Posterobasal left ventricular aneurysms: clinical results and surgical treatment

Of 152 left ventricular aneurysms that occurred after infarction and were treated surgically, eight were located in the posterobasal segment. All of them were true aneurysms. Combined procedures, performed at the time of the aneurysm resection, included mitral valve replacement (two patients), coronary artery bypass grafting (five patients), closure of an interventricular septal defect (one patient), and carotid artery endarterectomy (one patient). Four had slight mitral regurgitation that disappeared after resection of the aneurysm, and two exhibited severe mitral regurgitation that required mitral valve replacement. Six patients survived operation and are free of symptoms. The literature shows a high incidence of false aneurysms that have a propensity toward rupture in this anatomical location. At times, there are difficulties in the differential diagnosis of true and false aneurysms and, consequently, we recommend an aggressive surgical approach.     

颅内动脉瘤患者瘤壁雌激素和雄激素受体的表达及其作用

目的探讨颅内动脉瘤壁雌激素和雄激素受体表达水平的意义。方法前瞻性纳入2007年11月至2016年6月在四川大学华西医院接受开颅手术夹闭颅内动脉瘤的患者32例,获得颅内动脉瘤壁19个,颞浅动脉分支26个,共45个合格标本。采用免疫组化法检测颞浅动脉分支和颅内动脉瘤壁平滑肌层及内皮细胞的雌激素受体-α、β及雄激素受体表达水平。以Image Pro Plus6.0软件分析检测阳性细胞表达水平积分光密度值。统计学分析采用χ2检验,成组Mann-Whitney秩和检验。结果动脉瘤壁的雌激素受体-α、β表达中位数(M)与四分位距(P25,P75)分别为3 049(2 112,5 554)和4 364(2 314,5 667),低于颞浅动脉分支的6 544(3 507,10 103)和6 972(5 694,10 024)。动脉瘤壁雄激素受体表达水平3 299(1 375,4 895),高于颞浅动脉分支的1 130(794,1 922),两组比较差异均有统计学意义(均P0.05)。结论脑血管壁雌激素受体-α、β表达水平的降低,雄激素受体表达水平的升高,可能促进了颅内动脉瘤的进展,但具体机制尚需进一步研究。     

破裂颅内动脉瘤患者动脉瘤壁AIF-1、MMP-9和COX-2表达上调

目的 探讨同种异体移植物炎症因子-1(allograft inflammatory factor-1,AIF-1)、基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)和环加氧酶-2(cycloxygenase-2,COX-2)在颅内破裂动脉瘤组织中的表达及意义.方法 收集12例颅内破裂囊状动脉瘤瘤体和颞浅动脉标本,采用免疫组织化学染色法检测动脉瘤和颞浅动脉AIF-1、MMP-9和COX-2表达.结果 动脉瘤瘤壁可见淋巴细胞、巨噬细胞等炎性细胞浸润.AIF-1、MMp-9和COX-2表达主要见于破裂动脉瘤瘤壁组织的内膜层和中膜层,并且主要分布于巨噬细胞和淋巴细胞的细胞质内,而在颞浅动脉不表达或极少量表达.半定量分析显示,动脉瘤瘤壁AIF-1破裂IAAIF-1[0.006 7(0.004 2 ～0.014 6)对0.0000(0.0000～0.0010);Z=-4.236,P＜ 0.001]、MMP-9[0.002 2 (0.000 7～0.004 3)对0.000 0 (0.000 0 ～0.000 0);Z=-4.442,P＜0.001]和COX-2[0.002 8(0.002 2 ～ 0.004 3)对0.000 0(0.0000～0.000 0);Z=-4.442,P＜0.001]表达水平均显著高于颞浅动脉组.男性患者破裂动脉瘤瘤壁AIF-1表达水平显著高于女性患者(0.016±0.013对0.009±0.006;t=1.440,P=0.043).结论 颅内破裂囊状动脉瘤瘤壁AIF-1、MMP-9和COX-2表达显著上调,提示存在炎性反应,并可能参与了颅内动脉瘤发生、发展和破裂过程.     

