result.     

Iatrogenic tibial pseudoaneurysm following below-knee amputation

Tibial vessel injury during lower extremity amputation has not been reported, despite the obvious proximity of these vessels to the fibula and tibia. We present a case of acute pseudoaneurysm with arteriovenous fistula of the posterior tibial vessels following amputation, due to (unrecognized) arterial and venous injury due to fibular periosteal elevation.     

Infected aortic pseudoaneurysm following laparoscopic cholecystectomy

A 38-year-old hemodialysis-dependent diabetic female patient underwent a laparoscopic cholecystectomy for symptomatic cholelithiasis. Postoperatively, she developed chronic back pain. Eight months following laparoscopic cholecystectomy, she developed fevers and recurrent bacteremia with methicillin-resistant Staphylococcus aureus, despite removal of all indwelling intravenous dialysis access. An abdominal CT scan demonstrated a 7-cm pseudoaneurysm extending from the right anterolateral lower abdominal aorta. Following resection of her infected aneurysm and extraanatomic bypass, she cleared her bacteremia and recovered. This first report of an aortic pseudoaneurysm following laparoscopic cholecystectomy is presented in the context of other vascular complications reported following the same procedure.