Un aneurisma de aorta abdominal roto revela una enfermedad de Behçet / Ruptured abdominal aortic aneurysm reveals Behçet’s disease

Introducción: la enfermedad de Behçet es una vasculitis sistémica de etiología desconocida que afecta generalmente a adultos jóvenes y que puede producir manifestaciones sistémicas (oftálmicas, neurológicas, cardíacas, pulmonares, vasculares y renales) que con frecuencia son la causa final de muerte de estos pacientes. Caso clínico: presentamos el caso clínico de un paciente varón de 56 años con criterios clínicos para el diagnóstico de la enfermedad de Behçet (lesión oral y ulceración genital recurrente) que presentó la rotura de un aneurisma de aorta abdominal. El tratamiento quirúrgico fue mediante resección del aneurisma y reparación de la aorta asociado a terapia inmunosupresora. El posoperatorio cursó con buena evolución. Discusión: la enfermedad de Behçet se asocia con frecuencia a manifestaciones vasculares a diferentes niveles, por lo que el tratamiento debe individualizarse.(AU)

Background: Behçet´s disease is a systemic vasculitis of unknown etiology, which generally affects young adults and can produce systemic manifestations (ophthalmic, neurological, cardiac, pulmonary, vascular and renal), which are often the final cause of death in these patients.Case report: we present the clinical case of a 56-year-old male patient with clinical criteria for the diagnosis of Behçet’s disease (oral lesion and recurrent genital ulceration) who presented a ruptured abdominal aortic aneurysm. Surgical treatment was by resection of the aneurysm and repair of the aorta associated with immunosuppressive therapy. The postoperative period evolved satisfactorily. Disussion: Behçet´s disease is frequently associated with vascular manifestations at different levels, so treatment must be individualized.(AU)

Combined aortic mural thrombi and limb ischemia in inflammatory bowel disease - A rare vascular manifestation.

Venous thrombosis in the context of inflammatory bowel diseases has become a traditional complication, unlike arterial thrombosis, which remains very rare. We present the case of a patient with acute limb ischemia and aortic mural thrombosis as a complication of ulcerative colitis.

TEVAR for thoracic mycotic aneurysm: Case report.

INTRODUCTION: Mycobacterium tuberculosis is a cause of mycotic aortic pseudoaneurysms, wich are a rare case with high mortality rates. Three types of dissemination hematogenous by contiguity and direct to the aortic wall are possibles. PRESENTATION OF CASE: We report a rare case of tuberculous thoracic aortic pseudo aneurysm, successfully treated endovascularly associated to antituberculosis drugs. DISCUSSION: Classically TB pseudoaneurisms have been treated with open surgical therapy.however, they are associated to high morbidity and mortaity with increased lenghts of hospital stay. Due to advancements of endovascular technology, it be cames a good and successful alternative as a treatment, with a background of medical treatment. CONCLUSION: Thoracic endovascular aneurysm repair (TEVAR) associated to anti-tuberculosis medication have revolutionized the management and improved the prognosis of this pathology.

Pseudoaneurysm of the subclavian artery following clavicle fracture due to blunt traumatism: a case report.

The clavicle fractures are frequent, vascular injuries associated with closed fractures of clavicle are rare. The pseudoaneurysms of the subclavian artery constitute an exceptional complication. We report a case of a 40-year-old who presented an expanding hematoma of the right side of the neck after a road traffic accident. Radiography of the right shoulder showed a midclavicular fracture. An arterial doppler of vessels showed a circulating hematoma in the contact of the right subclavian artery with a correct distality flow. Computed tomographic angiogram of the chest confirmed the diagnosis of a false aneurysm in the postvertebral portion of the right subclavian artery. The treatment was surgical and consisted of excision of the false aneurysm and a repair of the arterial injury by an arterial patch, the clavicle was fixed with a reconstruction plate and screws. Early intervention appears to be indicated due to the risk of thrombo-embolic complications. Endovascular repair appears to be the preferred treatment modalities, due to a lower rate of cardiopulmonary complications, but it is reserved for much selected cases.

The persistent sciatic artery: Report of ten cases.