Brachial arteriomegaly and true aneurysmal degeneration: case report and literature review

While brachial artery aneurysms are rare and usually of infectious, post-traumatic or iatrogenic etiology, true aneurysms of the brachial artery are even more unusual. We report on a large brachial artery aneurysm complicated by chronic contained rupture and partial outflow obstruction. This was observed 19 years after ligation of a radiocephalic (Brescia-Cimino) arteriovenous fistula for hemodialysis that had existed for 2 years. Of 581 brachial artery reconstructions performed at the Cleveland Clinic Foundation between January 1989 and December 2000, only three involved repairs of brachial artery aneurysms; only the reported case was a true aneurysm of degenerative origin for an incidence of 0.17% (1/581). The management of brachial artery aneurysms is described and the pertinent literature was reviewed.     

Peripheral aneurysms.

Between January 1970 and December 1990, 17 cases of peripheral aneurysms were observed in 15 patients. Fourteen patients were male and one patient was female. Age ranged between 4 years and 82 years. From the 17 peripheral aneurysms, 4 were false aneurysms, 9 were true atherosclerotic aneurysms, 2 were mycotic and 2 were true blunt traumatic aneurysms. The false aneurysms were caused by gun shot (one case, common carotid artery); complication of carotid endarterectomy (2 cases); iatrogenic (one case, common femoral artery). The atherosclerotic aneurysms (9 cases) were located in the subclavian artery (one case); superficial femoral artery (2 cases in a single patient); and popliteal artery (5 cases). The mycotic aneurysms (two in one patient) were located in the profunda femoris artery and in the anterior tibial artery. The two traumatic true aneurysms were located in the distal radial artery and in one interdigital artery, respectively. From the 17 peripheral aneurysms, 15 were submitted to surgical treatment, with fairly good results, except for one case of infection and another case of fatal renal insufficiency. Follow-up time ranged from 1 to 18 years.     

Update on Aneurysm Disease: Current Insights and Controversies : Peripheral Aneurysms: When to Intervene – Is Rupture Really a Danger?

Peripheral artery aneurysms are rarer than abdominal aortic aneurysms (AAA), although the true prevalence is not well known. They often coexist with aortic and other peripheral artery aneurysms. In contrast to AAA, where the principal risk is that of rupture, thromboembolism is more common, contributing a bigger risk in the more common lesions. Although rupture does occur, with incidence related to anatomical site, aneurysm diameter cannot be used to guide management with the same confidence as in AAA. In addition, the rarity of these lesions results in a paucity of evidence with which to guide intervention. Consequently they are difficult lesions to manage, and numerous aneurysm and patient factors must be considered to provide treatment individualised for each case. We discuss popliteal, femoral, carotid, subclavian, upper limb, visceral and false aneurysms, focussing on the risk of rupture and thromboembolism, and current thresholds for intervention, based on the available published literature.     

An unexpected pulmonary arterial aneurysm in a COPD patient

We present a case of an idiopathic pulmonary artery aneurysm in an asymptomatic patient who was treated for an irrelevant medical condition. Pulmonary artery aneurysms (PAA) are quite rare and can either be congenital or acquired. Congenital aneurysms are usually associated with cardiac malformations leading to pulmonary hypertension. Acquired aneurysms can be idiopathic or associated with infections (tuberculosis, syphilis), trauma, pulmonary valvular stenosis, or collagen diseases. Pulmonary artery aneurysms are not common and an idiopathic pulmonary artery aneurysm is a rare finding that could be diagnosed incidentally.     

