Association Between the Degree of Severity of Pulmonary Hypertension With the Presence of Pulmonary Artery Aneurysm: A Brief Updated Review for Clinicians.

Pulmonary hypertension (PH) is defined as an increase in mean pulmonary arterial pressure (mPAP) ≥20 mm Hg at rest as assessed by right cardiac catheterization. It has a median survival nowadays of 6 years, compared to 2.8 years in the 1980s. A pulmonary artery aneurysm (PAA) is the focal dilation of a blood vessel involving all 3 layers of the vessel wall; they have a diameter greater than 4 cm measured in the trunk of the pulmonary artery. PAAs can be classified into proximal (or central) and peripheral. The clinical manifestations of PAA are primarily nonspecific, and most patients remain undiagnosed, even those with large PAA, due to its silent course; however, clinical manifestations occur unless when there are complications such as bronchial or tracheal compression (leading to cough and dyspnea), dissection, or rupture (leading to hemoptysis). PAH is observed in 66% of patients with PAA. PA dissections are usually associated with PAH; 80% of dissections occur in the main pulmonary trunk. Although there is no clear guideline for the best treatment of PAA, surgery is indicated in patients with a pulmonary trunk aneurysm >5.5 cm. It has been observed that patients in the PAH group associated with congenital heart disease tend to develop PAA more commonly. Those with PAH associated with connective tissue disease have a smaller diameter of PA dilation. This report presents a comprehensive review of PAA, discussing critical aspects of the clinical and imaging diagnosis, hemodynamics, and treatment. A comprehensive updated literature review is included; we believe this article will interest cardiopulmonologists.

Aneurisma venoso postraumático en extremidades superiores. Presentación de dos casos / Post-traumatic venous aneurysm in the upper limbs. Case report on two patients / Aneurisma venoso pós-traumático nos membros superiores. Apresentação de dois casos

RESUMEN Los aneurismas venosos, en especial de la extremidad superior, son malformaciones vasculares de baja frecuencia. Se presentó el manejo de dos pacientes del sexo femenino atendidas en el Servicio de Angiología y Cirugía Vascular del Hospital General Docente "Dr. Agostinho Neto" de la provincia Guantánamo, Cuba, a las que se les diagnosticaron aneurismas en diferentes segmentos del sistema venoso superficial de la extremidad superior, los que se resecaron quirúrgicamente y se les confirmó el diagnóstico mediante biopsia.

ABSTRACT Venous aneurysms, especially the ones located in the upper limbs, are vascular malformations with low incidence in the population. Two cases of venous aneurisms on female patients showed up at the Angiology and Vascular Surgery services at the General Teaching Hospital ¨Dr. Agostinho Neto¨ in Guantanamo, Cuba. Aneurism diagnosis was confirmed through biopsy. They were located in different segments of the superficial venous system of the upper limbs, and were surgically resected.

RESUMO Os aneurismas venosos, principalmente de membro superior, são malformações vasculares de baixa frequência. Foi apresentada a gestão de duas pacientes do sexo feminino atendidas no Serviço de Angiologia e Cirurgia Vascular do Hospital General Docente "Dr. Agostinho Neto" da província de Guantánamo, Cuba, que foram diagnosticados com aneurismas em diferentes segmentos do sistema venoso superficial do membro superior, os quais foram ressecados cirurgicamente e o diagnóstico foi confirmado por biópsia.