OBJECTIVE: The persistent sciatic artery (PSA) is a rare congenital anomaly with a high rate of aneurysm formation, occlusion and stenosis. It may lead to severe complications including thrombosis, distal embolisation, or aneurysm rupture. We reported herein our experience in the management of PSA and its complications, and discuss the therapeutic options. METHODS: Eight patients with 10 PSA were managed in our institutions between 1985 and 2017. An analysis was done for the clinical data, surgical technique, and results. RESULTS: The series included six women and two men. The median age of the patients was 66,5 years (37-80 years). Physical examination found a pulsatile gluteal mass in five patients, sciatic neuropathy in two cases. Four patients had an acute ischemia of the lower limb. Cowie's sign was described in only two patients (diminished or absent femoral pulse but presence of popliteal pulse). Digital subtraction angiography was performed in all patients, and was completed with a computed tomography angiography (CTA) with a diagnosis of PSA, associated with a symptomatic aneurysmal lesion in seven cases and with an occlusion in one case. The treatment was surgical in all cases: bipolar exclusion of the aneurysm and bypass between the iliac artery and the PSA distal to the aneurysm was performed in four cases, only proximal and distal ligation was done in 2 other cases. A Chopart amputation was necessary in 2 cases. CONCLUSION: We consider that the treatment of PSA is usually surgical in symptomatic cases. Surgical techniques depend on symptoms and classification describing anatomy of the PSA. However, future studies should compare the open versus the endovascular approach to optimize patient selection criteria and identify the most safe and effective strategy. In an asymptomatic patient, PSA does not require any intervention; continued follow-up is required because of the high incidence of aneurysmal formation and the risk of thromboembolic events.

Pseudoaneurysm of external iliac artery after extracorporeal shock wave lithotripsy revealing Behçet disease.

Extracorporeal shock wave lithotripsy (ESWL) can lead to rare but severe arterial complications. The causal relationship of ESWL with arterial pseudoaneurysm formation in a patient with Behçet disease is discussed. A 35-year-old man presented with acute recrudescence of right flank pain caused by ureteral lithiasis immediately after having undergone a last session of ESWL. Abdominal examination revealed a painful pulsatile mass in the right iliac region. Contrast-enhanced computed tomography identified a pseudoaneurysm of the right external iliac artery in a patient with a medical history of Behçet disease. The pseudoaneurysm was treated endovascularly, including the use of a covered stent with intensive immunosuppressive therapy. We obtained successful exclusion of the pseudoaneurysm. This case highlights that arterial pseudoaneurysm may occur after ESWL in patients with Behçet disease. Strict follow-up after ESWL sessions is necessary.

Dysphagia lusoria: report of a series of six cases.

Dysphagia lusoria is a rare cause of organic dysphagia. This report describes a series of six patients admitted to our university hospital for dysphagia lusoria. Dysphagia was a constant feature in all our patients. Upper gastrointestinal endoscopy and a barium esophagram prompted the diagnosis, which was confirmed by angiography of the aortic arch showing an aberrant right subclavian artery in all cases. Treatment was surgical in all patients with good results.

Endovascular management of severe bleeding after major abdominal surgery.

BACKGROUND: In this study we analyzed embolization and stent-graft results. METHODS: Demographics, indications, procedures, and outcomes of patients treated with embolization or stent grafting for late postoperative bleeding after major abdominal surgery were retrospectively recorded. Outcomes were analyzed on an intention-to-treat basis. RESULTS: Between 2004 and 2008, 14 consecutive patients (11 men and 3 women, mean age 64 years) were treated for hemorrhage responsible for shock in 6 patients (43%), occurring after pancreaticoduodenectomy (n=13) or subtotal gastrectomy (n=1). Mean onset occurred at 23 days postoperatively (range 7-75 days). Bleeding site included: the stump of the gastroduodenal artery (n=10), splenic artery (n=2), common hepatic artery (n=1), and right gastric artery (n=1). Initial success was obtained in 13 patients (93%); the only failure of stent-graft deployment required re-laparotomy. Treatment included embolization in 8 patients and stent grafting in 5 patients. In the embolization group, 5 complications (62%) occurred: 4 rebleeding and 1 gastric perforation, compared with no early complications in the stent-graft group. One patient died in each group. The mean follow-up was 25 months (range 6-57 months). CONCLUSIONS: Stent grafting seems to provide definitive hemostasis and fewer complications compared with embolization.

Laparoscopic transposition of the left renal vein into the inferior vena cava for nutcracker syndrome.

Reimplantation of the left renal vein into the infrarenal inferior vena cava is the standard surgical procedure for nutcracker syndrome. A 40-year-old woman with a solitary left kidney suffered from left lumbar pain and hematuria. Imaging techniques found a large kidney with nutcracker syndrome. A totally laparoscopic transposition of the left renal vein was performed. Twelve months later, the patient is improved and has no more hematuria. Duplex scan showed no residual stenosis. Laparoscopic transposition of the left renal vein into the inferior vena cava is feasible with short length of stay and good short-term result.