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Sample records for craniojugular saccular aneurysms

  1. Saccular Aneurysms of the Transverse Aortic Arch

    PubMed Central

    Preventza, Ourania; Coselli, Joseph S.

    2015-01-01

    Saccular aneurysms of the aortic arch, whether single or multiple, are uncommon. The choice of repair technique is influenced by patients' comorbidities and age. Repairing saccular aneurysms with traditional open techniques can be technically demanding; therefore, endovascular technology and a variety of hybrid approaches have been developed to facilitate such repairs and, potentially, to improve clinical outcomes, especially in high-risk patients. There have been no large, randomized studies to compare the outcomes of these different treatment options in patients with single or multiple saccular aneurysms of the arch. In this review, we outline the etiology and common locations of these aneurysms, the different open, completely endovascular, and hybrid techniques used to treat them, and the treatment selection process. PMID:26798759

  2. Saccular aneurysm caused by bacterial endocarditis in a syphilitic aorta

    PubMed Central

    Robinson, W. M.; McMillan, I. K. R.; Johnson, A. M.

    1973-01-01

    Robinson, W.M., McMillan, I.K.R., and Johnson, A. M. (1973). Thorax, 529-532. Saccular aneurysm caused by bacterial endocarditis in a syphilitic aorta. The rapid development of a saccular aneurysm during successfully treated bacterial endocarditis, in an ascending aorta previously affected by syphilis which had been treated with adequate chemotherapy 15 years previously, is described. Although bacterial endocarditis does occasionally complicate syphilitic aortic valve disease, the literature does not contain any report of resulting aneurysm development. The investigation and successful surgical treatment of the case are described. Images PMID:4741460

  3. Pathological findings of saccular cerebral aneurysms-impact of subintimal fibrin deposition on aneurysm rupture.

    PubMed

    Hokari, Masaaki; Nakayama, Naoki; Nishihara, Hiroshi; Houkin, Kiyohiro

    2015-07-01

    Although several studies have suggested that aneurysmal wall inflammation and laminar thrombus are associated with the rupture of saccular aneurysms, the mechanisms leading to the rupture remain obscure. We performed full exposure of aneurysms before clip application and attempted to keep the fibrin cap on the rupture point. Using these specimens in a nearly original state before surgery, we conducted a pathological analysis and studied the differences between ruptured and unruptured aneurysms to clarify the mechanism of aneurysmal wall degeneration. This study included ruptured (n = 28) and unruptured (n = 12) saccular aneurysms resected after clipping. All of the ruptured aneurysms were obtained within 24 h of onset. Immunostainings for markers of inflammatory cells (CD68) and classical histological staining techniques were performed. Clinical variables and pathological findings from ruptured and unruptured aneurysms were compared. Patients with ruptured or unruptured aneurysms did not differ by age, gender, size, location, and risk factors, such as hypertension, smoking, and hyperlipidemia. The absence or fragmentation of the internal elastica lamina, the myointimal hyperplasia, and the thinning of the aneurysmal wall were generally observed in both aneurysms. The existence of subintimal fibrin deposition, organized laminar thrombus, intramural hemorrhage, neovascularization, and monocyte infiltration are more frequently observed in ruptured aneurysms. Multivariate logistic regression analysis showed that ruptured aneurysm was associated with presence of subintimal fibrin deposition and monocyte infiltration. These findings suggest that subintimal fibrin deposition and chronic inflammation have a strong impact on degeneration of the aneurysmal wall leading to their rupture, and this finding may be caused by endothelial dysfunction. PMID:25860660

  4. Double Stent Assist Coiling of Ruptured Large Saccular Aneurysm in Proximal Basilar Artery Fenestration

    PubMed Central

    Park, Woong Bae; Huh, Joon; Cho, Chul Bum; Yang, Seung Ho; Kim, Il Sup; Hong, Jae Taek; Lee, Sang Won

    2015-01-01

    Basilar artery fenestration is infrequent and even rarer in association with a large aneurysm. With proximity to brain stem and vital perforators, endovascular coiling can be considered first. If the large ruptured aneurysm with a wide neck originated from fenestra of the proximal basilar artery and the fenestration loop has branches of posterior circulation, therapeutic consideration should be thorough and fractionized. We report endovascular therapeutic details for a case of a ruptured large saccular aneurysm in proximal basilar artery fenestration. PMID:26523257

  5. Giant saccular distal azygos artery aneurysm: Report of a case and review of literature

    PubMed Central

    Baldawa, Sachin; Katikar, Dattaprasanna; Marda, Sushil

    2016-01-01

    An azygos anterior cerebral artery (ACA) is a rare variant of normal embryogenesis in which confluence of two A1 segments results in a single A2 segment with the absence of anterior communicating artery. The occurrence of an aneurysm at the bifurcation of azygos ACA is rare with few cases reported in the literature. We report a case of a 40-year-old lady who presented with subarachnoid hemorrhage following rupture of a giant, saccular distal azygos ACA aneurysm. Bifrontal craniotomy and clipping of an aneurysm was performed. The clinical significance of azygos ACA and surgical strategies in clipping these aneurysms are discussed with a review of literature. PMID:27057234

  6. ATP transport in saccular cerebral aneurysms at arterial bends.

    PubMed

    Imai, Yohsuke; Sato, Kodai; Ishikawa, Takuji; Comerford, Andrew; David, Tim; Yamaguchi, Takami

    2010-03-01

    ATP acts as an extracellular signaling molecule in purinergic signaling that regulates vascular tone. ATP binds purinergic P2 nucleotide receptors on endothelial cells. Understanding the mass transport of ATP to endothelial cells by blood flow is thus important to predict functional changes in aneurysmal walls. While some clinical observations indicate a difference of wall pathology between ruptured and unruptured aneurysms, no study has focused on the mass transport in aneurysms. We investigated the characteristics of ATP concentration at aneurysmal wall using a numerical model of ATP transport in aneurysms formed at arterial bends. The magnitude of ATP concentration at the aneurysmal wall was significantly smaller than that at the arterial wall. In particular, significantly low concentration was predicted at the proximal side of the aneurysmal sac. A strong correlation was revealed between the inflow flux at the aneurysmal neck and the resultant concentration at the aneurysmal wall. PMID:20012692

  7. Evolution of Giant P2-Posterior Cerebral Artery Aneurysm over 16 Years: Saccular to Serpentine. A Case Report.

    PubMed

    Sharma, S

    2009-12-14

    Giant intracranial aneurysms account for only about 5% of all intracranial aneurysms. Giant intradural aneurysms are associated with severe natural history, yet remain potentially curable. These aneurysms cause symptoms due to their mass effect, and only 14-35% of cases present with subarachnoid haemorrhage (SAH). The present case report is an imaging evolution of a giant posterior cerebral artery (PCA) aneurysm in a patient who was lost on follow-up from 1992 to 2008 giving insight into the natural history and morphologic evolution of giant serpentine aneurysms. Attempted surgery 16 years previously for a saccular PCA aneurysm produced encephalomalacia and created a more spacious perianeurysmal environment, preventing any mass effect on vital structures in its vicinity. This allowed the patient to have a long symptom-free period and also allowed the aneurysm to follow a morphologic evolution over a long period without causing symptoms which would have called for intervention. This unusual development gave a unique opportunity to study the evolution of a gaint serpentine aneurysm from a saccular aneurysm and also the clinical and morphologic changes in an aneurysm if it can be prevented from producing mass effect. The Coanda effect, or boundary wall effect, has been considered responsible for the development of the serpentine channel in the original globular aneurysm . However many Authors conclude that giant serpentine aneurysms are not derived from saccular aneurysms. PMID:24209407

  8. Influence of medial collagen organization and axial in situ stretch on saccular cerebral aneurysm growth.

    PubMed

    Eriksson, Thomas; Kroon, Martin; Holzapfel, Gerhard A

    2009-10-01

    A model for saccular cerebral aneurysm growth, proposed by Kroon and Holzapfel (2007, "A Model for Saccular Cerebral Aneurysm Growth in a Human Middle Cerebral Artery," J. Theor. Biol., 247, pp. 775-787; 2008, "Modeling of Saccular Aneurysm Growth in a Human Middle Cerebral Artery," ASME J. Biomech. Eng., 130, p. 051012), is further investigated. A human middle cerebral artery is modeled as a two-layer cylinder where the layers correspond to the media and the adventitia. The immediate loss of media in the location of the aneurysm is taken to be responsible for the initiation of the aneurysm growth. The aneurysm is regarded as a development of the adventitia, which is composed of several distinct layers of collagen fibers perfectly aligned in specified directions. The collagen fibers are the only load-bearing constituent in the aneurysm wall; their production and degradation depend on the stretch of the wall and are responsible for the aneurysm growth. The anisotropy of the surrounding media was modeled using the strain-energy function proposed by Holzapfel et al. (2000, "A New Constitutive Framework for Arterial Wall Mechanics and a Comparative Study of Material Models," J. Elast., 61, pp. 1-48), which is valid for an elastic material with two families of fibers. It was shown that the inclusion of fibers in the media reduced the maximum principal Cauchy stress and the maximum shear stress in the aneurysm wall. The thickness increase in the aneurysm wall due to material growth was also decreased. Varying the fiber angle in the media from a circumferential direction to a deviation of 10 deg from the circumferential direction did, however, only show a little effect. Altering the axial in situ stretch of the artery had a much larger effect in terms of the steady-state shape of the aneurysm and the resulting stresses in the aneurysm wall. The peak values of the maximum principal stress and the thickness increase both became significantly higher for larger axial

  9. Experimental study of physiological flow in a cerebral saccular tip aneurysm

    NASA Astrophysics Data System (ADS)

    Tsai, William; Savas, Omer; Ortega, Jason; Maitland, Duncan; Saloner, David

    2006-11-01

    Allowed to grow unchecked, a cerebral aneurysm may hemorrhage, leading to possible brain damage or death. Preventive treatment can alleviate this risk. The research presented will focus on cerebral saccular aneurysms. Flow visualization and particle image velocimetry are used at physiological input flow conditions in a simplified model geometry of a basilar artery bifurcation with a tip aneurysm. The results show the formation of vortical structures at the neck which impinge near the fundus and travel along the walls of the aneurysm. The goal of this research is to aid in the development of the implementation of laser-activated shape memory polymer devices for treatment. Future work on this project includes fluid flow and temperature studies during and post treatment.

  10. Giant saccular superior vena cava aneurysm-a rare and difficult clinical case.

    PubMed

    Janczak, Dariusz; Skiba, Jacek; Gemel, Marek; Mak, Marek; Ziomek, Agnieszka; Malinowski, Maciej; Dorobisz, Tadeusz; Lesniak, Michal; Janczak, Dawid; Chabowski, Mariusz

    2016-03-01

    A superior vena cava (SVC) aneurysm is an extremely rare case of vascular malformation in the chest cavity. This is a report of a case of a 57-year-old woman with a saccular SVC aneurysm which was 8 cm wide. The chest computed tomography (CT) scan confirmed a giant 75 mm × 79 mm × 81 mm mass containing the contrast medium from SVC, constricting the right lung parenchyma, narrowing the right innominate vein, in contact with the anterolateral chest cavity wall, and adjoining the superior mediastinum. Under general anesthesia and employing the median sternotomy approach, using a cardiopulmonary bypass (CPB), the venous aneurysm was successfully resected. The postoperative period was uneventful. Radical surgical resection using a sternotomy and a CPB is recommended. PMID:27076981

  11. A system for saccular intracranial aneurysm analysis and virtual stent planning

    NASA Astrophysics Data System (ADS)

    Baloch, Sajjad; Sudarsky, Sandra; Zhu, Ying; Mohamed, Ashraf; Geiger, Berhard; Dutta, Komal; Namburu, Durga; Nias, Puthenveettil; Martucci, Gary; Redel, Thomas

    2012-02-01

    Recent studies have found correlation between the risk of rupture of saccular aneurysms and their morphological characteristics, such as volume, surface area, neck length, among others. For reliably exploiting these parameters in endovascular treatment planning, it is crucial that they are accurately quantified. In this paper, we present a novel framework to assist physicians in accurately assessing saccular aneurysms and efficiently planning for endovascular intervention. The approach consists of automatically segmenting the pathological vessel, followed by the construction of its surface representation. The aneurysm is then separated from the vessel surface through a graph-cut based algorithm that is driven by local geometry as well as strong prior information. The corresponding healthy vessel is subsequently reconstructed and measurements representing the patient-specific geometric parameters of pathological vessel are computed. To better support clinical decisions on stenting and device type selection, the placement of virtual stent is eventually carried out in conformity with the shape of the diseased vessel using the patient-specific measurements. We have implemented the proposed methodology as a fully functional system, and extensively tested it with phantom and real datasets.

  12. Experimental study of physiological flow in a cerebral saccular basilar tip aneurysm

    NASA Astrophysics Data System (ADS)

    Tsai, William; Savas, Omer; Ortega, Jason; Maitland, Duncan; Saloner, David

    2008-11-01

    The subject matter of the research is the flow within cerebral saccular basilar tip aneurysms and exploring correlations with their growth and rupture. The flow phantom consists of an inlet pipe branching out 90^o into two outlets, simulating the basilar artery bifurcation and a nearly spherical dome at the flow divider simulating the aneurysm. Input flow is a physiological waveform for the basilar artery. Flow outlet branching ratios are controlled at will. Experiments are done at Reynolds numbers 221-376 and Sexl-Wormersley number 4.46. Flow visualization and particle image velocimetry are used to study velocity, vorticity, and wall shear stress. All flows can be characterized by an off-center inlet jet and a circulation region, whose transient strength and behavior depends on the outflow ratios.

  13. In vitro measurement of tissue integrity during saccular aneurysm embolizations for simulator-based training.

    PubMed

    Tercero, C; Ikeda, S; Ooe, K; Fukuda, T; Arai, F; Negoro, M; Takahashi, I; Kwon, G

    2012-12-01

    In the domain of endovascular neurosurgery, the measurement of tissue integrity is needed for simulator-based training and for the development of new intravascular instruments and treatment techniques. In vitro evaluation of tissue manipulation can be achieved using photoelastic stress analysis and vasculature modeling with photoelastic materials. In this research we constructed two types of vasculature models of saccular aneurysms for differentiation of embolization techniques according to the respect for tissue integrity measurements based on the stress within the blood vessel model wall. In an aneurysm model with 5 mm dome diameter, embolization using MicroPlex 10 (Complex 1D, with 4 mm diameter loops), a maximum area of 3.97 mm² with stress above 1 kPa was measured. This area increased to 5.50 mm² when the dome was touched deliberately with the release mechanism of the coil, and to 4.87 mm² for an embolization using Micrusphere, (Spherical 18 Platinum Coil). In a similar way trans-cell stent-assisted coil embolization was also compared to human blood pressure simulation using a model of a wide-necked saccular aneurysm with 7 mm diameter. The area with stress above 1kPa was below 1 mm² for the pressure simulation and maximized at 3.79 mm² during the trans-cell insertion of the micro-catheter and at 8.92 mm² during the embolization. The presented results show that this measurement system is useful for identifying techniques compromising tissue integrity, comparing and studying coils and embolization techniques for a specific vasculature morphology and comparing their natural stress variations such as that produced by blood pressure. PMID:23217635

  14. Reconstruction of Saccular and Dissected Intracranial Aneurysms Using Solitaire™ AB Stents

    PubMed Central

    Xu, Yi; Hong, Bo; Huang, Qing-Hai; Zhao, Wen-Yuan; Yang, Peng-Fei; Liu, Jian-Min

    2013-01-01

    Introduction We aimed to evaluate the feasibility, safety, efficacy, and predictors for outcome of reconstructive treatment with Solitaire™ AB stent(s) based on 54 cases of saccular aneurysms and 14 of acute symptomatic dissecting aneurysms. Methods Fifty-eight consecutive patients (M/F = 28/30; median age, 53 years) harbouring 68 aneurysms (ruptured/unruptured = 12/56) underwent treatment with Solitaire™ AB stent(s) implantation between April 2010 and August 2011 in our institution. The data were retrospectively reviewed and analysed. Results The technical success rate of Solitaire™ AB stenting was 100%. The rates of the overall and the treatment-related adverse events were 9% (6/68) and 6% (4/68), respectively, and the recurrent rate was 1% (1/68). All of the adverse events (n = 6) occurred in tiny (n = 1, ≤3 mm) or small (n = 5, >3 to ≤10 mm) aneurysms. The majority (75%, 3/4) of thromboembolic events (thrombus, n = 2; infarction, n = 2) occurred in ruptured lesions, and 2 intraprocedural aneurysm ruptures occurred in the course of coiling when the stent(s) was/were applied within 6 months. Subarachnoid haemorrhages (SAH, p<0.05) and immediate occlusion grades (p<0.05) were predictors for overall adverse events by univariate analysis. Compared with the immediate post-treatment angiographic results, the follow-up angiographic imaging (mean, 13 months; range, 6–25 months) revealed that stent(s) implantation enhanced the rate of class I occlusion from 34% (23/68) to 93% (63/68). SAH was the only predictor for unfavourable outcomes (the modified Rankin Scale score [mRS], 2–6) during the mean 19-month (range, 12–27 months) of clinical follow-ups (p<0.05). Conclusions Although the complete obliteration of tiny and small aneurysms without complications remains a challenge, stent(s) implantation could lead to further occlusion of incompletely coiled aneurysms. SAH and the occlusion grade were the primary predictors for adverse

  15. [Hybrid operation for a posttraumatic saccular aneurysm of the aortic arch].

    PubMed

    Ignat'ev, I M; Volodiukhin, M Iu; Zanochkin, A V; Terekhin, S V

    2013-01-01

    The article deals with a case report of successful hybrid surgical treatment of a patient presenting with a posttraumatic large false saccular aneurysm of the aortic arch with mediastinal displacement and compression of the left recurrent laryngeal nerve and trachea. The patient was subjected to a hybrid operation, i. e., bypass grafting of the brachiocephalic trunk and the left common carotid artery with a bifurcation prosthesis from the ascending aorta through sternotomy, carotid-vertebral and carotid-subclavian bypass grafting on the left in a combination with endoprosthetic repair of the aortic arch with the stent graft Valiant Thoracic 40 × 224 mm (VAMF 4040c200TE) manufactured by the Medtronic Company. The postoperative period was uneventful followed by rather rapid rehabilitation of the patient. One month after the operation, the clinical state improved considerably. His voice restored virtually completely, and breathlessness disappeared. According to the findings of MSCT angiography, the aneurysmatic cavity is thrombosed, with the stent graft showing no evidence of either dislocation or endoleak. The bifurcation bypass graft is functioning. According to the data of duplex scanning, the anastomoses established on the neck are patent. PMID:23531669

  16. Biology of Saccular Cerebral Aneurysms: A Review of Current Understanding and Future Directions

    PubMed Central

    Fennell, Vernard S.; Kalani, M. Yashar S.; Atwal, Gursant; Martirosyan, Nikolay L.; Spetzler, Robert F.

    2016-01-01

    Understanding the biology of intracranial aneurysms is a clinical quandary. How these aneurysms form, progress, and rupture is poorly understood. Evidence indicates that well-established risk factors play a critical role, along with immunologic factors, in their development and clinical outcomes. Much of the expanding knowledge of the inception, progression, and rupture of intracranial aneurysms implicates inflammation as a critical mediator of aneurysm pathogenesis. Thus, therapeutic targets exploiting this arm of aneurysm pathogenesis have been implemented, often with promising outcomes. PMID:27504449

  17. Saccular Aneurysms of the Transverse Aortic Arch: Treatment Options Available in the Endovascular EraBased on a Presentation at the 2013 VEITH Symposium, November 19-23, 2013 (New York, NY, USA).

    PubMed

    Preventza, Ourania; Coselli, Joseph S

    2015-04-01

    Saccular aneurysms of the aortic arch, whether single or multiple, are uncommon. The choice of repair technique is influenced by patients' comorbidities and age. Repairing saccular aneurysms with traditional open techniques can be technically demanding; therefore, endovascular technology and a variety of hybrid approaches have been developed to facilitate such repairs and, potentially, to improve clinical outcomes, especially in high-risk patients. There have been no large, randomized studies to compare the outcomes of these different treatment options in patients with single or multiple saccular aneurysms of the arch. In this review, we outline the etiology and common locations of these aneurysms, the different open, completely endovascular, and hybrid techniques used to treat them, and the treatment selection process. PMID:26798759

  18. The effect of stent porosity and strut shape on saccular aneurysm and its numerical analysis with lattice Boltzmann method.

    PubMed

    Kim, Yong Hyun; Xu, Xiaofeng; Lee, Joon Sang

    2010-07-01

    The analysis of a flow pattern in cerebral aneurysms and the effect of stent strut shapes are presented in this article. The treatment of cerebral aneurisms with a porous stent has recently been proposed as a minimally invasive way to prevent rupture and favor coagulation mechanism inside the aneurism. The efficiency of stent is related to several parameters, including porosity and stent strut shapes. The goal of this article is to study the effect of the stent strut shape and porosity on the hemodynamic properties of the flow inside an aneurysm using a numerical analysis. In this study, we use the concept of flow reduction to characterize the stent efficiency. Also, we use the lattice Boltzmann method (LBM) of a non-Newtonian blood flow. To resolve the characteristics of a highly complex flow, we use an extrapolation method for the wall and stent boundary. To ease the code development and facilitate the incorporation of new physics, a scientific programming strategy based on object-oriented concepts is developed. Reduced velocity, smaller average vorticity magnitude, smaller average shear rate, and increased viscosity are observed when the proposed stent shapes and porosities are used. The rectangular stent is observed to be optimal and to decrease the magnitude of the velocity by 89.25% in the 2D model and 53.92% in the 3D model in the aneurysm sac. Our results show the role of the porosity and stent strut shape and help us to understand the characteristics of stent strut design. PMID:20300847

  19. Interactive decomposition and mapping of saccular cerebral aneurysms using harmonic functions: its first application with "patient-specific" computational fluid dynamics (CFD) simulations.

    PubMed

    Jiang, Jingfeng; Strother, Charles M

    2013-02-01

    Recent developments in medical imaging and advanced computer modeling simulations) now enable studies designed to correlate either simulated or measured "patient-specific" parameters with the natural history of intracranial aneurysm i.e., ruptured or unruptured. To achieve significance, however, these studies require rigorous comparison of large amounts of data from large numbers of aneurysms, many of which are quite dissimilar anatomically. In this study, we present a method that can likely facilitate such studies as its application could potentially simplify an objective comparison of surface-based parameters of interest such as wall shear stress and blood pressure using large multi-patient, multi-institutional data sets. Based on the concept of harmonic function/field, we present a unified and simple approach for mapping the surface of an aneurysm onto a unit disc. Requiring minimal human interactions the algorithm first decomposes the vessel geometry into 1) target aneurysm and 2) parent artery and any adjacent branches; it, then, maps the segmented aneurysm surface onto a unit disk. In particular, the decomposition of the vessel geometry quantitatively exploits the unique combination of three sets of information regarding the shape of the relevant vasculature: 1) a distance metric defining the spatially varying deviation from a tubular characteristic (i.e., cylindrical structure) of a normal parent artery, 2) local curvatures and 3) local concavities at the junction/interface between an aneurysm and its parent artery. These three sets of resultant shape/geometrical data are then combined to construct a linear system of the Laplacian equation with a novel shape-sensitive weighting scheme. The solution to such a linear system is a shape-sensitive harmonic function/field whose iso-lines will densely gather at the border between the normal parent artery and the aneurysm. Finally, a simple ranking system is utilized to select the best candidate among all possible

  20. Aneurysm

    MedlinePlus

    ... is thought to play a role in abdominal aortic aneurysms. Atherosclerotic disease (cholesterol buildup in arteries) may also ... your risk of an aneurysm. Images Cerebral aneurysm Aortic aneurysm Intracerebellar hemorrhage - CT scan References Hauser SC. Vascular ...

  1. Aneurysms

    MedlinePlus

    ... our e-newsletter! Aging & Health A to Z Aneurysms Basic Facts & Information Fill a balloon too full ... of what can happen when you have an aneurysm. Medically, when an artery “balloons,” or widens, it ...