Aneurisma em veia cava caudal de cão: relato de caso / Caudal vena cava aneurysm: case report

Uma paciente da espécie canina de 9 anos de idade, SRD, foi encaminhado ao serviço de oncologia, após a retirada de um hemangiossarcoma dérmico em região de abdome. Após pesquisa de metástase, constatou por meio da radiografia de tórax presença de uma formação circular, homogênea de 4 cm em hemitórax direito em topografia de lobo acessório pulmonar. Foi então realizado exames complementares cardiológicos e de imagem tais como ecocardiograma e posteriormente tomografia computadorizada com contraste, que confirmou a presença de aneurisma em veia cava caudal. A paciente apresentava-se assintomática, portanto, tendo sido considerado um achado em estadiamento clínico. O aneurisma é uma dilatação vascular, patologia rara em cães, principalmente em veia cava caudal e suas causas ainda permanecem incertas, tendo na genética como a mais provável. Embora o hemangiosarcoma não seja a causa principal para o desenvolvimento do aneurisma, serviu de gatilho para esse achado. Essa patologia ainda permanece rara na medicina veterinária, mesmo sendo os animais utilizados como principais modelos de estudos para tratamento de aneurismas em humanos.

A 9-year-old canine patient, SRD, was referred to the oncology service after removal of a dermal hemangiosarcoma in the abdomen. After searching for metastasis, he found through chest radiography the presence of a circular, homogeneous 4 cm formation in the right hemithorax in topography of the pulmonary accessory lobe. Complementary cardiological and imaging exams, such as echocardiography and later contrast-enhanced computed tomography, were performed, which confirmed the presence of aneurysm in the caudal vena cava. The patient was asymptomatic, therefore, having been considered a finding in clinical staging. Aneurysm is a vascular dilation, a rare pathology in dogs, mainly in the caudal vena cava and its causes are still uncertain, with genetics as the most plausible and probable. Although hemangiosarcoma is not the main cause for the development of the aneurysm, it served as a trigger for this finding. This pathology still remains rare in veterinary medicine, even though animals are used as the main study models for the treatment of aneurysms in humans.

Aneurisma em veia cava caudal de cão: relato de caso / Caudal vena cava aneurysm: case report

Uma paciente da espécie canina de 9 anos de idade, SRD, foi encaminhado ao serviço de oncologia, após a retirada de um hemangiossarcoma dérmico em região de abdome. Após pesquisa de metástase, constatou por meio da radiografia de tórax presença de uma formação circular, homogênea de 4 cm em hemitórax direito em topografia de lobo acessório pulmonar. Foi então realizado exames complementares cardiológicos e de imagem tais como ecocardiograma e posteriormente tomografia computadorizada com contraste, que confirmou a presença de aneurisma em veia cava caudal. A paciente apresentava-se assintomática, portanto, tendo sido considerado um achado em estadiamento clínico. O aneurisma é uma dilatação vascular, patologia rara em cães, principalmente em veia cava caudal e suas causas ainda permanecem incertas, tendo na genética como a mais provável. Embora o hemangiosarcoma não seja a causa principal para o desenvolvimento do aneurisma, serviu de gatilho para esse achado. Essa patologia ainda permanece rara na medicina veterinária, mesmo sendo os animais utilizados como principais modelos de estudos para tratamento de aneurismas em humanos.(AU)

A 9-year-old canine patient, SRD, was referred to the oncology service after removal of a dermal hemangiosarcoma in the abdomen. After searching for metastasis, he found through chest radiography the presence of a circular, homogeneous 4 cm formation in the right hemithorax in topography of the pulmonary accessory lobe. Complementary cardiological and imaging exams, such as echocardiography and later contrast-enhanced computed tomography, were performed, which confirmed the presence of aneurysm in the caudal vena cava. The patient was asymptomatic, therefore, having been considered a finding in clinical staging. Aneurysm is a vascular dilation, a rare pathology in dogs, mainly in the caudal vena cava and its causes are still uncertain, with genetics as the most plausible and probable. Although hemangiosarcoma is not the main cause for the development of the aneurysm, it served as a trigger for this finding. This pathology still remains rare in veterinary medicine, even though animals are used as the main study models for the treatment of aneurysms in humans.(AU)

Aneurismas de artéria esplênica: história natural e técnicas de tratamento / Splenic aneurysms: natural history and treatment techniques