吲哚菁绿血管造影在颅内动脉瘤手术中的初步应用

目的探讨吲哚菁绿（indocyanine green，ICG）脑血管造影在颅内动脉瘤手术中的作用。方法选择20例术中行ICG造影的颅内动脉瘤患者，其中16例手术直接夹闭动脉瘤，1例手术切除动脉瘤，3例行动脉瘤切除或孤立＋血管重建术。术中造影时，将即时稀释的对比剂（25mg的ICG加入到2ml注射用水中）一次性快速注入肘静脉，荧光手术显微镜下观察造影血管。术后行DSA造影。评价术中ICG造影在颅内动脉瘤手术中的作用。结果16例行动脉瘤夹闭手术患者中，1例小脑下后动脉动脉瘤患者，夹闭后ICG造影发现动脉瘤残余，经调整动脉瘤夹后再次ICG造影，证实动脉瘤夹闭完全；1例颈内动脉动脉瘤夹闭后术中造影发现颈内动脉狭窄，调整动脉瘤夹后再次造影证实无狭窄。1例大脑后动脉瘤患者，术中ICG造影发现动脉瘤内完全血栓形成，载瘤动脉近端闭塞，远端通过血管吻合支供血，遂术中决定行动脉瘤切除术。3例动脉瘤切除或孤立＋血管重建手术患者中，2例术中ICG造影证实吻合口通畅，远端血供良好；1例术中造影发现吻合口功能不良，但同侧额叶脑组织供血良好，故未进一步调整吻合口，术后患者无明显神经功能缺损症状，DSA证实同侧大脑中动脉侧支供血。16例术后行DSA检查者，均证实术中ICG造影结果。结论ICG血管造影是颅内动脉瘤术中监测动脉瘤是否残留、载瘤动脉是否狭窄及吻合血管是否通畅的重要的手段。     

Surgical treatment of vasculo-Behçet's disease. A review of patients with concomitant multiple aneurysms and venous lesions

BACKGROUND: Vascular complications can be seen in patients with Beh?et's disease. Arterial and venous complications may be found separately or concomitantly in patients. PATIENTS AND METHODS: Out of 29 patients with vasculo-Beh?et's disease 7 patients with multiple aneurysms and venous lesions were documented over a period of 20 years. All patients were male, ranging in age from 24 to 52 years. The mean duration of the disease was 6 +/- 2 years. The aneurysms were found in the following locations: one pulmonary artery, two abdominal aorta, four iliac, five femoral, and two popliteal artery. Both aneurysmal and occlusive lesions were present in three patients. In the venous lesions associated with the aneurysms there were three deep and three superficial venous thrombosis. Two patients had caval involvement-superior and inferior vena caval syndromes. RESULTS: We performed seven interposition grafting by polytetrafloroethylene, one Y-grafting, one aneurysmorrhaphy, one lobectomy. Re-anastomosis was performed in two patients who had anastomotic aneurysms and graft occlusion without disabling ischemia. Venous pathologies were treated by medical therapy. The patients were followed up between 1 to 8 years. One of the patients with iliac artery aneurysm died due to gastrointestinal bleeding 15 months after the operation. CONCLUSIONS: In conclusion, when an aneurysm has been found in a patient with Beh?et's disease, the patient should be scanned for possible multiple aneurysms and venous lesions since they might be found together. Surgical treatment, when feasible, should be performed in cases with Beh?et aneurysms because of a high risk of rupture. However, the possibility of an anastomotic aneurysm developing after surgery should also be kept in mind.     

Mechanical intervention and coronary artery aneurysm

Coronary artery aneurysms after intervention are rare, and most are pseudoaneurysms rather than true aneurysms. Stent infection has been associated with mycotic aneurysm formation, as is the use of drug-eluting stents (DES). The antiproliferative and immunomodulatory properties of DES may reduce the local host defense mechanism and thus increase the chance of infection and contribute to aneurysm formation. Mechanical factors during implantation also play an important role in aneurysm formation. We report 3 cases of complications of mechanical interventions in coronary arteries.     

Endovascular treatment of gastroduodenal artery aneurysm

Gastroduodenal artery aneurysms are rare. Common causes include blunt trauma, pancreatitis, infection, autoimmune disorders, vascular intervention and surgery. We report 2 patients with gastroduodenal artery aneurysms, the first being an idiopathic true aneurysm and the next, a pseudoaneurysm resulting from pancreatitis. Diagnoses were made by computed tomography scans with successful embolization of both patients. Treatment of gastroduodenal artery aneurysms includes surgery, endovascular techniques or observation. Embolization is a feasible option for gastroduodenal artery aneurysms and pseudoaneurysms.     

