A large unruptured isolated iliac artery aneurysm: rare presentation

Isolated iliac artery aneurysms without associated abdominal aortic aneurysms are rare. Incidence varies between 0.03% and 0.1%. Deep pelvic location of aneurysms, make their detection by physical examination very difficult. Usually they remain asymptomatic until ruptured. Other symptoms and signs are due to local compression of adjacent pelvic structure. Here we are presenting a case report of a patient with large unruptured isolated iliac artery aneurysm presented with abdominal lump and managed successfully.     

孤立性髂动脉瘤的腔内治疗

目的探讨利用血管腔内技术治疗孤立性髂动脉瘤的安全性、可行性、有效性和存在的问题。方法自1997年5月至2006年1月,对15例孤立性髂动脉瘤患者行血管腔内治疗。真性动脉瘤12例(80％),假性动脉瘤3例(20％);髂总动脉瘤9例(60％),髂内动脉瘤3例(20％),髂外动脉瘤3例(20％)。瘤径3．5-9．0 cm,平均(5．97±1．49)cm。髂内动脉瘤采用直接栓塞技术;髂总以及髂外动脉瘤采用支架型血管腔内修复技术或结合外科手术方法及栓塞技术进行治疗。术后观察瘤腔内血液动力学改变、髂内动脉以及下肢动脉供血的改变。结果术后仅1例保留双侧髂内动脉,其余仅保留单侧。术后2例发生内漏(13％)。无围手术期死亡,无移植物错放、移位、瘤体破裂、中转手术以及由于覆盖单侧髂内动脉而引起的肠道缺血、性功能改变等并发症发生,1例术后出现一侧臀肌酸痛症状。手术时间0．5-4．0 h,平均(1．9±1．1)h;出血量30-300 ml,平均(126．7±70．1) ml;恢复活动时间0．5-4 d,平均(2．1±1．1)d;住院时间3-12 d,平均(5．5±4．7)d。结论腔内技术治疗孤立性髂动脉瘤是一种安全、可行、有效的方法。髂内动脉的处理以及内漏防治仍是困难的问题。     

Post-traumatic brachial artery aneurysm and arteriovenous fistulae

A case of penetrating metal fragment injury to the cubital fossa with subsequent development of a false aneurysm of the brachial artery with a fistulae to the vena comitans and median basilic vein is described. Surgical management involved aneurysmectomy, interposition cephalic vein graft and lateral repair of the vena comitans. Early angiography should be considered in penetrating injuries near major limb vessels, as the initial signs and symptoms of vascular injury may be minimal.     

Surgical treatment of deep brachial artery aneurysm

Deep brachial artery aneurysms are extremely rare. The purpose of this article is to report a case of deep brachial artery aneurysm that was successfully treated by open surgery. A 76-year-old man presented with complaints of an asymptomatic pulsatile mass in the left axilla. A computed tomography angiography revealed a deep brachial artery aneurysm. The aneurysm was resected surgically, then the axillary artery was repaired, and the distal end of the deep brachial artery was ligated without vascular reconstruction. The patient had a good recovery with no complications, and the arterial pulses of the left upper extremity were normal.     

Restoration of upper arm function in traction injuries to the brachial plexus

Summary. Summary.   Background: Restoration of upper arm function presents the main priority in nerve repair of brachial plexus traction injuries. The results are predominantly influenced by the level and extent of injury, and the type of surgical procedure. The purpose of this study is to evaluate influence of these factors on final outcome.   Methods: Study included 91 surgically treated patients, including 71 patients with avulsions of one or more spinal nerve roots and 20 with peripheral traction injuries. We performed 120 nerve transfers, 25 nerve graftings and 29 neurolyses on different nerve elements depending on the type of nerve damage. Analysis of motor recovery for elbow flexion and arm abduction, isolated or in combination, was done.   Findings: Recovery of elbow flexion was obtained in 75% nerve transfers, and in 68,7% nerve graftings in peripheral traction injuries. Recovery of arm abduction was obtained in 78,5% nerve transfers, and in 44,4% nerve graftings in peripheral traction injuries. Neurolysis was successful in all cases. Generally, the quality of recovery was better for the musculocutaneous nerve. Useful global upper arm function was obtained in 49,3% of patients with avulsion of spinal nerve roots, and in 55% of patients with peripheral traction injuries.   Interpretation: Regarding upper arm function the prognosis of surgically treated patients with traction injuries to the brachial plexus is generally similar in cases with central or peripheral level of injury. However, nerve transfers of collateral branches seem to be superior to nerve grafting and may be another possibility for repair in cases with extensive nerve gaps.     

Hybrid management of ruptured isolated superior mesenteric artery dissecting aneurysm

A 70-year-old woman, with history of asymptomatic isolated superior mesenteric artery (SMA) dissection was admitted for acute abdominal pain. Computed tomography showed ruptured isolated SMA dissection. Endovascular treatment was chosen over surgical repair because of prior abdominal surgeries. Because an angulated SMA trunk and compressed true lumen by the dilated false lumen prevented the insertion of a guidewire into the SMA via the transfemoral artery, transmesenteric approach under laparotomy was selected. After creating a pull-through condition from the SMA to the left brachial artery, a successful stent graft placement with adequate hemostasis was achieved. The aneurysm shrunk remarkably, with no complication at follow-up.     

Rupture of an isolated true superficial femoral artery aneurysm: case report

True isolated atherosclerotic aneurysm of the superficial femoral artery is a rare pathology. We report a case of ruptured superficial femoral artery aneurysms (SFAA) not associated with aortic, common femoral or popliteal artery aneurysms. An emergency surgical procedure was performed and, after endoaneurysmal branches ligation, a ePTFE graft interposition was performed. The literature review shows a prevalence of rupture as compared with ischemic complications and the need for surgical repair in case of SFAA with diameter twice the normal vessel size. Early diagnosis and management are recommended because of the lower morbility and mortality rates associated with elective surgery by comparison with emergency procedures.     

Idiopathic true brachial artery aneurysm in a nine-month infant

Upper extremity peripheral artery aneurysms are a rarely encountered arterial disorder. Brachial artery aneurysms seen in the pediatric age group are generally trauma resultant. A nine-month-old male infant patient presented with complaints of an asymptomatic mass in the arm. Following Doppler ultrasonography and magnetic resonance imaging (MRI) examinations, saccular aneurysm, originating from the left brachial artery was diagnosed in the patient without history of trauma. The aneurysm was resected by surgical intervention, and primary repair of the brachial artery was performed by end-to-end anastomosis. No complication was observed during the follow-up. Surgical intervention for upper extremity aneurysms should be initiated without delay in order to prevent extremity ischemia and amputation.     

False aneurysm of the axillary artery following brachial plexus block

Brachial plexus blockade is a commonly used technique for providing surgical anesthesia for the upper extremity. Although various approaches have been described, the axillary approach is the safest and most frequently used. Most complications associated with axillary nerve block are related to local or systemic anesthetic toxicity, bleeding, infection, and nerve damage. A case of false aneurysm of the axillary artery following axillary nerve block is reported. The possible occurrence of this complication should be kept in mind to avoid permanent neurologic sequelae.     

Unusual presentation of inferior thyroid artery aneurysm

A rare case is reported of an aneurysm of the inferior thyroid artery with hoarseness as the only presenting symptom. The aneurysm was excised. Six years after the operation the patient is well and free of symptoms.