  2. Acquired Jugular Vein Aneurysm

    PubMed Central

    Hopsu, Erkki; Tarkkanen, Jussi; Vento, Seija I.; Pitkäranta, Anne

    2009-01-01

    Venous malformations of the jugular veins are rare findings. Aneurysms and phlebectasias are the lesions most often reported. We report on an adult patient with an abruptly appearing large tumorous mass on the left side of the neck identified as a jugular vein aneurysm. Upon clinical examination with ultrasound, a lateral neck cyst was primarily suspected. Surgery revealed a saccular aneurysm in intimate connection with the internal jugular vein. Histology showed an organized hematoma inside the aneurysmal sac, which had a focally thinned muscular layer. The terminology and the treatment guidelines of venous dilatation lesions are discussed. For phlebectasias, conservative treatment is usually recommended, whereas for saccular aneurysms, surgical resection is the treatment of choice. While an exact classification based on etiology and pathophysiology is not possible, a more uniform taxonomy would clarify the guidelines for different therapeutic modalities for venous dilatation lesions. PMID:20107571

  3. Saccular cyst with atypical presentation

    PubMed Central

    Zamfir-Chiru-Anton, A; Gheorghe, DC

    2016-01-01

    Respiratory obstruction and stridor in infants and children are not uncommon. A rare cause of these sometimes life-threatening symptoms is the congenital saccular cyst. Objectives: We present the case of a 5-year-old girl with a cervical tumor, which appeared after a laryngeal endoscopic surgery of a saccular cyst with two relapses and a particular local evolution of its recurrence through the cricothyroid membrane. Material and method: The patient data has been reviewed over the entire follow-up period and a thorough an analysis of her investigations and surgery was performed. Results: The unusual evolution of this case was marked by an atypical exteriorization – not found in the published literature. The surgical approach was external, by paramedian thyrotomy, with no further long-term recurrence. Conclusions: An accurate diagnosis of saccular cysts can be made with the help of medical history, by an endoscopic visualization of the lesion and by the CT-scan imaging of the cervical region. Sometimes, saccular cysts can extend beyond laryngeal limits, determining fluid-filled tumors in the cervical region. PMID:27453755

  4. Cerebral aneurysms following radiotherapy for medulloblastoma

    SciTech Connect

    Benson, P.J.; Sung, J.H.

    1989-04-01

    Three patients, two males and one female aged 21, 14, and 31 years, respectively, developed cerebral saccular aneurysms several years after undergoing radiotherapy for cerebellar medulloblastoma at 2, 5, and 14 years of age, respectively. Following surgery, all three received combined cobalt-60 irradiation and intrathecal colloidal radioactive gold (/sup 198/Au) therapy, and died from rupture of the aneurysm 19, 9, and 17 years after the radiotherapy, respectively. Autopsy examination revealed no recurrence of the medulloblastoma, but widespread radiation-induced vasculopathy was found at the base of the brain and in the spinal cord, and saccular aneurysms arose from the posterior cerebral arteries at the basal cistern or choroidal fissure. The aneurysms differed from the ordinary saccular aneurysms of congenital type in their location and histological features. Their locations corresponded to the areas where intrathecally administered colloidal /sup 198/Au is likely to pool, and they originated directly from a segment of the artery rather than from a branching site as in congenital saccular aneurysms. It is, therefore, concluded that the aneurysms in these three patients were most likely radiation-induced.

  5. Saccular impact on ocular torsion.

    PubMed

    De Graaf, B; Bos, J E; Groen, E

    1996-01-01

    When someone is tilted laterally, the shear force on the maculae of the utriculus and the sacculus is described by the sine and the cosine of the angle of tilt, respectively. So both the sacculus and the utriculus are stimulated, but in the literature, ocular torsion is normally attributed to utricular function alone (and, thus, seen as a response to y-axis linear acceleration). However, on the base of a series of experiments on a tilt chair, a linear track, human centrifuges, and during parabolic flights, we conclude that the sacculus contributes to ocular torsion as well (there is a response to z-axis linear acceleration). The data suggest that the ratio of the utricular and saccular impact on ocular torsion is 3:1. The utriculus generates conjugate and the sacculus disjunctive torsional eye movements. PMID:8886354

  6. Mycotic aneurysm accompanied by aspergillotic granuloma: a case report.

    PubMed

    Kurino, M; Kuratsu, J; Yamaguchi, T; Ushio, Y

    1994-08-01

    Solid granulomas and aneurysms caused by Aspergillus of the central nervous system are rare. A fungal aneurysm is usually situated proximally on the intracranial vessels and is often fatal. We report a case in which a ruptured aneurysm arose from the distal portion of the left posterior inferior cerebellar artery (PICA) in the course of treatment for chronic meningitis forming a granuloma at the left pyramis. After biopsy of the granuloma, he presented subarachnoid hemorrhage caused by a saccular PICA aneurysm. Histologic examination of the aneurysmal wall and the granuloma revealed infection with Aspergillus hyphae. The literature regarding the management of aspergillotic aneurysm is reviewed. PMID:8091294

  7. Giant saccular superior vena cava aneurysm—a rare and difficult clinical case

    PubMed Central

    Janczak, Dariusz; Skiba, Jacek; Gemel, Marek; Mak, Marek; Ziomek, Agnieszka; Malinowski, Maciej; Dorobisz, Tadeusz; Lesniak, Michal; Janczak, Dawid

    2016-01-01

    A superior vena cava (SVC) aneurysm is an extremely rare case of vascular malformation in the chest cavity. This is a report of a case of a 57-year-old woman with a saccular SVC aneurysm which was 8 cm wide. The chest computed tomography (CT) scan confirmed a giant 75 mm × 79 mm × 81 mm mass containing the contrast medium from SVC, constricting the right lung parenchyma, narrowing the right innominate vein, in contact with the anterolateral chest cavity wall, and adjoining the superior mediastinum. Under general anesthesia and employing the median sternotomy approach, using a cardiopulmonary bypass (CPB), the venous aneurysm was successfully resected. The postoperative period was uneventful. Radical surgical resection using a sternotomy and a CPB is recommended. PMID:27076981

  8. Life-Threatening Surgery for Mycotic Aneurysm

    PubMed Central

    Mitrev, Zan K.; Anguseva, Tanja N.

    2013-01-01

    Infected aneurysm (or mycotic aneurysm) is defined as an infectious disease of the wall of an artery with formation of a blind, saccular out-pouching that is contiguous with the arterial lumen. Symptoms are frequently absent or nonspecific during the early stages. Once clinically presented, infected aneurysms are often at an advanced stage of development and associated with complications such as rupture. Nontreatment or delayed treatment of infected aneurysms has a poor outcome, with high morbidity and mortality rate via fulminant sepsis or hemorrhage. In clinically suspected cases, computed tomography is used for diagnosis. Urgent surgery, performed to prevent aortic rupture carries high morbidity and mortality rates. PMID:26798693

  9. Coil Embolization for Intracranial Aneurysms

    PubMed Central

    2006-01-01

    Executive Summary Objective To determine the effectiveness and cost-effectiveness of coil embolization compared with surgical clipping to treat intracranial aneurysms. The Technology Endovascular coil embolization is a percutaneous approach to treat an intracranial aneurysm from within the blood vessel without the need of a craniotomy. In this procedure, a microcatheter is inserted into the femoral artery near the groin and navigated to the site of the aneurysm. Small helical platinum coils are deployed through the microcatheter to fill the aneurysm, and prevent it from further expansion and rupture. Health Canada has approved numerous types of coils and coil delivery systems to treat intracranial aneurysms. The most favoured are controlled detachable coils. Coil embolization may be used with other adjunct endovascular devices such as stents and balloons. Background Intracranial Aneurysms Intracranial aneurysms are the dilation or ballooning of part of a blood vessel in the brain. Intracranial aneurysms range in size from small (<12 mm in diameter) to large (12–25 mm), and to giant (>25 mm). There are 3 main types of aneurysms. Fusiform aneurysms involve the entire circumference of the artery; saccular aneurysms have outpouchings; and dissecting aneurysms have tears in the arterial wall. Berry aneurysms are saccular aneurysms with well-defined necks. Intracranial aneurysms may occur in any blood vessel of the brain; however, they are most commonly found at the branch points of large arteries that form the circle of Willis at the base of the brain. In 85% to 95% of patients, they are found in the anterior circulation. Aneurysms in the posterior circulation are less frequent, and are more difficult to treat surgically due to inaccessibility. Most intracranial aneurysms are small and asymptomatic. Large aneurysms may have a mass effect, causing compression on the brain and cranial nerves and neurological deficits. When an intracranial aneurysm ruptures and bleeds

  10. True aneurysm of brachial artery.

    PubMed

    Hudorović, Narcis; Lovričević, Ivo; Franjić, Dario Bjorn; Brkić, Petar; Tomas, Davor

    2010-10-01

    True upper extremity peripheral artery aneurysms are a rarely encountered arterial disorder. Following computer-tomography angiographic (CT-a) imaging examination, true saccular aneurysm, originating from the left brachial artery was diagnosed in the 77-year-old female without history of trauma. The aneurysm was resected by surgical intervention, and primary repair of the brachial artery was performed by interposition of a part of great saphenous vein harvested from the left groin and creation of two end-to-end anastomoses between interposition graft and previously resected part of brachial artery. No complication was observed during the follow-up. Surgical intervention for upper extremity aneurysms should be initiated without delay. Factors combined with minimal morbidity associated with repair suggest that surgical repair should be performed routinely for true upper extremity arterial aneurysms. PMID:20865459

  11. Syphilitic aortic aneurysm presenting with upper airway obstruction.

    PubMed

    Waikittipong, Somchai

    2012-10-01

    Syphilitic aortic aneurysms are uncommon today. A rare case of syphilitic aortic arch aneurysm with successful surgical treatment is reported. A 42-year-old man presented with upper airway obstruction. Chest radiography showed a superior mediastinal mass, and computed tomography revealed a large saccular aortic arch aneurysm that compressed the trachea. Dacron graft replacement of the aortic arch was successfully performed under circulatory arrest with antegrade cerebral perfusion. PMID:23087303

  12. Imaging features of left ovarian and renal venous aneurysms: two case reports and literature review.

    PubMed

    Yoo, Jeongin; Park, Sung Bin; Shin, Mack; Lee, Eun Sun; Park, Hyun Jeong; Lee, Jong Beum; Choi, Byung Ihn

    2016-01-01

    Venous aneurysms rarely occur in the visceral veins. We report two extremely rare cases of venous aneurysms, one of the ovarian vein and the other one of the renal vein. The aneurysms were depicted on grayscale and color Doppler ultrasonography as anechoic saccular structures with compressibility and blood flow. Pulsed Doppler ultrasonography showed venous flow. Contrast-enhanced computed tomography showed aneurysmal venous dilatation. We diagnosed left ovarian and renal venous aneurysms. We also review the clinical presentation and implications of visceral venous aneurysms. PMID:27317200

  13. Aneurysms of the P2P Segment of Posterior Cerebral Artery: Case Report and Surgical Steps.

    PubMed

    Aguiar, Paulo; Gatto, Luana; Neves, Maick; Martins, Carlos; Nakasone, Fabio; Isolan, Gustavo

    2014-01-01

    The posterior cerebral artery (PCA) is divided into 4 segments: precommunicating segment (P1), postcommunicating segment (P2), quadrigeminal segment (P3), and calcarine segment (P4). Small aneurysms are more prevalent than large aneurysms in patients with ruptured aneurysms. P2 and P3 aneurysms are usually managed by the subtemporal approach. This is a case report of rupture saccular aneurysm of posterior cerebral artery on P2P segment. The authors show the surgical steps of these rare aneurysms with an illustrative case. PMID:25548571

  14. Aneurysms of the P2P Segment of Posterior Cerebral Artery: Case Report and Surgical Steps

    PubMed Central

    Aguiar, Paulo; Neves, Maick; Martins, Carlos; Nakasone, Fabio; Isolan, Gustavo

    2014-01-01

    The posterior cerebral artery (PCA) is divided into 4 segments: precommunicating segment (P1), postcommunicating segment (P2), quadrigeminal segment (P3), and calcarine segment (P4). Small aneurysms are more prevalent than large aneurysms in patients with ruptured aneurysms. P2 and P3 aneurysms are usually managed by the subtemporal approach. This is a case report of rupture saccular aneurysm of posterior cerebral artery on P2P segment. The authors show the surgical steps of these rare aneurysms with an illustrative case. PMID:25548571

  15. Flow instability and wall shear stress variation in intracranial aneurysms

    PubMed Central

    Baek, H.; Jayaraman, M. V.; Richardson, P. D.; Karniadakis, G. E.

    2010-01-01

    We investigate the flow dynamics and oscillatory behaviour of wall shear stress (WSS) vectors in intracranial aneurysms using high resolution numerical simulations. We analyse three representative patient-specific internal carotid arteries laden with aneurysms of different characteristics: (i) a wide-necked saccular aneurysm, (ii) a narrower-necked saccular aneurysm, and (iii) a case with two adjacent saccular aneurysms. Our simulations show that the pulsatile flow in aneurysms can be subject to a hydrodynamic instability during the decelerating systolic phase resulting in a high-frequency oscillation in the range of 20–50 Hz, even when the blood flow rate in the parent vessel is as low as 150 and 250 ml min−1 for cases (iii) and (i), respectively. The flow returns to its original laminar pulsatile state near the end of diastole. When the aneurysmal flow becomes unstable, both the magnitude and the directions of WSS vectors fluctuate at the aforementioned high frequencies. In particular, the WSS vectors around the flow impingement region exhibit significant spatio-temporal changes in direction as well as in magnitude. PMID:20022896

  16. Intracranial aneurysm and sildenafil

    PubMed Central

    Edriss, Hawa; Nugent, Kenneth

    2016-01-01

    Sildenafil is one of the most commonly used drugs for the treatment of erectile dysfunction. To date, we found five reported cases of intracerebral bleeding and two reported cases of subarachnoid hemorrhage related to sildenafil use. We report a 49-year-old hypertensive and diabetic patient who presented with acute pulmonary edema and loss of consciousness following ingestion of 100 mg of sildenafil prior to sexual intercourse. He was not previously aware of the presence of an aneurysm and had no family history of it. Computed tomography of his head revealed a subarachnoid hemorrhage due to rupture of a saccular aneurysm with subsequent repeat hemorrhage within a few hours of presentation. A sudden increase in blood pressure led to pulmonary edema. Studies have shown that sildenafil acts on phosphodiesterase-1, -2 and -5 receptors and leads to a secondary increase in intracerebral circulation and vasodilatory effects, leading to sympathetic overactivity which increases the risk for intracranial bleeding. PMID:27034561

  17. Basilar Artery Aneurysm at a Persistent Trigeminal Artery Junction

    PubMed Central

    Aguiar, G.B.; Conti, M.L.M.; Veiga, J.C.E.; Jory, M.; Souza, R.B.

    2011-01-01

    Summary The trigeminal artery is an anastomosis between the embryonic precursors of the vertebrobasilar and carotid systems, and may persist into adult life. The association of the persistent primitive trigeminal artery (PTA) with cerebral aneurysm is well documented in the literature and, in general, aneurysms are located in the anterior circulation. We describe a patient who presented with a panencephalic Fisher III subarachnoid hemorrhage due to rupture of an intracranial aneurysm. Digital arteriography showed a saccular aneurysm in the middle third of the basilar artery, adjacent to the junction with a persistent trigeminal artery. She was submitted to endovascular treatment with embolization of the basilar artery aneurysm with coils. Aneurysms at the PTA junction with the basilar artery are rare. This paper describes a case of PTA associated with an aneurysm in the basilar artery at PTA junction and briefly reviews the literature. PMID:22005697

  18. Optical coherence tomography of traumatic aneurysms of the internal carotid artery: report of 2 cases.

    PubMed

    Griessenauer, Christoph J; Foreman, Paul M; Deveikis, John P; Harrigan, Mark R

    2016-02-01

    The pathophysiology of extracranial traumatic aneurysm formation has not been fully elucidated. Intraarterial optical coherence tomography (OCT), an imaging modality capable of micrometer cross-sectional resolution, was used to evaluate patients presenting with saccular traumatic aneurysms of the internal carotid artery (ICA). Two consecutive trauma patients diagnosed with saccular traumatic aneurysms of the cervical ICA, per the institutional screening protocol for traumatic cerebrovascular injury, underwent digital subtraction angiography (DSA) with OCT. Optical coherence tomography demonstrated disruption of the intima with preservation and stretching of the more peripheral layers. In 1 patient the traumatic aneurysm was associated with thrombus formation and a separate, more proximal dissection not visible on CT angiography (CTA) or DSA. Imaging with OCT indicates that saccular traumatic aneurysms may develop from disruption of the intima with at least partial preservation of the media and adventitia. This provides in vivo evidence that saccular traumatic aneurysms result from a partial arterial wall tear rather than complete disruption. Interestingly, OCT was also able to detect arterial injury and thrombi not visible on CTA or DSA. PMID:26252460

  19. Left Main Coronary Artery Aneurysm

    PubMed Central

    Doustkami, Hossein; Maleki, Nasrollah; Tavosi, Zahra

    2016-01-01

    Aneurysms of the left main coronary artery are exceedingly rare clinical entities, encountered incidentally in approximately 0.1% of patients who undergo routine angiography. The most common cause of coronary artery aneurysms is atherosclerosis. Angiography is the gold standard for diagnosis and treatment. Depending on the severity of the coexisting coronary stenosis, patients with left main coronary artery aneurysms can be effectively managed either surgically or pharmacologically. We herein report a case of left main coronary artery aneurysm in a 72-year-old man with a prior history of hypertension presenting to our hospital because of unstable angina. The electrocardiogram showed ST-segment depression and T-wave inversion in the precordial leads. All the data of blood chemistry were normal. Echocardiography showed akinetic anterior wall, septum, and apex, mild mitral regurgitation and ejection fraction of 45%. Coronary angiography revealed a saccular aneurysm of the left main coronary artery with significant stenosis in the left anterior descending, left circumflex, and right coronary artery. The patient immediately underwent coronary artery bypass grafting and ligation of the aneurysm. At six months’ follow-up, he remained asymptomatic. PMID:27403190

  20. Endovascular Treatment of a Renal Artery Branch Aneurysm

    SciTech Connect

    Malacrida, G.; Dalainas, Ilias Medda, Massimo; Nano, Giovanni; Inglese, Luigi

    2007-02-15

    A 58-year-old woman was admitted to our institution because of a left renal artery branch saccular aneurysm with a 2 cm diameter. Due to a hostile abdomen and the infrarenal location, an endovascular approach was chosen. A Jostent Peripheral Stent-Graft was placed under angiographic control, excluding the aneurysm from the circulation. No peri- or postprocedural complications were observed. At 6 months follow-up, the endograft is patent, excluding the aneurysm. Endovascular treatment may represent an alternative to surgery, especially in the distal infraparenchymal location.

  1. Surgical repair for giant ascending aortic aneurysm to superior vena cava fistula with positive syphilitic test.

    PubMed

    Sekine, Yuji; Yamamoto, Shin; Fujikawa, Takuya; Oshima, Susumu; Ono, Makoto; Sasaguri, Shiro

    2015-10-01

    Syphilitic aortitis is usually associated with thoracic aortic saccular aneurysm, aortic regurgitation and coronary ostial stenosis. However, syphilitic aneurysms have rarely been reported today. Here, we report a patient with ascending aortic aneurysm with aorta-superior vena cava (SVC) fistula with positive syphilitic test. A 52-year-old man was admitted to our institution with a giant ascending aortic aneurysm complicated with SVC syndrome. Computed tomography revealed a giant ascending aneurysm 79 mm in diameter. The result of serodiagnostic tests for syphilis had not been judged yet preoperatively. Total arch replacement concomitant with elephant trunk was performed. Intraoperatively, we detected the ascending aorta to SVC fistula. Postoperatively, we suspected the syphilitic aneurysm strongly, because preoperative serodiagnostic test was concluded to be positive. However, histological examination did not show typical syphilitic features. The patient remains asymptomatic 1 year later. Although extremely rarely today, syphilitic aneurysm should be still considered in the differential diagnosis of ascending aortic aneurysm. PMID:24000069

  2. Successful coil embolization of a ruptured basilar artery aneurysm in a child with leukemia: a case report.

    PubMed

    Hayashi, Shihori; Maehara, Taketoshi; Mukawa, Maki; Aoyagi, Masaru; Yoshino, Yoshikazu; Nemoto, Shigeru; Ono, Toshiaki; Ohno, Kikuo

    2014-01-01

    Ruptured intracranial aneurysms are rare in the pediatric population compared to adults. This has incited considerable discussion on how to treat children with this condition. Here, we report a child with a ruptured saccular basilar artery aneurysm that was successfully treated with coil embolization. A 12-year-old boy with acute lymphoblastic leukemia and accompanying abdominal candidiasis after chemotherapy suddenly complained of a severe headache and suffered consciousness disturbance moments later. Computed tomography scans and cerebral angiography demonstrated acute hydrocephalus and subarachnoid hemorrhage caused by saccular basilar artery aneurysm rupture. External ventricular drainage was performed immediately. Because the patient was in severe condition and did not show remarkable signs of central nervous system infection in cerebrospinal fluid studies, we applied endovascular treatment for the ruptured saccular basilar artery aneurysm, which was successfully occluded with coils. The patient recovered without new neurological deficits after ventriculoperitoneal shunting. Recent reports indicate that both endovascular and microsurgical techniques can be used to effectively treat ruptured cerebral aneurysms in pediatric patients. A minimally invasive endovascular treatment was effective in the present case, but long-term follow-up will be necessary to confirm the efficiency of endovascular treatment for children with ruptured saccular basilar artery aneurysms. PMID:24257487

  3. Successful Coil Embolization of a Ruptured Basilar Artery Aneurysm in a Child with Leukemia: A Case Report

    PubMed Central

    HAYASHI, Shihori; MAEHARA, Taketoshi; MUKAWA, Maki; AOYAGI, Masaru; YOSHINO, Yoshikazu; NEMOTO, Shigeru; ONO, Toshiaki; OHNO, Kikuo

    2014-01-01

    Ruptured intracranial aneurysms are rare in the pediatric population compared to adults. This has incited considerable discussion on how to treat children with this condition. Here, we report a child with a ruptured saccular basilar artery aneurysm that was successfully treated with coil embolization. A 12-year-old boy with acute lymphoblastic leukemia and accompanying abdominal candidiasis after chemotherapy suddenly complained of a severe headache and suffered consciousness disturbance moments later. Computed tomography scans and cerebral angiography demonstrated acute hydrocephalus and subarachnoid hemorrhage caused by saccular basilar artery aneurysm rupture. External ventricular drainage was performed immediately. Because the patient was in severe condition and did not show remarkable signs of central nervous system infection in cerebrospinal fluid studies, we applied endovascular treatment for the ruptured saccular basilar artery aneurysm, which was successfully occluded with coils. The patient recovered without new neurological deficits after ventriculoperitoneal shunting. Recent reports indicate that both endovascular and microsurgical techniques can be used to effectively treat ruptured cerebral aneurysms in pediatric patients. A minimally invasive endovascular treatment was effective in the present case, but long-term follow-up will be necessary to confirm the efficiency of endovascular treatment for children with ruptured saccular basilar artery aneurysms. PMID:24257487

  4. Cerebral Aneurysms

    MedlinePlus

    ... Enhancing Diversity Find People About NINDS NINDS Cerebral Aneurysms Information Page Synonym(s): Aneurysm, Brain Aneurysm Condensed from ... Español Additional resources from MedlinePlus What is Cerebral Aneurysms? A cerebral aneurysm is a weak or thin ...

  5. Aortic Aneurysm

    MedlinePlus

    ... chest and abdomen. There are two types of aortic aneurysm: Thoracic aortic aneurysms - these occur in the part of the aorta running through the chest Abdominal aortic aneurysms - these occur in the part of the aorta ...

  6. Aortic Aneurysm

    MedlinePlus

    ... chest and abdomen. There are two types of aortic aneurysm: Thoracic aortic aneurysms (TAA) - these occur in the part of the aorta running through the chest Abdominal aortic aneurysms (AAA) - these occur in the part of the ...

  7. Aneurysm Repair

    MedlinePlus

    ... to other parts of the body (the aorta). Aortic aneurysms can occur in the area below the stomach ( ... or in the chest (thoracic aneurysms). An abdominal aortic aneurysm (AAA) is usually located below the kidneys. In ...

  8. WEB in Partially Thrombosed Intracranial Aneurysms: A Word of Caution.

    PubMed

    Anil, G; Goddard, A J P; Ross, S M; Deniz, K; Patankar, T

    2016-05-01

    Despite the proved safety and efficacy of Woven EndoBridge (WEB) flow disruption in conventional intracranial saccular aneurysms, the literature on its use in partially thrombosed intracranial aneurysms is scarce. We report a series of 4 patients in whom partially thrombosed intracranial aneurysms were treated with the WEB. The 2 patients who received additional intraluminal treatment with conventional stents made a good clinical recovery. Meanwhile, those patients who were treated with the WEB alone had fatal rupture of the aneurysm at short- to medium-term follow-up. This small, select case series demonstrates that WEB placement with adjunctive stent placement may be an effective treatment in the management of partially thrombosed intracranial aneurysms, which merits further validation. However, exclusive intrasaccular flow disruption may have an adverse influence on the natural history of this disease. PMID:26585255

  9. Basilar artery aneurysm at a persistent trigeminal artery junction. A case report and literature review.

    PubMed

    Aguiar, G B; Conti, M L M; Veiga, J C E; Jory, M; Souza, R B

    2011-09-01

    The trigeminal artery is an anastomosis between the embryonic precursors of the vertebrobasilar and carotid systems, and may persist into adult life. The association of the persistent primitive trigeminal artery (PTA) with cerebral aneurysm is well documented in the literature and, in general, aneurysms are located in the anterior circulation. We describe a patient who presented with a panencephalic Fisher III subarachnoid hemorrhage due to rupture of an intracranial aneurysm. Digital arteriography showed a saccular aneurysm in the middle third of the basilar artery, adjacent to the junction with a persistent trigeminal artery. She was submitted to endovascular treatment with embolization of the basilar artery aneurysm with coils. Aneurysms at the PTA junction with the basilar artery are rare. This paper describes a case of PTA associated with an aneurysm in the basilar artery at PTA junction and briefly reviews the literature. PMID:22005697

  10. Characterization of cerebral aneurysms using 3D moment invariants

    NASA Astrophysics Data System (ADS)

    Millan, Raul D.; Hernandez, Monica; Gallardo, Daniel; Cebral, Juan R.; Putman, Christopher; Dempere-Marco, Laura; Frangi, Alejandro F.

