Delayed hemorrhage from a pseudoaneurysm after blunt renal trauma

Renal artery pseudoaneurysm is uncommon complication after blunt trauma injury. We report here on a case of delayed bleeding from a renal artery pseudoaneurysm at 21 days after the injury. It was successfully treated by angioembolization despite the fact that the patient was hemodynamically unstable.     

Life-threatening gastrointestinal bleeding after liver transplatation due to hepatic artery pseudoaneurysm perforating into the common bile duct. A case report

A 54-year-old male presented with acute rejection and life-threatening gastrointestinal bleeding 2 months following orthotopic liver transplantation. Since no bleeding was identified in the entire gastrointestinal (GI) tract, hematobilia was first suspected and an arteriocholedochal fistula angiographically confirmed. Two days after resection of a pseudoaneurysm of the hepatic artery (HA) with primary repair and closure of the bile duct fistula, hepatic artery thrombosis (HAT) occurred. Various attempts to revascularize the HA eventually failed. Two weeks later, a CT scan showed necrotic areas within the two left lateral segments. At relaparotomy, major parts of the bile duct were found to be necrotic, and the biliary anastomosis was therefore abandoned and necrotic tissue removed. HAT was otherwise well tolerated by the graft and, at a further relaparotomy some weeks later, a hepaticojejunostomy was performed. Two years after transplantation the patient is well with a normally functioning graft.     

Anastomotic pseudoaneurysm occurred at long time after surgery for atherosclerotic thoracic aortic aneurysm

We encountered two cases of ruptured anastomotic pseudoaneurysms 47 and 77 months after surgery for atherosclerotic thoracic aortic aneurysms. Autopsy was performed in one case and emergency re-operation was performed in the other case. We gained some interesting findings in the autopsy and the re-operation. The anastomotic sites were sustained by sutures only, and there was no evidence of tissue supplementation at the anastomotic sites in macroscopic observation. Microscopic findings demonstrated endothelium healing on the internal side of the prosthesis near the anastomotic site. There was no tissue connection between the prostheses and the native aortic walls, although over four or six years had passed after the previous anastomoses. Anastomotic pseudoaneurysms may occur even in a long time after surgery. Careful operative procedures and long-term computed tomography or magnetic resonance imaging follow-up are crucial.     

Subepicardial aneurysm following ventriculotomy closure of ventricular septal rupture due to ccute myocardial infarction

We report an unusual case of subepicardial aneurysm (SEA) of the left ventricle. An 82-year-old man had undergone patch closure of a ventricular septal rupture due to anterior acute myocardial infarction. A postoperative left ventriculogram showed the presence of contrast medium outside the left ventricle, and urgent surgery was performed. The lesion was diagnosed as SEA, and was repaired before rupture.     

Intravascular ultrasound imaging for detection of oseudoaneurysm with aortobronchopulmonary fistula after graft replacement of descending aorta

A 63-year-old man had undergone graft replacement of the descending aorta due to dissection of aortic aneurysm nine years before and closure of an aortobronchopulmonary fistula two years before. He was admitted to our hospital because of massive hemoptysis. Angiography and chest computed tomography (CT) revealed a pseudoaneurysm on the proximal end caused by graft detachment. Intravascular ultrasound clearly revealed half round detachment on both ends of the graft. Replacement of the ascending, arch and distal aorta including the graft was performed, and the patient’s postoperative course has been satisfactory. We have concluded that intravascular ultrasound is a useful method for detecting pseudoaneurysm after graft replacement which is not evident on cineangiography, CT or distal subtraction angiography.     

Lumbar artery pseudoaneurysm: An unusual cause of a retroperitoneal hematoma: Report of a case

Pseudoaneurysm of the lumbar artery is a rare complication of penetrating trauma. We present herein a case thought to have been caused by a blow to the left flank without any evidence of a stab wound. In this patient, the diagnosis of a first lumbar artery pseudoaneurysm with a retroperitoneal hematoma was confirmed by computed tomography (CT) findings, after which transcatheter embolization was successfully performed.     

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.     

Hepatic artery reconstruction and successful management of its complications in living donor liver transplantation using a right lobe

Kim S‐J, Yoon Y‐C, Park J‐H, Oh D‐Y, Yoo Y‐K, Kim D‐G. Hepatic artery reconstruction and successful management of its complications in living donor liver transplantation using a right lobe.
Clin Transplant 2011: 25: 929–938. © 2010 John Wiley & Sons A/S. Abstract: Background: The aim of the present study was to improve the techniques of hepatic artery (HA) reconstruction and to properly manage arterial complications after living donor liver transplantation (LDLT). Methods: Prospectively collected data collected from 371 patients who underwent adult LDLT using a right lobe from January 2000 to August 2009 were retrospectively reviewed. Results: Of 17 patients (4.6%, 17/371) with double HA stumps in the graft, 12 patients (70.6%) received dual HA reconstruction. HA complications were composed of thrombosis (n = 6), pseudoaneurysm (n = 2), and stenosis (n = 4), showing 3.2% (12/371) of incidence. In patients with HA thrombosis, whereas operative thrombectomies with re‐anastomosis rescued all the grafts in early attack (n = 3, ≤1 wk), angiographic thrombolysis successfully reestablished the flow in patients with late attack (n = 3, >1 wk). In all patients with HA complications, except for one, all of our treatment modalities – operation and angiographic intervention – resulted in successful rescue of grafts and no patient received re‐transplantation because of HA complications. Conclusion: Prompt diagnosis of HA complications by serial post‐operative Doppler ultrasound and corresponding treatment strategies, including operative and radiological intervention, can rescue both grafts and patients without necessitating re‐transplantation.