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1.
Port J Card Thorac Vasc Surg ; 30(4): 75-79, 2024 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-38345877

RESUMO

INTRODUCTION: Popliteal artery aneurysms (PAA) can be very challenging, especially in cases of very large PAAs, with a minimal number of case reports published in the literature. METHODS: This is a case report of a 68-year-old male patient with hypertension, hyperlipidemia, diabetes, and schizophrenia who was found to have a giant (10x8x6cm) partially thrombosed PAA, treated with interposition polytetrafluoroethylene (PTFE) graft via a posterior approach. RESULTS: Under general anesthesia, the patient was placed in a prone position, and an extended lazy "S" incision was made on the popliteal fossa. After obtaining proximal and distal exposure, the aneurysm sac was skeletonized, preserving the popliteal vein and the tibial nerve. After proximal and distal control was obtained, the patient was systemically heparinized, and the aneurysm sac was opened. Some genicular branches were ligated inside the aneurysm, and part of the aneurysm sac was excised. A 7 mm PTFE graft was used for reconstruction in an end-to-end fashion. Suction drains were placed in the popliteal space, and the fascia and skin were approximated. The patient was discharged home on the 2nd postoperative day on aspirin and statin with ultrasound surveillance. The patient has remained asymptomatic during follow-up with a patent graft. CONCLUSIONS: Open surgical repair constitutes the gold standard of care for huge PAAs to prevent distal thromboembolic events and mass pressure effects from the aneurysm. Documentation of additional experience with open repair of huge PAAs would be beneficial and could help clinical decision-making.


Assuntos
Aneurisma , Aneurisma da Artéria Poplítea , Masculino , Humanos , Idoso , Aneurisma/diagnóstico , Joelho , Extremidade Inferior , Politetrafluoretileno , Artéria Poplítea/diagnóstico por imagem
4.
J Pak Med Assoc ; 74(2): 341-365, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38419237

RESUMO

Objective: To identify and critically appraise literature on true brachial artery aneurysm, exploring its demographic characteristics, aetiologies, clinical manifestations and different methods of repair along with complication rates to determine future treatment strategies. METHODS: The systematic review was conducted at Liaquat National Hospital, Karachi, from September 30, 2021, to November 30, 2022, in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Literature was searched on MEDLINE, EMBASE and Cochrane databases for relevant studies in English language or with English translation published till May 31, 2022. The key words used for the search were "brachial artery aneurysm". Data was noted on a proforma and was subjected to descriptive analysis. RESULTS: Of 113 articles, 6 (5.3%) were retrospective studies, 7 (6.1%) were case series and 100 (88.4%) were case reports. The total number of patients involved was 157 with mean age 43.1±23.4 years (range: 2 months to 84 years). The gender was mentioned for 152(96.8%) patients; 111(73%) males and 41(27%) females. The mean diameter of true brachial artery aneurysm was 36.2 ±17.5mm and 106(67.5%) patients presented with localised swelling, 65(41.4%) with pain, 41(26.1%) with distal ischaemic symptoms, and 28(17.8%) with median nerve compression. True brachial artery aneurysms were more common in renal failure patients having a history of arteriovenous fistula creation in the affected limb and were on immunosuppressant drugs due to renal transplant 81(51.5%). Less common causes included primary/idiopathic 27(17.1%), trauma 13(8.2%), connective tissue disorders 8(5%) and vasculitis 7(4.5%). The treatment of choice was aneurysmectomy in 142(90.4%) cases, with revascularisation of limb primarily with reversed great saphenous vein graft 79(50.3 %), followed by end-to-end anastomosis of brachial artery 17(10.8%) and synthetic grafting 17(10.8%). Endovascular intervention was performed in 6(3.8%) cases to exclude true brachial artery aneurysm, and to re-establish adequate blood flow to the associated limb. Conclusion: True brachial artery aneurysm, although a rarity, may lead to significant neurological and vascular problems if ignored. Arteriovenous fistula and immunosuppression are identified as two significant risk factors in the development of true brachial artery aneurysm. Therefore, an effective long-term follow up in renal failure patients is recommended to prevent its complications. Open surgical repair has been the most preferred mode of treatment, but further significant studies are needed to explore and compare different modes of surgical intervention, like open versus endovascular, to plan future treatment strategies.