    2005-04-01

    The rupture mechanism of intracranial aneurysms is still not fully understood. Although the size of the aneurysm is the shape index most commonly used to predict rupture, some controversy still exists about its adequateness as an aneurysm rupture predictor. In this work, an automatic method to geometrically characterize the shape of cerebral saccular aneurysms using 3D moment invariants is proposed. Geometric moments are efficiently computed via application of the Divergence Theorem over the aneurysm surface using a non-structured mesh. 3D models of the aneurysm and its connected parent vessels have been reconstructed from segmentations of both 3DRA and CTA images. Two alternative approaches have been used for segmentation, the first one based on isosurface deformable models, and the second one based on the level set method. Several experiments were also conducted to both assess the influence of pre-processing steps in the stability of the aneurysm shape descriptors, and to know the robustness of the proposed method. Moment invariants have proved to be a robust technique while providing a reliable way to discriminate between ruptured and unruptured aneurysms (Sensitivity=0.83, Specificity=0.74) on a data set containing 55 aneurysms. Further investigation over larger databases is necessary to establish their adequateness as reliable predictors of rupture risk.

  11. An Aneurysmal Left Circumflex Artery-to-Right Atrium Fistula in a Patient with Ischemic Symptoms: Accurate Diagnosis with Dual-Source CT Angiography

    SciTech Connect

    Oncel, Dilek Oncel, Guray

    2008-07-15

    In this report, we present a 55-year-old female patient with a left circumflex artery-to-right atrial fistula associated with a huge saccular aneurysm. She had undergone conventional angiography due to ischemic symptoms. In conventional angiography, a very dilated and tortuous vessel originating from the circumflex artery and continuous with a huge saccular aneurysm was visualized but the drainage site could not be demonstrated. With dual-source CT coronary angiography, the exact anatomy of this fistula was demonstrated and surgery was planned.

  12. Coil embolization of an aneurysm located at the trunk of the persistent primitive trigeminal artery.

    PubMed

    Kai, Yutaka; Ohmori, Yuki; Watanabe, Masaki; Morioka, Motohiro; Hirano, Teruyuki; Kawano, Takayuki; Sakurama, Tomotaka; Miura, Akiko; Kuratsu, Jun-Ichi

    2011-01-01

    A 71-year-old woman presented with an aneurysm at the trunk of the persistent primitive trigeminal artery (PPTA) manifesting as subarachnoid hemorrhage. Angiography and three-dimensional computed tomography revealed a wide-necked saccular aneurysm at the trunk of the left PPTA. Coil embolization with the balloon-assist technique was successful and PPTA patency was preserved. Preoperative conventional angiography should be performed to check for cross-filling of the PPTA. This case demonstrates that an aneurysm of the trunk of the PPTA can be successfully treated by coil embolization using the balloon-assist technique. PMID:21613761

  13. Congenital internal jugular vein aneurysm in an infant: A rare entity.

    PubMed

    Awasthy, Neeraj; Khandelwal, Nidhi; Iyer, Krishna S

    2016-05-01

    A 1-month old baby boy presented with a mass at the root of the neck. On investigation, a saccular aneurysm arising from the internal jugular vein was diagnosed. The aneurysm was excised after ligating the patent internal jugular vein above and below the origin of the aneurysm. Histopathology confirmed the diagnosis of a vascular malformation. Vascular malformation of the internal jugular vein, presenting as neck mass, is extremely rare with no case described in neonates. We present one such interesting case. PMID:25425716

  14. Syphilitic aortitis complicated by multiple aortic aneurysms: findings of multidetector CT.

    PubMed

    Liu, Jianhua; Yuan, Qinghai; Golamaully, Reza; Gong, Tingting

    2011-06-01

    We report a case of syphilitic aortitis complicated by multiple aortic aneurysms in a 50-year-old man with elevated rapid plasma reagin titer of 1:128 and positive Treponema pallidum particle agglutination test. 256-slice MDCT depicted two saccular aneurysms in the descending thoracic aorta with a markedly thick mural thrombus causing the trachea and esophagus to shift to the right. Thickening of the aortic wall was also noted. Stenting of the proximal descending thoracic aortic aneurysm and aorto-right common carotid artery bypass were performed. Operative findings revealed thickening of the descending thoracic aortic wall with a coarse luminal surface. PMID:21505957

  15. On the perceptual and behavioral significance of saccular acoustic sensitivity

    NASA Astrophysics Data System (ADS)

    Todd, Neil P. M.

    2002-05-01

    Evidence accumulated over the last few decades supports the case that the sacculus has conserved an acoustic sensitivity throughout vertebrate phylogeny [N. P. Todd, J. Acoust. Soc. Am. 110, 380-390 (2001)]. In humans saccular acoustic sensitivity may be demonstrated by means of myogenic vestibular evoked potentials (MVEP) but the question remains whether saccular acoustic sensitivity in humans has any perceptual or behavioral significance. It has been shown that MVEP have the following properties: (1) MVEP can be obtained to natural acoustic stimuli above about 90 dB SPL; (2) MVEP have a frequency tuning property with a best frequency between 300 Hz-350 Hz; (3) MVEP exhibit adaptation, characteristic or normal sensory processing; and (4) there is a change of the quality of sensation above the MVEP threshold, indicative that saccular acoustic sensitivity may play a role in the perception of loud sound. In this paper new evidence is discussed which indicates that both myogenic and neurogenic vestibular evoked potentials (NVEP), particularly those obtainable from prefrontal cortex, may be linked to subjective and behavioral responses to loud sound. These responses may in turn be related to individual differences in the functioning of the mesolimbic dopamine system, including prefrontal cortex.

  16. Automatic aneurysm neck detection using surface Voronoi diagrams.

    PubMed

    Cárdenes, Rubén; Pozo, José María; Bogunovic, Hrvoje; Larrabide, Ignacio; Frangi, Alejandro F

    2011-10-01

    A new automatic approach for saccular intracranial aneurysm isolation is proposed in this work. Due to the inter- and intra-observer variability in manual delineation of the aneurysm neck, a definition based on a minimum cost path around the aneurysm sac is proposed that copes with this variability and is able to make consistent measurements along different data sets, as well as to automate and speedup the analysis of cerebral aneurysms. The method is based on the computation of a minimal path along a scalar field obtained on the vessel surface, to find the aneurysm neck in a robust and fast manner. The computation of the scalar field on the surface is obtained using a fast marching approach with a speed function based on the exponential of the distance from the centerline bifurcation between the aneurysm dome and the parent vessels. In order to assure a correct topology of the aneurysm sac, the neck computation is constrained to a region defined by a surface Voronoi diagram obtained from the branches of the vessel centerline. We validate this method comparing our results in 26 real cases with manual aneurysm isolation obtained using a cut-plane, and also with results obtained using manual delineations from three different observers by comparing typical morphological measures. PMID:21622072

  17. Brain Aneurysm

    MedlinePlus

    A brain aneurysm is an abnormal bulge or "ballooning" in the wall of an artery in the brain. They are sometimes called berry aneurysms because they ... often the size of a small berry. Most brain aneurysms produce no symptoms until they become large, ...

  18. Statistical wall shear stress maps of ruptured and unruptured middle cerebral artery aneurysms

    PubMed Central

    Goubergrits, L.; Schaller, J.; Kertzscher, U.; van den Bruck, N.; Poethkow, K.; Petz, Ch.; Hege, H.-Ch.; Spuler, A.

    2012-01-01

    Haemodynamics and morphology play an important role in the genesis, growth and rupture of cerebral aneurysms. The goal of this study was to generate and analyse statistical wall shear stress (WSS) distributions and shapes in middle cerebral artery (MCA) saccular aneurysms. Unsteady flow was simulated in seven ruptured and 15 unruptured MCA aneurysms. In order to compare these results, all geometries must be brought in a uniform coordinate system. For this, aneurysms with corresponding WSS data were transformed into a uniform spherical shape; then, all geometries were uniformly aligned in three-dimensional space. Subsequently, we compared statistical WSS maps and surfaces of ruptured and unruptured aneurysms. No significant (p > 0.05) differences exist between ruptured and unruptured aneurysms regarding radius and mean WSS. In unruptured aneurysms, statistical WSS map relates regions with high (greater than 3 Pa) WSS to the neck region. In ruptured aneurysms, additional areas with high WSS contiguous to regions of low (less than 1 Pa) WSS are found in the dome region. In ruptured aneurysms, we found significantly lower WSS. The averaged aneurysm surface of unruptured aneurysms is round shaped, whereas the averaged surface of ruptured cases is multi-lobular. Our results confirm the hypothesis of low WSS and irregular shape as the essential rupture risk parameters. PMID:21957117

  19. Endovascular coil embolization for ruptured kissing aneurysms associated with A1 fenestration

    PubMed Central

    Mitsuhara, Takafumi; Sakamoto, Shigeyuki; Kiura, Yoshihiro; Kurisu, Kaoru

    2011-01-01

    Background: Fenestration of intracranial arteries is a rare anomaly, and is frequently associated with cerebral aneurysms. In this paper, we report rare kissing aneurysms associated with A1 fenestration. Case Description: A 71-year-old woman presented with subarachnoid hemorrhage. Diagnostic digital subtraction angiography revealed two saccular aneurysms at the proximal junction of a fenestration and posterior aspect of the fenestration that appeared to be ‘kissing’ each other. Emergent endovascular coil embolization was performed. Conclusion: Kissing aneurysms associated with fenestration of the horizontal segment in the anterior cerebral artery are rare, and have not been reported. During treatment of such specific types of aneurysms by endovascular treatment, three-dimensional rotational digital subtraction angiography was very useful for deciding the appropriate working angles. PMID:21748037

  20. Basilar vascular system supplied by only right proatlantal intersegmentary artery type 1 with aneurysm and left internal carotid occlusion: a case report and review from the literature.

    PubMed

    Ferrone, Alessandro; Brogna, Barbara; Giliberti, Raffaele; Vassallo, Pasquale; De Magistris, Giuseppe

    2016-09-01

    Persistence of proatlantal artery (PA) is a rare condition. More than 40 cases were described in the literature. Aneurysm may involve the PA itself in approximately 2% of cases, most arising from the internal carotid artery (ICA) side of PA. This case was particular because the PA showed a saccular aneurysm on the posterior wall, probably due to atherosclerosis disease and other alterations: plaque ulcerative of ICA, occlusion of left ICA, and aberrant right VA. PMID:27594943

  1. The effect of inlet waveforms on computational hemodynamics of patient-specific intracranial aneurysms.

    PubMed

    Xiang, J; Siddiqui, A H; Meng, H

    2014-12-18

    Due to the lack of patient-specific inlet flow waveform measurements, most computational fluid dynamics (CFD) simulations of intracranial aneurysms usually employ waveforms that are not patient-specific as inlet boundary conditions for the computational model. The current study examined how this assumption affects the predicted hemodynamics in patient-specific aneurysm geometries. We examined wall shear stress (WSS) and oscillatory shear index (OSI), the two most widely studied hemodynamic quantities that have been shown to predict aneurysm rupture, as well as maximal WSS (MWSS), energy loss (EL) and pressure loss coefficient (PLc). Sixteen pulsatile CFD simulations were carried out on four typical saccular aneurysms using 4 different waveforms and an identical inflow rate as inlet boundary conditions. Our results demonstrated that under the same mean inflow rate, different waveforms produced almost identical WSS distributions and WSS magnitudes, similar OSI distributions but drastically different OSI magnitudes. The OSI magnitude is correlated with the pulsatility index of the waveform. Furthermore, there is a linear relationship between aneurysm-averaged OSI values calculated from one waveform and those calculated from another waveform. In addition, different waveforms produced similar MWSS, EL and PLc in each aneurysm. In conclusion, inlet waveform has minimal effects on WSS, OSI distribution, MWSS, EL and PLc and a strong effect on OSI magnitude, but aneurysm-averaged OSI from different waveforms has a strong linear correlation with each other across different aneurysms, indicating that for the same aneurysm cohort, different waveforms can consistently stratify (rank) OSI of aneurysms. PMID:25446264

  2. The Effect of Inlet Waveforms on Computational Hemodynamics of Patient-Specific Intracranial Aneurysms

    PubMed Central

    Xiang, J.; Siddiqui, A.H.; Meng, H.

    2014-01-01

    Due to the lack of patient-specific inlet flow waveform measurements, most computational fluid dynamics (CFD) simulations of intracranial aneurysms usually employ waveforms that are not patient-specific as inlet boundary conditions for the computational model. The current study examined how this assumption affects the predicted hemodynamics in patient-specific aneurysm geometries. We examined wall shear stress (WSS) and oscillatory shear index (OSI), the two most widely studied hemodynamic quantities that have been shown to predict aneurysm rupture, as well as maximal WSS (MWSS), energy loss (EL) and pressure loss coefficient (PLc). Sixteen pulsatile CFD simulations were carried out on four typical saccular aneurysms using 4 different waveforms and an identical inflow rate as inlet boundary conditions. Our results demonstrated that under the same mean inflow rate, different waveforms produced almost identical WSS distributions and WSS magnitudes, similar OSI distributions but drastically different OSI magnitudes. The OSI magnitude is correlated with the pulsatility index of the waveform. Furthermore, there is a linear relationship between aneurysm-averaged OSI values calculated from one waveform and those calculated from another waveform. In addition, different waveforms produced similar MWSS, EL and PLc in each aneurysm. In conclusion, inlet waveform has minimal effects on WSS, OSI distribution, MWSS, EL and PLc and a strong effect on OSI magnitude, but aneurysm-averaged OSI from different waveforms has a strong linear correlation with each other across different aneurysms, indicating that for the same aneurysm cohort, different waveforms can consistently stratify (rank) OSI of aneurysms. PMID:25446264

  3. Effects of Variations of Flow and Heart Rate on Intra-Aneurysmal Hemodynamics in a Ruptured Internal Carotid Artery Aneurysm During Exercise

    PubMed Central

    Sarrami-Foroushani, Ali; Nasr Esfahany, Mohsen; Saligheh Rad, Hamidreza; Firouznia, Kavous; Shakiba, Madjid; Ghanaati, Hossein

    2016-01-01

    Background: Hemodynamics is thought to play an important role in the mechanisms responsible for initiation, growth, and rupture of intracranial aneurysms. Computational fluid dynamic (CFD) analysis is used to assess intra-aneurysmal hemodynamics. Objectives: This study aimed to investigate the effects of variations in heart rate and internal carotid artery (ICA) flow rate on intra-aneurysmal hemodynamics, in an ICA aneurysm, by using computational fluid dynamics. Patients and Methods: Computed tomography angiography (CTA) was performed in a 55 years old female case, with a saccular ICA aneurysm, to create a patient-specific geometrical anatomic model of the aneurysm. The intra-aneurysmal hemodynamic environments for three states with different flow and heart rates were analyzed using patient-specific image-based CFD modeling. Results: Results showed significant changes for the three simulated states. For a proportion of the states examined, results were counterintuitive. Systolic and time-averaged wall shear stress and pressure on the aneurysm wall showed a proportional evolution with the mainstream flow rate. Conclusion: Results reinforced the pivotal role of vascular geometry, with respect to hemodynamics, together with the importance of performing patient-specific CFD analyses, through which the effect of different blood flow conditions on the aneurysm hemodynamics could be evaluated. PMID:27110332

  4. Aortic Aneurysm Statistics

    MedlinePlus

    ... Blood Pressure Salt Cholesterol Million Hearts® WISEWOMAN Aortic Aneurysm Fact Sheet Recommend on Facebook Tweet Share Compartir ... cause of most deaths from aortic aneurysms. Aortic Aneurysm in the United States Aortic aneurysms were the ...

  5. Abdominal Aortic Aneurysm (AAA)

    MedlinePlus

    ... Resources Professions Site Index A-Z Abdominal Aortic Aneurysm (AAA) Abdominal aortic aneurysm (AAA) occurs when atherosclerosis ... aortic aneurysm treated? What is an abdominal aortic aneurysm? The aorta, the largest artery in the body, ...

  6. What Is an Aneurysm?

    MedlinePlus

    ... from the NHLBI on Twitter. What Is an Aneurysm? An aneurysm (AN-u-rism) is a balloon-like bulge ... the weakened or injured walls can cause an aneurysm. An aneurysm can grow large and rupture (burst) ...

  7. Brain aneurysm repair

    MedlinePlus

    ... aneurysm repair; Dissecting aneurysm repair; Endovascular aneurysm repair - brain; Subarachnoid hemorrhage - aneurysm ... Your scalp, skull, and the coverings of the brain are opened. A metal clip is placed at ...

  8. Thoracic aortic aneurysm

    MedlinePlus

    Aortic aneurysm - thoracic; Syphilitic aneurysm; Aneurysm - thoracic aortic ... The most common cause of a thoracic aortic aneurysm is hardening of the ... with high cholesterol, long-term high blood pressure, or who ...

  9. Abdominal Aortic Aneurysms: Treatments

    MedlinePlus

    ... information Membership Directory (SIR login) Interventional Radiology Abdominal Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists ...

  10. Epidemiology, genetic, natural history and clinical presentation of giant cerebral aneurysms.

    PubMed

    Lonjon, M; Pennes, F; Sedat, J; Bataille, B

    2015-12-01

    Giant cerebral aneurysms represent 5% of intracranial aneurysms, and become symptomatic between 40 and 70 years with a female predominance. In the paediatric population, the giant aneurysm rate is higher than in the adult population. Classified as saccular, fusiform and serpentine, the natural history of giant cerebral aneurysms is characterized by thrombosis, growth and rupture. The pathogenesis of these giant aneurysms is influenced by a number of risk factors, including genetic variables. Genome-wide association studies have identified some chromosomes highlighting candidate genes. Although these giant aneurysms can occur at the same locations as their smaller counterparts, a predilection for the cavernous location has been observed. Giant aneurysms present with symptoms caused by a mass effect depending on their location or by rupture; ischemic manifestations rarely reveal the aneurysm. If the initial clinical descriptions have been back up by imagery, the clinical context with a pertinent analysis of the risk factors remain the cornerstone for the management decisions of these lesions. Five year cumulative rupture rates for patients with giant aneurysm were 40% for those located on the anterior part of circle of Willis and 50% for those on the posterior part. The poor outcome of untreated patients justifies the therapeutic risks. PMID:26598391

  11. Stent-assisted coil embolization of a symptomatic middle cerebral artery aneurysm in an infant.

    PubMed

    Savastano, Luis E; Chaudhary, Neeraj; Gemmete, Joseph J; Garton, Hugh J L; Maher, Cormac O; Pandey, Aditya S

    2014-11-01

    Pediatric intracranial aneurysms are rare and challenging to treat. Achieving efficacy and durability of aneurysmal occlusion while maintaining parent vessel patency requires innovative treatment strategies, especially in cases in which aneurysmal location or morphology pose substantial morbidity associated with microsurgical treatment. In the last 3 decades, endovascular treatments have had a remarkable evolution and are currently considered safe and effective therapeutic options for cerebral aneurysms. While endovascular techniques are well described in the English literature, the endovascular management of pediatric aneurysms continues to pose a challenge. In this report, the authors describe the case of a 9-month-old infant who presented with a 1-day history of acute-onset left-sided hemiparesis and left facial droop. Imaging revealed a large symptomatic saccular middle cerebral artery aneurysm. Treatment included successful stent-assisted aneurysm coiling. At follow-up, the patient continued to fare well and MR angiography confirmed complete occlusion of the aneurysm dome. This case features the youngest patient in the English literature to harbor an intracranial aneurysm successfully treated with stent-assisted coiling. Based on this experience, endovascular intervention with vascular reconstruction can be safe and effective for the treatment of infants and could further improve prognosis; however, further studies are necessary to confirm these findings. PMID:25171722

  12. Selective treatment of an anterior spinal artery aneurysm with endosaccular coil therapy. Case report.

    PubMed

    Lavoie, Pascale; Raymond, Jean; Roy, Daniel; Guilbert, François; Weill, Alain

    2007-05-01

    The authors report the case of a 12-year-old boy with spinal cord arteriovenous malformation (AVM) and an associated anterior spinal artery (ASA) aneurysm treated with selective coil placement in the context of subarachnoid hemorrhage (SAH). The patient presented with headache. Head computed tomography scanning revealed no abnormal findings. The cerebrospinal fluid was sampled and analyzed and a diagnosis of SAH was established. Investigation, including magnetic resonance imaging of the cord as well as cerebral and spinal angiography, revealed a conus medullaris AVM and a saccular aneurysm located on the ASA at the T-11 level. The aneurysm was thought to be responsible for the bleeding. Superselective ASA angiography showed that the aneurysm was at the bifurcation between a large coronal artery supplying the AVM and the ASA. The relation of the aneurysm's neck to the main spinal axis and the aneurysm's morphological features indicated that the lesion was suited for endosaccular coil therapy. The aneurysm was selectively occluded, using electrodetachable bare platinum coils. Follow-up angiography immediately after surgery and at 6 months thereafter demonstrated complete occlusion of the aneurysm and a perfectly patent anterior spinal axis. On clinical follow-up examination, the patient remained neurologically intact. When the morphological features of a spinal aneurysm and its relation with the anterior spinal axis are favorable, selective endosaccular coil placement can successfully be achieved. PMID:17542515

  13. Tangential Resection of a Popliteal Vein Aneurysm in a Patient Complaining of Localized Popliteal Pain

    PubMed Central

    Han, Sun; Ryu, Jae Wook

    2016-01-01

    A 48-year old man presented with left popliteal pain. A 2.2×1.6 cm sized saccular aneurysm at the level of the left popliteal fossa was diagnosed by ultrasonography. Tangential aneurysmectomy and popliteal vein repair was performed uneventfully. The patient fared well for a year without symptoms. Popliteal vein aneurysms are rare and typically found in patients with fatal thromboembolic features without warning symptoms. Fortunately, our patient had localized pain which was helpful in its early diagnosis and treatment. PMID:27051660

  14. Surgical and Antimicrobial Management of a Thoracic Aortic Aneurysm Due to Q Fever: A Case Report and Brief Review.

    PubMed

    Robinson, William P; Schuksz, Manuela

    2016-05-01

    Coxiella burnetii, the etiologic agent of Q fever, has been associated with vascular infection and aneurysm formation. We report the case of a 36-year-old woman from Iraq who presented with long-standing malaise as well as vague chest and shoulder discomfort and was found to have a saccular aneurysm of the descending thoracic aorta. Serology assays were positive for chronic C burnetii infection. She was treated with successful aneurysm resection and aortic replacement with a rifampin-impregnated Maquet Hemashield (TM) Dacron interposition graft interposition graft in addition to 18 months of doxycycline and hydroxychloroquine. The patient is without evidence of recurrent infection on follow-up at 3 years. To our knowledge, this is the first case of aortic aneurysm secondary to Q fever reported in the United States. We review the diagnosis, surgical management, antibiotic therapy, and surveillance of a thoracic aortic aneurysm secondary to Q fever. PMID:27075992

  15. Atrial Septal Aneurysm Presenting as Clubbing without Clinically Apparent Cyanosis.

    PubMed

    Goyal, Laxmi Kant; Banerjee, S; Yadav, R N; Singh, Gajraj; Ganguli, Sujata; Isran, Rohit

    2015-09-01

    Atrial septal aneurysm (ASA) is a localised "saccular" deformity which protrudes to the right or the left atrium or on both sides. It is a rare, but well recognised cardiac abnormality. It is usually an incidental finding or may presents as atrial arrhythmias or arterial embolism. Though it is an acyanotic congenital heart disease but it may result in significant right to left shunt and cyanosis. We describe a patient of ASA with atrial septal defect who presented with clubbing and right to left shunt without clinically apparent cyanosis. PMID:27608873

  16. Ruptured cerebral aneurysm associated with a persistent primitive trigeminal artery variant

    PubMed Central

    Yamamoto, Takahiro; Hasegawa, Yu; Ohmori, Yuki; Kawano, Takayuki; Kai, Yutaka; Morioka, Motohiro; Kuratsu, Jun-ichi

    2011-01-01

    Background: Primitive trigeminal artery variants (PTAVs) are one of the rare persistent fetal anastomoses between the carotid and vertebrobasilar circulations. They originate from the internal carotid artery and join one of the cerebellar arteries instead of the basilar artery. Case Description: We present an 82-year-old woman with subarachnoid hemorrhage due to a ruptured aneurysm originating at a PTAV. Three-dimensional computed tomography angiogram and cerebral angiography revealed bilateral PTAV and two aneurysms originating at the left PTAV. The proximal and distal aneurysms were saccular and fusiform, respectively. She underwent surgical treatment and her postoperative course was uneventful. Conclusion: Our case demonstrates that extremely rare cerebral aneurysms associated with PTAV can be addressed successfully by surgical intervention. PMID:22059121

  17. An Unruptured Cerebral Aneurysm at the Origin of the Duplicated Middle Cerebral Artery

    PubMed Central

    Kim, Jin Seong; Park, Hyun; Han, Jong-Woo

    2015-01-01

    A variety of cerebral vascular anomalies are widely applied, however anomalies of the middle cerebral artery (MCA) are relatively infrequent. The duplicated MCA (DMCA) is a MCA anomaly. Aneurysm arising from the origin of the DMCA is rare. Cerebral angiography in a 61-year-old female demonstrated a small (about 3 mm) saccular aneurysm located at the origin of the DMCA in the anterior direction. Considering the unusual location, the lesion was treated, regardless of the size. Aneurysmal characteristics of a broad neck and small size limited the endovascular approach, necessitating open surgery. Her postoperative course was uneventful and postoperative angiography showed complete obliteration of the aneurysm. The patient was discharged without neurologic deficit. PMID:26523256

  18. Ductus arteriosus aneurysm presenting as hoarseness: successful repair with an endovascular approach.

    PubMed

    De Freitas, Simon; Connolly, Caoilfhionn; Neary, Colm; Sultan, Sherif

    2016-01-01

    An aneurysm of the ductus arteriosus is a rare finding, particularly in the adult population. These saccular aneurysms arise at the site of an incompletely obliterated ductus arteriosus along the lesser curvature of the aortic arch. Left untreated, it is associated with a high risk of potentially life-threatening complications including rupture, infection and thromboembolism. As a result, surgical correction is recommended. Previously, options were limited to open repair but as endovascular experience grows, novel techniques afford safer and less invasive alternatives. In contrast, neonatal ductus arteriosus aneurysms may regress spontaneously and expectant treatment can be justified. We present the case of a 74-year-old woman who presented with hoarseness secondary to a ductus arteriosus aneurysm; a diagnosis consistent with Ortner's syndrome. The patient underwent an uncomplicated endovascular repair using the chimney-graft technique. PMID:27141045

  19. [Stent graft for rapidly growing thoracic mycotic aneurysm in a patient with advanced lung cancer].

