A technique for reconstruction of a giant extracranial internal carotid artery aneurysm: A technical note.

Background: Surgery is effective for extracranial internal carotid artery (EICA) aneurysms. However, the risk of cranial nerve injury associated with surgical repair, such as graft-assisted resection and extracranial-intracranial bypass techniques, is relatively high. Here, we report two cases of surgical treatment for EICA aneurysms and describe the surgical techniques and strategies to avoid cranial nerve injury. Methods: Two patients presented to our facility with an increasing cervical pulsatile mass and no neurological symptoms. Angiography showed a large aneurysm in the cervical internal carotid artery. Surgical treatment was performed to prevent rupture of the aneurysm. In both patients, the aneurysm was strongly attached to the vagus nerve. The aneurysm and vagus nerve were carefully dissected using a low-power bipolar (20 Malis; 3 watts), leaving connective tissue on the vagus nerve side. Results: The aneurysm was detached from the vagus nerve without injury. Based on intraoperative findings, one patient underwent clipping, and the other underwent aneurysmectomy and primary closure for aneurysm obliteration and angioplasty. Both patients were discharged without any cranial nerve dysfunction. Conclusion: The selection of a strategy based on intraoperative findings and low-power bipolar cutting is important for the treatment of extracranial carotid artery aneurysms to preserve cranial nerves.

A mycotic aneurysm of a jejunal branch treated by aneurysmectomy without bowel resection.

Jejunal artery pseudoaneurysms are extremely rare, accounting for <1% of all visceral artery pseudoaneurysms. Fewer than 50 cases were reported in literature during the previous century. This case report describes the case of a 72-year-old man who underwent aneurysmectomy to treat a 21-mm mycotic jejunal artery pseudoaneurysm found in the setting of endocarditis. This pseudoaneurysm was treated with laparotomy, and gentle dissection of the tissues surrounding the pseudoaneurysm was performed before ligation and resection. This allowed for vascular collateral branch preservation, which, thus, avoided concomitant bowel resection. This report highlights the feasibility of this technique.

Open surgical repair of a giant celiac artery aneurysm with complex anatomy using a retrograde balloon occlusion technique.

Several options exist for the treatment of celiac artery (CA) aneurysms (CAAs), including surgical repair and endovascular procedures. However, treatment of CAAs can be challenging owing to their proximity to the ostium of the CA and involvement of the CA branches. In the present report, we have described a case of a giant CAA extending from the proximal CA to the hepatosplenic bifurcation. Owing to the anatomic complexity of this CAA, proximal control was a major therapeutic concern. The patient underwent open aneurysmectomy using the retrograde balloon occlusion technique to control the inflow of the CAA, with a satisfactory result.

Surgical treatment of left ventricular aneurysm in patients with prior myocardial infarction in the absence of obstructive coronary artery disease (MINOCA): a cohort study.

BACKGROUND: There is a paucity of studies examining the treatment of patients with prior myocardial infarction in the absence of obstructive coronary arteries (MINOCA) and with a concomitant left ventricular aneurysm. Our study aims to illustrate the clinical characteristics and report the mid-term surgical outcomes in this distinct entity. METHODS: Ten patients with MINOCA and left ventricular aneurysm were investigated. The MINOCA was diagnosed according to Scientific Statement from the American Heart Association. The indication for left ventricular reconstruction was as follows: clear evidence of both an aneurysmal and akinetic left ventricle with a history of myocardial infarction accompanied by heart failure symptoms, angina, or ventricular arrhythmias. Major adverse cardiovascular and cerebrovascular events (MACCE), including death, myocardial infarction, stroke was considered the primary endpoints. RESULTS: The median follow-up for the whole study population was 64.5 months. Seven MINOCA patients developed a left ventricular aneurysm within 4 years and three MINOCA patients were found to have a concomitant left aneurysm at the first admission. Before surgery, no patients were prescribed angiotensin-converting enzyme inhibitors. Statins, dual antiplatelet therapy, and ß-blockers were prescribed in 2, 5, and 5 patients, respectively. After surgery, no MACCE occurred in the follow-up. There was a significant increase in ejection fraction (EF) in the follow-up (p = 0.0009). CONCLUSIONS: Close monitoring and standard medical treatment are required before a left ventricular aneurysm occurs in MINOCA patients. Left ventricular reconstruction remains a viable option for MINOCA patients with left ventricular aneurysms and mid-term outcomes were satisfying in this distinct entity.