Assuntos
Aneurisma , Fístula Arteriovenosa , Insuficiência Renal , Masculino , Feminino , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Artéria Braquial/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Aneurisma/cirurgia , Insuficiência Renal/complicações
5.
Sci Rep ; 14(1): 4803, 2024 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-38413764

RESUMO

To investigate the endothelialization of covered and bare stents deployed in the canine carotid arteries and subclavian arteries for treating experimental aneurysms and arteriovenous fistulas, twenty aneurysms were created in 10 dogs, and 20 fistulas in another 10 dogs. The Willis balloon-expandable covered stent and a self-expandable covered stent were used to treat these lesions, and a self-expandable bare stent was deployed in the subclavian artery for comparison. Followed up for up to 12 months, the gross observation, pathological staining, and scanning electronic microscopic data were analyzed. Two weeks after creation of animal model, thirty self-expandable covered stents and ten balloon-expandable covered stents were deployed. Fifteen bare stents were deployed within the left subclavian arteries. Twenty days after stenting, the aneurysm significantly shrank. At 6 months, the thrombi within the aneurysm cavity were organized. Three to 12 months later, most covered and bare stents were covered by a thin transparent or white layer of endothelial intima. Layers of intima or pseudomembrane were formed on the stent 20-40 days after stent deployment. Over three months, the pseudomembrane became organized, thinner, and merged into the vascular wall. Under scanning electronic microscopy, the surface of covered and bare stents had only deposition of collagen fibers and rare endothelial cells 20-40 days after stenting. From three to ten months, the endothelial cells on the internal surface of stent became mature, with spindle, stripe-like or quasi round morphology along the blood flow direction. Over time, the endothelial cells became mature. In conclusion, three months after deployment in canines' arteries, the self-expandable bare and covered stents have mostly been covered by endothelial cells which become maturer over time, whereas the balloon-expandable covered stents do not have complete coverage of endothelial cells at three months, especially for protruding stent struts and areas. Over time, the endothelialization will become mature.


Assuntos
Aneurisma , Fístula Arteriovenosa , Cães , Animais , Células Endoteliais , Aneurisma/cirurgia , Aneurisma/patologia , Stents/efeitos adversos , Artérias Carótidas/cirurgia , Artérias Carótidas/patologia , Fístula Arteriovenosa/patologia , Politetrafluoretileno
6.
BMJ Case Rep ; 17(2)2024 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-38417939

RESUMO

Skull base osteomyelitis can be more life-threatening in immunocompromised patients and patients with diabetes. Here, we present a case of a petrous internal carotid artery pseudoaneurysm resulting from skull base osteomyelitis in a diabetic male in his 50s. This case report highlights the need to be conscious of the various complications associated with skull base osteomyelitis, be proficient in detecting them and treat them as early as possible for better outcomes. After adequate control of the disease process with medical treatment, immediate management of the aneurysm with balloon angioplasty and stenting was done. Acknowledging the trivial nasal and ear bleed, radiological evaluation is necessary to rule out rare complications like pseudoaneurysms in a diagnosed case of skull base osteomyelitis. In the discussion, we have cited the various treatment methods and similar cases of pseudoaneurysm caused by osteomyelitis. Currently, the patient continues to live a disease and disability-free life.


Assuntos
Falso Aneurisma , Aneurisma , Osteomielite , Humanos , Masculino , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Aneurisma/complicações , Radiografia , Artéria Carótida Interna/cirurgia , Osteomielite/diagnóstico por imagem , Osteomielite/terapia , Osteomielite/complicações
7.
Vascular ; 32(1): 32-41, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38308424