    PubMed

    Ikeuchi, Masaki; Ando, Makoto; Hisano, Kumi; Nakamura, Ryo; Urabe, Yoshitoshi; Uchida, Takayuki

    2015-02-01

    We report a compromised patient with mycotic aneurysm, who was successfully treated by urgent placement of a stent graft. A man in his seventies was admitted to our hospital with relapsing high fever and back pain during chemotherapy for advanced squamous cell carcinoma of the lung. Contrast CT demonstrated a saccular aneurysm of the thoracic aorta and left pleural effusion. Blood cultures were positive for Escherichia coli producing extended spectrum beta-lactamase (ESBL). Therefore, thoracic mycotic aneurysm was diagnosed. Because of rapid growth on consecutive examinations, absolute bed rest was required. Therefore, we performed antibiotic therapy combined with stent graft placement, which achieved complete exclusion of the aneurysm. He was discharged in an ambulatory state, and his quality of life remained good at home until just before death from terminal state of the cancer. PMID:26021128

  20. Ductus arteriosus aneurysm presenting as hoarseness: successful repair with an endovascular approach

    PubMed Central

    De Freitas, Simon; Connolly, Caoilfhionn; Neary, Colm; Sultan, Sherif

    2016-01-01

    An aneurysm of the ductus arteriosus is a rare finding, particularly in the adult population. These saccular aneurysms arise at the site of an incompletely obliterated ductus arteriosus along the lesser curvature of the aortic arch. Left untreated, it is associated with a high risk of potentially life-threatening complications including rupture, infection and thromboembolism. As a result, surgical correction is recommended. Previously, options were limited to open repair but as endovascular experience grows, novel techniques afford safer and less invasive alternatives. In contrast, neonatal ductus arteriosus aneurysms may regress spontaneously and expectant treatment can be justified. We present the case of a 74-year-old woman who presented with hoarseness secondary to a ductus arteriosus aneurysm; a diagnosis consistent with Ortner’s syndrome. The patient underwent an uncomplicated endovascular repair using the chimney-graft technique. PMID:27141045

  1. Alteration of Intra-Aneurysmal Hemodynamics for Flow Diversion Using Enterprise and Vision Stents

    PubMed Central

    Tremmel, Markus; Xiang, Jianping; Natarajan, Sabareesh K.; Hopkins, L. Nelson; Siddiqui, Adnan H.; Levy, Elad I.; Meng, Hui

    2010-01-01

    Objective Flow diversion is a novel concept for intracranial aneurysm treatment. The recently developed Enterprise Vascular Reconstruction Device (Codman Neurovascular, Raynham MA) provides easy delivery and repositioning. Although designed specifically for restraining coils within an aneurysm, this stent has theoretical effects on modifying flow dynamics, which have not been studied. The goal of this study was to quantify the effect of single and multiple self-expanding Enterprise stents alone or in combination with balloon-mounted stents on aneurysm hemodynamics using computational fluid dynamics (CFD). Methods The geometry of a wide-necked, saccular, basilar trunk aneurysm was reconstructed from computed tomographic angiography images. Various combinations of 1–3 stents were “virtually” conformed to fit into the vessel lumen and placed across the aneurysm orifice. CFD analysis was performed to calculate hemodynamic parameters considered important in aneurysm pathogenesis and thrombosis for each model. Results The complex aneurysmal flow pattern was suppressed by stenting. Stent placement lowered average flow velocity in the aneurysm; further reduction was achieved by additional stent deployment. Aneurysmal flow turnover time, an indicator of stasis, was increased to 114-117% for single-stent, 127-128% for double-stent, and 141% for triple-stent deployment. Furthermore, aneurysmal wall shear stress (WSS) decreased with increasing number of deployed stents. Conclusion This is the first study analyzing flow modifications associated with placement of Enterprise stents for aneurysm occlusion. Placement of 2-3 stents significantly reduced intra-aneurysmal hemodynamic activities, thereby increasing the likelihood of inducing aneurysm thrombotic occlusion. PMID:21197155

  2. Aneurysms: thoracic aortic aneurysms.

    PubMed

    Chun, Kevin C; Lee, Eugene S

    2015-04-01

    Thoracic aortic aneurysms (TAAs) have many possible etiologies, including congenital heart defects (eg, bicuspid aortic valves, coarctation of the aorta), inherited connective tissue disorders (eg, Marfan, Ehlers-Danlos, Loeys-Dietz syndromes), and degenerative conditions (eg, medial necrosis, atherosclerosis of the aortic wall). Symptoms of rupture include a severe tearing pain in the chest, back, or neck, sometimes associated with cardiovascular collapse. Before rupture, TAAs may exert pressure on other thoracic structures, leading to a variety of symptoms. However, most TAAs are asymptomatic and are found incidentally during imaging for other conditions. Diagnosis is confirmed with computed tomography scan or echocardiography. Asymptomatic TAAs should be monitored with imaging at specified intervals and patients referred for repair if the TAAs are enlarging rapidly (greater than 0.5 cm in diameter over 6 months for heritable etiologies; greater than 0.5 cm over 1 year for degenerative etiologies) or reach a critical aortic diameter threshold for elective surgery (5.5 cm for TAAs due to degenerative etiologies, 5.0 cm when associated with inherited syndromes). Open surgery is used most often to treat asymptomatic TAAs in the ascending aorta and aortic arch. Asymptomatic TAAs in the descending aorta often are treated medically with aggressive blood pressure control, though recent data suggest that endovascular procedures may result in better long-term survival rates. PMID:25860136

  3. Morphology Parameters for Intracranial Aneurysm Rupture Risk Assessment

    PubMed Central

    Dhar, Sujan; Tremmel, Markus; Mocco, J; Kim, Minsuok; Yamamoto, Junichi; Siddiqui, Adnan H.; Hopkins, L. Nelson; Meng, Hui

    2008-01-01

    OBJECTIVE The aim of this study is to identify image-based morphological parameters that correlate with human intracranial aneurysm (IA) rupture. METHODS For 45 patients with terminal or sidewall saccular IAs (25 unruptured, 20 ruptured), three-dimensional geometries were evaluated for a range of morphological parameters. In addition to five previously studied parameters (aspect ratio, aneurysm size, ellipticity index, nonsphericity index, and undulation index), we defined three novel parameters incorporating the parent vessel geometry (vessel angle, aneurysm [inclination] angle, and [aneurysm-to-vessel] size ratio) and explored their correlation with aneurysm rupture. Parameters were analyzed with a two-tailed independent Student's t test for significance; significant parameters (P < 0.05) were further examined by multivariate logistic regression analysis. Additionally, receiver operating characteristic analyses were performed on each parameter. RESULTS Statistically significant differences were found between mean values in ruptured and unruptured groups for size ratio, undulation index, nonsphericity index, ellipticity index, aneurysm angle, and aspect ratio. Logistic regression analysis further revealed that size ratio (odds ratio, 1.41; 95% confidence interval, 1.03−1.92) and undulation index (odds ratio, 1.51; 95% confidence interval, 1.08−2.11) had the strongest independent correlation with ruptured IA. From the receiver operating characteristic analysis, size ratio and aneurysm angle had the highest area under the curve values of 0.83 and 0.85, respectively. CONCLUSION Size ratio and aneurysm angle are promising new morphological metrics for IA rupture risk assessment. Because these parameters account for vessel geometry, they may bridge the gap between morphological studies and more qualitative location-based studies. PMID:18797347

  4. MR Imaging of Myeloperoxidase Activity in a Model of the Inflamed Aneurysm Wall

    PubMed Central

    Gounis, M.J.; van der Bom, I.M.J.; Wakhloo, A.K.; Zheng, S.; Chueh, J.-Y.; Kühn, A.L.; Bogdanov, A.A.

    2014-01-01

    Background and Purpose Although myeloperoxidase (MPO) activity in vivo can be visualized using non-invasive imaging, successful clinical translation requires further optimization of the imaging approach. We report a motion-sensitized-driven-equilibrium (MSDE) for the detection of an MPO activity-specific gadolinium (Gd)-containing imaging agent (IA) in experimental aneurysm models that compensates for irregular blood flow enabling vascular wall imaging in the aneurysm. Materials and Methods We deployed a phantom model to optimize a MSDE MR sequence that suppresses complex flow patterns within the aneurysm for detection of an MPO-specific Gd-chelate. The phantom was built from rotational angiography of a rabbit elastase aneurysm model and connected to a cardiac pulse duplicator mimicking rabbit-specific flow conditions. Thereafter, we further refined the MSDE sequence and applied it in vivo to rabbit aneurysm models with and without inflammation in the aneurysmal wall. Under each condition, the aneurysms were imaged before and after intravenous administration of the IA. The signal-to-noise ratio (SNR) of each MR slice through the aneurysm was calculated. Results The MSDE sequence was optimized to reduce flow signal enabling detection of the MPO-IA in the phantom. The optimized imaging protocol in the rabbit model of saccular aneurysms revealed a significant increase in the change of SNR pre- to postcontrast MR signal intensities in the inflamed aneurysms as compared to naïve aneurysms and the adjacent carotid artery (p<0.0001). Conclusion A diagnostic MR protocol was optimized for molecular imaging of an MPO-specific molecular imaging agent in an animal model of brain aneurysms. PMID:25273534

  5. Treatment of ruptured intracranial dissecting aneurysms in Hong Kong

    PubMed Central

    Wong, George Kwok Chu; Tang, Hoi Bun; Poon, Wai Sang; Yu, Simon Chun Ho

    2010-01-01

    Background: Data suggests that hemorrhagic presentations occur in 20% of internal carotid artery dissections and 50% of vertebral artery dissections. A Finnish study has reported favorable outcomes in only 32% of patients. We aimed to review the epidemiology and management outcomes in a Chinese population. Methods: We reviewed the aneurysmal subarachnoid hemorrhage registry of patients who presented with intracranial dissecting aneurysms at a neurosurgical center in Hong Kong over a five-year period. Results: A total of 23 patients with intracranial dissecting aneurysms were identified, accounting for 8% of all spontaneous subarachnoid hemorrhage patients. Forty-eight percent of the patients identified were treated by main trunk occlusion and 39% were treated by embolization or stent-assisted embolization or stent alone. Thirteen percent were managed by craniotomy and trapping or wrapping. Favorable outcomes at six months were achieved in 67%. Conclusions: Patients with intracranial dissecting aneurysms account for a significant proportion of the cases of spontaneous subarachnoid hemorrhage in our population. Carefully selected endovascular and microsurgical treatments can lead to management outcomes similar to patients with saccular aneurysms. PMID:21206536

  6. Management of Complicated Aortic Aneurysms Using Multiple Overlapping Uncovered Stents

    PubMed Central

    Zhang, Yongxue; Teng, Zhongzhao; Lu, Qingsheng; Zhao, Zhiqing; Bao, Junmin; Feng, Xiang; Feng, Rui; Chen, Zengsheng; Huang, Yuan; Sadat, Umar; Gillard, Jonathan H; Jing, Zaiping

    2014-01-01

    Abstract This study sought to report the mid-term outcome of a modified flow-diverting strategy in the treatment of complicated aortic aneurysms of different morphology. Historical data suggested aortic aneurysm expansion and rupture after endovascular treatment with current commercial flow-diverters, indicating the essentiality of further investigation of this technique prior to its large-scale clinical application. An alternative flow-diverting strategy using layer-by-layer assembled multiple overlapping uncovered stents was employed in this study. The treatment outcome in aneurysms of different morphology (saccular, fusiform, and dissecting) was assessed during a mid-term follow-up period. Of 42 patients enrolled in this study (30 male, mean age: 63.3 years), technical success was achieved in 40 cases. During an average follow-up period of 20.9 months, mean aneurysm diameter shrunk from 53.4 ± 13.6 mm to 48.8 ± 13.9 mm (P < 0.001), while stent-induced sac thrombosis ratio increased significantly (18.1 ± 14.9% to 93.6 ± 9.5%, P < 0.001). The majority of side branches (74/76 major visceral branches, 237/244 minor segmental arteries), covered by 3.3 stents on average, maintained their patency after stenting. Saccular aneurysms manifested the highest thrombus deposition speed (18/20 were totally thrombosed within 12 months) and most significant shrinkage (51.4 ± 13.3 mm pre-operatively vs 43.5 ± 10.2 mm during follow-up, P < 0.001) compared with fusiform and dissecting aneurysms. This modified flow-diverting strategy could be a feasible alternative in the management of complicated aortic aneurysms where vital branches need to be preserved. The treatment outcome may depend on the aneurysm type. Further studies with larger patient cohort and longer follow-up are required to substantiate these results. PMID:25501077

  7. Cerebral Aneurysms Fact Sheet

    MedlinePlus

    ... Awards Enhancing Diversity Find People About NINDS Cerebral Aneurysms Fact Sheet See a list of all NINDS ... I get more information? What is a cerebral aneurysm? A cerebral aneurysm (also known as an intracranial ...

  8. Aortic aneurysm repair - endovascular

    MedlinePlus

    ... Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular ... leaking or bleeding. You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. ...

  9. Aortic aneurysm repair - endovascular

    MedlinePlus

    EVAR; Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular ... leaking or bleeding. You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. ...

  10. Epithelial-Derived Inflammation Disrupts Elastin Assembly and Alters Saccular Stage Lung Development.

    PubMed

    Benjamin, John T; van der Meer, Riet; Im, Amanda M; Plosa, Erin J; Zaynagetdinov, Rinat; Burman, Ankita; Havrilla, Madeline E; Gleaves, Linda A; Polosukhin, Vasiliy V; Deutsch, Gail H; Yanagisawa, Hiromi; Davidson, Jeffrey M; Prince, Lawrence S; Young, Lisa R; Blackwell, Timothy S

    2016-07-01

    The highly orchestrated interactions between the epithelium and mesenchyme required for normal lung development can be disrupted by perinatal inflammation in preterm infants, although the mechanisms are incompletely understood. We used transgenic (inhibitory κB kinase β transactivated) mice that conditionally express an activator of the NF-κB pathway in airway epithelium to investigate the impact of epithelial-derived inflammation during lung development. Epithelial NF-κB activation selectively impaired saccular stage lung development, with a phenotype comprising rapidly progressive distal airspace dilation, impaired gas exchange, and perinatal lethality. Epithelial-derived inflammation resulted in disrupted elastic fiber organization and down-regulation of elastin assembly components, including fibulins 4 and 5, lysyl oxidase like-1, and fibrillin-1. Fibulin-5 expression by saccular stage lung fibroblasts was consistently inhibited by treatment with bronchoalveolar lavage fluid from inhibitory κB kinase β transactivated mice, Escherichia coli lipopolysaccharide, or tracheal aspirates from preterm infants exposed to chorioamnionitis. Expression of a dominant NF-κB inhibitor in fibroblasts restored fibulin-5 expression after lipopolysaccharide treatment, whereas reconstitution of fibulin-5 rescued extracellular elastin assembly by saccular stage lung fibroblasts. Elastin organization was disrupted in saccular stage lungs of preterm infants exposed to systemic inflammation. Our study reveals a critical window for elastin assembly during the saccular stage that is disrupted by inflammatory signaling and could be amenable to interventions that restore elastic fiber assembly in the developing lung. PMID:27181406

  11. Usefulness of Motor-Evoked Potentials Monitoring for Neurosurgical Treatment of an Unusual Distal Anterior Choroidal Artery Aneurysm

    PubMed Central

    Jecko, Vincent; Eimer, Sandrine; Penchet, Guillaume

    2016-01-01

    A 35 years old woman presented with an acute meningeal syndrome following an intra ventricular haemorrhage without subarachnoid haemorrhage. The angiography demonstrated a 6 mm partially thrombosed saccular aneurysm at the plexal point of the right anterior choroidal artery (AChoA). It was surgically approached inside the ventricle through a trans-temporal corticotomy. The aneurysm was excised after distal exclusion of the feeding artery under motor-evoked potentials monitoring. Of the 19 cases of distal AChoA aneurysm neurosurgical treatment, this is the only one performed under electrophysiology monitoring, a simple and safe method to detect and prevent motor tract ischemia. We discuss this rare case, along with a comprehensible review of the literature of the previous surgical cases of distal AChoA aneurysms. PMID:27446526

  12. Unruptured anterior communicating artery aneurysm presenting as depression: A case report and review of literature

    PubMed Central

    Bunevicius, Adomas; Cikotas, Paulius; Steibliene, Vesta; Deltuva, Vytenis P.; Tamsauskas, Arimantas

    2016-01-01

    Background: Intracranial aneurysms most commonly present following rupture causing subarachnoid hemorrhage. Mental disorders are common among patients with unruptured intracranial aneurysms and in aneurysmal subarachnoid hemorrhage survivors. However, to the best of our knowledge, there is no published report of unruptured intracranial aneurysm presenting as a mental disorder. Case Description: A 69-year-old male without a past history of mental disorders and neurological symptoms presented with a 2-month history of anxiety, sadness, lack of pleasure in usual activities, fatigue, difficulties falling asleep and waking up early in the morning, reduced appetite, and weight loss. The patient was diagnosed with major depressive disorder and antidepressant treatment was initiated. Subsequent non-contrast computed tomography (CT) of the head demonstrated hypointense oval-shaped lesion within the projection of the anterior communicating artery. CT angiography confirmed the diagnosis of a 0.8 × 0.6 cm saccular aneurysm originating from the anterior communicating artery and anterior cerebral artery. The patient underwent microsurgical clipping of the aneurysm. On psychiatric assessment 1 month after the surgery, there were no signs of depressive disorder and antidepressive treatment was discontinued. On follow-up visit 1 year after the surgery, the patient did not have any mood symptoms. Conclusions: The case indicates that organic brain lesions, including intracranial aneurysms, should be suspected in elderly patients presenting with their first episode of mental disorder. PMID:27583172

  13. Combined Visualization of Wall Thickness and Wall Shear Stress for the Evaluation of Aneurysms.

    PubMed

    Glaßer, Sylvia; Lawonn, Kai; Hoffmann, Thomas; Skalej, Martin; Preim, Bernhard

    2014-12-01

    For an individual rupture risk assessment of aneurysms, the aneurysm's wall morphology and hemodynamics provide valuable information. Hemodynamic information is usually extracted via computational fluid dynamic (CFD) simulation on a previously extracted 3D aneurysm surface mesh or directly measured with 4D phase-contrast magnetic resonance imaging. In contrast, a noninvasive imaging technique that depicts the aneurysm wall in vivo is still not available. Our approach comprises an experiment, where intravascular ultrasound (IVUS) is employed to probe a dissected saccular aneurysm phantom, which we modeled from a porcine kidney artery. Then, we extracted a 3D surface mesh to gain the vessel wall thickness and hemodynamic information from a CFD simulation. Building on this, we developed a framework that depicts the inner and outer aneurysm wall with dedicated information about local thickness via distance ribbons. For both walls, a shading is adapted such that the inner wall as well as its distance to the outer wall is always perceivable. The exploration of the wall is further improved by combining it with hemodynamic information from the CFD simulation. Hence, the visual analysis comprises a brushing and linking concept for individual highlighting of pathologic areas. Also, a surface clustering is integrated to provide an automatic division of different aneurysm parts combined with a risk score depending on wall thickness and hemodynamic information. In general, our approach can be employed for vessel visualization purposes where an inner and outer wall has to be adequately represented. PMID:26356964

  14. Popliteal aneurysms.

    PubMed

    Farina, C; Cavallaro, A; Schultz, R D; Feldhaus, R J; di Marzo, L

    1989-07-01

    A 15 year experience with 50 popliteal aneurysms in 36 patients is reviewed. Forty-seven popliteal aneurysms were atherosclerotic while three were related to entrapment of the popliteal artery. Fourteen asymptomatic popliteal aneurysms were observed preoperatively during a mean period of 26 months. Ischemic complications developed in five of these. At admission, 16 limbs were asymptomatic (group 1) while the other 34 limbs presented with ischemic symptoms (group 2). No operation was performed upon three limbs, and another two were surgically explored and amputated. No operative deaths resulted from 45 vascular reconstructions. Results from follow-up study of one to 176 months (a mean of 57 months) revealed a late patency rate of 62 per cent. The late patency rate of autologous saphenous vein (ASV) was 100 per cent; polytetrafluoroethylene (PTFE) and Dacron (polyester fiber) grafts had a patency rate of 74 and 34 per cent, respectively (ASV versus PTFE, p = N.S.; ASV versus Dacron, p less than 0.002). The rate of late salvage of limbs was 88 per cent. The bypass grafts of group 1 and those performed upon limbs with good runoff fared significantly better than others (p less than 0.05 and p less than 0.001). The risk of natural complications of popliteal aneurysms and the good results from surgical treatment suggested that a revascularization procedure in the asymptomatic stage is always recommended. The use of PTFE grafts for repair of popliteal aneurysms is justified when the ASV is not available. The use of Dacron grafts is no longer indicated. PMID:2740973

  15. Saccular lung cannulation in a ball python (Python regius) to treat a tracheal obstruction.

    PubMed

    Myers, Debbie A; Wellehan, James F X; Isaza, Ramiro

    2009-03-01

    An adult male ball python (Python regius) presented in a state of severe dyspnea characterized by open-mouth breathing and vertical positioning of the head and neck. The animal had copious discharge in the tracheal lumen acting as an obstruction. A tube was placed through the body wall into the caudal saccular aspect of the lung to allow the animal to breathe while treatment was initiated. The ball python's dyspnea immediately improved. Diagnostics confirmed a bacterial respiratory infection with predominantly Providencia rettgeri. The saccular lung (air sac) tube was removed after 13 days. Pulmonary endoscopy before closure showed minimal damage with a small amount of hemorrhage in the surrounding muscle tissue. Respiratory disease is a common occurrence in captive snakes and can be associated with significant morbidity and mortality. Saccular lung cannulation is a relatively simple procedure that can alleviate tracheal narrowing or obstruction, similar to air sac cannulation in birds. PMID:19368267

  16. Use of Triple Microcatheters for Endovascular Treatment of Wide-Necked Intracranial Aneurysms: A Single Center Experience

    PubMed Central

    Cho, Young Dae; Rhim, Jong Kook; Kang, Hyun-Seung; Park, Jeong Jin; Jeon, Jin Pyeong; Kim, Jeong Eun; Cho, Won Sang

    2015-01-01

    Objective The dual microcatheter technique is common practice for coil embolization of a wide-necked aneurysm, due to safety and efficacy. However, technical limitations of some complex configurations may necessitate additional microcatheters to bolster coil stability, compact the coil, or for protection. Described herein is a triple microcatheter technique for endovascular management of wide-necked intracranial aneurysms. Materials and Methods Data accruing prospectively between January 2006 and October 2014 on simultaneously executed triple microcatheter coil embolization procedures done in 38 saccular aneurysms were reviewed. Clinical and morphological outcomes were assessed, with emphasis on technical aspects of treatment. Results The triple microcatheter technique was successfully applied to all 38 saccular aneurysms, involving the posterior communicating artery (n = 13), the middle cerebral artery (n = 10), the basilar tip (n = 7), the anterior cerebral artery (n = 5), and the internal carotid artery (n = 3). Stent protection was added in four patients and balloon remodeling in one. Dual microcatheters (n = 24) were usually deployed to deliver the coil within sacs of aneurysms, with the additional microcatheter used for protection. Otherwise, triple microcatheters were deployed for coil delivery (n = 11) or coils were delivered via a single microcatheter, with dual microcatheters deployed for protection (n = 3). Successful occlusion of aneurysms was achieved in 89.5% of cases, with no procedure-related morbidity or mortality. Stable occlusion was maintained in 72.2% (26/36) of the aneurysms at the final follow-up (mean interval, 30.2 ± 22.7 months). Conclusion The outcomes of this limited study suggest that the triple microcatheter technique may be an effective and safe therapeutic option for wide-necked aneurysms, using technical strategies tailored to complex angio-anatomic configurations. PMID:26356992