Giant saccular aneurysm of the cervical internal carotid artery treated with aneurysmectomy and side-to-end anastomosis.

Background: Cervical aneurysms are rare, accounting for <1% of all arterial aneurysms, including dissecting, traumatic, mycotic, atherosclerotic, and dysplastic aneurysms. Symptoms are usually caused by cerebrovascular insufficiency; local compression or rupture is rare. We present the case of a 77-year-old man with a giant saccular aneurysm of the cervical internal carotid artery (ICA), which was treated with aneurysmectomy and side-to-end anastomosis of the ICA. Case Description: The patient had experienced cervical pulsation and shoulder stiffness for 3 months. The patient had no significant medical history. An otolaryngologist performed the vascular imaging and referred the patient to our hospital for definitive management. Neurological deficits were not observed. Digital subtraction angiography showed a giant cervical aneurysm with a diameter of 25 mm within the ICA, and there was no evidence of thrombosis within the aneurysm. Aneurysmectomy and side-to-end anastomosis of the cervical ICA were performed under general anesthesia. After the procedure, the patient experienced partial hypoglossal nerve palsy but fully recovered with speech therapy. Postoperative computed tomography angiography revealed the complete aneurysm removal and patency of the ICA. The patient was discharged on postoperative day 7. Conclusion: Despite several limitations, surgical aneurysmectomy and reconstruction are recommended to eliminate the mass effect and to avoid postoperative ischemic complications, even in the endovascular era.

Pulmonary Artery Aneurysm: A Rarity and Surgical Enigma.

Given the low incidence of pulmonary artery aneurysms (PAAs), proven surgical indications do not yet exist. We present a patient with a 6.3 cm PAA who underwent an open sternotomy, pulmonary artery aneurysmectomy, and repair with an aortic homograft. We discuss surgical indications, including pain, growth in diameter, and diameter of 5.5 cm and larger. The current recommended surgical indication for the size of PAAs is based on recommendations for aortic aneurysms and observation in a small number of operable patients, highlighting the need for more discussion and reporting of this rare presentation.

Refractory electrical storm in a patient with hypertrophic cardiomyopathy and an implantable cardioverter-defibrillator.

A 63-year-old man with hypertrophic cardiomyopathy (HCM), mid-ventricular obstruction, and an apical aneurysm had an episode of cardiac arrest due to sustained ventricular tachycardia (VT). He was resuscitated and an implantable cardioverter-defibrillator (ICD) was implanted. In the following years, several episodes of VT and ventricular fibrillation were successfully terminated by antitachycardia pacing or ICD shocks. Three years after ICD implantation, he was re-admitted because of refractory electrical storm (ES). Since aggressive pharmacological treatments, direct current cardioversions, and deep sedation were not effective, he underwent epicardial catheter ablation which was successful to terminate ES. However, because of the recurrence of refractory ES after one year, he proceeded to surgical left ventricular myectomy with apical aneurysmectomy which provided him a relatively stable clinical course for six years. Although epicardial catheter ablation may be an acceptable option, surgical resection of apical aneurysm seems to be most efficacious for ES in patients with HCM and an apical aneurysm. Learning objectives: In patients with hypertrophic cardiomyopathy (HCM), implantable cardioverter-defibrillators (ICDs) are the gold standard of therapy for prophylaxis against sudden death. Electrical storm (ES) caused by recurrent episodes of ventricular tachycardia can cause sudden death even in patients with ICDs. Although epicardial catheter ablation may be an acceptable option, surgical resection of apical aneurysm is most efficacious for ES in patients with HCM, mid-ventricular obstruction, and an apical aneurysm.

A Novel Approach for the Treatment of Pulmonary Artery Aneurysm Repair Using Inclusion Technique: A Case Report.

Pulmonary artery aneurysm (PAA) is a rare disease with life-threatening complications, especially when accompanied by pulmonary artery hypertension. Due to its rarity, there are currently no specific guidelines for the treatment of PAA. Several surgical techniques have been described to be beneficial in the treatment of PAA originating at the pulmonary trunk. However, several adverse complications have been described for traditional techniques. In this case, we present the first successful repair of PAA with idiopathic pulmonary artery hypertension using a graft inclusion technique.

Successful treatment of a rare 6.5-cm true profunda femoris artery aneurysm with aneurysmectomy and interposition bypass.