RESUMO

BACKGROUND: Popliteal artery aneurysms (PAA) were traditionally treated by open repair (OR). Endovascular repair (ER) has become a new treatment strategy. The aim of this systemic review and meta-analysis was to evaluate and compare the current outcomes of OR and ER in the emergency treatment of PAA. METHODS: A systematic literature search of the PubMed/Medline database was carried out. Outcomes were 30-day mortality, morbidity, major amputation rate (30 days), major amputation rate (1 year), 1-year primary patency rate, 1-year secondary patency rate and 1-year survival. Additionally, we included clinical data of patients with popliteal aneurysms treated between 2009 and 2021 at the Martin-Luther University Halle-Wittenberg. RESULTS: We identified two cohort studies from 2014 and 2015 with a total of 199 patients that underwent emergent surgery (39 ER and 160 OR). We also included 26 patients from our institution. For emergency treatment, 30-day major amputation rates (18% vs 3%, Odds Ratio 5.82, 95% CI [1.75; 19.30], p = .004), 30-day mortality rates (10% vs 1%, Odds Ratio 5.57, 95% CI [1.01; 30.58], p = .05), 1-year major amputation rates (15% vs 6% Odds Ratio 3.61, 95% CI [1.18; 11.09], p = .02), 1-year loss of primary patency (54% vs 23%, Odds Ratio 3.19, 95% CI [0.91; 11.20], p = .07), and 1-year loss of secondary patency (44% vs 12%, Odds Ratio 6.91, 95% CI [3.01; 15.83], p < .05) were higher in the ER group when compared to the OR group. CONCLUSION: Endovascular repair represents an alternative approach for the emergency treatment of PAA. Limited evidence from the available non-randomized studies shows unfavorable outcomes for patients undergoing ER. However, the results are prone to selection bias, and only randomized trials comparing ER to OR might reveal whether a subgroup of patients would benefit from ER as primary treatment of PAA in an emergency setting.


Assuntos
Aneurisma , Procedimentos Endovasculares , Aneurisma da Artéria Poplítea , Humanos , Grau de Desobstrução Vascular , Salvamento de Membro , Resultado do Tratamento , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Aneurisma/etiologia , Tratamento de Emergência , Estudos Retrospectivos , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/cirurgia , Fatores de Risco
8.
Comput Assist Surg (Abingdon) ; 29(1): 2311940, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38315080

RESUMO

OBJECTIVES: We aimed to prospectively investigate the benefit of using augmented reality (AR) for surgery residents learning aneurysm surgery. MATERIALS AND METHODS: Eight residents were included, and divided into an AR group and a control group (4 in each group). Both groups were asked to locate an aneurysm with a blue circle on the same screenshot after their viewing of surgery videos from both AR and non-AR tests. Only the AR group was allowed to inspect and manipulate an AR holographic representation of the aneurysm in AR tests. The actual location of the aneurysm was defined by a yellow circle by an attending physician after each test. Localization deviation was determined by the distance between the blue and yellow circle. RESULTS: Localization deviation was lower in the AR group than in the control group in the last 2 tests (AR Test 2: 2.7 ± 1.0 mm vs. 5.8 ± 4.1 mm, p = 0.01, non-AR Test 2: 2.1 ± 0.8 mm vs. 5.9 ± 5.8 mm, p < 0.001). The mean deviation was lower in non-AR Test 2 as compared to non-AR Test 1 in both groups (AR: p < 0.001, control: p = 0.391). The localization deviation of the AR group decreased from 8.1 ± 3.8 mm in Test 2 to 2.7 ± 1.0 mm in AR Test 2 (p < 0.001). CONCLUSION: AR technology provides an effective and interactive way for neurosurgery training, and shortens the learning curve for residents in aneurysm surgery.


Assuntos
Aneurisma , Realidade Aumentada , Cirurgia Assistida por Computador , Humanos , Curva de Aprendizado , Cirurgia Assistida por Computador/métodos , Procedimentos Neurocirúrgicos/métodos
9.
J Biomed Mater Res B Appl Biomater ; 112(2): e35385, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38345190