  17. Carotid rete mirabile associated with subarachnoid hemorrhage from intracranial aneurysm: A case report and systematic review

    PubMed Central

    Yamaki, Vitor Nagai; Júnior, Fernando Mendes Paschoal; Piske, Ronie Leo; Teixeira, Manoel Jacobsen; Bor-Seng-Shu, Edson

    2015-01-01

    Carotid rete mirabile (CRM) is a rare physiological vascular network in humans that is most often found in Eastern populations. This paper describes a CRM associated with an aneurysmal subarachnoid hemorrhage (aSAH) and discusses the details of the patient’s treatment. A 28-year-old woman was admitted to our service with clinical signs and symptoms of a spontaneous aSAH. Computed tomography revealed a diffuse and extensive SAH (Fisher group IV), while an angiogram showed an abnormal collateral network in the right carotid system and a hypoplastic aspect to the internal carotid artery (ICA) on the same side. In addition, a saccular aneurysm with a diameter of 9.5 mm was present in the ophthalmic segment of the left ICA. This case is extremely uncommon. To avoid rebleeding in the patient, we successfully treated the patient by clipping the aneurysmal lesion. No procedure was performed for the CRM. PMID:25934776

  18. Seasonal plasticity of auditory saccular sensitivity in the vocal plainfin midshipman fish, Porichthys notatus.

    PubMed

    Sisneros, Joseph A

    2009-08-01

    The plainfin midshipman fish, Porichthys notatus, is a seasonally breeding species of marine teleost fish that generates acoustic signals for intraspecific social and reproductive-related communication. Female midshipman use the inner ear saccule as the main acoustic endorgan for hearing to detect and locate vocalizing males that produce multiharmonic advertisement calls during the breeding season. Previous work showed that the frequency sensitivity of midshipman auditory saccular afferents changed seasonally with female reproductive state such that summer reproductive females became better suited than winter nonreproductive females to encode the dominant higher harmonics of the male advertisement calls. The focus of this study was to test the hypothesis that seasonal reproductive-dependent changes in saccular afferent tuning is paralleled by similar changes in saccular sensitivity at the level of the hair-cell receptor. Here, I examined the evoked response properties of midshipman saccular hair cells from winter nonreproductive and summer reproductive females to determine if reproductive state affects the frequency response and threshold of the saccule to behaviorally relevant single tone stimuli. Saccular potentials were recorded from populations of hair cells in vivo while sound was presented by an underwater speaker. Results indicate that saccular hair cells from reproductive females had thresholds that were approximately 8 to 13 dB lower than nonreproductive females across a broad range of frequencies that included the dominant higher harmonic components and the fundamental frequency of the male's advertisement call. These seasonal-reproductive-dependent changes in thresholds varied differentially across the three (rostral, middle, and caudal) regions of the saccule. Such reproductive-dependent changes in saccule sensitivity may represent an adaptive plasticity of the midshipman auditory sense to enhance mate detection, recognition, and localization during the

  19. Semicircular canal, saccular and utricular function in patients with bilateral vestibulopathy: analysis based on etiology

    PubMed Central

    Bremova, Tatiana; Kremmyda, Olympia; Strupp, Michael

    2014-01-01

    The diagnosis of bilateral vestibulopathy (BV) is typically established based on bilateral semicircular canal dysfunction. The degree to which both otolith organs—the saccule and utricle—are also impaired in BV is not wellestablished, particularly with respect to the etiology and severity of BV. The aim of this study was to evaluate semicircular canal, saccular and utricular function in patients with BV due to aminoglycoside ototoxicity and bilateral Menière’s disease, and with different severities of BV. Caloric and head impulse testing were used as measures of canal function. Cervical vestibular-evoked myogenic potentials (cVEMP) and ocular VEMPs (oVEMP) were used as measures of saccular and utricular function, respectively. We enrolled 34 patients with BV and 55 controls in a prospective case–control study. Patients with BV were less likely to have saccular (61 %) or utricular (64 %) dysfunction relative to canal dysfunction (100 %). Utricular function differed significantly between patients by etiologic group: the poorest function was found in patients with BV due to aminoglycoside toxicity, and the best function in Menière’s disease patients. Canal and saccular function did not vary according to etiology. Further, utricular but not saccular function was significantly correlated with canal function. Saccular and utricular function had the strongest association with Dizziness Handicap Inventory scores relative to canal function. These data suggest that when a patient with BV is identified in a clinical context, oVEMP testing is the most sensitive test in distinguishing between aminoglycoside toxicity and bilateral Menière’s disease. Both cVEMP and oVEMP testing may be considered to evaluate the functional impact on the patient. PMID:23104126

  20. How Is an Aneurysm Treated?

    MedlinePlus

    ... NHLBI on Twitter. How Is an Aneurysm Treated? Aortic aneurysms are treated with medicines and surgery. Small aneurysms ... doing your normal daily activities Treatment for an aortic aneurysm is based on its size. Your doctor may ...

  1. Is aspect ratio sufficient to classify intra-aneurysmal hemodynamics- a parametric approach

    NASA Astrophysics Data System (ADS)

    Durka, Michael; Robertson, Anne

    2013-11-01

    Intracranial aneurysms are a vascular pathology in which a localized bulge is formed in the arterial wall, most often in a saccular shape. It is believed that the blood flow field within the aneurysm plays a critical role in the degradation of the wall. Aneurysm rupture has a high mortality risk. Since only a small fracture of aneurysms rupture, and common treatments have their own risks, it is desirable to identify a useful means of assessing rupture risk. Therefore, numerous groups have endeavored to identify a correlation between rupture risk and sac geometry or flow dynamics. However, no clinically useful parameters have been identified to date. Prior work has suggested that the aspect ratio (sac height/neck) could be useful for risk stratification due to its influence on the sac hemodynamics. In this work, we make of a previously developed parametric model of the aneurysm geometry to evaluate the influence of aspect ratio (sac height/sac neck) on flow dynamics, using computational fluid dynamics. In particular, we assess the influence of aspect ratio on the number of vortices in the aneurysm sac over a wide range of sac geometries. The conclusions obtained for the parametric model are then assessed in 20 clinical cases.

  2. Tailored PICA Revascularization for Unusual Ruptured Fusiform Vertebro-PICA Origin Aneurysms: Rationale and Case Illustrations

    PubMed Central

    Carlson, Andrew P.

    2015-01-01

    Ruptured fusiform aneurysms of the vertebral artery involving posterior inferior cerebellar artery (PICA) origin are difficult to manage without sacrificing PICA. In this report, two very unusual cases are described which highlight different revascularization strategies that may be required. The first case initially appeared to be a small saccular PICA origin aneurysm, but detailed angiography showed a serpentine recanalization of a fusiform aneurysm. This was treated with PICA–PICA anastomosis and trapping of the aneurysm. The second case is a dissecting vertebral aneurysm with both PICA and the anterior spinal artery originating from the dome. PICA was found to be a bihemispheric variant, so no in situ bypass was available, and an occipital artery to PICA bypass was performed. The vertebral artery was occluded proximally only and follow-up angiography showed remodeling of the distal vertebral artery with the anterior spinal artery filling by retrograde flow from the distal vertebral artery. These cases illustrate both the anatomic variability of this region as well as the need to be familiar with multiple treatment strategies including revascularization techniques to be able to successfully treat these aneurysms. PMID:26623241

  3. Tailored PICA Revascularization for Unusual Ruptured Fusiform Vertebro-PICA Origin Aneurysms: Rationale and Case Illustrations.

    PubMed

    Carlson, Andrew P

    2015-11-01

    Ruptured fusiform aneurysms of the vertebral artery involving posterior inferior cerebellar artery (PICA) origin are difficult to manage without sacrificing PICA. In this report, two very unusual cases are described which highlight different revascularization strategies that may be required. The first case initially appeared to be a small saccular PICA origin aneurysm, but detailed angiography showed a serpentine recanalization of a fusiform aneurysm. This was treated with PICA-PICA anastomosis and trapping of the aneurysm. The second case is a dissecting vertebral aneurysm with both PICA and the anterior spinal artery originating from the dome. PICA was found to be a bihemispheric variant, so no in situ bypass was available, and an occipital artery to PICA bypass was performed. The vertebral artery was occluded proximally only and follow-up angiography showed remodeling of the distal vertebral artery with the anterior spinal artery filling by retrograde flow from the distal vertebral artery. These cases illustrate both the anatomic variability of this region as well as the need to be familiar with multiple treatment strategies including revascularization techniques to be able to successfully treat these aneurysms. PMID:26623241

  4. Sensitivity of CFD Based Hemodynamic Results in Rabbit Aneurysm Models to Idealizations in Surrounding Vasculature

    PubMed Central

    Zeng, Zijing; Kallmes, David F.; Durka, Michael J.; Ding, Yonghong; Lewis, Debra; Kadirvel, Ramanathan

    2010-01-01

    Computational fluid dynamics (CFD) studies provide a valuable tool for evaluating the role of hemodynamics in vascular diseases such as cerebral aneurysms and atherosclerosis. However, such models necessarily only include isolated segments of the vasculature. In this work, we evaluate the influence of geometric approximations in vascular anatomy on hemodynamics in elastase induced saccular aneurysms in rabbits. One representative high aspect ratio (AR—height/neck width) aneurysm and one low AR aneurysm were created at the origin of the right common carotid artery in two New Zealand white rabbits. Three-dimensional (3D) reconstructions of the aneurysm and surrounding arteries were created using 3D rotational angiographic data. Five models with varying extents of neighboring vasculature were created for both the high and low AR cases. A reference model included the aneurysm sac, left common carotid artery (LCCA), aortic arch, and downstream trifurcation/quadrification. Three-dimensional, pulsatile CFD studies were performed and streamlines, wall shear stress (WSS), oscillatory shear index, and cross sectional velocity were compared between the models. The influence of the vascular domain on intra-aneurysmal hemodynamics varied between the low and high AR cases. For the high AR case, even a simple model including only the aneurysm, a small section of neighboring vasculature, and simple extensions captured the main features of the steamline and WSS distribution predicted by the reference model. However, the WSS distribution in the low AR case was more strongly influenced by the extent of vasculature. In particular, it was necessary to include the downstream quadrification and upstream LCCA to obtain good predictions of WSS. The findings in this work demonstrate the accuracy of CFD results can be compromised if insufficient neighboring vessels are included in studies of hemodynamics in elastase induced rabbit aneurysms. Consideration of aspect ratio, hemodynamic

  5. Sensitivity of CFD based hemodynamic results in rabbit aneurysm models to idealizations in surrounding vasculature.

    PubMed

    Zeng, Zijing; Kallmes, David F; Durka, Michael J; Ding, Yonghong; Lewis, Debra; Kadirvel, Ramanathan; Robertson, Anne M

    2010-09-01

    Computational fluid dynamics (CFD) studies provide a valuable tool for evaluating the role of hemodynamics in vascular diseases such as cerebral aneurysms and atherosclerosis. However, such models necessarily only include isolated segments of the vasculature. In this work, we evaluate the influence of geometric approximations in vascular anatomy on hemodynamics in elastase induced saccular aneurysms in rabbits. One representative high aspect ratio (AR-height/neck width) aneurysm and one low AR aneurysm were created at the origin of the right common carotid artery in two New Zealand white rabbits. Three-dimensional (3D) reconstructions of the aneurysm and surrounding arteries were created using 3D rotational angiographic data. Five models with varying extents of neighboring vasculature were created for both the high and low AR cases. A reference model included the aneurysm sac, left common carotid artery (LCCA), aortic arch, and downstream trifurcation/quadrification. Three-dimensional, pulsatile CFD studies were performed and streamlines, wall shear stress (WSS), oscillatory shear index, and cross sectional velocity were compared between the models. The influence of the vascular domain on intra-aneurysmal hemodynamics varied between the low and high AR cases. For the high AR case, even a simple model including only the aneurysm, a small section of neighboring vasculature, and simple extensions captured the main features of the steamline and WSS distribution predicted by the reference model. However, the WSS distribution in the low AR case was more strongly influenced by the extent of vasculature. In particular, it was necessary to include the downstream quadrification and upstream LCCA to obtain good predictions of WSS. The findings in this work demonstrate the accuracy of CFD results can be compromised if insufficient neighboring vessels are included in studies of hemodynamics in elastase induced rabbit aneurysms. Consideration of aspect ratio, hemodynamic

  6. The Numerical Study of the Hemodynamic Characteristics in the Patient-Specific Intracranial Aneurysms before and after Surgery

    PubMed Central

    Byun, Jun Soo; Choi, Sun-Young

    2016-01-01

    The patient-specific pre- and postsurgery cerebral arterial geometries in the study were reconstructed from computed tomography angiography (CTA). Three-dimensional computational fluid dynamics models were used to investigate the hemodynamic phenomena in the cerebral arteries before and after surgery of the aneurysm under realistic conditions. CFD simulations for laminar flow of incompressible Newtonian fluid were conducted by using commercial software, ANSYS v15, with the rigid vascular wall assumption. The study found that the flow patterns with the complex vortical structures inside the aneurysm were similar. We also found that the inflow jet streams were coming strongly in aneurysm sac in the presurgery models, while the flow patterns in postsurgery models were quite different from those in presurgery models. The average wall shear stress after surgery for model 1 was approximately three times greater than that before surgery, while it was about twenty times greater for model 2. The area of low WSS in the daughter saccular aneurysm region in model 2 is associated with aneurysm rupture. Thus the distribution of WSS in aneurysm region provides useful prediction for the risk of aneurysm rupture. PMID:27274764

  7. The Numerical Study of the Hemodynamic Characteristics in the Patient-Specific Intracranial Aneurysms before and after Surgery.

    PubMed

    Byun, Jun Soo; Choi, Sun-Young; Seo, Taewon

    2016-01-01

    The patient-specific pre- and postsurgery cerebral arterial geometries in the study were reconstructed from computed tomography angiography (CTA). Three-dimensional computational fluid dynamics models were used to investigate the hemodynamic phenomena in the cerebral arteries before and after surgery of the aneurysm under realistic conditions. CFD simulations for laminar flow of incompressible Newtonian fluid were conducted by using commercial software, ANSYS v15, with the rigid vascular wall assumption. The study found that the flow patterns with the complex vortical structures inside the aneurysm were similar. We also found that the inflow jet streams were coming strongly in aneurysm sac in the presurgery models, while the flow patterns in postsurgery models were quite different from those in presurgery models. The average wall shear stress after surgery for model 1 was approximately three times greater than that before surgery, while it was about twenty times greater for model 2. The area of low WSS in the daughter saccular aneurysm region in model 2 is associated with aneurysm rupture. Thus the distribution of WSS in aneurysm region provides useful prediction for the risk of aneurysm rupture. PMID:27274764

  8. Cerebral aneurysm (image)

    MedlinePlus

    ... loss of nerve function may indicate that an aneurysm may be causing pressure on adjacent brain tissue. ... changes or other neurological changes can indicate the aneurysm has ruptured and is bleeding into the brain. ...

  9. Abdominal aortic aneurysm

    MedlinePlus

    ... to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs when an area of the aorta becomes ... blood pressure Male gender Genetic factors An abdominal aortic aneurysm is most often seen in males over age ...

  10. QUANTIFICATION OF HEMODYNAMIC CHANGES INDUCED BY VIRTUAL PLACEMENT OF MULTIPLE STENTS ACROSS A WIDE-NECKED BASILAR TRUNK ANEURYSM

    PubMed Central

    Kim, Minsuok; Levy, Elad I.; Meng, Hui; Hopkins, L. Nelson

    2009-01-01

    OBJECTIVE The porous intravascular stents that are currently available may not cause complete aneurysm thrombosis and may therefore fail to provide durable protection against aneurysm rupture when used as a sole treatment modality. The goal of this study was to quantify the effects of porous stents on aneurysm hemodynamics using computational fluid dynamics. METHODS The geometry of a wide-necked saccular basilar trunk aneurysm was reconstructed from a patient′s computed tomographic angiography images. Three commercial stents (Neuroform2; Boston Scientific/Target, San Leandro, CA; Wingspan; Boston Scientific, Fremont, CA; and Vision; Guidant Corp., Santa Clara, CA) were modeled. Various combinations of one to three stents were virtually conformed to fit into the vessel lumen and placed across the aneurysm orifice. An unstented aneurysm served as a control. Computational fluid dynamics analysis was performed to calculate the hemodynamic parameters considered important in aneurysm pathogenesis and thrombosis for each of the models. RESULTS The complex flow pattern observed in the unstented aneurysm was suppressed by stenting. Stent placement lowered the wall shear stress in the aneurysm, and this effect was increased by additional stent deployment. Turnover time was moderately increased after single- and double-stent placement and markedly increased after three stents were placed. The influence of stent design on hemodynamic parameters was more significant in double-stented models than in other models. CONCLUSION Aneurysm hemodynamic parameters were significantly modified by placement of multiple stents. Because the associated modifications may be helpful as well as harmful in terms of rupture risk, use of this technique requires careful consideration. PMID:18162911

  11. Stent-graft implantation for clinically diagnosed syphilitic aortic aneurysm in an HIV-infected patient.

    PubMed

    Yasuda, Shota; Imoto, Kiyotaka; Uchida, Keiji; Kawaguchi, Satoshi; Yokoi, Yoshihiko; Shigematsu, Hiroshi; Masuda, Munetaka

    2014-01-01

    We describe our experience with stent-graft placement in a patient with a clinically diagnosed syphilitic aortic aneurysm.The patient was a 43-year-old man with syphilitic and human immunodeficiency virus (HIV) co-infection. Computed tomography (CT) revealed an aortic aneurysm with 89 mm in maximum size which was located at distal aortic arch and was considered syphilis derived saccular aneurysm. The aneurysm was judged at high risk of rupture from its shape. We decided to perform stent-graft implantation. Before surgery, the patient was given antibacterial and anti-HIV agents. Hand-made fenestrated stent graft by Tokyo Medical University was implanted. The graft was placed from the ascending aorta to Th 9 level in the descending aorta. The aneurysm completely disappeared during follow-up, with no flare-up of syphilitic infection up to 2 years after surgery.The number of patients with syphilis and human immunodeficiency virus co-infection is now increasing. Stent-graft implantation may be an effective treatment in such immunocompromised patients. PMID:23774613

  12. Long-term prognosis in patients with clipped unruptured cerebral aneurysms--increased cerebrovascular events in patients with surgically treated unruptured aneurysms.

    PubMed

    Hokari, Masaaki; Kuroda, Satoshi; Nakayama, Naoki; Houkin, Kiyohiro; Ishikawa, Tatsuya; Kamiyama, Hiroyasu

    2013-10-01

    We retrospectively investigated surgical immediate and long-term overall results after clipping of the unruptured aneurysms. Between 1991 and 2008, 166 patients underwent neck clipping of unruptured saccular aneurysms at our institute. Patients were subsequently followed to clarify the occurrence of subarachnoid hemorrhage (SAH), and stroke other than SAH, aneurysm recurrence, cerebrovascular death, all-cause death, and risk factors. Surgical complication was noted in 14 patients (8.4%) and surgical morbidity in two patients (1.2%). Of 164 patients except for these two patients who suffered surgical morbidity, we could obtain more than 3 years follow-up information for 144 patients (87.8%). There were 49 men and 95 women. The mean age was 58.5 years, and mean follow-up period was 7.9 years. Eight cases had died during follow-up (hepatic insufficiency in one, renal insufficiency in one, suicide in one, intracerebral hemorrhage (ICH) in two, SAH in one, and pneumonia after stroke in two). Therefore, the cause of death was stroke and late effects of stroke. Twelve symptomatic cerebrovascular events (cerebral infarction in seven, ICH in four, and SAH in one) occurred in ten patients. Consequently, annual risk of SAH after clipping of unruptured aneurysms was 0.085%. Besides, annual risk of stroke in those patients was 1.06%, and this incidence was higher than that in the general population. Although this study confirmed the good surgical result, annual risk of stroke after clipping of unruptured aneurysms was much higher than that in the general population. The long-term periodic examination to detect recurrent aneurysms and appropriate management to prevent stroke should be performed for patients with surgically treated unruptured aneurysm. PMID:23605078

  13. Celiac Artery Aneurysm

    PubMed Central

    McMullan, D. Michael; McBride, Michael; Livesay, James J.; Dougherty, Kathryn G.; Krajcer, Zvonimir

    2006-01-01

    Aneurysm of the celiac artery is an uncommon clinical problem; fewer than 180 cases have been reported in the world medical literature. Most patients are symptomatic at the time of diagnosis. However, occasionally such aneurysms are detected incidentally during diagnostic imaging for other diseases. We present the case of a 72-year-old man who had an asymptomatic celiac artery aneurysm detected by computed tomographic angiography after endoluminal exclusion of an infrarenal aortic aneurysm. The patient underwent successful resection of the aneurysm and revascularization of the aorta–common hepatic and splenic arteries with use of an autologous saphenous vein graft. PMID:16878636

  14. [Idiopathic pulmonary trunk aneurysm].

    PubMed

    Uehara, Mayuko; Kuroda, Yosuke; Ohori, Syunsuke; Mawatari, Toru; Morishita, Kiyofumi

    2010-07-01

    Pulmonary trunk aneurysm is generally associated with congenital cardiac defects, pulmonary hypertension, or infection. Idiopathic pulmonary trunk aneurysm without any associated diseases is a rare lesion and has seldom been reported. Here, we report a case of a 68-year-old woman with idiopathic pulmonary trunk aneurysm. The maximum diameter of the aneurysm was 53 mm while she was 142 cm in height. We successfully performed aneurysmorrhaphy and her postoperative course was uneventful. Aneurysmorrhaphy was an effective technique for idiopathic pulmonary trunk aneurysm without pulmonary hypertention. PMID:20662238

  15. Embolization of Brain Aneurysms and Fistulas

    MedlinePlus

    ... Professions Site Index A-Z Embolization of Brain Aneurysms and Arteriovenous Malformations/Fistulas Embolization of brain aneurysms ... Aneurysms and Fistulas? What is Embolization of Brain Aneurysms and Fistulas? Embolization of brain aneurysms and arteriovenous ...

  16. Aortic aneurysm repair - endovascular- discharge

    MedlinePlus

    ... page: //medlineplus.gov/ency/patientinstructions/000236.htm Aortic aneurysm repair - endovascular - discharge To use the sharing features ... enable JavaScript. AAA repair - endovascular - discharge; Repair - aortic aneurysm - endovascular - discharge; EVAR - discharge; Endovascular aneurysm repair - discharge ...

  17. Endovascular management of renal artery aneurysms using the multilayer flow modulator

    PubMed Central

    Sultan, Sherif; Basuoniy Alawy, Mahmoud; Flaherty, Rita; Kavanagh, Edel P; Elsherif, Mohamed; Elhelali, Ala; Stefanov, Florian; Lundon, Violet; Hynes, Niamh

    2016-01-01

    Objective Our aim was to describe our experience of the Multilayer Flow Modulator (MFM, Cardiatis, Isnes, Belgium) used in the treatment of type III renal artery aneurysms (RAA). Methods This is a single-centre study. 3 patients (2 men and 1 woman; mean age 59 years; range 41–77 years) underwent treatment of a type III renal artery aneurysm using the MFM. The indications were a 23.9 mm type III RAA at the bifurcation of the upper and lower pole vessels, with 4 side branches; a 42.4 mm type III saccular RAA at the renal hilum; and a 23 mm type III RAA at the origin of the artery, supplying the upper pole. Results Patients had a mean follow-up of 27 months, and were assessed by perioperative renal function tests, and repeat postoperative CT scan. There were no immediate postoperative complications or mortality. The first patient's aneurysm shrank by 8.6 mm, from 23.9 to 15.3 mm over 19 months, with all 4 side branches remaining patent. The largest aneurysm at 42.4 mm completely thrombosed, while the renal artery remained patent to the kidney. The final patient refused to have any follow-up scans but had no deterioration in renal function below 30 mL/min, and no further symptoms reported. Conclusions The MFM is safe and effective in the management of patients with complex renal artery aneurysms. The MFM can be used to treat branched or distal renal artery aneurysms with exclusion of the aneurysm from the circulation, while successfully preserving the flow to the side branches and kidney. Initial results are promising, however, longer follow-up and a larger cohort are required to prove the effectiveness of this emerging technology. PMID:27042315

  18. Visualization and finite element analysis of pulsatile flow in models of the abdominal aortic aneurysm.

    PubMed

    Fukushima, T; Matsuzawa, T; Homma, T

    1989-01-01

    Pulsatile flows in glass models simulating fusiform and lateral saccular aneurysms were investigated by a flow visualization method. When resting fluid starts to flow, the initial fluid motion is practically irrotational. After a short period of time, the flow began to separate from the proximal wall of the aneurysm. Then the separation bubble or vortex grew rapidly in size and filled the whole area of the aneurysm circumferentially. During this period of time, the center of the vortex moved from the proximal end to the distal point of the aneurysm. The transient reversal flow, for instance, which may occur at the end of the ejection period, passed between the wall of the aneurysm and the centrally located vortex. When the rate and pulsatile frequency of flow were high, the vortex broke down into highly disturbed flow (or turbulence) at the distal portion of the aneurysm. The same effect was observed when the length of the aneurysm was increased. A reduction in pulsatile amplitude made the flow pattern close to that in steady flow. A finite element analysis was made to obtain velocity and pressure fields in pulsatile flow through a tube with an axisymmetric expansion. Calculations were performed with the pulsatile flows used in the visualization experiment in order to study the effects of change in the pulsatile wave form by keeping the time-mean Reynolds number and Womersley's parameter unchanged. Calculated instantaneous patterns of velocity field and stream lines agreed well with the experimental results. The appearance and disappearance of the vortex in the dilated portion and its development resulted in complex distributions of pressure and shear fields. Locally minimum and maximum values of wall shear stress occurred at points just upstream and downstream of the distal end of the expansion when the flow rate reached its peak. PMID:2605323

  19. Cardiac ventricular aneurysm

    PubMed Central

    Harley, Hugh R. S.