Profunda femoris artery aneurysms (PFAAs) are rare and account for only 0.5% of all peripheral artery aneurysms. Potential complications include compression of surrounding nerves and veins, limb ischemia, and rupture. Currently there are no guidelines on the management of true PFAAs, and suggested treatment modalities include endovascular, open, and hybrid approaches. We report a case of an 82-year-old male with a history of aneurysmal disease who presented with a symptomatic 6.5-cm PFAA. He underwent successful aneurysmectomy and interposition bypass, which remains an effective method for treatment of this rare pathology.

Anesthesia with ciprofol in cardiac surgery with cardiopulmonary bypass: A case report.

BACKGROUND: Ciprofol is a novel agent for intravenous general anesthesia. In February 2022, it was approved by the National Medical Products Administration for general anesthesia induction and maintenance. It has the advantages of fast onset, fast elimination, stable circulation, and few adverse reactions. However, the efficacy and safety of ciprofol in cardiac surgery with cardiopulmonary bypass have not been reported. Here we describe a case where ciprofol was successfully used for anesthesia in cardiac surgery with cardiopulmonary bypass. CASE SUMMARY: A 72-year-old man (height 176 cm; weight 70 kg) was diagnosed with coronary atherosclerotic cardiomyopathy requiring coronary artery bypass grafting and left ventricular aneurysmectomy. Ciprofol was administered for induction (0.4 mg/kg) and maintenance (0.6-1.0 mg/kg/h) of general anesthesia. During the entire operation, the bispectral index, hemodynamics, and blood oxygen saturation were maintained at normal levels. The patient recovered well after surgery, with no serious adverse events related to ciprofol. CONCLUSION: Ciprofol is safe and effective for anesthesia in cardiac surgery with cardiopulmonary bypass.

Left ventricular pseudoaneurysmectomy in patient without hemodynamic instability: A case report.

We present a case of a 66-year-old male with a history of two previous diagnoses of myocardial infarction, followed by drug-eluting stent implantation. During the check-up, he complained of dyspnea, fatigue, and dizziness. Echocardiography revealed a massive left ventricular pseudoaneurysm (LVP). According to the patient's clinical manifestations and radiologic data, urgent surgical intervention was performed. Postoperatively, several complications appeared, which were managed successfully. The patient was discharged in stable condition. This is an interesting case of massive LVP without hemodynamic instability.

A case report of an intracranial giant aneurysm in a 10-year-old female

@#Pediatric intracranial aneurysms are rare and differ from aneurysms in adults in terms of location, etiology, natural history and management. This is a case report of giant aneurysm in a 10-year old patient presenting with symptoms of headache and vomiting. Cerebral catheter angiogram revealed a large aneurysm in the left middle cerebral artery, M1 segment. The patient underwent left pterional craniotomy, clip reconstruction of the patent artery, and aneurysmectomy. Post operatively the patient had an unremarkable course and was discharged improved after 1 week. Cerebral catheter angiogram was performed after 2 months and revealed no residual aneurysm.

Right ventricle outflow tract dilatation and pulmonary artery aneurysm, rare cardiac conditions.

We describe a rare case of simultaneous idiopathic right ventricular outflow tract dilatation and idiopathic main pulmonary artery aneurysm. A 59-year-old male presented with complaints of exertional shortness of breath and a cardiac murmur since childhood. CT pulmonary angiogram showed main pulmonary artery dilatation with a diameter of 5.8 cm. Cardiac MRI revealed right ventricular outflow tract dilatation with a diameter of 5.4 cm and a main pulmonary artery aneurysm with a 5.6 cm diameter. Cardiothoracic surgery was consulted for surgical repair. Definitive management of right ventricular outflow tract dilatation and pulmonary artery aneurysms is challenging due to their infrequent diagnosis and lack of established guidelines. The treatment for central aneurysms is surgery which includes aneurysmectomy and right ventricular outflow tract repair or replacement.

Giant aneurysm of left circumflex artery branch with fistula to the coronary sinus: a case report.