Resumo Aneurismas da artéria esplênica (AAE) verdadeiros são uma patologia rara, mas potencialmente fatal. São o terceiro aneurisma abdominal mais comum, após aneurismas da aorta e da artéria ilíaca, e representam quase todos os aneurismas de artérias viscerais. Os aneurismas verdadeiros são responsáveis ​​por 60% dos AAEs e afetam as mulheres quatro vezes mais do que os homens, geralmente relacionados a uma descoberta incidental ou sintomática aumentada que coincide com o uso da ultrassonografia na gravidez. Em pacientes grávidas, a mortalidade, após a ruptura, é de 65-75%, com mais de 90% de mortalidade fetal. Têm múltiplas etiologias, e acredita-se que as influências hormonais e as alterações do fluxo portal durante a gestação desempenhem um papel importante no desenvolvimento do AAE. Esta revisão discorrerá sobre sua história, epidemiologia, fisiopatologia, diagnóstico, e as técnicas atuais de tratamento.

Abstract True splenic artery aneurysms (SAA) are a rare, but potentially fatal, pathology. They are the third most common type of abdominal aneurysm, after aneurysms of the aorta and of the iliac artery, and account for almost the all aneurysms of visceral arteries. True aneurysms account for 60% of SAA and affect four times as many women as men, generally related to increased incidental or symptomatic findings that coincide with use of ultrasonography in pregnancy. Among pregnant patients, mortality after rupture is 65-75%, with fetal mortality exceeding 90%. There are multiple etiologies and it is believed that hormonal influences and changes in portal flow during gestation play an important role in development of SAA. This review discusses their history, epidemiology, pathophysiology, and diagnosis and current treatment techniques.

Further observations on a bilateral IRVAN syndrome case.

PURPOSE: Reporting clinical features of the late course of the disease after long-term follow-up in a bilaterally affected patient with idiopathic retinitis, vasculitis, retinal aneurysms and neuroretinitis (IRVAN) and new peripheral retinal findings on wide-field angiography and multimodal imaging. METHODS: This was a retrospective observational study, based on current diagnostic studies including wide-field fluorescein angiography, optical coherence tomography (OCT) and treatment of aneurysms with argon laser photocoagulation. RESULTS: A 21-year-old female with bilateral IRVAN syndrome-stage 2 in the right eye and stage 3 in the left eye-previously treated bilaterally with laser photocoagulation for retinal macroaneurysms and ischemic areas between 1985 and 1992. Follow-up interrupted on two occasions, with subsequent fundus re-examinations confirming the prevention of retinal neovascularization in both eyes, as recently evidenced on wide-field angiography. CONCLUSIONS: A case of bilateral IRVAN disease with multiple retinal aneurysms, neuroretinitis and peripheral capillary nonperfusion successfully treated with laser photocoagulation, maintaining normal visual acuity in one eye and preventing retinal neovascular complications.

Aneurisma de arteria testicular: reporte de un caso y revisión de la literatura / Testicular artery aneurysm: case report and review of the literature

Resumen: Introducción: El aneurisma de la arteria testicular es poco frecuente; el término se describe como la dilatación de cualquier vaso sanguíneo en el cuerpo. Caso clínico: Se presenta el caso de un paciente de 15 años con un aneurisma de la arteria testicular izquierda sin ningún antecedente de importancia familiar ni personal, quien se presentó a consulta por aumento de volumen en la región inguinal de larga evolución, acompañado de dolor esporádico y sin más síntomas. Se diagnosticó hernia inguinal y se procedió a cirugía. El diagnóstico se realizó de manera posoperatoria por medio de estudio histopatológico. En este caso, se destaca la presentación de un aneurisma verdadero de la arteria testicular y el resultado después del tratamiento quirúrgico definitivo. Conclusiones: La etiología del aneurisma y del pseudoaneurisma reportada en la literatura se describe posterior a un traumatismo testicular, y en pocos casos de origen congénito. Las manifestaciones clínicas pueden ser dolor y una masa inguinal, y muchas de las veces pueden confundirse con hernias inguinales o ser una patología agregada, por lo que el abordaje de los pacientes con patología inguinal o testicular debe ser protocolizado e incluir el aneurisma dentro de los diagnósticos diferenciales.