    1969-01-01

    A case of successful excision of a ventricular aneurysm due to myocardial infarction is presented. The aetiology, incidence, pathogenesis, pathology, clinical features, and diagnosis of the condition are discussed. An account is given of the haemodynamic upset caused by aneurysms of the ventricle. The prognosis of untreated aneurysms is discussed. Although there is difference of opinion, it is concluded that a ventricular aneurysm adversely affects the prognosis after myocardial infarction. The indications for, and the mortality and results of, resection of ventricular aneurysms are discussed. The conclusion is drawn that persistent cardiac failure and angina can be relieved and the risk of systemic embolism reduced by the excision of expansile ventricular aneurysms of a fibrous nature. It is possible that excision may also reduce the incidence of subsequent acute myocardial infarction. Images PMID:5821618

  20. Parosteal aneurysmal bone cyst☆

    PubMed Central

    Meohas, Walter; de Sá Lopes, Ana Cristina; da Silveira Möller, João Victor; Barbosa, Luma Duarte; Oliveira, Marcelo Bragança dos Reis

    2015-01-01

    The incidence of aneurysmal bone cysts is 0.14 cases per 100,000 individuals. Parosteal aneurysmal bone cysts are the least prevalent subtype and represent 7% of all aneurysmal bone cysts. We present the case of a 38-year-old male patient with pain and bulging in his right arm for eight months. He had previously been diagnosed as presenting giant-cell tumor, but his slides were reviewed and his condition was then diagnosed as parosteal aneurysmal bone cyst. The patient was treated with corticosteroid and calcitonin infiltration into the lesion and evolved with clinical and radiological improvement within the first five weeks after the operation. PMID:26535209

  1. Abdominal Aortic Aneurysms

    PubMed Central

    Fortner, George; Johansen, Kaj

    1984-01-01

    Aneurysms are common in our increasingly elderly population, and are a major threat to life and limb. Until the advent of vascular reconstructive techniques, aneurysm patients were subject to an overwhelming risk of death from exsanguination. The first successful repair of an abdominal aortic aneurysm using an interposed arterial homograft was reported by Dubost in 1952. A milestone in the evolution of vascular surgery, this event and subsequent diagnostic, operative and prosthetic graft refinements have permitted patients with an unruptured abdominal aortic aneurysm to enjoy a better prognosis than patients with almost any other form of major systemic illness. Images PMID:6702193

  2. A case of acute subdural hematoma due to ruptured aneurysm detected by postmortem angiography.

    PubMed

    Inokuchi, Go; Makino, Yohsuke; Yajima, Daisuke; Motomura, Ayumi; Chiba, Fumiko; Torimitsu, Suguru; Hoshioka, Yumi; Iwase, Hirotaro

    2016-03-01

    Acute subdural hematoma (ASDH) is mostly caused by head trauma, but intrinsic causes also exist such as aneurysm rupture. We describe here a case involving a man in his 70s who was found lying on the bedroom floor by his family. CT performed at the hospital showed ASDH and a forensic autopsy was requested. Postmortem cerebral angiography showed dilatation of the bifurcation of the middle cerebral artery, which coincided with the dilated part of the Sylvian fissure. Extravasation of contrast medium into the subdural hematoma from this site was suggestive of a ruptured aneurysm. Autopsy revealed a fleshy hematoma (total weight 110 g) in the right subdural space and findings of brain herniation. As indicated on angiography, a ruptured saccular aneurysm was confirmed at the bifurcation of the middle cerebral artery. Obvious injuries to the head or face could not be detected on either external or internal examination, and intrinsic ASDH due to a ruptured middle cerebral artery aneurysm was determined as the cause of death. One of the key points of forensic diagnosis is the strict differentiation between intrinsic and extrinsic onset for conditions leading to death. Although most subdural hematomas (SDH) are caused by extrinsic factors, forensic pathologists should consider the possibility of intrinsic SDH. In addition, postmortem angiography can be useful for identifying vascular lesions in such cases. PMID:26362305

  3. Bronchial Aneurysms Mimicking Aortic Aneurysms: Endovascular Treatment in Two Patients

    SciTech Connect

    Vernhet, Helene; Bousquet, Claudine; Jean, Betty; Lesnik, Alvian; Durand, Gerard; Giron, Jacques; Senac, Jean Paul

    1999-05-15

    Bronchial artery dilatation and aneurysm formation is a potential complication of local inflammation, especially in bronchiectasis. When the bronchial artery has an ectopic origin from the inferior segment of the aortic arch, aneurysms may mimick aortic aneurysms. Despite this particular location, endovascular treatment is possible. We report two such aneurysms that were successfully embolized with steel coils.

  4. Abdominal aortic aneurysm.

    PubMed

    Keisler, Brian; Carter, Chuck

    2015-04-15

    Abdominal aortic aneurysm refers to abdominal aortic dilation of 3.0 cm or greater. The main risk factors are age older than 65 years, male sex, and smoking history. Other risk factors include a family history of abdominal aortic aneurysm, coronary artery disease, hypertension, peripheral artery disease, and previous myocardial infarction. Diagnosis may be made by physical examination, an incidental finding on imaging, or ultrasonography. The U.S. Preventive Services Task Force released updated recommendations for abdominal aortic aneurysm screening in 2014. Men 65 to 75 years of age with a history of smoking should undergo one-time screening with ultrasonography based on evidence that screening will improve abdominal aortic aneurysm-related mortality in this population. Men in this age group without a history of smoking may benefit if they have other risk factors (e.g., family history of abdominal aortic aneurysm, other vascular aneurysms, coronary artery disease). There is inconclusive evidence to recommend screening for abdominal aortic aneurysm in women 65 to 75 years of age with a smoking history. Women without a smoking history should not undergo screening because the harms likely outweigh the benefits. Persons who have a stable abdominal aortic aneurysm should undergo regular surveillance or operative intervention depending on aneurysm size. Surgical intervention by open or endovascular repair is the primary option and is typically reserved for aneurysms 5.5 cm in diameter or greater. There are limited options for medical treatment beyond risk factor modification. Ruptured abdominal aortic aneurysm is a medical emergency presenting with hypotension, shooting abdominal or back pain, and a pulsatile abdominal mass. It is associated with high prehospitalization mortality. Emergent surgical intervention is indicated for a rupture but has a high operative mortality rate. PMID:25884861

  5. Endovascular embolization

    MedlinePlus

    Treatment - endovascular embolism; Coil embolization; Cerebral aneurysm - endovascular; Coiling - endovascular; Saccular aneurysm - endovascular; Berry aneurysm - endovascular repair; Fusiform aneurysm repair - endovascular; Aneurysm repair - endovascular

  6. Aneurysm in the brain

    MedlinePlus

    ... Supplements Videos & Tools Español You Are Here: Home → ... JavaScript. An aneurysm is a weak area in the wall of a blood vessel that causes the blood vessel to bulge or balloon out. When an aneurysm occurs in a blood ...

  7. Brain aneurysm repair - discharge

    MedlinePlus

    ... Supplements Videos & Tools Español You Are Here: Home → ... You had a brain aneurysm. An aneurysm is a weak area in the wall of a blood vessel that bulges or balloons out. Once it reaches a certain size, it ...

  8. Epistaxis and pituitary apoplexy due to ruptured internal carotid artery aneurysm embedded within pituitary adenoma

    PubMed Central

    Peng, Zesheng; Tian, Daofeng; Wang, Hongliu; Kong, Derek Kai; Zhang, Shenqi; Liu, Baohui; Deng, Gang; Xu, Zhou; Wu, Liquan; Ji, Baowei; Wang, Long; Cai, Qiang; Li, Mingchang; Wang, Junmin; Zhang, Aimin; Chen, Qianxue

    2015-01-01

    Epistaxis due to ruptured internal carotid artery (ICA) aneurysm embedded within a pituitary adenoma (PA) has seldom been reported in the literature. Here we want to elaborate the incidence, mechanisms, clinical manifestations, and treatment strategy for this condition. The first survived case of a patient with epistaxis and pituitary apoplexy due to ruptured aneurysm embedded within PA was reported and the literature was reviewed. A 53-year-old male patient presented to our institution with sudden onset epistaxis and progressive vision loss. Neurological examination revealed bilateral ptosis and dilated unresponsive pupils. A CT scan showed a large mass in the pituitary fossa with bony erosion. MRI revealed a large pituitary tumor and abnormal signal intensity in the tumor. No aneurysm was noted during the pre-operative MR angiography. Abundant arterial bleeding suddenly occurred during urgent transsphenoidal surgery. Digital subtraction angiography confirmed the presence of a 14 mm unexpected saccular aneurysm of right ICA in the cavernous sinus with the dome protruding into the sella turcica. Balloon test occlusion of the right ICA was undertaken and permanent occlusion was performed. The patient recovered well and received bromocriptine and thyroid hormone replacement therapy during the follow-up period. At 14-month followup, the patient had no neurological deficits, no features of ischaemia relating to the right ICA therapeutic occlusion. Our case indicated that epistaxis and pituitary apoplexy could be due to the rupture of an ICA aneurysm embedded in a PA. Clinical suspicion should remain high when evaluating any case of epistaxis and pituitary apoplexy. Optimal treatment should take into consideration individual features of the tumor, aneurysm, and patient. Making the correct diagnosis as well as identifying an appropriate management strategy is critical in the care of such patients. PMID:26823732

  9. An Unusual Aneurysm of the Main Pulmonary Artery Presenting as Acute Coronary Syndrome

    SciTech Connect

    Kholeif, Mona A.; El Tahir, Mohamed Kholeif, Yasser A.; El Watidy, Ahmed

    2006-10-15

    A 70-year old man presented with retrosternal chest pain. His electrocardiogram showed nonspecific T wave changes. Cardiac-specific troponin I (cTnI) was elevated. His condition was managed as acute coronary syndrome, following which he had two minor episodes of hemoptysis. A CT pulmonary angiogram showed no evidence of pulmonary embolism, but a large mass lesion was seen in the mediastinum. Echocardiography and cardiac MRI demonstrated a large solid mass, arising from the right ventricular outflow tract and causing compression of the main pulmonary artery (MPA). The differential diagnosis included pericardial and myocardial tumors and clotted aneurysm of the MPA. At surgery, a clotted aneurysmal sac was identified originating from the MPA and the defect was healed. Aneurysms of the MPA are rare. They most commonly present with dyspnea and chest pain. Compression of surrounding structures produces protean manifestations. A high index of suspicion coupled with imaging modalities establishes the diagnosis. Blunt trauma to the chest, at the time of an accident 4 years previously, may explain this aneurysm. The patient's presentation with chest pain was probably due to compression and/or stretching of surrounding structures. Coronary artery compression simulating acute coronary syndrome has been documented in the literature. The rise in cTnI may have been due to right ventricular strain, as a result of right ventricular outflow obstruction by the aneurysm. This has not been reported previously in the literature. The saccular morphology and narrow neck of the aneurysm predisposed to stagnation leading to clotting of the lumen and healing of the tear, which caused the diagnostic difficulty.

  10. What You Should Know about Cerebral Aneurysms

    MedlinePlus

    ... About Stroke What You Should Know About Cerebral Aneurysms Updated:Jun 13,2014 About Cerebral Aneurysms Diagnosis ... to view an animation What is a cerebral aneurysm? An aneurysm is a weak area in a ...

  11. Hemodynamics of Cerebral Aneurysms

    PubMed Central

    Sforza, Daniel M.; Putman, Christopher M.; Cebral, Juan Raul

    2009-01-01

    The initiation and progression of cerebral aneurysms are degenerative processes of the arterial wall driven by a complex interaction of biological and hemodynamic factors. Endothelial cells on the artery wall respond physiologically to blood-flow patterns. In normal conditions, these responses are associated with nonpathological tissue remodeling and adaptation. The combination of abnormal blood patterns and genetics predisposition could lead to the pathological formation of aneurysms. Here, we review recent progress on the basic mechanisms of aneurysm formation and evolution, with a focus on the role of hemodynamic patterns. PMID:19784385

  12. High-Pass Filtering at Vestibular Frequencies by Transducer Adaptation in Mammalian Saccular Hair Cells

    NASA Astrophysics Data System (ADS)

    Songer, Jocelyn E.; Eatock, Ruth Anne

    2011-11-01

    The mammalian saccule detects head tilt and low-frequency head accelerations as well as higher-frequency bone vibrations and sounds. It has two different hair cell types, I and II, dispersed throughout two morphologically distinct regions, the striola and extrastriola. Afferents from the two zones have distinct response dynamics which may arise partly from zonal differences in hair cell properties. We find that type II hair cells in the rat saccular epithelium adapt with a time course appropriate for influencing afferent responses to head motions. Moreover, striolar type II hair cells adapted by a greater extent than extrastriolar type II hair cells and had greater phase leads in the mid-frequency range (5-50 Hz). These differences suggest that hair cell transduction may contribute to zonal differences in the adaptation of vestibular afferents to head motions.

  13. Endovascular treatment of basilar aneurysms.

    PubMed

    Marlin, Evan S; Ikeda, Daniel S; Shaw, Andrew; Powers, Ciarán J; Sauvageau, Eric

    2014-07-01

    Basilar artery aneurysms account for a small percentage of intracranial aneurysms; however, they are a diverse group of lesions necessitating different treatment techniques for those that are ruptured and unruptured. Basilar apex aneurysms are the most common type and are frequently wide-necked, necessitating stent-assisted coiling or balloon remodeling. Other techniques have evolved to forego stenting in acutely ruptured wide-necked aneurysms. The prevention of delayed thromboembolic complications with dual antiplatelet therapy in patients with stents is critical. After treatment, basilar aneurysms require close follow-up to ensure complete occlusion. Basilar apex aneurysms often require delayed re-treatment, especially when previously ruptured. PMID:24994086

  14. Giant Subclavian Artery Aneurysm.

    PubMed

    Counts, Sarah; Zeeshan, Ahmad; Elefteriades, John

    2016-06-01

    We report the case of a 37-year-old construction executive presenting with chest pain, shortness of breath, and dizziness on exertion secondary to a giant left subclavian artery aneurysm and aortic valvular disease. PMID:27231430

  15. Abdominal aortic aneurysm

    MedlinePlus

    ... main blood vessel that supplies blood to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs ... dissection). Symptoms of rupture include: Pain in the abdomen or back. The pain may be severe, sudden, ...

  16. Popliteal vein aneurysm.

    PubMed

    Falkowski, A; Poncyljusz, W; Zawierucha, D; Kuczmik, W

    2006-06-01

    The incidence of a popliteal vein aneurysm is extremely low. Two cases of this rare venous anomaly are described. The epidemiology, morphology, and diagnostic methods are discussed and the potentially dangerous complications and treatment methods are presented. PMID:16796307

  17. Aneurysmal Subarachnoid Hemorrhage.

    PubMed

    D'Souza, Stanlies

    2015-07-01

    Aneurysmal subarachnoid hemorrhage (SAH) is a worldwide health burden with high fatality and permanent disability rates. The overall prognosis depends on the volume of the initial bleed, rebleeding, and degree of delayed cerebral ischemia (DCI). Cardiac manifestations and neurogenic pulmonary edema indicate the severity of SAH. The International Subarachnoid Aneurysm Trial (ISAT) reported a favorable neurological outcome with the endovascular coiling procedure compared with surgical clipping at the end of 1 year. The ISAT trial recruits were primarily neurologically good grade patients with smaller anterior circulation aneurysms, and therefore the results cannot be reliably extrapolated to larger aneurysms, posterior circulation aneurysms, patients presenting with complex aneurysm morphology, and poor neurological grades. The role of hypothermia is not proven to be neuroprotective according to a large randomized controlled trial, Intraoperative Hypothermia for Aneurysms Surgery Trial (IHAST II), which recruited patients with good neurological grades. Patients in this trial were subjected to slow cooling and inadequate cooling time and were rewarmed rapidly. This methodology would have reduced the beneficial effects of hypothermia. Adenosine is found to be beneficial for transient induced hypotension in 2 retrospective analyses, without increasing the risk for cardiac and neurological morbidity. The neurological benefit of pharmacological neuroprotection and neuromonitoring is not proven in patients undergoing clipping of aneurysms. DCI is an important cause of morbidity and mortality following SAH, and the pathophysiology is likely multifactorial and not yet understood. At present, oral nimodipine has an established role in the management of DCI, along with maintenance of euvolemia and induced hypertension. Following SAH, hypernatremia, although less common than hyponatremia, is a predictor of poor neurological outcome. PMID:25272066

  18. Abdominal aortic aneurysm.

    PubMed

    Setacci, Francesco; Galzerano, Giuseppe; De Donato, Gianmarco; Benevento, Domenico; Guerrieri, Massimiliano W; Ruzzi, Umberto; Borrelli, Maria P; Setacci, Carlo

    2016-02-01

    Endovascular repair of abdominal aortic aneurysms has become a milestone in the treatment of patients with abdominal aortic aneurysm. Technological improvement allows treatment in more and more complex cases. This review summarizes all grafts available on the market. A complete review of most important trial on this topic is provided to the best of our knowledge, and technical tips and tricks for standard cases are also included. PMID:26771730

  19. Pelvic aneurysmal bone cyst

    PubMed Central

    Sharifah, MIA; Nor Hazla, MH; Suraya, A; Tan, SP

    2011-01-01

    This paper describes an extremely rare case of a huge aneurysmal bone cyst (ABC) in the pelvis, occurring in the patient’s 5th decade of life. The patient presented with a history of painless huge pelvic mass for 10 years. Plain radiograph and computed tomography showed huge expansile lytic lesion arising from the right iliac bone. A biopsy was performed and histology confirmed diagnosis of aneurysmal bone cyst. Unfortunately, the patient succumbed to profuse bleeding from the tumour. PMID:22279501

  20. Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    2015-01-01

    Aneurysmal subarachnoid hemorrhage (SAH) is a worldwide health burden with high fatality and permanent disability rates. The overall prognosis depends on the volume of the initial bleed, rebleeding, and degree of delayed cerebral ischemia (DCI). Cardiac manifestations and neurogenic pulmonary edema indicate the severity of SAH. The International Subarachnoid Aneurysm Trial (ISAT) reported a favorable neurological outcome with the endovascular coiling procedure compared with surgical clipping at the end of 1 year. The ISAT trial recruits were primarily neurologically good grade patients with smaller anterior circulation aneurysms, and therefore the results cannot be reliably extrapolated to larger aneurysms, posterior circulation aneurysms, patients presenting with complex aneurysm morphology, and poor neurological grades. The role of hypothermia is not proven to be neuroprotective according to a large randomized controlled trial, Intraoperative Hypothermia for Aneurysms Surgery Trial (IHAST II), which recruited patients with good neurological grades. Patients in this trial were subjected to slow cooling and inadequate cooling time and were rewarmed rapidly. This methodology would have reduced the beneficial effects of hypothermia. Adenosine is found to be beneficial for transient induced hypotension in 2 retrospective analyses, without increasing the risk for cardiac and neurological morbidity. The neurological benefit of pharmacological neuroprotection and neuromonitoring is not proven in patients undergoing clipping of aneurysms. DCI is an important cause of morbidity and mortality following SAH, and the pathophysiology is likely multifactorial and not yet understood. At present, oral nimodipine has an established role in the management of DCI, along with maintenance of euvolemia and induced hypertension. Following SAH, hypernatremia, although less common than hyponatremia, is a predictor of poor neurological outcome. PMID:25272066

  1. Magnetic Particle Imaging for High Temporal Resolution Assessment of Aneurysm Hemodynamics

    PubMed Central

    Frölich, Andreas; Spallek, Johanna; Forkert, Nils D.; Faizy, Tobias D.; Werner, Franziska; Knopp, Tobias; Krause, Dieter; Fiehler, Jens; Buhk, Jan-Hendrik

    2016-01-01

    Purpose The purpose of this work was to demonstrate the capability of magnetic particle imaging (MPI) to assess the hemodynamics in a realistic 3D aneurysm model obtained by additive manufacturing. MPI was compared with magnetic resonance imaging (MRI) and dynamic digital subtraction angiography (DSA). Materials and Methods The aneurysm model was of saccular morphology (7 mm dome height, 5 mm cross-section, 3–4 mm neck, 3.5 mm parent artery diameter) and connected to a peristaltic pump delivering a physiological flow (250 mL/min) and pulsation rate (70/min). High-resolution (4 h long) 4D phase contrast flow quantification (4D pc-fq) MRI was used to directly assess the hemodynamics of the model. Dynamic MPI, MRI, and DSA were performed with contrast agent injections (3 mL volume in 3 s) through a proximally placed catheter. Results and Discussion 4D pc-fq measurements showed distinct pulsatile flow velocities (20–80 cm/s) as well as lower flow velocities and a vortex inside the aneurysm. All three dynamic methods (MPI, MRI, and DSA) also showed a clear pulsation pattern as well as delayed contrast agent dynamics within the aneurysm, which is most likely caused by the vortex within the aneurysm. Due to the high temporal resolution of MPI and DSA, it was possible to track the contrast agent bolus through the model and to estimate the average flow velocity (about 60 cm/s), which is in accordance with the 4D pc-fq measurements. Conclusions The ionizing radiation free, 4D high resolution MPI method is a very promising tool for imaging and characterization of hemodynamics in human. It carries the possibility of overcoming certain disadvantages of other modalities like considerably lower temporal resolution of dynamic MRI and limited 2D characteristics of DSA. Furthermore, additive manufacturing is the key for translating powerful pre-clinical techniques into the clinic. PMID:27494610

  2. Screening for Abdominal Aortic Aneurysm

    MedlinePlus

    Understanding Task Force Recommendations Screening for Abdominal Aortic Aneurysm The U.S. Preventive Services Task Force (Task Force) ... final recommendation statement on Screening for Abdominal Aortic Aneurysm. This final recommendation statement applies to adults ages ...

  3. How Is an Aneurysm Diagnosed?

    MedlinePlus

    ... from the NHLBI on Twitter. How Is an Aneurysm Diagnosed? If you have an aortic aneurysm but no symptoms, your doctor may find it ... a routine physical exam. More often, doctors find aneurysms during tests done for other reasons, such as ...

  4. Evaluation of flow with dynamic x-ray imaging for aneurysms

    NASA Astrophysics Data System (ADS)

    Dohatcu, Andreea Cristina

    The main goal of this thesis is to evaluate blood flow inside cerebrovascular aneurysms using dynamic x-ray imaging. X-ray contrast substance (dye) was auto injected in elastomer aneurysm models placed in a flow loop (for in-vitro studies) to trace flow passing through aneurysms. More specifically, an improved Time-Density Curves (TDC) Roentgen-videodensitometric tracking technique, that included looking to designated regions (R) within an aneurysm rather than focusing on the entire aneurysm, was employed to get information about blood flow using cine-angiographic sequences. It is the first time R-TDC technique has been used. In complex real-time interventions on patients, 2D/3D angiographic analysis of contrast media flow is the only reliable and rapid source of information that we have in order to assess the seriousness of the disease, suggest the treatment, and verify the result of the treatment. The present study focused on finding a "correlation metric" to quantitatively describe the flow behavior within the aneurysms and examine the hemodynamic implications of several treatments using flow modulating devices applied to saccular and bifurcation geometries aneurysms. The main idea in treatment of an aneurysm is rapid reduction of the risk of rupture. This is usually done endovascularly now by totally occluding the aneurysm by packing it with mechanical or chemical agents. Our research, however, involves a new method of blocking the neck using various types of asymmetric vascular stents (AVS). We proposed and analyzed, using R-TDCs, the feasibility of a new modified endovascular method of treatment based on alteration of blood flow through the aneurysm by partial occlusion only. In-vitro studies using aneurysm phantoms with patient-specific aneurysm models were performed. Also, for the first time the new methods were used in in-vivo studies as well, on rabbit-model experimental data, in an attempt to correlate thrombogenic response of a living organism to flow

  5. Unruptured Intracranial Aneurysms:

    PubMed Central

    Raymond, J.; Nguyen, T.; Chagnon, M.; Gevry, G.

