I saw the sign: He felt a pang and we saw the Yin-Yang (sign).

The yin-yang sign, also known as the Pepsi sign, is used to describe the classic appearance of bidirectional blood flow within an aneurysm or pseudoaneurysm sac on color Doppler ultrasound. The corresponding spectral Doppler finding is a "to-and-fro" waveform, caused by inflow to the aneurysm/pseudoaneurysm sac during systole and outflow during diastole. It is important to recognize this sign in order to quickly identify the presence of an aneurysm or pseudoaneurysm and prevent complications such as expansion and rupture.

Reduced Levels of Selenium and Thioredoxin Reductase in the Thoracic Aorta Could Contribute to Aneurysm Formation in Patients with Marfan Syndrome.

Marfan syndrome (MFS) is an autosomal dominant disorder caused by a heterozygous mutation of the FBN1 gene. MFS patients present oxidative stress that disturbs redox homeostasis. Redox homeostasis depends in part on the enzymatic antioxidant system, which includes thioredoxin reductase (TrxR) and glutathione peroxidases (GPx), both of which require an adequate concentration of selenium (Se). Therefore, the aim of this study was to determine if Se levels are decreased in the TAA of patients with MFS since this could contribute to the formation of an aneurysm in these patients. The results show that interleukins IL-1ß, IL-6 TGF-ß1, and TNF-α (p ≤ 0.03), and carbonylation (p ≤ 0.03) were increased in the TAA of patients with MFS in comparison with control subjects, while Se, thiols (p = 0.02), TrxR, and GPx (p ≤ 0.001) were decreased. TLR4 and NOX1 (p ≤ 0.03), MMP9 and MMP2 (p = 0.04) and NOS2 (p < 0.001) were also increased. Therefore, Se concentrations are decreased in the TAA of MFS, which can contribute to a decrease in the activities of TrxR and GPx, and thiol groups. A decrease in the activities of these enzymes can lead to the loss of redox homeostasis, which can, in turn, lead to an increase in the pro-inflammatory interleukins associated with the overexpression of MMP9 and MMP2.

Multiple Enlarged Aneurysms in Primary Racemose Hemangioma of the Bronchial Artery: Successful Prophylactic Transcatheter Arterial Embolization Using N-butyl-2-cyanoacrylate and Coils.

An asymptomatic 48-year-old man presented with multiple aneurysms in a primary racemose hemangioma of the right bronchial artery. Bronchial arteriography revealed a tortuous artery with four fusiform aneurysms of varying sizes and aneurysmal dilatation with marked thrombus formation in the long segment of the distal portion. Because the tip of catheter could not pass beyond the aneurysmal dilatation, we performed balloon-occluded embolization using a mixture of N-butyl-2-cyanoacrylate (NBCA) and iodized oil. For four other aneurysms, we performed embolization using a coil alone or with NBCA. After 6 months, right bronchial arteriography revealed no enhancement of the aneurysms. Despite the rarity of this procedure, embolization with NBCA is a good option for bronchial artery aneurysm embolization.

Aneurisma del seno portal: diagnóstico prenatal / Portal sinus aneurysm: prenatal diagnosis

Se presentan dos casos de aneurisma del seno portal diagnosticados en la semana 36 y 20 de gestación, que se confirmaron en el periodo posnatal. La complicación más frecuente y grave de los aneurismas fetales es la trombosis, hecho que se asocia a alto riesgo fetal. El diagnóstico y la vigilancia se realizan por ecografía; sin embargo, no existen pautas determinadas para su tratamiento y solo la administración de corticoides puede mejorar su pronóstico si se considera necesario terminar la gestación antes de la semana 35 (AU)

Two cases of portal sinus aneurysm are reported. The aneurysms were diagnosed in the 36th and 20th week of the pregnancy and were confirmed in the postnatal period. The most important and frequent complication in aneurysmal formations in the fetus is thrombosis, which is associated with high fetal risk. Diagnosis and monitoring are performed with ultrasonography. There are no specific guidelines for treatment and the prognosis can be improved only by corticosteroid administration. If necessary, the pregnancy can be terminated before the 35th week (AU)

[Emergencies in vascular surgery--a major challenge for the local infrastructure]. / Gefäßchirurgische Notfälle--eine große Herausforderung an die lokale Infrastruktur.