Abstract: Background: Aneurysm of the testicular artery is a rare entity; the term is described as the dilation of any blood vessel in the body. Case report: An 18-year-old patient with a left testicular artery aneurysm, with no family or personal history of medical importance, presented for consultation due to a volume increase of long evolution in the inguinal region, accompanied by sporadic pain with no other symptoms. The testicular artery aneurysm was not detectable preoperatively by ultrasound, which only reported data compatible with left inguinal hernia and varicocele. The diagnosis was made postoperatively by a histopathological study. This case highlights the presentation of a true aneurysm of the testicular artery and the result after definitive surgical treatment. Conclusions: The etiology of the aneurysm and pseudoaneurysm reported in the literature is described after a testicular trauma and, a few cases of congenital origin. The clinical manifestations are pain and an inguinal mass, which can be frequently confused with inguinal hernias or an aggregated pathology. Therefore, the approach of patients with inguinal or testicular pathology should be protocolized and include aneurysm within the differential diagnoses.

[Aneurisma de arteria testicular: reporte de un caso y revisión de la literatura]. / Testicular artery aneurysm: case report and review of the literature.

Background: Aneurysm of the testicular artery is a rare entity; the term is described as the dilation of any blood vessel in the body. Case report: An 18-year-old patient with a left testicular artery aneurysm, with no family or personal history of medical importance, presented for consultation due to a volume increase of long evolution in the inguinal region, accompanied by sporadic pain with no other symptoms. The testicular artery aneurysm was not detectable preoperatively by ultrasound, which only reported data compatible with left inguinal hernia and varicocele. The diagnosis was made postoperatively by a histopathological study. This case highlights the presentation of a true aneurysm of the testicular artery and the result after definitive surgical treatment. Conclusions: The etiology of the aneurysm and pseudoaneurysm reported in the literature is described after a testicular trauma and, a few cases of congenital origin. The clinical manifestations are pain and an inguinal mass, which can be frequently confused with inguinal hernias or an aggregated pathology. Therefore, the approach of patients with inguinal or testicular pathology should be protocolized and include aneurysm within the differential diagnoses.

Introducción: El aneurisma de la arteria testicular es poco frecuente; el término se describe como la dilatación de cualquier vaso sanguíneo en el cuerpo. Caso clínico: Se presenta el caso de un paciente de 15 años con un aneurisma de la arteria testicular izquierda sin ningún antecedente de importancia familiar ni personal, quien se presentó a consulta por aumento de volumen en la región inguinal de larga evolución, acompañado de dolor esporádico y sin más síntomas. Se diagnosticó hernia inguinal y se procedió a cirugía. El diagnóstico se realizó de manera posoperatoria por medio de estudio histopatológico. En este caso, se destaca la presentación de un aneurisma verdadero de la arteria testicular y el resultado después del tratamiento quirúrgico definitivo. Conclusiones: La etiología del aneurisma y del pseudoaneurisma reportada en la literatura se describe posterior a un traumatismo testicular, y en pocos casos de origen congénito. Las manifestaciones clínicas pueden ser dolor y una masa inguinal, y muchas de las veces pueden confundirse con hernias inguinales o ser una patología agregada, por lo que el abordaje de los pacientes con patología inguinal o testicular debe ser protocolizado e incluir el aneurisma dentro de los diagnósticos diferenciales.