RESUMO

Insufficient healing of aneurysms following treatment with vascular occlusion devices put patients at severe risk of fatal rupture. Therefore, promoting healing and not just occlusion is vital to enhance aneurysm healing. Following occlusion device implantation, healing is primarily orchestrated by macrophage immune cells, ending with fibroblasts depositing collagen to stabilize the aneurysm neck and dome, preventing rupture. Several modified occlusion devices are available currently on-market. Previous in vivo work demonstrated that modifications of occlusion devices with a shape memory polymer foam had enhanced aneurysm healing outcomes. To better understand cellular response to occlusion devices and improve aneurysm occlusion device design variables, we developed an in vitro assay to isolate prominent interactions between devices and key healing players: macrophages and fibroblasts. We used THP-1 monocyte derived macrophages and human dermal fibroblasts in our cell culture models. Macrophages were allowed device contact with on-market competitor aneurysm occlusion devices for up to 96 h, to allow for any spontaneous device-driven macrophage activation. Macrophage secreted factors were captured in the culture media, in response to device-specific activation. Fibroblasts were then exposed to device-conditioned macrophage media (with secreted factors alone), to determine if there were any device-induced changes in collagen secretion. Our in vitro studies were designed to test the direct effect of devices on macrophage activation, and the indirect effect of devices on collagen secretion by fibroblasts to promote aneurysm healing and stabilization. Over 96 h, macrophages displayed significant migration toward and interaction with all tested devices. As compared to other devices, shape memory polymer foams (SMM, Shape Memory Medical) induced significant changes in gene expression indicating a shift toward an anti-inflammatory pro-healing M2-like phenotype. Similarly, macrophages in contact with SMM devices secreted more vascular endothelial growth factor (VEGF) compared with other devices. Macrophage conditioned media from SMM-contacted macrophages actively promoted fibroblast secretion of collagen, comparable to amounts observed with exogenous stimulation via VEGF supplementation. Our data indicate that SMM devices may promote good aneurysm healing outcomes, because collagen production is an essential step to ultimately stabilize an aneurysm.


Assuntos
Aneurisma , Materiais Inteligentes , Humanos , Fator A de Crescimento do Endotélio Vascular/metabolismo , Macrófagos/metabolismo , Aneurisma/terapia , Colágeno/metabolismo , Meios de Cultivo Condicionados/metabolismo , Meios de Cultivo Condicionados/farmacologia , Materiais Inteligentes/metabolismo , Fibroblastos
11.
G Ital Cardiol (Rome) ; 25(3): 176-178, 2024 Mar.
Artigo em Italiano | MEDLINE | ID: mdl-38410899

RESUMO

Cervical aortic arch is a rare malformation that often has anatomical abnormalities of the supra-aortic trunks and may also be associated with aortic stenosis, aneurysms, or cardiac malformations. To correct them, symptomatic patients undergo surgery, which usually consists of a prosthetic graft repair, aortoplasty patch, or an end-to-end anastomosis. In addition, circulatory arrest and deep hypothermia are often required, as in aortic arch surgery. We report the case of a 13-year-old patient who underwent correction of a right cervical aortic arch stenosis with a post-stenotic aneurysm between the origin of the right carotid artery and the right subclavian artery. The anatomy of the aortic branches was abnormal. The surgical procedure consisted of an extensive resection with direct end-to-end anastomosis, without the use of a prosthetic graft, using moderate hypothermic cardiopulmonary bypass and without circulatory arrest.


Assuntos
Aneurisma , Aneurisma da Aorta Torácica , Parada Cardíaca , Cardiopatias Congênitas , Humanos , Adolescente , Aorta Torácica/cirurgia , Resultado do Tratamento , Ponte Cardiopulmonar , Aneurisma da Aorta Torácica/cirurgia
12.
Neurosurg Rev ; 47(1): 41, 2024 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-38206429

RESUMO

The utilization of the internal maxillary artery (IMAX) in subcranial-intracranial bypass for revascularization in complex aneurysms, tumors, or refractory ischemia shows promise. However, robust evidence concerning its outcomes is lacking. Hence, the authors embarked on a systematic review with pooled analysis to elucidate the efficacy of this approach. We systematically searched PubMed, Embase, and Web of Science databases following PRISMA guidelines. Included articles used the IMAX as a donor vessel for revascularizing an intracranial area and reported at least one of the following outcomes: patency, complications, or clinical data. Favorable outcomes were defined as the absence of neurologic deficits or improvement in the baseline condition. Complications were considered any adverse event directly related to the procedure. Out of 418 retrieved articles, 26 were included, involving 183 patients. Among them, 119 had aneurysms, 41 experienced ischemic strokes (transient or not), 2 had arterial occlusions, and 3 had neoplasia. Furthermore, 91.8% of bypasses used radial artery grafts, and 87.9% revascularized the middle cerebral artery territory. The median average follow-up period was 12 months (0.3-53.1). The post-operation patency rate was 99% (95% CI: 97-100%; I2=0%), while the patency rate at follow-up was 82% (95% CI: 68-96%; I2=77%). Complications occurred in 21% of cases (95% CI: 9-32%; I2=58%), with no significant procedure-related mortality in 0% (95% CI: 0-2%; I2=0%). Favorable outcomes were observed in 88% of patients (95% CI: 81-96%; I2=0%), and only 3% experienced ischemia (95% CI: 0-6%; I2=0%). The subcranial-intracranial bypass with the IMAX shows excellent postoperative patency and considerable favorable clinical outcomes. While complications exist, the procedure carries a minimal risk of mortality. However, long-term patency presents heterogeneous findings, warranting additional research.