    2007-01-01

    'if a man will begin with certainties, he shall end in doubts; 'but if he will be content to begin with doubts he shall end in certainties'. Sir Francis Bacon, The Advancement of Learning Summary In the absence of level one evidence, the treatment of unruptured intracranial aneurysms is grounded on opinions. Results of the largest registry available, ISUIA (the International Study on Unruptured Intraacranial Aneurysms) suggest that surgical or endovascular treatments are rarely justified. Yet the unruptured aneurysm is the most frequent indication for treatment in many endovascular centres. In preparation for the initiation of a randomized trial, we aimed at a better knowledge of endovascular expert opinions on unruptured aneurysms. We administered a standard questionnaire to 175 endovascular experts gathered at the WFITN meeting in Val d'lsère in 2007. Four paradigm unruptured aneurysms were used to poll opinions on risks of treatment or observation, as well as on their willingness to treat, observe or propose to the patient participation in a randomized trial, using six questions for each aneurysm. Opinions varied widely among lesions and among participants. Most participants (92.5%) were consistent, as they would offer treatment only if their estimate of the ten-year risk of spontaneous hemorrhage would exceed risks of treatment. Estimates of the natural history were consistently higher than that reported by ISUIA. Conversely, treatment risks were underestimated compared to those reported in ISUIA, but within the range reported in a recent French registry (ATENA). Participants were more confident in their evaluation of treatment risks and in their skills at treating aneurysms than in their estimates of risks of rupture entailed by the presence of the lesion, the latter being anchored at or close to 1% /year. The gulf between expert opinions, clinical practices and available data from registries persist. Expert opinions are compatible with the primary hypothesis

  6. The developmental segregation of posterior crista and saccular vestibular fibers in mice: a carbocyanine tracer study using confocal microscopy

    NASA Technical Reports Server (NTRS)

    Maklad, Adel; Fritzsch, Bernd

    2002-01-01

    The developmental segregation of gravistatic input mediated by saccular fibers and of angular acceleration input mediated by posterior crista (PC) fibers was analyzed for the first time in a developing mammal using carbocyanine dye tracing in fixed tissue. The data reveal a more extensive projection of either endorgan in 7-day-old mice (P7) than has previously been reported in adult mammals. While we confirm and extend many previous findings, we also describe a novel segregation of saccular and posterior crista fibers in the anterior half of the medial vestibular nucleus (Mv) not reported before. Our developmental analysis shows a progressive segregation of posterior crista and saccular fibers to their respective discrete projection areas between embryonic day 15 (E15) and birth (P0). Retention of overlap in young adult animals appears to reflect the early embryonic overlap found in most areas. The vestibular projection does not show a topological projection as has been described in many other sensory systems. We propose that the unique projection features of the vestibular endorgans may relate to the transformation of vestibular signals into a motor output in the three neuron reflex arc of the VOR, of which the primary vestibular projection constitutes the first leg.

  7. Contrast Extravasation on Computed Tomography Angiography Imitating a Basilar Artery Trunk Aneurysm in Subsequent Conventional Angiogram-Negative Subarachnoid Hemorrhage: Report of Two Cases with Different Clinical Courses

    PubMed Central

    Cho, Won Ho; Choi, Hyuk Jin; Nam, Kyoung Hyup

    2015-01-01

    Contrast extravasation on computed tomography angiography (CTA) is rare but becoming more common, with increasing use of CTA for various cerebral vascular diseases. We report on two cases of spontaneous subarachnoid hemorrhage (SAH) in which the CTA showed an upper basilar trunk saccular lesion suggesting ruptured aneurysm. However, immediate subsequent digital subtraction angiography (DSA) failed to show a vascular lesion. In one case, repeated follow up DSA was also negative. The patient was treated conservatively and discharged without any neurologic deficit. In the other case, the patient showed sudden mental deterioration on the third hospital day and her brain CT showed rebleeding. The immediate follow up DSA showed contrast stagnation in the vicinity of the upper basilar artery, suggestive of pseudoaneurysm. Double stents deployment at the disease segment was performed. Due to the frequent use of CTA, contrast extravasation is an increasingly common observation. Physicians should be aware that basilar artery extravasation can mimic the appearance of an aneurysm. PMID:27066442

  8. Duplicated middle cerebral artery arising from the origin of the hyperplastic anterior choroidal artery that mimicked aneurysm on routine MR angiography.

    PubMed

    Uchino, Akira; Ito, Sayaka; Kurita, Hiroki; Tanaka, Masahiko

    2016-04-01

    We report a case of duplicated right middle cerebral artery that arose from the origin of the right hyperplastic anterior choroidal artery diagnosed by magnetic resonance angiography. To our knowledge, this is the first case of such a variation reported with magnetic resonance angiographic images. The internal carotid artery-hyperplastic anterior choroidal artery-duplicated middle cerebral artery junction was dilated and mimicking aneurysm. Partial maximum intensity projection images and volume-rendering images showed that it was not a saccular aneurysm but an infundibular dilatation. Careful observation of magnetic resonance angiographic images including its source images is important for detecting rare arterial variations. To identify an anomalous artery on magnetic resonance angiography, creation of partial maximum intensity projection images and volume-rendering images is valuable. PMID:26915899

  9. Verminous aneurysm caused by filaria.

    PubMed

    Toledo, F V; de Araújo, A P; da Cunha, A M; Sidow, J R; Pavão, S G; de Araújo, E D

    1983-06-01

    Aneurysms caused by atherosclerosis are relatively frequent, as a consequence of the high incidence of this degenerative disease of the arteries. Other types of aneurysm, for example, those of infectious etiology, are more uncommon. Bacterias and fungi are able to cause aneurysms in several parts of the arterial tree. Stengel et al (1943), in a review of world literature described 217 cases of mycotic aneurysms. The Stedman's Medical Dictionary refers to a special type of aneurysm observed in horses, caused by intra-vascular migration of a worm, the Strongylus vulgaris. It has been named verminous aneurysm and generally involves the mesenteric arteries. We haven't found in medical literature any similar observations refering to human cases. The purpose of this paper is to describe a case of aneurysm the etiology of which we have imputed to the filaria (Wuchereria bancrofti). This case was observed in Marcilio Dias Naval Hospital, Rio de Janeiro, Brazil. PMID:6346961

  10. Voltage-Mediated Control of Spontaneous Bundle Oscillations in Saccular Hair Cells.

    PubMed

    Meenderink, Sebastiaan W F; Quiñones, Patricia M; Bozovic, Dolores

    2015-10-28

    Hair cells of the vertebrate vestibular and auditory systems convert mechanical inputs into electrical signals that are relayed to the brain. This transduction involves mechanically gated ion channels that open following the deflection of mechanoreceptive hair bundles that reside on top of these cells. The mechano-electrical transduction includes one or more active feedback mechanisms to keep the mechanically gated ion channels in their most sensitive operating range. Coupling between the gating of the mechanosensitive ion channels and this adaptation mechanism leads to the occurrence of spontaneous limit-cycle oscillations, which indeed have been observed in vitro in hair cells from the frog sacculus and the turtle basilar papilla. We obtained simultaneous optical and electrophysiological recordings from bullfrog saccular hair cells with such spontaneously oscillating hair bundles. The spontaneous bundle oscillations allowed us to characterize several properties of mechano-electrical transduction without artificial loading the hair bundle with a mechanical stimulus probe. We show that the membrane potential of the hair cell can modulate or fully suppress innate oscillations, thus controlling the dynamic state of the bundle. We further demonstrate that this control is exerted by affecting the internal calcium concentration, which sets the resting open probability of the mechanosensitive channels. The auditory and vestibular systems could use the membrane potential of hair cells, possibly controlled via efferent innervation, to tune the dynamic states of the cells. PMID:26511238

  11. Siamang gibbons exceed the saccular threshold: Intensity of the song of Hylobates syndactylus

    NASA Astrophysics Data System (ADS)

    McAngus Todd, Neil P.; Merker, Bjorn

    2004-06-01

    Measurements are reported of the intensity of the siamang gibbon loud call obtained from the vocal bouts of three family groups at Twycross Zoo, UK. Across 25 samples the maximum intensity ranged from 95 to 113 dB SPL (linear frequency-weighting and fast time-weighting) and exhibited three frequency modes of 250-315 Hz, 630-800 Hz and 1.2-1.6 kHz. The lowest frequency mode, which may correspond to the ``boom'' sound produced by resonance of the siamang inflated vocal sac, had a mean maximum intensity of 99 dB SPL. These values, which are in excess of the saccular acoustic threshold of about 90 dB at 300 Hz for air conducted sound, suggest that primate loud calls recruit a primitive mode of acoustic sensitivity furnished by the sacculus. Thus reproductive vocal behavior of primates may be influenced by a primitive acoustical reward pathway inherited from a common ancestor with anamniotes. In humans such a pathway could explain the compulsion for exposure to loud music.

  12. Abdominal aortic aneurysm repair - open - discharge

    MedlinePlus

    AAA - open - discharge; Repair - aortic aneurysm - open - discharge ... You had open aortic aneurysm surgery to repair an aneurysm (a widened part) in your aorta, the large artery that carries blood to your ...

  13. Spontaneous low-frequency voltage oscillations in frog saccular hair cells

    PubMed Central

    Catacuzzeno, Luigi; Fioretti, Bernard; Perin, Paola; Franciolini, Fabio

    2004-01-01

    Spontaneous membrane voltage oscillations were found in 27 of 130 isolated frog saccular hair cells. Voltage oscillations had a mean peak-to-peak amplitude of 23 mV and a mean oscillatory frequency of 4.6 Hz. When compared with non-oscillatory cells, oscillatory cells had significantly greater hyperpolarization-activated and lower depolarization-activated current densities. Two components, the hyperpolarization-activated cation current, Ih, and the K+-selective inward-rectifier current, IK1, contributed to the hyperpolarization-activated current, as assessed by the use of the IK1-selective inhibitor Ba2+ and the Ih-selective inhibitor ZD-7288. Five depolarization-activated currents were present in these cells (transient IBK, sustained IBK, IDRK, IA, and ICa), and all were found to have significantly lower densities in oscillatory cells than in non-oscillatory cells (revealed by using TEA to block IBK, 4-AP to block IDRK, and prepulses at different voltages to isolate IA). Bath application of either Ba2+ or ZD-7288 suppressed spontaneous voltage oscillations, indicating that Ih and IK1 are required for generating this activity. On the contrary, TEA or Cd2+ did not inhibit this activity, suggesting that IBK and ICa do not contribute. A mathematical model has been developed to test the interpretation derived from the pharmacological and biophysical data. This model indicates that spontaneous voltage oscillations can be generated when the electrophysiological features of oscillatory cells are used. The oscillatory behaviour is principally driven by the activity of IK1 and Ih, with IA playing a modulatory role. In addition, the model indicates that the high densities of depolarization-activated currents expressed by non-oscillatory cells help to stabilize the resting membrane potential, thus preventing the spontaneous oscillations. PMID:15489251

  14. Vocal differentiation parallels development of auditory saccular sensitivity in a highly soniferous fish.

    PubMed

    Vasconcelos, Raquel O; Alderks, Peter W; Ramos, Andreia; Fonseca, Paulo J; Amorim, M Clara P; Sisneros, Joseph A

    2015-09-01

    Vocal differentiation is widely documented in birds and mammals but has been poorly investigated in other vertebrates, including fish, which represent the oldest extant vertebrate group. Neural circuitry controlling vocal behaviour is thought to have evolved from conserved brain areas that originated in fish, making this taxon key to understanding the evolution and development of the vertebrate vocal-auditory systems. This study examines ontogenetic changes in the vocal repertoire and whether vocal differentiation parallels auditory development in the Lusitanian toadfish Halobatrachus didactylus (Batrachoididae). This species exhibits a complex acoustic repertoire and is vocally active during early development. Vocalisations were recorded during social interactions for four size groups (fry: <2 cm; small juveniles: 2-4 cm; large juveniles: 5-7 cm; adults >25 cm, standard length). Auditory sensitivity of juveniles and adults was determined based on evoked potentials recorded from the inner ear saccule in response to pure tones of 75-945 Hz. We show an ontogenetic increment in the vocal repertoire from simple broadband-pulsed 'grunts' that later differentiate into four distinct vocalisations, including low-frequency amplitude-modulated 'boatwhistles'. Whereas fry emitted mostly single grunts, large juveniles exhibited vocalisations similar to the adult vocal repertoire. Saccular sensitivity revealed a three-fold enhancement at most frequencies tested from small to large juveniles; however, large juveniles were similar in sensitivity to adults. We provide the first clear evidence of ontogenetic vocal differentiation in fish, as previously described for higher vertebrates. Our results suggest a parallel development between the vocal motor pathway and the peripheral auditory system for acoustic social communication in fish. PMID:26400979

  15. Management of Unruptured Intracranial Aneurysms.

    PubMed

    Nasr, Deena M; Brown, Robert D

    2016-09-01

    Unruptured intracranial aneurysms (UIA) occur in approximately 2-3 % of the population. Most of these lesions are incidentally found, asymptomatic and typically carry a benign course. Although the risk of aneurysmal subarachnoid hemorrhage is low, this complication can result in significant morbidity and mortality, making assessment of this risk the cornerstone of UIA management. This article reviews important factors to consider when managing unruptured intracranial aneurysms including patient demographics, comorbidities, family history, symptom status, and aneurysm characteristics. It also addresses screening, monitoring, medical management and current surgical and endovascular therapies. PMID:27443382

  16. Early Experience in the Treatment of Intra-Cranial Aneurysms by Endovascular Flow Diversion: A Multicentre Prospective Study

    PubMed Central

    Byrne, James V.; Beltechi, Radu; Yarnold, Julia A.; Birks, Jacqueline; Kamran, Mudassar

    2010-01-01

    Introduction Flow diversion is a new approach to the endovascular treatment of intracranial aneurysms which uses a high density mesh stent to induce sac thrombosis. These devices have been designed for the treatment of complex shaped and large size aneurysms. So far published safety and efficacy data on this approach is sparse. Material and Methods Over 8 months, standardized clinical and angiographic data were collected on 70 patients treated with a flow diverter device (SILK flow diverter (SFD)) in 18 centres worldwide. Treatment and early follow up details were audited centrally. SFDs were deployed alone in 57 (81%) or with endosaccular coils in 10 (14%) aneurysms, which included: 44 (63%) saccular, 26 (37%) fusiform shapes and 18 (26%) small, 37 (53%) large, 15 (21%) giant sizes. Treatment outcome data up to 30 days were reported for all patients, with clinical (50 patients) and imaging (49 patients) follow up (median 119 days) data available. Results Difficulties in SFD deployment were reported in 15 (21%) and parent artery thrombosis in 8 (11%) procedures. Procedural complications caused stroke in 1 and serious extracranial bleeding in 3 patients; 2 of whom developed fatal pneumonias. Delayed worsening of symptoms occurred in 5 patients (3 transient, 1 permanent neurological deficit, and 1 death) and fatal aneurysm bleeding in 1 patient. Overall permanent morbidity rates were 2 (4%) and mortality 4 (8%). Statistical analysis revealed no significant association between complications and variables related to treated aneurysm morphology or rupture status. Conclusion This series is the largest reporting outcome of the new treatment approach and provides data for future study design. Procedural difficulties in SFD deployment were frequent and anti-thrombosis prophylaxis appears to reduce the resulting clinical sequelae, but at the cost of morbidity due to extracranial bleeding. Delayed morbidity appears to be a consequence of the new approach and warrants care in

  17. The morphology of saccular otoliths as a tool to identify different mugilid species from the Northeastern Atlantic and Mediterranean Sea

    NASA Astrophysics Data System (ADS)

    Callicó Fortunato, Roberta; Benedito Durà, Vicent; Volpedo, Alejandra

    2014-06-01

    In the Northeastern Atlantic and Mediterranean Sea there are 8 species of the Mugilidae family: Mugil cephalus, Liza aurata, Liza ramada, Oedalechilus labeo, Chelon labrosus, Liza saliens, Liza carinata and Liza haematocheila. The identification of mugilids is very important for local fisheries management and regulations, but it is difficult using gross morphological characters. This work aims to contribute to the identification of mullets present in the Northeastern Atlantic Ocean and Mediterranean Sea using saccular otolith features of each species. Specimens of C. labrosus, L. aurata, L. ramada, L. saliens and M. cephalus were obtained from Delta del Ebro (40°38'N-0°44'E) in artisanal catches. For L. carinata and O. labeo photographs extracted from AFORO online database were used. L. haematocheila was not studied for lack of otolith samples. A general pattern of the saccular otoliths for this family was identified: the shape of the otoliths are rectangular to oblong with irregular margins; they present a heterosulcoid, ostial sulcus acusticus, with an open funnel-like ostium to the anterior margin and a closed, tubular cauda, ending towards the posterior ventral corner, always larger than the ostium. In the present study, the mugilid species could be recognized using their saccular otolith morphology. Here we give the first key to identify Northeastern Atlantic and Mediterranean mullets. The distinctive features between the species were the position and centrality of the sulcus, the curvature of the cauda, the presence of areal depositions and plateaus, and the type of anterior and posterior regions. These features could be used not only to reinforce the identification keys through morphological and meristic characters of the species, but also to identify the species consumed by piscivores, being the otoliths the only identifiable remains of the individuals.

  18. Monoparesis after graft replacement of non-ruptured abdominal aortic aneurysm.

    PubMed

    Matsuda, Hitoshi; Ogino, Hitoshi; Saito, Shunsuke; Sasaki, Hiroaki; Minatoya, Kenji; Kobayashi, Junjiro; Yagihara, Toshikatsu; Kitamura, Soichiro

    2006-10-01

    A 67-year-old man was admitted with a saccular aneurysm of the abdominal aorta. Preoperative CT revealed cylindrical calcification of the abdominal aorta and the patent internal iliac arteries (IIAs). At the elective surgery, a cylinder-shaped and severely calcified intimal layer was found, and the lumbar arteries were totally occluded. Hypotension caused by the loose iliac clamp due to severe calcification continued for 15 minutes and long-time cross clamp was necessary. Monoparesis of the left lower extremity and dysuria occurred postoperatively. Spinal MRI revealed small infarction at the Th10 level. Symptoms improved and he could walk with a cane and within a few months no uninary catheter support was needed. Thoracic spinal cord infarction after abdominal aortic aneurysm (AAA) surgery and a severely calcified abdominal aorta indicated the importance of the blood flow in the IIA as the significant source of spinal blood supply. To prevent spinal cord injury (SCI) which is rare but significant complication of AAA surgery, understanding of the spinal blood supply, quick surgery, and complete revascularization of pelvic arteries are important. PMID:17095985

  19. 21 CFR 882.5200 - Aneurysm clip.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Aneurysm clip. 882.5200 Section 882.5200 Food and... NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5200 Aneurysm clip. (a) Identification. An aneurysm clip is a device used to occlude an intracranial aneurysm (a balloonlike sac formed on a blood...

  20. 21 CFR 882.5200 - Aneurysm clip.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Aneurysm clip. 882.5200 Section 882.5200 Food and... NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5200 Aneurysm clip. (a) Identification. An aneurysm clip is a device used to occlude an intracranial aneurysm (a balloonlike sac formed on a blood...

  1. 21 CFR 882.5200 - Aneurysm clip.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Aneurysm clip. 882.5200 Section 882.5200 Food and... NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5200 Aneurysm clip. (a) Identification. An aneurysm clip is a device used to occlude an intracranial aneurysm (a balloonlike sac formed on a blood...

  2. 21 CFR 882.5200 - Aneurysm clip.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Aneurysm clip. 882.5200 Section 882.5200 Food and... NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5200 Aneurysm clip. (a) Identification. An aneurysm clip is a device used to occlude an intracranial aneurysm (a balloonlike sac formed on a blood...

  3. 21 CFR 882.5200 - Aneurysm clip.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Aneurysm clip. 882.5200 Section 882.5200 Food and... NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5200 Aneurysm clip. (a) Identification. An aneurysm clip is a device used to occlude an intracranial aneurysm (a balloonlike sac formed on a blood...

  4. Successful treatment of a ruptured aneurysm at the vertebral artery-posterior inferior cerebellar artery junction and simultaneous treatment of the stenotic vertebral artery with a single flow-diverting stent: a case report

    PubMed Central

    2014-01-01

    Introduction This is the first report on the simultaneous successful treatment of a large ruptured saccular aneurysm and stenotic parent artery with a single flow-diverting stent. Case presentation We report the case of a 68-year-old Caucasian man with occlusion of the right vertebral artery and a ruptured aneurysm at the junction of the left posterior inferior cerebellar artery-left vertebral artery that was successfully treated by the deployment of a single flow-diverting stent in the stenotic left vertebral artery. Stent deployment was complicated by thrombotic occlusion of the basilar artery, which was successfully reopened. The patient recovered completely, and follow-up angiography at 4 months and 1 year showed patent vertebral artery with gradual shrinkage of the aneurysm. Conclusions This report contributes to the literature on treatment of large ruptured aneurysms localized in stenotic arteries and in areas of the endocranium where a mass of embolic material in the aneurysm (coils) might compromise the circulation in the parent blood vessel or compress vital brain structures. PMID:24886040

  5. Presentation and management of aneurysms.

    PubMed Central

    Wyatt, A. P.

    1976-01-01

    The aetiology and pathology of aneurysms, their sites of occurrence, and their general management are outlined. Since the abdominal aortic aneurysm is the type most commonly encountered by the surgeon its presentation, assessment, and operative and postoperative management are discussed in detail. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 8 Fig. 9 PMID:1259327

  6. Voltage-Mediated Control of Spontaneous Bundle Oscillations in Saccular Hair Cells

    PubMed Central

    Meenderink, Sebastiaan W. F.; Quiñones, Patricia M.

    2015-01-01

    Hair cells of the vertebrate vestibular and auditory systems convert mechanical inputs into electrical signals that are relayed to the brain. This transduction involves mechanically gated ion channels that open following the deflection of mechanoreceptive hair bundles that reside on top of these cells. The mechano-electrical transduction includes one or more active feedback mechanisms to keep the mechanically gated ion channels in their most sensitive operating range. Coupling between the gating of the mechanosensitive ion channels and this adaptation mechanism leads to the occurrence of spontaneous limit-cycle oscillations, which indeed have been observed in vitro in hair cells from the frog sacculus and the turtle basilar papilla. We obtained simultaneous optical and electrophysiological recordings from bullfrog saccular hair cells with such spontaneously oscillating hair bundles. The spontaneous bundle oscillations allowed us to characterize several properties of mechano-electrical transduction without artificial loading the hair bundle with a mechanical stimulus probe. We show that the membrane potential of the hair cell can modulate or fully suppress innate oscillations, thus controlling the dynamic state of the bundle. We further demonstrate that this control is exerted by affecting the internal calcium concentration, which sets the resting open probability of the mechanosensitive channels. The auditory and vestibular systems could use the membrane potential of hair cells, possibly controlled via efferent innervation, to tune the dynamic states of the cells. SIGNIFICANCE STATEMENT The sensation of sound and balance starts by converting minute mechanical motions into electrical signals. This is accomplished by sensory hair cells, in which the opening and closing of mechanosensitive channels follows the motion of their hair bundles. These hair bundles can exhibit motility without an external drive. Underlying these spontaneous bundle oscillations are two

  7. Initial Clinical Experience with a New Self-Expanding Nitinol Microstent for the Treatment of Wide-Neck Intracranial Cerebral Aneurysms: The Acandis Acclino Stent

    PubMed Central

    Kabbasch, C; Liebig, T; Faymonville, A; Dorn, F; Mpotsaris, A

    2015-01-01

    BACKGROUND AND PURPOSE The Acclino is a laser-cut closed-cell microstent composed of nitinol. It was developed for stent-assisted coiling of wide-neck intracranial aneurysms. The key feature of the stent is its deployability via low-profile microcatheters with an inner diameter of 0.0165 inch, which are also suited for coil deployment. The objective of this study was to evaluate the safety and feasibility as well as the immediate and mid-term results of this new device. MATERIALS AND METHODS Our database was screened for all Acclino-based stent-assisted intracranial coil embolizations since its introduction to the European market in June 2012. Case files and imaging data were retrospectively analyzed for angiographical and clinical outcome parameters, including immediate and mid-term modified Raymond-Roy aneurysm occlusion classification (RROC) rates and procedural complications. RESULTS Fourteen patients comprising 14 aneurysms (9 unruptured and 5 ruptured) were treated with the Acclino. All except for a dissecting one were wide-neck saccular aneurysms. Immediate complete occlusion (RROC1) was observed in 8/14 cases (57%), a residual neck (RROC2) in 4/14 (29%), and a persistent filling of the dome (RROC 3) in 1/14 cases (7%). An in-stent thrombus formation in one case (7%) was medically resolved without neurological deficit. Follow-up was available in 9/14 cases (64%) after a mean of 137 days (SD ± 50). All followed cases depicted a complete occlusion (RROC1). CONCLUSIONS The Acclino microstent showed a satisfactory safety profile and a promising rate of immediate and mid-term complete aneurysm occlusion for stent-assisted coil embolization in wide-neck intracranial aneurysms, warranting further investigation of the device. PMID:26301024

  8. Vein graft aneurysms following popliteal aneurysm repair are more common than we think.

    PubMed

    Sharples, Alistair; Kay, Mark; Sykes, Timothy; Fox, Anthony; Houghton, Andrew

    2015-10-01

    True infrainguinal vein graft aneurysms are reported infrequently in the literature. We sought to identify the true incidence of these graft aneurysms after popliteal aneurysm repair and identify factors which may increase the risk of such aneurysms developing. Using a prospectively compiled database, we identified patients who underwent a popliteal aneurysm repair between January 1996 and January 2011 at a single district general hospital. Patients were routinely followed up in a graft surveillance programme. Out of 45 patients requiring repair of a popliteal aneurysm over a 15-year period, four (8.8%) patients developed aneurysmal graft disease. Of the patients who developed graft aneurysms, all had aneurysmal disease at other sites compared with 18 (45.0%) patients who did not develop graft aneurysms. Patients with graft aneurysms had a mean of 1.60 aneurysms elsewhere compared to 0.58 in patients with non-aneurysmal grafts (P = 0.005). True vein graft aneurysms occur in a significant number of patients following popliteal aneurysm repair. Our data would suggest this to be more likely in patients who have aneurysms elsewhere and therefore a predisposition to aneurysmal disease. It may be appropriate for patients with aneurysms at other sites to undergo more prolonged post-operative graft surveillance. PMID:25331071

  9. Aneurysm-osteoarthritis syndrome with visceral and iliac artery aneurysms

    PubMed Central

    van der Linde, Denise; Verhagen, Hence J. M.; Moelker, Adriaan; van de Laar, Ingrid M. B. H.; Van Herzeele, Isabelle; De Backer, Julie; Dietz, Harry C.; Roos-Hesselink, Jolien W.