BACKGROUND: Aneurysm of a coronary artery branch with a fistula is extremely rare. Here, we present a case of giant aneurysm of the left circumflex artery branch with a fistula to the coronary sinus treated successfully with aneurysmectomy. CASE PRESENTATION: A 58-year-old woman was referred to our hospital due to an abnormal pericardial mass found by multidetector computed tomography. Imaging examination revealed a dilated left circumflex artery branch with a 30-mm aneurysm. Coronary angiography confirmed a left circumflex artery branch aneurysm with a fistula to the coronary sinus. As percutaneous occlusion of the aneurysm by catheterization was considered unsuccessful, the aneurysm was resected, and the fistula was occluded surgically with excellent outcome. Pathological examination suggested that congenital factors may have contributed to the development of the aneurysm. Computed tomography showed no recurrence of the aneurysm at 1-year postoperative follow-up. CONCLUSIONS: We presented a case of giant aneurysm of the left circumflex artery branch with a fistula to the coronary sinus. This is the first report of the combination of a giant coronary artery branch aneurysm with a fistula to the coronary sinus. Surgical aneurysmectomy should be considered in such cases to avoid fatal aneurysmal complications.

Rupture of a deep femoral artery aneurysm with pulsating hematoma: a case report.

True deep femoral artery aneurysms are a rare abnormality of the human vascular system and account for approximately 0.13% of all peripheral arterial aneurysms. We report a 66-year-old man with a ruptured deep femoral artery aneurysm and a pulsating hematoma. The patient underwent urgent endovascular embolization of the aneurysm-supplying artery. Then, 4 days later, in connection with the residual hematoma, which caused severe discomfort to the patient, and also due to the high risk of septic complications in the area of the hematoma, it was decided to perform an open aneurysmectomy and deep femoral artery ligation.

A deep femoral artery aneurysm (a bulge in a blood vessel caused by a weakness in the blood vessel wall) is a rare abnormality of the human vascular system. A ruptured aneurysm can cause serious health problems such as bleeding, hemorrhagic shock and even death. We report a 66-year-old man with a ruptured femoral artery aneurysm. The patient underwent urgent intravascular plugging of the artery supplying the aneurysm. Then, 4 days later, in connection with the residual hematoma, which caused severe discomfort to the patient, and also due to the high risk of complications, it was decided to perform an open operative excision of the aneurysm. The postoperative period and 2-year follow-up were uneventful.

Mending the broken valentine heart: a case report.

Background: Mortality from myocardial infarction (MI) has been decreasing since the introduction of primary percutaneous intervention. Late complications still pose a dilemma, such as deterioration of left ventricle (LV) function, LV aneurysms, and LV thrombus formation. If not adequately managed in a timely manner, this can result in life-threatening consequences. Restoration of LV function by surgical resection of the infarcted LV wall is an option for a few complicated cases, with variable outcomes. Case summary: A 66-year-old man presented with dyspnoea 2 years after his initial MI, which was treated with a drug-eluting stent to his left circumflex artery. His Warfarin had been stopped after 6 months of treatment of a small LV thrombus, which was noted at the time of his initial infarction. His echocardiogram on admission demonstrated severe LV systolic impairment of 23% (which had deteriorated from 40%) with a giant true aneurysm of the basal to mid-lateral wall, which resembled a Valentine heart. The presence of a large, organized thrombus filling the aneurysm complicated the case further. The patient underwent a resection of the LV aneurysm and thrombus. He remained asymptomatic and maintained a significant improvement of his LV function to 47% at his 5 months scan. Discussion: The importance of imaging post-large MI and follow-up imaging once thrombus resolution has occurred is crucial. Patients with large LV aneurysm associated with severe refractory LV impairment and LV thrombus should be considered for LV aneurysmectomy for prognostic benefit and symptom relief.

Left Ventricular Pseudoaneurysm With a Bead-Like Appearance After Myocardial Infarction: The Utility of Cardiac Computed Tomography.

A left ventricular pseudoaneurysm is a rare but life-threatening complication after myocardial infarction. Because untreated pseudoaneurysms have a 30%-45% risk of rupture, surgery is the preferred therapeutic option. However, its diagnosis is sometimes challenging, as a pseudoaneurysm presents with non-specific symptoms that can mimic myocardial infarction or heart failure. We report a male patient with a history of aortic dissection surgery who presented with recurrent chest pain probably due to acute coronary syndrome. Transthoracic echocardiography revealed a cavity at the apex of the left ventricle, indicating a mechanical complication after myocardial infarction. As the coronary angiography was considered difficult because of the patient's anatomical problem, contrast-enhanced computed tomography (CT) was performed. CT angiography revealed multiple nodular cavities continued from within the left ventricle. It seemed that the pseudoaneurysm was formed in stages in the adherent pericardium after myocardial infarction, resulting in a bead-like appearance. Emergent pseudoaneurysmectomy and left ventricular wall repair were performed, and the patient was discharged without any complications. This case illustrates the utility of cardiac CT to establish the diagnosis of left ventricular pseudoaneurysm and coronary artery atherosclerosis.