Assuntos
Aneurisma , AVC Isquêmico , Humanos , Artéria Maxilar , Bases de Dados Factuais , Isquemia
13.
Acta Neurochir (Wien) ; 166(1): 17, 2024 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-38231317

RESUMO

PURPOSE: In aneurysmal intracerebral hemorrhage (aICH), our review showed the lack of the patient's individual (i) timeline panels and (ii) serial brain CT/MRI slice panels through the aICH evacuation and neurointensive care until the final brain tissue outcome. METHODS: Our retrospective cohort consists of 54 consecutive aICH patients from a defined population who acutely underwent the clipping of a middle cerebral artery bifurcation saccular aneurysm (Mbif sIA) with the aICH evacuation at Kuopio University Hospital (KUH) from 2010 to 2019. We constructed the patient's individual timeline panels since the emergency call and serial brain CT/MRI slice panels through the aICH evacuation and neurointensive care until the final brain tissue outcome. The patients were indicated by numbers (1.-54.) in the pseudonymized panels, tables, results, and discussion. RESULTS: The aICH volumes on KUH admission (median 46 cm3) plotted against the time from the emergency call to the evacuation (median 8 hours) associated significantly with the rebleeds (n=25) and the deaths (n=12). The serial CT/MRI slice panels illustrated the aICHs, intraventricular hemorrhages (aIVHs), residuals after the aICH evacuations, perihematomal edema (PHE), delayed cerebral injury (DCI), and in the 42 survivors, the clinical outcome (mRS) and the brain tissue outcome. CONCLUSIONS: Regarding aICH evacuations, serial brain CT/MRI panels present more information than words, figures, and graphs. Re-bleeds associated with larger aICH volumes and worse outcomes. Swift logistics until the sIA occlusion with aICH evacuation is required, also in duty hours and weekends. Intraoperative CT is needed to illustrate the degree of aICH evacuation. PHE may evoke uncontrollable intracranial pressure (ICP) in spite of the acute aICH volume reduction.


Assuntos
Aneurisma , Artéria Cerebral Média , Humanos , Encéfalo , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/cirurgia , Progressão da Doença , Hematoma , Imageamento por Ressonância Magnética , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
14.
Acta Neurochir (Wien) ; 166(1): 27, 2024 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-38261093

RESUMO

Adenosine induced cardiac arrest (AiCA) is one of the methods used to facilitate microsurgical aneurysm clipping by providing more visibility and less pressure in the aneurysmal sac and neighboring vessels. We report the use of laser speckle contrast imaging (LSCI) during AiCA to monitor the changes in pulsation and perfusion on the cortical surface during adenosine induced cardiac arrest for aneurysm clipping surgery. Application of this technology for perfusion monitoring may improve workflow and surgical guidance and provide valuable feedback continuously throughout the procedure. ClinicalTrials.gov identifier: NCT0502840.


