Pseudoaneurysm of the abdominal aorta due to a needle-like osteophyte on the first lumbar vertebra

A 46-year-old woman was admitted with acute abdominal pain radiating to the back. Computed tomography examinations showed a needle-thin perforation of the aorta, opposite the origin of the superior mesenteric artery, with a pseudoaneurysm. A needle-sharp spinal osteophyte was located exactly opposite the perforation. There was no sign of infection, and the perforation seemed to have been caused by the osteophyte. This aortic perforation occurred without any major trauma, but repeated minor occupational trauma to her abdomen may have played an etiologic role. The pseudoaneurysm and adjacent aorta were exposed through a thoracolaparotomy. The aortic wall was normal, with good tensile strength; therefore, the perforation in the aortic wall was sutured with a double vascular suture, and the osteophyte was resected. To our knowledge, aortic perforation due to a vertebral osteophyte in the absence of major trauma has not previously been described.     

Surgical treatment of aneurysmal subarachnoid haemorrhage in the presence of 24-h endovascular availability: management and results

Endovascular treatment of ruptured intracranial aneurysms increasingly supersedes surgical repair. This study focuses on the management and results in 109 individuals treated surgically when both treatment modalities were available. The management principles were immediate identification of the origin of haemorrhage, early aneurysm repair, minimal brain retraction during surgery and rigorous prevention of secondary brain damage. Predominantly, aneurysms located on the middle cerebral artery and those of the posterior communicating artery were allocated to surgery. Despite of ultra-swift care, aneurysm rebleeds remained a challenge. Although one-third of the patients presented in a poor clinical grade, outcome was good with 87 (80%) of the individuals being independent, 16 (15%) being dependent and six patients (6%) dying. Results of surgical aneurysm repair are good presupposed the untiring ongoing efforts of an inter-disciplinary team of dedicated physicians and nurses.