Aneurisma de la vena de Galeno: diagnóstico prenatal y manejo / Vein of Galen aneurysm: prenatal diagnosis and management

RESUMEN Las malformaciones vasculares cerebrales son infrecuentes, dentro de ellas, el aneurisma de la vena de Galeno (AVG) tiene una incidencia de 1 en 25.000 recién nacidos. El ultrasonido obstétrico de rutina ha permitido el diagnóstico prenatal de dicha alteración, permitiendo establecer el pronóstico del recién nacido. En la exploración mediante ultrasonido del cerebro fetal, la presencia de una imagen quística supratentorial con flujo turbulento al Doppler color permite establecer el diagnóstico. La asociación con signos de insuficiencia cardiaca ha mostrado altas tasas de mortalidad neonatal. Se presenta el caso de un feto al que se realiza el diagnóstico prenatal mediante ultrasonido y su confirmación por neuroimagenes al nacimiento.

ABSTRACT Cerebral vascular abnormalities are rare. The vein of Galen aneurysmal malformation (VGAM) has an incidence of 1 in 25,000 newborns. The routine obstetric ultrasound has allowed the prenatal diagnosis and establish the prognosis of the newborn. In the ultrasound examination of the fetal brain, the presence of a supratentorial cystic image with turbulent flow to the color Doppler makes the diagnosis. The association with signs of heart failure have shown high neonatal mortality. We present a case of a fetus with prenatal diagnosis of VGAM by 2D ultrasound and confirmation by neuroimaging at birth.

Internal carotid artery aneurysm mimicking normal-tension glaucoma / Aneurisma de carótida interna simulando glaucoma de pressão normal

ABSTRACT Differentiating glaucomatous from nonglaucomatous optic disc cupping remains challenging. We present a case of a 48-year-old woman with an internal carotid aneurysm of approximately 3.5 mm × 6.5 mm that mimicked normal-tension glaucoma. The patient had a 2-year history of low vision acuity in her left eye and frontal oppressive headache. Owing to the carotid aneurysm, she developed an asymmetric vertical cup-to-disc ratio above 0.2, and marked inferotemporal neuronal rim loss and pallor of the residual rim were noted in the left disc. She also developed a visual field defect with an arcuate scotoma in the left eye. The patient was referred to a neurosurgeon and underwent endovascular aneurysm occlusion. This case highlights the diagnostic importance of recognizing that many neurological defects remain underdiagnosed.

RESUMO diferenciação de escavações glaucomatosas e não glaucomatosas ainda permanece um desafio ainda nos dias de hoje. Nos descrevemos um caso de aneurisma de carótida interna medindo 3.5mm x 6.5mm que simulava um glaucoma de pressão normal. O caso é sobre uma paciente feminino de 48 anos com história de 2 anos de baixa acuidade visual no olho esquerdo e cefaléia frontal. Devido ao aneurisma de carótida a paciente desenvolveu uma assimetria de escavação vertical maior que 0.2 no olho esquerdo em relação ao direito com defeito localizado da camada de fibras nervosas temporal inferior. Ela também apresentava um defeito arqueado temporal superior a esquerda, cruzando a linha média vertical consistente. Após o diagnostico confirmado pela ressonância magnética funcional, a paciente foi enviada para o neurocirurgião para realização de uma oclusão endovascular do aneurisma. Esse caso nos alerta da importância de se lembrar que não apenas o glaucoma gera escavações suspeitas no disco óptico e que ainda muitos defeitos por causas neurológicas são subdiagnosticados.

Aneurisma cerebral associado a coarctação de aorta em atleta máster de futebol de salão: relato de caso cerebral / Aneurysm associated with coarctation of aorta in federated master soccer: report case