Assuntos
Aneurisma , Imagem de Contraste de Manchas a Laser , Humanos , Perfusão , Adenosina , Parada Cardíaca Induzida
15.
Acta Neurochir (Wien) ; 166(1): 11, 2024 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-38227061

RESUMO

BACKGROUND: The pterional or frontosphenotemporal craniotomy has stood the test of time and continues to be a commonly used method of managing a variety of neurosurgical pathology. Already described in the beginning of the twentieth century and perfected by Yasargil in the 1970s, it has seen many modifications. These modifications have been a normal evolution for most neurosurgeons, tailoring the craniotomy to the patients' specific anatomy and pathology. Nonetheless, an abundance of variations have appeared in the literature. METHODS: A search strategy was devised according to the 2020 Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) statement. To identify articles investigating the variations in the pterional approach, the following search terms were applied: (pterional OR minipterional OR supraorbital) AND (approach OR craniotomy OR technique). RESULTS: In total, 3552 articles were screened with 74 articles being read in full with 47 articles being included for review. Each article was examined according the name of the technique, temporalis dissection technique, craniotomy technique and approach. CONCLUSION: This systematic review gives an overview of the different techniques and modifications to the pterional craniotomy since it was initially described. We advocate for the use of a more standardised nomenclature that focuses on the target zone to simplify the management approach to supratentorial aneurysms.


Assuntos
Aneurisma , Humanos , Craniotomia , Neurocirurgiões , Músculo Temporal
16.
Ulus Travma Acil Cerrahi Derg ; 30(1): 38-42, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38226572

RESUMO

BACKGROUND: Although true splenic artery aneurysms (SAA) are rare, due to advancements in imaging techniques, they are seen more frequently. The aim of this study is to present our strategy of managing patients with SAA. METHODS: Retrospectively, 13 patients who were treated in a tertiary university care center between 2012 and 2020 were included. Their demographic, clinical information, and post-operative complications were analyzed. RESULTS: Seven male and six female patients were evaluated between the ages of 27 and 73. The mean age was 49.8±13.2. The diameter of the aneurysm was between 17 and 80 mm with a mean range of 31.5±16 mm. Seven patients were treated with endovascular interventions (EV). Two patients were referred to surgery with failed attempt of EV, but patients refused surgery and were followed up consequently. Patients who had larger aneurysms with an increased risk of rupture underwent aneurysmectomy and splenectomy. Conservative management was decided on two patients initially: A patient who was previously operated on for a sigmoid colon tumor, and had an aneurysm size of 15 mm and another patient with a surgical history of thoracic aortic dissection with an aneurysm size of 18 mm. One patient who underwent surgery had post-operative pancreatic fistula and was treated with percutaneous drainage. The treatment of the remaining 12 patients was completed without any further complications. CONCLUSION: Splenic artery aneurysm treatment should be individualized. Endovascular treatment can be considered for patients with stable aneurysms larger than 2 cm in the elective setting. Open surgical treatment should be considered in patients with ruptured SAA or hemodynamically unstable, complicated patients.


Assuntos
Aneurisma , Embolização Terapêutica , Procedimentos Endovasculares , Gastroenteropatias , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Artéria Esplênica/diagnóstico por imagem , Artéria Esplênica/cirurgia , Estudos Retrospectivos , Procedimentos Endovasculares/efeitos adversos , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Aneurisma/etiologia , Embolização Terapêutica/efeitos adversos , Resultado do Tratamento
17.
J Cardiothorac Surg ; 19(1): 11, 2024 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-38243244

RESUMO

BACKGROUND: The celiacomesenteric trunk (CMT) is a common duct of the celiac artery (CA) and the superior mesenteric artery originating from the aorta, which is an uncommon anatomical variant of visceral artery circulation. Because of the variety of visceral circulation in those with CMT, the visceral circulation associated with each branch should be evaluated prior to surgical treatment of visceral artery aneurysm in the CMT. CASE PRESENTATION: A 64-year-old woman was diagnosed with a CA aneurysm in the CMT. Aneurysmectomy of the aneurysm was performed successfully. On preoperative selective visceral angiography, the CA was seen to bifurcate into the common hepatic and splenic artery. The left gastric artery was directly isolated from the aorta and perfused to the common hepatic and splenic artery through collateral circulation. These findings showed that celiac artery embolization is anatomically feasible, even in cases of celiac artery aneurysm rupture. CONCLUSIONS: Selective visceral angiography can contribute to surgical strategy planning for CA aneurysm with CMT.