INTRODUCTION: Emergencies in vascular surgery are often life-threatening and require a timely and prompt treatment. Little information is available in the literature about which demands must be made for this on the personnel and infrastructural resources of a hospital. METHODS: All vascular surgical emergency operations of the Surgical University Hospital of Munich - Grosshadern over a period of 2 years were evaluated concerning the emergency category, the leading clinical symptomatology, the genesis, the affected stream area, the intervention time, as well as the need for postoperative intensive medical care. RESULTS: The prevailing procedures were arterial operations (76 %). Ischaemia with 37 % and bleeding with 29 % were the leading clinical symptomatology. Thrombotic events (34 %) showed the most frequent genesis followed by embolism (13 %), stenosis (11 %), aneurysms (10 %) and iatrogenic impairments (10 %). 68 % of the emergencies were treated outside of the daytime working hours. A total of 77 % of the patients needed intensive care treatment or observation after surgery. CONCLUSION: The spectrum and the frequency of emergencies in vascular surgery make high demands on local infrastructure of the hospital and require a fair number of intensive care beds and an adequate and highly trained staff. Only under these conditions can a high quality of treatment be guaranteed for the sometimes life-threatened patients.

Polyarteritis nodosa with multiple aneurysms and renal arteriovenous fistula successfully diagnosed by colour Doppler sonography.

Polyarteritis nodosa (PAN) is a vasculitis that typically affects small- and middle-sized arteries of multiple organs. The kidney is most commonly involved. To date, few cases of PAN involving the celiac artery and no cases of iliac artery or internal carotid artery involvement have been published. The most frequent lesions reported were due to occlusions and aneurysms. Finally, no cases of PAN causing arteriovenous fistula have been reported. Here we present a case of PAN with multiple aneurysms and renal arteriovenous fistula that was successfully diagnosed and followed-up by ultrasound. This case report describes the challenges in diagnosing PAN and highlights the importance of a holistic approach when encountering patients with multiple vascular diseases. Ultrasound should be considered the first-line approach in the diagnosis of PAN.

External jugular vein aneurysm: a source of thrombotic complications.

Superficial venous aneurysms are rare and usually are uneventful. We present a case in which a 40-year old female presenting with a thrombosed external jugular vein aneurysm which previously caused an undetected pulmonary embolism. The aneurysm was excised and the external jugular vein was ligated under local anesthesia and anticoagulation was initiated. In conclusion aneurysms of the superficial venous system should be considered as a possible source of pulmonary emboli. These sites can safely be excised and ligated under local anesthesia offering long term protection from its possible complications.

Popliteal aneurysm as a cause of leg pain in a geriatric patient.

OBJECTIVE: To discuss the management of a patient with unilateral lower extremity pain as a consequence of a popliteal aneurysm. CLINICAL FEATURES: An 85-year-old male had difficulty in ambulating due to low back and lower extremity pain. Standard tests demonstrated and reproduced pain at the lower back while inspection, palpation, and auscultation revealed a pulsatile mass in the popliteal fossa of the right knee. INTERVENTION AND OUTCOME: Specific joint manipulation for relief of low back pain was performed. Comanagement of the patient with a vascular surgeon and subsequent surgical intervention resulted in relief of lower extremity pain. CONCLUSION: Resolution of pain and guarded gait was accomplished by a multidisciplinary approach combining conservative care and invasive techniques.

Extracranial internal carotid artery aneurysm presenting as symptomatic hypoglossal and glossopharyngeal nerve paralysis.

Aneurysms of the extracranial portion of the internal carotid artery are rare, particularly in young patients. They usually develop following trauma, or secondary to infection involving the parapharyngeal space that extends to the vessel wall. This is a case of an internal carotid artery aneurysm presenting acutely following chiropractic neck manipulation with hypoglossal and glossopharyngeal nerve palsy. The imaging findings and subsequent operative management are described.

Lesiones vasculares múltiples y precoces en la neurofibromatosis. Descripción de un caso clínico y revisión bibliográfica / Multiple premature vascular lesions in neurofibromatosis. Description of a clinical case and a review of the literature

Introducción. La neurofibromatosis tipo I de von Recklinghausen es un síndrome neurocutáneo que, con escasa frecuencia, tiene alteraciones vasculares, y éstas pueden ser muy variadas. La afectación más frecuente es la estenosis de aorta pararrenal, asociada a estenosis proximal de arteria renal, que produce hipertensión vasculorrenal. La afectación típica de las arterias cerebrales es la estenosis de la porción terminal de la carótida interna, o de la porción proximal de las arterias cerebrales anterior o media; es menos frecuente que afecte a la mitad posterior del círculo de Willis. Puede haber lesiones estenóticas o aneurismáticas (saculares) de arterias viscerales y de arterias de miembros inferiores. Caso clínico. Presentamos el caso de una paciente con afectación vascular multifocal, muy grave y precoz, en la que se decidió una actitud conservadora en espera de la evolución clínica durante el seguimiento; también se realiza una revisión bibliográfica del tema (AU)