Nonatherosclerotic aneurysm of the left circumflex coronary artery presenting with accelerated angina pectoris: response to medical management--a case report

Coronary artery aneurysm is defined as coronary dilatation with a diameter of more than 1.5 times the adjacent normal coronary artery. Most of the coronary aneurysms remain asymptomatic. More than 90% of coronary aneurysms are of atherosclerotic origin. Nonatherosclerotic coronary aneurysms are rare, and the majority of them are diffuse. Among the three major coronary arteries, the left circumflex artery is the least commonly involved. The management strategies for nonatherosclerotic coronary aneurysms are not clear, and each case should be managed on an individual basis depending on the clinical context. Here described is a case of a discrete nonatherosclerotic aneurysm of the left circumflex coronary artery in a 46-year-old man who presented with accelerated angina pectoris and was treated medically. The patient was free of symptoms on 2-year follow-up. The clinical perspectives of the nonatherosclerotic coronary aneurysm are discussed.     

Bilateral True Isolated Superficial Femoral Artery Aneurysm: Report of a Case and Literature Review

We report a case of an 85-year-old man with true isolated bilateral superficial femoral artery aneurysms. The aneurysm size was 6.2 cm on the right and 4.8 cm on the left. They were repaired with transfemoral endovascular placement of three excluder stent grafts on the right and two excluder stent grafts on the left. Both procedures were done under local anesthesia.     

Case report of a rare spontaneous superficial temporal artery aneurysm

Unlike posttraumatic temporal artery aneurysm, spontaneous temporal artery aneurysm is an exceptional finding. We report the case of a 34-year-old woman with no history of previous trauma who presented a progressively enlarging right temporal lump. A CT scan revealed a 1.6 cm diameter aneurysm arising from the superficial temporal artery. The aneurysm was surgically resected. The postoperative course was uneventful. Histological examination revealed the presence of intima, media and adventitia.     

Saccular coronary aneurysms: angiographic and clinical profile and follow-up of 22 cases

Saccular coronary aneurysms are defined as aneurysms with the transverse dimension at least 1.5 times the longitudinal dimension. Out of 3,200 coronary angiograms reviewed, there were 22 patients (20 males) with saccular coronary aneurysms (totalling 25 aneurysms). The morphology of the aneurysms, the extent and severity of associated coronary lesions, the clinical profile and follow-up data of these patients were analysed. Aneurysms were located in left main coronary artery 3 (12%), left anterior descending coronary artery 13 (52%), right coronary artery 5 (20%) and left circumflex 4 (16%). There were 5 large aneurysms (> 15 mm in diameter) (1 in left main coronary artery, 2 each in right coronary artery and left anterior descending coronary artery) averaging 32 mm in size. Fifteen aneurysms had significant coronary artery stenosis located proximal to it, supporting the theory of post-stenotic dilatation as the aetiology of aneurysm formation. Two patients had associated muscle bridges distal to the aneurysm; 20 had atherosclerotic coronary artery disease and one had coronary artery ectasia. Five patients were lost to follow-up, which ranged from 1 year to 19 years (mean 5.3 +/- 4.1 years). No patient had history suggestive of rupture of the aneurysm on follow-up. Two patients had myocardial infarction in the territory of the vessel with the aneurysm. Rest of the patients were in NYHA class I/II. One large right coronary artery aneurysm was subjected to aneurysmectomy due to symptoms of tricuspid valve obstruction. One left main coronary artery aneurysm measuring 12 mm, on follow-up of 19 years increased in size to 45 mm, in addition the patient developed a right coronary artery aneurysm. Coronary risk factor profiles in the 20 patients with atherosclerotic coronary artery disease and aneurysms were similar to age- and sex-matched control population with atherosclerotic coronary artery disease without aneurysms.     