Assuntos
Aneurisma , Artéria Celíaca , Feminino , Humanos , Pessoa de Meia-Idade , Artéria Celíaca/diagnóstico por imagem , Artéria Celíaca/cirurgia , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Aneurisma/etiologia , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/cirurgia , Radiografia , Angiografia
18.
Echocardiography ; 41(1): e15743, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38284679

RESUMO

BACKGROUND: Isolated redundant foramen ovale flap aneurysm (RFOA) in the absence of restrictive foramen ovale is believed to be a cause for pseudocoarctation of aorta since the impediment of blood flow to the left heart can be severe, resembling the picture of left ventricular hypoplasia with retrograde aortic flow. The primary objective of the study is to find whether RFOA is always a benign lesion. The main focus of the study is to share my experience in particular on fetuses having redundant foramen ovale flap aneurysm developing into coarctation of aorta and to study the associated factors. METHODS: Retrospective study (January 2020 to June 2023). All fetuses with RFOA associated with and without congenital heart defects were included. Fetuses with restrictive foramen ovale and RFOA with single ventricle hearts were excluded. The imaging, in-utero hemodynamics, pregnancy, and postnatal outcomes with at least 3 months follow-up were presented. RESULTS: During the study period, a total of 1499 fetal echocardiography were performed. Twenty-two fetuses with RFOA were included. Fourteen fetuses had isolated RFOA and eight had associated abnormalities [extracardiac (n = 5); intracardiac (n = 2), Both (n = 1)]. Genetic evaluation were performed only in fetuses with associated defects were normal. Postnatally all isolated RFOA fetuses had no aortic arch obstruction. Fetuses with associated aberrant right subclavian artery, isolated left superior vena cava, absent ductus venosus and ventricular septal defects developed aortic arch obstruction after birth. RFOA causes smallish left ventricle in fetuses with tetralogy of Fallot which recovered to normal size postnatally. CONCLUSION: Isolated RFOA can be benign, however, if it is associated with cardiac or extracardiac anomalies predominantly resulted in aortic arch obstruction. Though it is a cause for pseudocoarctation of aorta, through postnatal reassessment of aortic arch is mandatory. Careful search for intracardiac and systemic venous anomalies is recommended. It created confusion regarding adequacy of left ventricle when associated with congenital heart defects.


Assuntos
Aneurisma , Forame Oval , Cardiopatias Congênitas , Gravidez , Feminino , Humanos , Estudos Retrospectivos , Veia Cava Superior , Ultrassonografia Pré-Natal , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico por imagem , Diagnóstico Pré-Natal , Coração Fetal/diagnóstico por imagem , Hemodinâmica
20.
Eur Radiol Exp ; 8(1): 3, 2024 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-38191711

RESUMO

Intracranial aneurysms (IAs) are usually incidentally discovered by magnetic resonance imaging (MRI). Once discovered, the risk associated with their treatment must be balanced with the risk of an unexpected rupture. Although clinical observations suggest that the detection of contrast agent in the aneurysm wall using a double-inversion recovery black-blood (BB) sequence may point to IA wall instability, the exact meaning of this observation is not understood. Validation of reliable diagnostic markers of IA (in)stability is of utmost importance to deciding whether to treat or not an IA. To longitudinally investigate IA progression and enhance our understanding of this devastating disease, animal models are of great help. The aim of our study was to improve a three-dimensional (3D)-time-of-flight (TOF) sequence and to develop a BB sequence on a standard preclinical 3-T MRI unit to investigate intracranial arterial diseases in rats. We showed that our 3D-TOF sequence allows reliable measurements of intracranial artery diameters, inter-artery distances, and angles between arteries and that our BB sequence enables us to visualize intracranial arteries. We report the first BB-MRI sequence to visualize intracranial arteries in rats using a preclinical 3-T MRI unit. This sequence could be useful for a large community of researchers working on intracranial arterial diseases.Relevance statement We developed a black-blood MRI sequence to study vessel wall enhancement in rats with possible application to understanding IAs instability and finding reliable markers for clinical decision-making.Key points• Reliable markers of aneurysm stability are needed for clinical decision.• Detection of contrast enhancement in the aneurysm wall may be associated with instability.• We developed a black-blood MRI sequence in rats to be used to study vessel wall enhancement of IAs.


Assuntos
Aneurisma , Doenças Arteriais Intracranianas , Animais , Ratos , Artérias , Angiografia por Ressonância Magnética , Modelos Animais
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