A Coarctação de Aorta (CoA) é uma doença congênita que causa estreitamento do vaso ao longo de seu trajeto. Corresponde aproximadamente 5% das doenças cardíacas congênitas. A CoA frequentemente ocorre no arco distal ou na região descendente. As manifestações clínicas são diversas, sendo a hipertensão arterial um marcador importante de gravidade e lesões em orgãos-alvo. Muitos apresentam cefaleia, tontura, pulsação da cabeça e pescoço, fraqueza, claudicação de membros inferiores. Os aneurismas cerebrais correspondem a 50% nos pacientes com CoA, descritos em 1871 por Eppinger. A fisiopatologia é incerta, contudo é de conhecimento o baixo risco de ruptura e que seu tamanho é menor que os demais aneurismas. Raramente os aneurismas são encontrados em pessoas acima de 50 anos sendo mais comum entre 20-30 anos. Os pacientes que sobrevivem após os dois anos sem intervenção evoluem sem complicações nas maioria dos casos. Relato de Caso: paciente, 46 anos, engenheiro e jogador de futebol de salão master federado desde os 15 anos de idade. Apresentou-se na emergência com quadro de cefaleia de forte intensidade, a pior da vida, com paraparesia de membros inferiores, náuseas e vômitos. Ao exame físico estava em mal estado geral, sopro sistólico contínuo em região interescapular e sopro em diamante em região de precordio, pressão arterial de 180 x100 mmHg, normocardio, força muscular grau 2 em membros inferiores, ausência de pulsos pediosos em membros inferiores e anisocoria. Realizado tomografia de crâneo que evidencia a hemorragia subaracnoidea fisher 2, posteriormente com a angiotomografia cerebral constatou dois aneurismas saculares. Realizado eletrocardiograma, ecocardiograma e fundo de olho sem lesões de órgãos-alvo. Devido à característica do sopro evidenciado no exame e ao Rx de tórax com Sinal de Rosler e 3 invertido solicitou-se uma angiotomografia de aorta que mostrou uma CoA da aorta descendente. Comentários: o caso apresentando apresenta um paciente de 46 anos, jogador de futebol profissional sem sintomas até o presente momento, em tratamento irregular para hipertensão arterial desde os 24 anos de idade. Na grande maioria dos casos de CoA os pacientes adultos jovens e idosos evoluem com lesões de órgãos-alvo e complicações decorrentes da hipertensão de longa data. O presente caso demonstra a necessidade de um exame físico completo, a investigação ativa de hipertensão secundária em pacientes jovens

Coarctation of the Aorta (CoA) is a congenital disease that causes narrowing of the vessel along its way. Measure up 5 % of congenital heart disease. CoA often occurs in the distal arch or descending aorta. Clinical manifestations are diverse, arterial hypertension being an important marker of severity and lesions in organs, many show with headache, dizziness, pulsation of the head and neck, weakness, claudication of the legs. Described in 1871 by Eppinger, Cerebral aneurysms correspond to 50% in patients with CoA. Rarely, aneurysms are found in people over 50 years of age and are more common in the 20-30 year age group. Patients who survive without the necessity of intervention, after two years, have being develop uncomplicated. Case Report: patient, 46 years old, engineer and federated master soccer player since 15 years old. Admited in the emergency department reporting the worst headache of his life, associated, paraparesis of lower limbs, nausea and vomiting. At physical exam: continuous systolic murmur in interscapular region and diamond shaped systolic murmur at precordium. Arterial blood pressure was 180 x100 mmHg, normocardium, muscle strength level 2 in lower limbs , absence of pedis's pulses in lower limbs and anisocoria. Cranial CT scan showed hemorrhage subarachnoid (Fisher 2) and the cerebral angiotomography revealed two saccular aneurysms. Electrocardiogram, echocardiogram and fundus of the eye without lesions. Owing to the characteristic of the murmur evidenced at physical exam and the Rosler's Signal, "3 Sign" seen and at chest X- Ray, an aortic angiotomography was performed which showed a Coa of the descending aorta. Conclusion: the case presents a patient of 46 years, professional soccer player with no symptoms until the present moment, in irregular treatment for hypertension since the 24 years of age. In majority of cases of CoA, young-adult and elderly patients develop with target organ damage and complications resulting from long-standing hypertension. Therefore, a complete physical examination, the active investigation of secondary hypertension in young patients, becomes essential.

Membranous ventricular septal aneurysm in a black-tailed prairie dog ( Cynomys ludovicianus).