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Macroaneurismas retinales adquirido: estudio retrospectivo / Acquired retinal macroaneurisms: retrospective study

Se estudian en forma retrospectiva 22 ojos de 21 pacientes con el diagnóstico de macroaneurismas retinales adquiridos, evaluados en el Servicio Oftalmología del Hospitalclínico de la U. de Chile, en la Fundación Oftalmológica Los Andes y e la práctica privada de los autores. El objetivo de este trabajo fue definir las características clínicas de los pacientes con esta con fotocoagulación con láser argón y el resultado de otro grupo no tratado. Se estudiaron 22 ojos de 21 pacientes con macroaneurisma retinales, de los cuales 13 pacientes fueron sometidos a tratamiento con láser argón y 8 fueron observados. En los resultados se encuentra que la patología se presenta de predominio en mujeres mayores de 65 años, con hipertensión arterial asociada y que consultan por baja de visión o un escotoma central. Se encuentra una agudeza visual promedio de 0,15 (Snellen) del ojo afectado v/s 0.22 (Snellen) del ojo contralateral (t test p<0.05). Al fondo de ojo el macroaneurisma predominal en el O1 en 13 casos (62 por ciento), es visible en 11 casos (50 por ciento) en el primer examen, es predominante único en 20 casos (91 por ciento) y se ubica preferentemente en la rama temporal superior en 13 casos (62 por ciento). Encontramos 2 formas clínicas de presentación del macroaneurisma: una asociada a edema macular y exudación lipídica, y la otra asociada a hemorragia prerretinal, intrarretinal, subretinal o hemorragia vítrea. La angiofluoresceinografía nos muestra el macroaneurisma en 12 casos (57 por ciento), y nos ayuda al diagnóstico en 6 casos (28 por ciento) sin diagnóstico claro inicial. existen 5 casos (22 por ciento) en que el diagnóstico se hace en forma tardía, por que se presentan con una complicación hemorrágica y luego el macroaneurisma finalmente se hace visible al desaparecer la hemorragia. Se dispone el seguimiento en 16 casos (77 por ciento), y se observa que los ojos que presentan complicaciones hemorrágicas mejoran la agudeza visual, mientras que aquellos que se asocian a edema maculary exudación lipídica mantienen igual su agudeza visual. Trece casos (62 por ciento) fueron tratados con láser argón, y estos ojos finalmente mantuvieron igual visión. En nuestro estudio el resultado visual final más bien se asocia a la presencia o no edema macular o hemorragia en el examen inicial, y no al tratamiento con láser argón. El tratamiento con láser argón se sugiere solamente en caso con edema macular

Retinal macroaneurysm: natural history and guidelines for treatment.

This report describes the features and clinical significance of retinal macroaneurysm. Two groups can be defined: those with acute aneurysmal decompensation, Group I; and those with chronic aneurysmal decompensation, Group II. Haemorrhage is the main feature of the former group and exudates of the latter. Systemic and local associations are noted, and guidelines for treatment by phototherapy are discussed.

[Angiographic diagnosis and therapy of acute and chronic gastrointestinal hemorrhages]. / Angiographische Diagnostik und Therapie der akuten und chronischen gastrointestinalen Blutung.

In acute gastrointestinal bleeding visceral angiography has been showing its importance for years. It contributes to diagnosis especially in cases with persistent acute hemorrhage. In chronic gastrointestinal bleeding conventional radiographic procedures such as upper gastrointestinal series and barium enema will be preferred to angiography. The function of the radiologist goes beyond mere diagnosis of gastrointestinal bleeding. Treatment with vasopressin via the angiographic catheter has proven its clinical value. This method will be indicated especially in cases with high risk anesthesia and surgery. It will help to postpone necessary surgery to a more favorable moment following hemostasis. Side effects such as hypertension and antidiuresis are relatively rare and easy to manage. Numerous substances are used for embolization showing that ideal material has not been found yet and further development seems necessary. In contrast to vasopressin treatment, vascular occlusion is often irreversible, complications (unwanted reflux of embolization material, necrosis and plugging of the catheter) are more difficult to manage. Superselective visualization of a bleeding artery is always needed. Embolization is justified in cases when a possibility for anesthesia and surgery cannot be foreseen. The electrical vascular occlusion using direct current is still in the phase of animal experiments; its clinical value has not sufficiently been assessed as yet.