Aneurisma aislado y asintomático en la arteria ilíaca común derecha / Isolated and asymptomatic aneurysm in the right common iliac artery

Los aneurismas de la arteria ilíaca aislados son extremadamente raros y representan solo entre el 2 por ciento y el 7 por ciento de todos los aneurismas intraabdominales. Este artículo tuvo como objetivo asociar los criterios actuales para el tratamiento quirúrgico en los aneurismas aislados y asintomáticos en la arteria ilíaca común. Se presenta un paciente masculino de 62 años, fumador, remitido del departamento de radiología, porque se observó en el ultrasonido abdominal dilatación aneurismática en arteria ilíaca común derecha. En la tomografía computarizada contrastada se confirmó aneurisma aislado con diámetros quirúrgicos. Se decidió operar y se realizó aneurismectomía más injerto por sustitución protésica con dacrón ilio-ilíaco, con una evolución clínica posoperatoria inmediata y tardía satisfactoria. El tratamiento de referencia para el aneurisma de la arteria ilíaca común ha sido la reparación quirúrgica abierta con injertos protésicos. El algoritmo de decisión se basó en el riesgo de ruptura, que depende a su vez del diámetro aneurismático y del ritmo de crecimiento. Actualmente, el umbral para la reparación electiva de la arteria ilíaca aislada puede considerarse con un mínimo de 3,5 cm de diámetro, pero existe nueva evidencia científica de que muchos pacientes pueden someterse a un tratamiento innecesario si se utiliza este diámetro. Esta es una entidad especial, no solo por su infrecuencia sino también por la mayor complejidad de su reparación(AU)

Isolated iliac artery aneurysms are extremely rare and account for only 2 percent to 7 percent of all intra-abdominal aneurysms. This article aimed to associate current criteria for surgical treatment in isolated and asymptomatic aneurysms in the common iliac artery. A 62-year-old male patient, smoker, referred from the radiology department, is presented because aneurysmal dilation was observed in the abdominal ultrasound in the right common iliac artery. The contrasted computed tomography confirmed an isolated aneurysm with surgical diameters. It was decided to operate and aneurysmectomy plus grafting was performed by prosthetic replacement with ilio-iliac dacron, with a satisfactory immediate and late postoperative clinical evolution. The reference treatment for common iliac artery aneurysm has been open surgical repair with prosthetic grafts. The decision algorithm was based on the risk of rupture, which in turn depends on the aneurysmal diameter and the rate of growth. Currently, the threshold for elective repair of the isolated iliac artery can be considered to be a minimum of 3.5 cm in diameter, but there is new scientific evidence that many patients may undergo unnecessary treatment if this diameter is used. This is a special entity, not only because of its infrequency but also because of the higher complexity of its repair(AU)

Renal artery aneurysm misdiagnosed as a pelvic stone: A case report.

INTRODUCTION AND IMPORTANCE: Renal artery aneurysm (RAA) is an extremely rare condition that is usually symptomless and may be diagnosed by a chance in imaging. However, misdiagnosis is not out of mind and few cases of misdiagnosis of RAA with renal stone have been reported. Misdiagnosis leads to wrong treatment, so it is very important for the correct diagnosis. CASE PRESENTATION: We reported a similar case in a 57 years old female that referred with right flank pain and ultrasonography and computed tomography (CT) scan reported a calcified mass, resembling renal stone. Through the operation the RAA was diagnosed; however, the mass was damaged and the patient underwent aneurysmectomy. Although she was a single kidney case, collateral circulation saved the kidney. CLINICAL DISCUSSION: The patients may be asymptomatic or may present symptoms like treatment-resistant hypertension, hematuria, thrombosis, renal infarction, abdominal, or flank pain. As literature shows the diagnosis of RAA is challenging and affects patients' timely treatment. Our patient, who was a single kidney person, also survived the condition with no nephrectomy. The case of our study was single kidney and the collateral vessels give a further chance to kidney for survival. Although the affected artery was not further used, the collateral vessels circulation helped the kidney and the patient survived nephrectomy. She was discharged with a normal state and normal urination. CONCLUSION: The timely diagnosis may help the patient with less invasive treatments.