Ventricular septal defects are one of the most common congenital cardiac malformations in animals, and most often affect the membranous portion of the septum. These defects may rarely close spontaneously. An adult male black-tailed prairie dog ( Cynomys ludovicianus) had a smooth shiny botryoid red mass arising from the area of the septal cusp of the right atrioventricular (tricuspid) valve and membranous interventricular septum, and bulging into the right ventricular lumen. Histology and special staining demonstrated a membranous ventricular septal defect closed by the adherence of the septal cusp of the tricuspid valve to the muscular septum (so-called membranous ventricular septal aneurysm or aneurysm of the [peri]membranous ventricular septum). This is a rare finding in animals, and the histologic appearance has not been documented previously, to our knowledge.

Tratamento endovascular de aneurisma de aorta abdominal com erosão de vértebra lombar associada à doença de Behçet: relato de caso / Endovascular repair of abdominal aortic aneurysm with lumbar vertebral erosion in Behçet's disease: case report

A doença de Behçet é uma doença sistêmica, multifatorial e autoimune com diversas manifestações clínicas, entre elas o acometimento vascular. Aneurisma de aorta associado a erosão de vértebra lombar é condição rara na literatura, existindo apenas quatro relatos de caso nas bases de dados da PubMed. O presente artigo relata o caso de paciente do sexo feminino com diagnóstico de Doença de Behçet de longa data e aneurisma sacular de aorta abdominal infrarrenal com erosão de vértebra lombar. O caso foi tratado por meio de técnica endovascular com colocação de endoprótese monoilíaca e enxerto fêmoro-femoral cruzado, devido a limitações anatômicas da bifurcação aórtica. O artigo aborda a raridade desse tipo de apresentação da doença e o desfecho do tratamento e apresenta revisão da literatura sobre esse tema

Behçet's disease is an autoimmune, multifactorial, systemic condition with several clinical manifestations, including vascular disorders. An aortic aneurysm with vertebral erosion is rare in association with this pathology and there are only four case reports listed on the PubMed database. This article reports the case of a female patient with a long-standing diagnosis of Behçet's Disease who developed a saccular infrarenal abdominal aortic aneurysm with lumbar vertebral erosion. Her surgical treatment consisted of endovascular repair with a monoiliac endoprosthesis and a femorofemoral crossover bypass, because of limitations imposed by the anatomy of the aortic bifurcation. This paper discusses the rarity of this presentation of the disease and treatment outcomes and offers a brief review of the relevant literature

Aneurisma verdadeiro pós-traumático de artéria temporal / True posttraumatic aneurysm of the temporal artery

Os aneurismas de artéria temporal pós-traumático são eventos raros. Geralmente, são pseudoaneurismas. Como a causa mais frequente são ferimentos contusos, deve-se investigar todo paciente que possuir nodulação pulsátil na região da artéria temporal. O paciente apresentava protuberância pulsátil em região frontal direita há quatro meses, após queda de objeto pontiagudo, e o eco-Doppler evidenciou dilatação aneurismática. Assim, foi indicada sua excisão, que foi realizada com sucesso. O exame anatomopatológico demonstrou aneurisma verdadeiro traumático de artéria temporal superficial. Ocorrem devido ao fato de a artéria temporal superficial se localizar diretamente sobre o periósteo, o que a torna muito superficializada. Os aneurismas verdadeiros pós-traumáticos de artéria temporal são extremamente raros e podem ser confundidos com diversas outras afecções, como lipomas e cistos sebáceos.

Posttraumatic aneurysms of the temporal artery are rare events and are generally pseudoaneurysms. Since the most frequent cause is blunt injury, all patients with a pulsating nodule in the region of the temporal artery should be investigated. This patient presented with a pulsating protuberance in the right frontal area with onset 4 months previously after being hit by a falling sharp object. Doppler ultrasonography showed evidence of aneurysmal dilatation, which was excised successfully. Pathology results demonstrated a true traumatic aneurysm of the superficial temporal artery. They occur because the superficial temporal artery is located directly over the periosteum, meaning it is very superficial. True posttraumatic aneurysms of the temporal artery are extremely rare and may be confused with many other conditions, such as lipomas and sebaceous cysts.

