Case Reports in Vascular Medicine最新文献

Visceral artery aneurysms and pseudoaneurysms are defined as aneurysms of the splenic, superior mesenteric, or inferior mesenteric arteries and their respective branches. Mycotic aneurysms, defined as aneurysms of the arterial wall caused by bacterial or fungal embolization, are a rapidly progressive and often fatal form of arterial aneurysms that can form in the visceral arteries. Aneurysms and pseudoaneurysms of the visceral arteries most commonly present as abdominal pain. The ambiguity with which they often present, paired with their high risk of rupture and hemorrhage, creates a highly precarious situation for clinicians. Failure to identify an aneurysm or pseudoaneurysm of the visceral arteries in time can be a fatal mistake. We present a case of mycotic pseudoaneurysms of the superior mesenteric artery and splenic artery secondary to infective endocarditis managed with open surgical resection, coil embolization, and splenectomy in a 36-year-old male with a history of intravenous drug use. The patient presented with a chief complaint of abdominal pain and confusion. He was admitted for sepsis and work-up of suspected bacteremia and endocarditis. MRI revealed multiple cortical infarcts suggestive of an embolic shower, and transesophageal echocardiogram showed mitral valve vegetations. CT imaging showed an aneurysm of the superior mesenteric artery, later determined to be a pseudoaneurysm. The patient underwent emergent open superior mesenteric artery pseudoaneurysm resection as well as splenectomy due to intraparenchymal pseudoaneurysms and associated necrosis and intraparenchymal hemorrhage. Our case highlights the importance of considering visceral artery aneurysms when formulating a list of differential diagnoses for patients presenting with abdominal pain due to their vague presenting symptoms in conjunction with their potential to rapidly progress to aneurysmal rupture and catastrophic hemorrhage.

Popliteal artery aneurysms (PAAs) are largely attributed to arteriosclerotic disease processes, with a rare aetiology of infective and traumatic origin. This disease may be complicated by acute limb ischaemia, which could result in limb loss. Therefore, early management of symptomatic aneurysms, or asymptomatic aneurysms > 2 cm, is suggested. We present a unique case of PAA secondary to a fractured femoropopliteal stent and discuss ongoing challenges toward the management of femoropopliteal disease, along with treatments for PAA.

[This corrects the article DOI: 10.1155/2023/7081000.].

Intracranial arteriovenous malformations (AVMs) are vascular anomalies that can present with intracranial hemorrhage, seizures, or neurological deficits. In this case, we present a woman with a giant right frontoparietal AVM (Spetzler-Martin Grade V) initially diagnosed after an intracerebral hemorrhage at Age 6. Surgical, endovascular, and radiosurgical treatments were not viable due to the lesion's size and eloquent location. Over time, the patient developed focal seizures, including catamenial patterns and left-arm spastic monoparesis. Initial antiseizure medications (ASMs) such as carbamazepine and phenytoin failed to provide adequate control at optimal dosage, with phenytoin exacerbating seizure frequency. Partial seizure control was eventually achieved with a combination of levetiracetam and carbamazepine. Neuroimaging showcases a large AVM, while EEG revealed focal epileptiform activity. This case illustrates the complexity of treating epilepsy secondary to giant AVMs, emphasizing the need for individualized ASM strategies and collaborative, multidisciplinary management.

Background: Partial anomalous pulmonary venous connections are embryologic defects in which the normal connection between the pulmonary veins and left atrium is disrupted. These rare anomalies are often asymptomatic and identified incidentally. The most common variant is a connection between the left upper pulmonary veins and the left innominate vein. Although typically asymptomatic, these variants are important to be aware of, particularly when performing procedures involving the venous anatomy. Case Presentation: We present the case of a 52-year-old female with a previous history of colon cancer who underwent right hemicolectomy and presented to the hospital due to severe dehydration secondary to profuse nausea, vomiting, and diarrhea. She developed an acute kidney injury with electrolyte derangement and metabolic acidosis requiring initiation of hemodialysis. Due to her preexisting right internal jugular port access, the decision was made to proceed with left internal jugular dialysis catheter access. Central venous access was performed in standard fashion. There was venous-appearing blood return at the time of needle access and subsequent dilations. However, at the time of catheter advancement, there was noted return of bright red blood and resistance to advancement, concerning for possible arterial cannulation. Concerning arterial placement, an arterial blood gas (ABG) test and chest x-ray were performed; however, the transducer waveforms were not consistent with this. Computed tomography angiography obtained revealed left internal jugular venous access with catheter extension into an anomalous pulmonary vein within the left upper lobe. The patient was taken to the angiography suite and under fluoroscopy guidance had new left internal jugular catheter access with the catheter terminating successfully in the superior vena cava. She underwent successful dialysis and was subsequently discharged on postprocedure Day 8. Conclusions: Central line placement is a commonly performed procedure in hospitals. There are steps that have been developed to limit complications for this procedure, including ultrasound guidance, visualization of venous blood, and confirmatory imaging prior to use. This is a case in which arterial-appearing blood, paO2, and chest x-ray were concerning for incorrect placement, but additional imaging revealed accurate access with anomalous anatomy. Overall, the case of central line placement in anomalous pulmonary venous connections is rare but needs consideration when the clinical scenario is appropriate.

