RESUMO
Coronary artery aneurysms are rare and are often associated with atherosclerosis in adults and Kawasaki disease in children. Thromboembolism and rupture of the aneurysm are common complications associated with this condition. We report a case of coronary aneurysm resection and coronary artery bypass grafting (CABG) in a 36-year-old man with a history of recurrent acute myocardial infarction. There was no coronary aneurysms in first acute myocardial infarction. Histopathological examination of the resected coronary artery aneurysm wall revealed features of vasculitis, although the patient showed no episodes and physical findings of vasculitis. Coronary vasculitis can cause vascular endothelial cell injury and therefore requires careful follow-up.
Assuntos
Aneurisma Coronário , Síndrome de Linfonodos Mucocutâneos , Infarto do Miocárdio , Trombose , Adulto , Criança , Humanos , Masculino , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/complicações , Ponte de Artéria Coronária/efeitos adversos , Aneurisma Coronário/complicações , Aneurisma Coronário/diagnóstico por imagem , Síndrome de Linfonodos Mucocutâneos/complicações , Síndrome de Linfonodos Mucocutâneos/cirurgia , Angiografia Coronária/efeitos adversosRESUMO
INTRODUCTION: Isolated internal iliac artery (IIA) aneurysms (IIIAAs) rarely occur. However, they may enlarge asymptomatically and rupture, causing fatality. Even after successful surgery of ruptured IIIAAs, there might be a potential risk of postoperative spinal cord ischemia (SCI)-related paraplegia, which is extremely rare. However, this paraplegia significantly impacts patients' activities of daily living. PATIENT CONCERNS: A 71-year-old man who had no remarkable medical history was referred to our hospital with sudden lower abdominal pain. DIAGNOSIS: Computed tomography (CT) revealed right IIIAA with small volumes of contrast medium extravasation and hematoma. He presented with cyanosis in the bilateral lower limbs. Moreover, blood gas analysis showed lactic acidosis. Therefore, he was diagnosed with ruptured IIIAA complicated by peripheral circulatory failure. INTERVENTIONS: Considering his pre-shock status, an emergency operation comprising ligation of the proximal neck and suture closure of the distal IIA orifice was successfully performed. OUTCOMES: Immediately after surgery, motor and sensory dysfunction in the bilateral lower limbs occurred. Magnetic resonance imaging confirmed the presence of SCI. The patient could not stand independently and had neurogenic bladder and rectal disorder. CONCLUSION: Postoperative SCI is a serious complication with no definitive predictors, preventive methods, or highly efficacious treatments. Therefore, vascular surgeons should preempt its occurrence and focus on preventing hemodynamic instability and maintain collateral extra-segmental arterial blood flow, especially in ruptured cases.
Assuntos
Aneurisma Roto/cirurgia , Aneurisma Ilíaco/cirurgia , Artéria Ilíaca/cirurgia , Isquemia do Cordão Espinal/etiologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Atividades Cotidianas , Idoso , Humanos , Masculino , Isquemia do Cordão Espinal/patologiaRESUMO
RATIONAL: Bacillus Calmette-Guérin (BCG) intravesical instillation therapy is a widely used treatment for bladder cancer; however, an infectious aneurysm has been reported as a rare complication. PATIENT CONCERNS: A 76-year-old man who underwent BCG intravesical instillation therapy for bladder cancer presented with prolonged dull back pain for 3âmonths. DIAGNOSIS: Computed tomography (CT) revealed both thoracic and abdominal aortic aneurysms (AAAs). Follow-up CT at 4âweeks after the initial examination showed rapid enlargement of both aneurysms and typical findings of inflammation. Therefore, he was diagnosed with an impending rupture of infectious aneurysms. INTERVENTIONS: Although open surgical resection of both aneurysms and vascular reconstruction were ideal, these operations were considered highly invasive for the patient. Therefore, a hybrid operation consisting of simultaneous endovascular repair of the thoracic aneurysm and open surgery of the abdominal lesion was performed. OUTCOMES: BCG "Tokyo-172" strain was identified in the resected sample from the aneurysmal wall, and he continued to receive oral antituberculosis drugs for 6âmonths. No sign of recurrent infection was observed 1âyear after the operation. LESSONS: A hybrid operation might be justified as an alternative to the conventional open surgical procedure, especially for patients with infectious aneurysms caused by weak pathogenic bacteria such as, the BCG mycobacteria.