Tratamento do aneurisma aterosclerótico da artéria temporal superficial: relato de caso / Treatment of an atherosclerotic aneurysm of the superficial temporal artery: case report

Aneurismas da artéria temporal superficial são incomuns segundo a literatura. A grande maioria é secundária a traumatismos ou cirurgia na região temporal, sendo que 95% dos casos evoluem para pseudoaneurismas. Entretanto, os aneurismas verdadeiros ou espontâneos são extremamente raros e representam 8% dos casos de aneurismas da artéria temporal superficial, sendo estes, geralmente, de origem aterosclerótica. Aneurismas temporais espontâneos podem coexistir com outras lesões vasculares, incluindo aneurismas intracranianos. Nosso relato trata de um paciente com aneurisma de artéria temporal superficial esquerda, de origem aterosclerótica, no qual foi realizada a excisão cirúrgica, sob anestesia geral.

According to the literature, aneurysms of the superficial temporal artery are uncommon. The vast majority are secondary to trauma or surgery in the temporal region and 95% of cases progress to pseudoaneurysms. However, true or spontaneous aneurysms are extremely rare, accounting for 8% of cases of superficial temporal artery aneurysms, and are usually caused by atherosclerosis. Spontaneous temporal aneurysms can coexist with other vascular lesions, including intracranial aneurysms. Our report deals with a patient with an aneurysm of the left superficial temporal artery, of atherosclerotic origin, for whom surgical excision was performed under general anesthesia.

Contemporary outcomes of intact and ruptured visceral artery aneurysms.

OBJECTIVE: The treatment outcomes of ruptured visceral artery aneurysms (rVAAs) have been sparsely characterized, with no clear comparison between different treatment modalities. The purpose of this paper was to review the perioperative and long-term outcomes of open and endovascular interventions for intact visceral artery aneurysms (iVAAs) and rVAAs. METHODS: This was a retrospective review of all treated VAAs at one institution from 2003 to 2013. Patient demographics, aneurysm characteristics, management, and subsequent outcomes (technical success, mortality, reintervention) and complications were recorded. RESULTS: The study identified 261 patients; 181 patients were repaired (77 ruptured, 104 intact). Pseudoaneurysms were more common in rVAAs (81.8% vs 35.3% for iVAAs; P < .001). The rVAAs were smaller than the iVAAs (20.7 mm vs 27.5 mm; P = .018), and their most common presentation was abdominal pain; 29.7% were hemodynamically unstable. Endovascular intervention was the initial treatment modality for 67.4% (75.3% for rVAAs, 61.5% for iVAAs). The perioperative complication rate was higher for rVAAs (13.7% vs 1% for iVAAs; P = .003), as was mortality at 30 days (13% vs 0% for iVAAs; P = .001), 1 year (32.5% for rVAAs vs 4.1% for iVAAs; P < .001), and 3 years (36.4% for rVAAs vs 8.3% for iVAAs; P < .001). Lower 30-day mortality was noted with endovascular repair for rVAAs (7.4% vs 28.6% open; P = .025). Predictors of mortality for rVAAs included age (odds ratio, 1.04; P = .002), whereas endovascular repair was protective (odds ratio, 0.43; P = .037). Mean follow-up was 26.2 months, and Kaplan-Meier estimates of survival were higher for iVAAs at 3 years (88% vs 62% for rVAAs; P = .045). The 30-day reintervention rate was higher for rVAAs (7.7% vs 19.5% for iVAAs; P = .019) but was similar between open and endovascular repair (8.2% vs 15%; P = NS). CONCLUSIONS: rVAAs have significant mortality. Open and endovascular interventions are equally durable for elective repair of VAAs, but endovascular interventions for rVAAs result in lower morbidity and mortality. Aggressive treatment of pseudoaneurysms is electively recommended at diagnosis regardless of size.