Multiple Giant Coronary Artery Aneurysms

Coronary artery aneurysms are rare, and giant coronary artery aneurysms are even rarer. We describe a patient who had giant coronary aneurysms of the right, left circumflex, and left anterior descending coronary arteries. The aneurysms were successfully treated with surgical intervention. To the best of our knowledge, ours is the 1st report of giant aneurysms involving all 3 major coronary arteries.Key words: Atherosclerosis, coronary aneurysm/diagnosis/surgery, coronary vessels/surgery, matrix metalloproteinases, polyarteritis nodosa, Takayasu diseaseCoronary artery aneurysm is defined as any coronary artery dilation exceeding the diameter of normal adjacent segments or the diameter of the largest coronary artery by 1.5 times.¹ Giant coronary aneurysm refers to an aneurysm with a diameter larger than 20 mm.² Coronary aneurysms are uncommon entities seen in a small percentage of coronary angiograms. Giant coronary artery aneurysms are even less common. Herein, we describe the surgical management of a 61-year-old patient who had multiple giant coronary aneurysms.     

Hepatic artery aneurysm in a patient with hepatitis C liver cirrhosis: report of a case

Visceral artery aneurysms are rare, with an incidence rate of only 0.01–0.2 % in routine autopsies, and hepatic artery aneurysms account for approximately 20 % of these aneurysms. Despite recent advances in therapeutic techniques and diagnostic tools, the management of visceral artery aneurysms remains clinically challenging. We report a case of hepatic artery aneurysm with liver cirrhosis due to hepatitis C in an 81-year-old woman. A computed tomography scan demonstrated a hepatic artery aneurysm 4.4 cm in diameter. She underwent successful aneurysmectomy with vascular anastomosis. A computed tomography scan on postoperative day 7 demonstrated patent hepatic artery. The patient was followed-up for 1 year after surgery and died owing to progressive liver failure. However, she did not show any hepatic artery problem such as hepatic arterial thrombosis or occlusion. We discuss the risk factors of atherosclerosis in patients with liver cirrhosis, and present an overview of the treatment of hepatic artery aneurysms.     

False aneurysm formation during the chronic phase of myocardial infarction at the margin of a previously-detected true aneurysm]

The patient was a 59-year-old man who had acute extensive anterior myocardial infarction in October, 1989. One month later, he was transferred to Kyoto University Hospital and underwent cardiac catheterization. Left ventricular aneurysm and significant stenosis in the proximal portion of the left anterior descending artery were documented. Because he experienced chest pain on slight exertion accompanied by a slight increase in the depth of the negative T wave on electrocardiogram, percutaneous transluminal coronary angioplasty (PTCA) was performed. Thereafter, chest pain disappeared, and the patient was discharged. Three months later, he was re-admitted to Kyoto University Hospital for a repeat cardiac catheterization after PTCA. PTCA site was found to be restenosed, and a small diverticulous aneurysm was found at the margin of the previously-detected ventricular aneurysm. As the diverticulous aneurysm was considered likely to precipitate the ventricular aneurysm into rupture, expeditious left ventricular aneurysmectomy was performed to prevent cardiac rupture. Ventricular aneurysms, common complications in myocardial infarction, are of two types, either true or false. Most aneurysms develop during the acute phase of myocardial infarction, and rupture of true aneurysms during the chronic phase of myocardial infarction rarely occurs. However, in the present case, a small diverticulous aneurysm, which was not demonstrated at the initial cardiac catheterization, developed during the chronic phase of myocardial infarction. Pathological examination revealed that the diverticulous aneurysm was a false aneurysm due to incomplete rupture. When the common pathogenesis of ventricular aneurysms in myocardial infarction is considered, the present report might represent an extraordinary rare case.(ABSTRACT TRUNCATED AT 250 WORDS)     

Giant coronary artery aneurysms involving all three coronary arteries

Coronary artery aneurysm is defined as any coronary artery dilation exceeding the diameter of normal adjacent segments or the diameter of the largest coronary artery by 1.5 times. Giant coronary aneurysm refers to an aneurysm with a diameter larger than 20 mm. Giant coronary artery aneurysms have an incidence of 0.02%–2%. Here we describe a patient who had giant coronary aneurysms involving all three coronary arteries. He was managed conservatively with no cardiac events on a follow up of 1 year.