Ruptured bronchial artery aneurysm associated with bronchiectasis: a case report.

A massive hemothorax from a ruptured bronchial artery aneurysm (BAA) is very rare. Only 12 cases of ruptured mediastinal BAA have been reported. This case study describes a 77-year-old female with bronchiectasis who presented with anemia, hypertension, hemothorax, and a mediastinal mass. A chest tube was inserted through which 2 liters of unclotted blood was drained from the left pleural cavity. An enhanced computed tomography scan revealed a ruptured 3-cm diameter mediastinal aneurysm of a bronchial artery supplying the left lower lobe. Transcatheter artery embolization (TAE) with multiple microcoils was performed successfully. Although the patient needed a transfusion, the subsequent course was uneventful. In the absence of trauma or other causes for hemothorax and mediastinal hemorrhage, the possibility of a BAA should be considered. TAE is the treatment method of choice as a minimally invasive strategy in patients with ruptured BAA.

An animal model for type II endoleaks with use of a tsuzumi drum-shaped stent-graft.

PURPOSE: To create an animal model of type II endoleaks after endoluminal deployment of a specially designed stent-graft (SG). MATERIALS AND METHODS: Five swine were used. A tsuzumi drum-shaped SG consisting of a covered Z stent with its diameter narrowed at the center was deployed in the midthoracic aorta. In this way, a residual space (RS) was created between the aortic wall and the graft to simulate an aneurysm sac. A 5-F catheter was placed into the RS, and then aortography, RS angiography, and pressure measurements were performed. Follow-up was performed at 3 and 10 days after the procedure. Mean pressure indexes (MPIs) were calculated as the ratio of the mean RS pressure to the aortic pressure. Histologic examination was also performed. RESULTS: RSs with two or three pairs of intercostal arteries were successfully created in all cases. Aortography showed two type II endoleaks in five swine just after SG deployment and four type II endoleaks at 10 days. RS angiography showed circulation between the RS and the intercostal arteries in all cases. The mean MPI was 69.4% +/- 10.4% just after SG deployment and increased to 87.8% +/- 5.2% at 10 days. By gross examination, RS patency was retained. CONCLUSIONS: A swine model of type II endoleaks was successfully created endoluminally. This model does not require direct surgery to the aorta and its side branches and promises to be useful to study the mechanism of and therapy for type II endoleaks.

Brachytherapy for the prevention of neointimal hyperplasia in the canine inferior vena cava after stent placement.

The aim of this study was to evaluate the efficacy of brachytherapy for preventing neointimal hyperplasia in the inferior vena cava (IVC) after stent placement. Sixteen beagles underwent Z-stent placement in the IVC and the aorta. For 8 of 16 beagles, irradiation (15 Gy) was delivered endoluminally to the stented segments of each vessel immediately after stent placement using the 192Ir. All animals were sacrificed after 6 weeks for morphometric and histopathologic examination. Morphometrically, neointimal thickness in the IVC of the radiation group was significantly decreased compared with the control group as well as that in the aorta (p < 0.05). Histopathologic findings showed the neointima in the IVC of the control group contained markedly organization of thrombus and neovascularization though that in the IVC of the radiation group consisted mainly of smooth muscle cells without organization of thrombus and neovascularization. From these data intravenous irradiation may prevent clinical restenosis after stent placement.