A 78-year-old man was diagnosed with an abdominal aortic aneurysm with a meandering mesenteric artery. We performed abdominal aortic replacement and inferior mesenteric artery reconstruction using intraoperative inferior mesenteric artery perfusion during surgery. A 4-Fr arterial sheath was inserted into the left brachial artery, and a 10-Fr balloon catheter was inserted into the inferior mesenteric artery for perfusion. The intraoperative intestinal blood flow was satisfactory, and the patient's postoperative course was favorable. This method was an easy and effective option for abdominal aortic surgery in patients with a meandering mesenteric artery.

An infection and aortic arch pseudoaneurysm can be fatal if not emergently and adequately treated. Optimal surgical procedures and optimal graft materials remain controversial. We describe a 61-year-old patient who underwent in situ repair of the infected pseudoaneurysm of the aortic arch. A porcine pericardium patch (BioIntegral Surgical Inc., Mississauga, ON, Canada) was used to reconstruct the aortic wall, followed by the reconstruction of the brachiocephalic trunk using a surgeon-made tube. The patient made a full recovery. Self-made tube grafts for in situ reconstruction offer many advantages and may be a valuable option.

Objective: With the increasing prevalence of mechanical thrombectomy (MT) for large vessel occlusion strokes, encountering unruptured cerebral aneurysms (uANs) in MT target vessels has become more common, necessitating case accumulation to establish safety guidelines for MT in such cases. In this study, we aimed to review and present cases of uAN associated with MT target vessels at our hospital. Methods: Among 320 patients who underwent MT for large vessel occlusion strokes at our hospital between January 2018 and December 2021, we selected patients with uAN in the MT target vessel and analyzed various parameters including the occluded vessel, uAN location, timing of uAN discovery, thrombus retrieval procedures, materials, recanalization outcomes, and uAN rupture incidence. Results: Of the 320 patients, 7 had aneurysms in the target vessel (2.2%). The uANs were identified before the device crossed the occluded lesion (lesion crossing (LC)) in four cases, while in three cases, identification occurred after LC or recanalization. In 1 of the 3 cases, a uAN was suspected on preoperative computed tomography at the retrospective review. The thrombectomy procedures included a direct aspiration first pass technique (ADAPT) alone in one patient, stent retrieval (SR) alone in two patients, combination therapy in three patients, and SR combined with local infusion of urokinase in one patient. The effective recanalization rate, defined as TICI 2b or 3, was 57.1% (4/7). The average puncture-to-recanalization time was 77.4 min, and there were no instances of uAN rupture associated with MT. Conclusions: We presented seven cases of uAN in the MT target vessel. No uAN rupture was associated with MT, although the same strategies and techniques of routine MT at our hospital were employed, prioritizing recanalization. Preoperative image assessment considering the possibility of a uAN being present in the MT target vessel is more essential, as well as careful selection of MT procedures according to the situation of each patient.

Acute limb ischemia (ALI) in neonates is a rare but critical condition often resulting from iatrogenic causes, such as arterial catheterization. This case highlights the unique challenges in diagnosing and managing ALI in this population, where evidence-based guidelines are scarce and treatment decisions rely heavily on expert consensus and extrapolation from adult data. We report the case of a premature neonate, born at 30 weeks' gestation, who developed ALI secondary to femoral artery thrombosis following arterial line insertion. The patient presented with bluish discoloration, diminished capillary refill, and absent distal pulses in the affected limb. Duplex ultrasonography confirmed occlusion of the right common femoral artery. Conservative management with anticoagulation and close observation was adopted by multidisciplinary consensus involving neonatology and vascular surgery. Despite signs of worsening ischemia and skin necrosis during therapeutic anticoagulation, the team opted to continue conservative management due to the high surgical risk posed by the patient's prematurity and multiple comorbidities. Over the next week, gradual clinical and imaging improvements were noted, including recanalization of the occluded artery and restoration of arterial flow, ultimately leading to successful limb salvage. This case underscores the importance of individualized, multidisciplinary decision-making in managing neonatal ALI. Conservative management with therapeutic anticoagulation can achieve favorable outcomes, even in cases with worsening ischemia, provided that close monitoring and optimal supportive care are ensured. It also highlights the need for further research to develop standardized pediatric guidelines for this rare but potentially devastating condition.

Introduction: Postthrombotic syndrome (PTS) describes a condition arising after an acute deep venous thrombosis (DVT) that is characterised by leg heaviness, discomfort, and recurrent venous ulceration. Venous disease is associated with significant morbidity and impairment of mobility due to pain, infection, and oedema. Report: We present a patient in his 40s attending with left lower limb ulceration, swelling, and refractory pain despite previous best medical management and superficial radiofrequency ablation. A venous duplex ultrasound revealed a trifid femoral vein with a competent and incompetent component. Venography showed patent deep veins but failed to offer the same level of detail as duplex. The patient underwent a femoral vein ligation after multidisciplinary discussion. The role of intraoperative duplex ultrasound was essential. The patient clinically improved and is now free of his venous ulcerations. Conclusion: Duplex provided vital information for surgical planning, which venogram was unable to offer. This is an imaging pitfall that is important to be aware of in patients presenting with recurrent venous disease. Our case highlights the importance of thorough clinical assessment and the value of the Doppler ultrasonography assessment in confirming venous incompetence.