    2014-01-01

    Objective Aneurysms-osteoarthritis syndrome (AOS), caused by SMAD3 mutations, is a recently described autosomal-dominant syndrome characterized by arterial aneurysms, tortuosity, and aortic dissections in combination with osteoarthritis. Our objective was to evaluate the AOS-related vascular consequences in the visceral and iliac arteries and raise awareness for this aggressive syndrome among vascular specialists. Methods All AOS patients were monitored regularly according to our clinical AOS protocol. The study included those with one or more visceral aneurysms or tortuosity, or both. Clinical and surgical data were obtained from record abstraction. Results The study included 17 AOS patients (47% men) aged 47 ± 13 years. A total of 73 aneurysms were encountered, of which 46 were located in the abdomen. The common iliac artery was most commonly affected (37%), followed by the superior mesenteric artery (15%), celiac trunk (11%), and splenic artery (9%). Rapid aneurysm growth ≤1 year was found in three arteries (gastric, hepatic, and vertebral artery). Furthermore, arterial tortuosity was noted in 94% of patients. Four patients underwent six elective (endo) vascular interventions for aneurysms in the iliac, hepatic, gastric, or splenic artery, without major perioperative or postoperative complications. Conclusions AOS predisposes patients to widespread visceral and iliac artery aneurysms and extreme arterial tortuosity. Early elective aneurysm repair should be considered because the risk of aneurysm rupture is estimated to be very high and elective (endo) vascular interventions were not complicated by fragility of arterial tissue. Given the aggressive behavior of AOS, it is of utmost importance that vascular specialists are aware of this new syndrome. PMID:22975338

  10. Left Atrial Appendage Aneurysm.

    PubMed

    Hosseini, Saeid; Hashemi, Arash; Saedi, Sedigheh; Jalili, Farshad; Maleki, Majid; Jalalian, Rozita; Rezaei, Yousef

    2016-09-01

    Left atrial appendage aneurysms (LAAA) are extremely rare. This condition is usually diagnosed incidentally or after the occurrence of thrombotic events or cardiac tachyarrhythmias in the second to fourth decades of life. It can predispose to hazardous adverse events, including atrial fibrillation, myocardial infarction, and systemic thromboembolism. We report a case of LAAA in a 68-year-old woman presenting with atypical chest pain, exertional dyspnea, and episodes of sudden-onset palpitation. Aneurysmectomy with the patient under cardiac arrest with cardiopulmonary bypass was performed. In addition, we explore the diagnosis, management, and prognosis of this entity through a meticulous literature review. PMID:27549544

  11. Spontaneous thrombosis in giant intracranial aneurysms.

    PubMed Central

    Whittle, I R; Dorsch, N W; Besser, M

    1982-01-01

    Twelve patients in a series of 22 with giant intracranial aneurysms demonstrated neuroradiological features of partial or total spontaneous intra-aneurysmal thrombosis. The presence of this intra-aneurysmal clot significantly altered the computed tomographic appearance of the giant aneurysm. Massive intra-aneurysmal thrombosis did not protect against subarachnoid haemorrhage and the likelihood of rupture of a clot containing giant aneurysm was not significantly different from that of a non-thrombosed giant aneurysm. Although parent artery occlusion from a thrombosed giant aneurysm, and massive aneurysmal thrombosis leading to the formation of giant serpentine aneurysm were documented, these are rare epiphenomena. The risk of embolisation from a partially thrombosed giant aneurysm, which was documented in one case, would appear to be greater than that from a non-thrombosed giant aneurysm. The findings in this series, and a review of literature, suggest that the presence of intra-aneurysmal clot in giant intracranial aneurysms has little prognostic significance and does not alter the management or outcome after treatment. Images PMID:7175528

  12. Development of utricular otoliths, but not saccular otoliths, is necessary for vestibular function and survival in zebrafish

    NASA Technical Reports Server (NTRS)

    Riley, B. B.; Moorman, S. J.

    2000-01-01

    We have been studying the consequences of embryonic vestibular dysfunction caused by the monolith (mnl) mutation in zebrafish. mnl is a dominant mutation that specifically inhibits formation of utricular otoliths. However, briefly immobilizing mnl/mnl embryos in agarose with the otic vesicle orientated at certain angles selectively induces or prevents formation of utricular and/or saccular otoliths. With this noninvasive technique, we generated six phenotypic classes of mnl/mnl mutants, designated S-S, U-U, U-S, S-US, U-US, and US-US, depending on which otoliths are present on each side (U, utricular otolith; S, saccular otolith). All mnl/mnl larvae survived through day 10 of development. Thereafter, S-S larvae showed a rapid decline, probably because of starvation, and none survived to adulthood. Survival rates in all other classes of mnl/mnl larvae (those having at least one utricular otolith) were close to normal. The presence or absence of utricular otoliths also correlated with vestibular function during early larval development, as measured by three criteria: First, unlike wild-type larvae, S-S mutant larvae showed almost no detectable counter-rotation of the eyes when tilted tail up or tail down. Second, 95% of S-S mutant larvae never acquired the ability to maintain a balanced dorsal-up posture. Third, although most wild-type larvae responded to gentle prodding by swimming in a straight line, S-S larvae responded by swimming in rapid circles, showing sudden and frequent changes in direction ("zigzagging"), and/or rolling and spiraling. All other phenotypic classes of mnl/mnl larvae behaved normally in these assays. These data demonstrate that bilateral loss of utricular otoliths disrupts the ability to sense gravity, severely impairs balance and motor coordination, and is invariably lethal. The presence of a utricular otolith in at least one inner ear is necessary and sufficient for vestibular function and survival. In contrast, saccular otoliths are

  13. Micromanaging abdominal aortic aneurysms.

    PubMed

    Maegdefessel, Lars; Spin, Joshua M; Adam, Matti; Raaz, Uwe; Toh, Ryuji; Nakagami, Futoshi; Tsao, Philip S

    2013-01-01

    The contribution of abdominal aortic aneurysm (AAA) disease to human morbidity and mortality has increased in the aging, industrialized world. In response, extraordinary efforts have been launched to determine the molecular and pathophysiological characteristics of the diseased aorta. This work aims to develop novel diagnostic and therapeutic strategies to limit AAA expansion and, ultimately, rupture. Contributions from multiple research groups have uncovered a complex transcriptional and post-transcriptional regulatory milieu, which is believed to be essential for maintaining aortic vascular homeostasis. Recently, novel small noncoding RNAs, called microRNAs, have been identified as important transcriptional and post-transcriptional inhibitors of gene expression. MicroRNAs are thought to "fine tune" the translational output of their target messenger RNAs (mRNAs) by promoting mRNA degradation or inhibiting translation. With the discovery that microRNAs act as powerful regulators in the context of a wide variety of diseases, it is only logical that microRNAs be thoroughly explored as potential therapeutic entities. This current review summarizes interesting findings regarding the intriguing roles and benefits of microRNA expression modulation during AAA initiation and propagation. These studies utilize disease-relevant murine models, as well as human tissue from patients undergoing surgical aortic aneurysm repair. Furthermore, we critically examine future therapeutic strategies with regard to their clinical and translational feasibility. PMID:23852016

  14. Ventricular Aneurysm Following Myocardial Infarction

    PubMed Central

    Walters, M. B.

    1966-01-01

    Cineradiographic examination appears to be the best method for the study of cardiac pulsations. Fifty consecutive patients, who had sustained transmural myocardial infarction at least six months previously, were studied by this technique. Thirty-six had some abnormality of pulsation and eight had dynamic ventricular aneurysm. Six of the eight had suffered severe infarct. Functional recovery in those with aneurysm was not as complete as in the rest of the group. Two made a poor functional recovery, two a fair recovery, and four a moderately good recovery. Clinically, there were no systemic emboli in the patients with dynamic aneurysms. Five of the 50 had persistent ST-segment elevation and “coving” of the T waves; three of these patients had aneurysms. There was no good correlation between the electrocardiographic site of the infarct and the site of the abnormal pulsation. ImagesFig. 1 PMID:5928534

  15. Hemodynamic Intervention of Cerebral Aneurysms

    NASA Astrophysics Data System (ADS)

    Meng, Hui

    2005-11-01

    Cerebral aneurysm is a pathological vascular response to hemodynamic stimuli. Endovascular treatment of cerebral aneurysms essentially alters the blood flow to stop them from continued growth and eventual rupture. Compared to surgical clipping, endovascular methods are minimally invasive and hence rapidly gaining popularity. However, they are not always effective with risks of aneurysm regrowth and various complications. We aim at developing a Virtual Intervention (VI) platform that allows: patient-specific flow calculation and risk prediction as well as recommendation of tailored intervention based on quantitative analysis. This is a lofty goal requiring advancement in three areas of research: (1). Advancement of image-based CFD; (2) Understanding the biological/pathological responses of tissue to hemodynamic factors in the context of cerebral aneurysms; and (3) Capability of designing and testing patient-specific endovascular devices. We have established CFD methodologies based on anatomical geometry obtained from 3D angiographic or CT images. To study the effect of hemodynamics on aneurysm development, we have created a canine model of a vascular bifurcation anastomosis to provide the hemodynamic environment similar to those in CA. Vascular remodeling was studied using histology and compared against the flow fields obtained from CFD. It was found that an intimal pad, similar to those frequently seen clinically, developed at the flow impingement site, bordering with an area of `groove' characteristic of an early stage of aneurysm, where the micro environment exhibits an elevated wall shear stresses. To further address the molecular mechanisms of the flow-mediated aneurysm pathology, we are also developing in vitro cell culture systems to complement the in vivo study. Our current effort in endovascular device development focuses on novel stents that alters the aneurysmal flow to promote thrombotic occlusion as well as favorable remodeling. Realization of an

  16. Aneurysm of the Splenic Artery

    PubMed Central

    Bedford, P. D.; Lodge, Brian

    1960-01-01

    This paper records an incidence of 10·4% of aneurysm of the splenic artery in 250 consecutive routine post-mortem examinations. Medial degeneration seemed to be the commonest cause of such aneurysms and although a number were associated with other intraabdominal pathology, including portal hypertension, the association may be fortuitous and not causal. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6 PMID:13688586

  17. Smooth Muscle Cell Foam Cell Formation, Apolipoproteins, and ABCA1 in Intracranial Aneurysms: Implications for Lipid Accumulation as a Promoter of Aneurysm Wall Rupture.

    PubMed

    Ollikainen, Eliisa; Tulamo, Riikka; Lehti, Satu; Lee-Rueckert, Miriam; Hernesniemi, Juha; Niemelä, Mika; Ylä-Herttuala, Seppo; Kovanen, Petri T; Frösen, Juhana

    2016-07-01

    Saccular intracranial aneurysm (sIA) aneurysm causes intracranial hemorrhages that are associated with high mortality. Lipid accumulation and chronic inflammation occur in the sIA wall. A major mechanism for lipid clearance from arteries is adenosine triphosphate-binding cassette A1 (ABCA1)-mediated lipid efflux from foam cells to apolipoprotein A-I (apoA-I). We investigated the association of wall degeneration, inflammation, and lipid-related parameters in tissue samples of 16 unruptured and 20 ruptured sIAs using histology and immunohistochemistry. Intracellular lipid accumulation was associated with wall remodeling (p = 0.005) and rupture (p = 0.020). Foam cell formation was observed in smooth muscle cells, in addition to CD68- and CD163-positive macrophages. Macrophage infiltration correlated with intracellular lipid accumulation and apolipoproteins, including apoA-I. ApoA-I correlated with markers of lipid accumulation and wall degeneration (p = 0.01). ApoA-I-positive staining colocalized with ABCA1-positive cells particularly in sIAs with high number of smooth muscle cells (p = 0.003); absence of such colocalization was associated with wall degeneration (p = 0.017). Known clinical risk factors for sIA rupture correlated inversely with apoA-I. We conclude that lipid accumulation associates with sIA wall degeneration and risk of rupture, possibly via formation of foam cells and subsequent loss of mural cells. Reduced removal of lipids from the sIA wall via ABCA1-apoA-I pathway may contribute to this process. PMID:27283327

  18. When Blood Vessels Bulge: All About Aneurysms

    MedlinePlus

    ... Vessels Bulge When Blood Vessels Bulge All About Aneurysms An aneurysm—a balloon-like bulge in an artery—can ... for years without causing any symptoms. But an aneurysm is a silent threat to your health. If ...

  19. Aspergillus mycotic aneurysm--case report.

    PubMed

    Komatsu, Y; Narushima, K; Kobayashi, E; Tomono, Y; Nose, T

    1991-06-01

    A 61-year-old female developed subarachnoid hemorrhage after trans-sphenoidal surgery for Rathke's cleft cyst. Neuroradiological examination revealed a large aneurysm at the C1 portion of the right internal carotid artery. Autopsy revealed marked proliferation of aspergillus hyphae in the wall of the aneurysm. A review of previously reported cases of fungal aneurysm proposes two developmental processes. Aneurysms secondary to fungal meningitis tend to be large in size and located in the major cerebral artery trunk, but aneurysms following fungal sepsis tend to be small and in peripheral branches. The former aneurysms are probably caused by fungus invasion into the intracranium, usually from the paranasal sinus, and the latter may be due to fungal emboli like bacterial emboli in bacterial endocarditis. Ruptured fungal aneurysms are difficult to treat, so fungal meningitis or sepsis must be eradicated before an aneurysm develops. PMID:1724300

  20. Aneurysms - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Aneurysms URL of this page: https://medlineplus.gov/languages/aneurysms.html Other topics A-Z A B ...

  1. Aneurysms - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Aneurysms URL of this page: https://www.nlm.nih.gov/medlineplus/languages/aneurysms.html Other topics A-Z A B ...

  2. Aneurysmal bone cyst.

    PubMed

    Rapp, Timothy B; Ward, James P; Alaia, Michael J

    2012-04-01

    Aneurysmal bone cysts are rare skeletal tumors that most commonly occur in the first two decades of life. They primarily develop about the knee but may arise in any portion of the axial or appendicular skeleton. Pathogenesis of these tumors remains controversial and may be vascular, traumatic, or genetic. Radiographic features include a dilated, radiolucent lesion typically located within the metaphyseal portion of the bone, with fluid-fluid levels visible on MRI. Histologic features include blood-filled lakes interposed between fibrous stromata. Differential diagnosis includes conditions such as telangiectatic osteosarcoma and giant cell tumor. The mainstay of treatment is curettage and bone graft, with or without adjuvant treatment. Other management options include cryotherapy, sclerotherapy, radionuclide ablation, and en bloc resection. The recurrence rate is low after appropriate treatment; however, more than one procedure may be required to completely eradicate the lesion. PMID:22474093

  3. Endovascular Exclusion of Renal Artery Aneurysm

    SciTech Connect

    Andersen, Poul Erik Rohr, Nils

    2005-06-15

    A patient who was operated for an abdominal aortic aneurysm 7 years earlier presented with recently discovered iliac and renal artery aneurysms. The renal artery had an angulation of 90{sup o}, but the aneurysm was successfully excluded using a covered vascular stent graft placed over an extrastiff guidewire. Even in cases of complex anatomy of a renal aneurysm, endovascular treatment should be considered. With development of more flexible and low-profile endoprosthesis with accurate deployment, these have become more usable.

  4. [Mycotic Aneurysm of Distal Aortic Arch, after Total Arch Replacement with Open-stent Graft;Report of a Case].

    PubMed

    Suzuki, Kotaro; Kawahara, Yu; Masaki, Naoki; Kobayashi, Yuriko; Takahara, Shingo; Nakamura, Ken; Toyama, Shuji; Fukasawa, Manabu

    2015-05-01

    The patient was a 72-year-old man, who had undergone total arch replacement with an open-stent graft due to saccular aneurysm of distal arch, 2 years before. He was admitted to a local hospital with the complaint of high fever, and was diagnosed as having pyothorax, after computed tomography (CT) scanning. After transferred to our hospital, he was treated by drainage, and antibiotic therapy. But CT scans showed the enlargement of distal arch aneurysm, and migration of the stent graft. Urgent operation was performed. We approached to the site by a full sternotomy, and left anterolateral thoracotomy. Segment 1+2 of the left lung was resected to avoid bleeding and lung injury. Graft replacement of distal arch and descending aorta was performed on cardiopulmonary bypass, with hypothermia, selective brain perfusion and systemic circulatory arrest. To protect from recurrence of infection, the omental flap was transposed to the graft site. Until now, there is no recurrence of infection. PMID:25963790

  5. Thoracoabdominal aortic aneurysm repair: current endovascular perspectives

    PubMed Central

    Orr, Nathan; Minion, David; Bobadilla, Joseph L

    2014-01-01

    Thoracoabdominal aneurysms account for roughly 3% of identified aneurysms annually in the United States. Advancements in endovascular techniques and devices have broadened their application to these complex surgical problems. This paper will focus on the current state of endovascular thoracoabdominal aneurysm repair, including specific considerations in patient selection, operative planning, and perioperative complications. Both total endovascular and hybrid options will be considered. PMID:25170271

  6. Transcatheter Coil Embolization of Splenic Artery Aneurysm

    SciTech Connect

    Yamamoto, Satoshi Hirota, Shozo; Maeda, Hiroaki; Achiwa, Sachiko Arai, Keisuke; Kobayashi, Kaoru; Nakao, Norio

    2008-05-15

    The purpose of this study was to evaluate clinical results and technical problems of transcatheter coil embolization for splenic artery aneurysm. Subjects were 16 patients (8 men, 8 women; age range, 40-80 years) who underwent transcatheter embolization for splenic artery aneurysm (14 true aneurysms, 2 false aneurysms) at one of our hospitals during the period January 1997 through July 2005. Two aneurysms (12.5%) were diagnosed at the time of rupture. Multiple splenic aneurysms were found in seven patients. Aneurysms were classified by site as proximal (or strictly ostial) (n = 3), middle (n = 3), or hilar (n = 10). The indication for transcatheter arterial embolization was a false or true aneurysm 20 mm in diameter. Embolic materials were fibered coils and interlocking detachable coils. Embolization was performed by the isolation technique, the packing technique, or both. Technically, all aneurysms were devascularized without severe complications. Embolized aneurysms were 6-40 mm in diameter (mean, 25 mm). Overall, the primary technical success rate was 88% (14 of 16 patients). In the remaining 2 patients (12.5%), partial recanalization occurred, and re-embolization was performed. The secondary technical success rate was 100%. Seven (44%) of the 16 study patients suffered partial splenic infarction. Intrasplenic branching originating from the aneurysm was observed in five patients. We conclude that transcatheter coil embolization should be the initial treatment of choice for splenic artery aneurysm.

  7. Haemodynamics of giant cerebral aneurysm: A comparison between the rigid-wall, one-way and two-way FSI models

    NASA Astrophysics Data System (ADS)

    Khe, A. K.; Cherevko, A. A.; Chupakhin, A. P.; Bobkova, M. S.; Krivoshapkin, A. L.; Orlov, K. Yu

    2016-06-01

    In this paper a computer simulation of a blood flow in cerebral vessels with a giant saccular aneurysm at the bifurcation of the basilar artery is performed. The modelling is based on patient-specific clinical data (both flow domain geometry and boundary conditions for the inlets and outlets). The hydrodynamic and mechanical parameters are calculated in the frameworks of three models: rigid-wall assumption, one-way FSI approach, and full (two-way) hydroelastic model. A comparison of the numerical solutions shows that mutual fluid- solid interaction can result in qualitative changes in the structure of the fluid flow. Other characteristics of the flow (pressure, stress, strain and displacement) qualitatively agree with each other in different approaches. However, the quantitative comparison shows that accounting for the flow-vessel interaction, in general, decreases the absolute values of these parameters. Solving of the hydroelasticity problem gives a more detailed solution at a cost of highly increased computational time.

  8. Endovascular treatment of intracranial aneurysms.

    PubMed

    Diaz, Orlando; Rangel-Castilla, Leonardo

    2016-01-01

    Intracranial aneurysms are abnormal dilations of the intracranial vessels, in which all the layers of the vascular wall are affected by degenerative changes that lead to distension of the vessel. Intracranial aneurysms can be classified based on their anatomic location, size, and morphology. Subarachnoid hemorrhage is the most devastating clinical presentation. The goal of preventing hemorrhage or rehemorrhage can only be achieved by excluding the aneurysm from the cerebral circulation. Endovascular or surgical clipping can achieve this goal. Multiple surgical and endovascular approaches have been described for treatment of intracranial aneurysm. Surgical approaches for anterior-circulation intracranial aneurysms include: pterional, orbitozygomatic, and lateral supraorbital craniotomies. Modern microsurgical techniques involve skull base dissection to achieve adequate exposure with minimal brain retraction. Endovascular techniques can be divided into: parent artery reconstruction with coil deposition (primary coil, balloon-assisted coiling, stent-assisted coiling, and other new techniques such as neck reconstruction devices and intraluminal occlusion devices); reconstruction with flow diversion; and deconstructive techniques with involving parent artery sacrifice with or without bypass. PMID:27430470

  9. Endovascular Repair of Thoracic Aortic Aneurysms

    PubMed Central

    Findeiss, Laura K.; Cody, Michael E.

    2011-01-01

    Degenerative aneurysms of the thoracic aorta are increasing in prevalence; open repair of descending thoracic aortic aneurysms is associated with high rates of morbidity and mortality. Repair of isolated descending thoracic aortic aneurysms using stent grafts was introduced in 1995, and in an anatomically suitable subgroup of patients with thoracic aortic aneurysm, repair with endovascular stent graft provides favorable outcomes, with decreased perioperative morbidity and mortality relative to open repair. The cornerstones of successful thoracic endovascular aneurysm repair are appropriate patient selection, thorough preprocedural planning, and cautious procedural execution, the elements of which are discussed here. PMID:22379281

  10. Iatrogenic cortical aneurysm post-craniotomy.

    PubMed

    Zanini, Marco Antonio; Borges, Rodrigo Almeida; Nunes Aquino, Gustavo Henrique; de Freitas, Carlos Clayton Macedo

    2010-04-01

    Taking into account the number of craniotomies performed every day around the world, iatrogenic aneurysm post-craniotomy is extremely rare with only anecdotal cases reported in literature. We report an iatrogenic aneurysm affecting a cortical vessel which probably developed during dural closure of a conventional craniotomy. The aneurysm was discovered 6 months after surgery on a routine control angiography. The patient was successfully treated by trapping the parent vessel and excising the aneurysm. Histopathological findings were compatible with a true type of traumatic aneurysm. The possibility of this rare condition occurring highlights the risk of arterial injury during craniotomy. PMID:20121386

  11. Bilateral asymptomatic giant renal artery aneurysm

    PubMed Central

    Özkan, G; Ulusoy, Ş; Dinç, H; Kaynar, K; Sönmez, B; Akagündüz, K

    2011-01-01

    The incidence of renal artery aneurysm is very low. Approximately in 20% of these patients hypertension is observed. The diameter of aneurysm increases with accompanying complication rates. The most feared complication is rupture. The risk of rupture also increases with the diameter of aneurysm. We report an aneurysm with the biggest diameter reported in the literature. The patient had a 12 cm-diameter of aneurysm in one kidney and did not show any symptoms including hypertension until she was seventy years old. PMID:22435028

  12. Surgical Resection of a Giant Coronary Aneurysm.

    PubMed

    Mehall, John R; Verlare, Jordan L

    2015-06-01

    Coronary aneurysms are quite uncommon, and those qualifying as giant aneurysms are even more so. Currently, no standardized treatment protocol exists. We report the case of a 46-year-old man presenting with clinical signs and symptoms of acute myocardial infarction who was found to have a giant coronary aneurysm. The patient was initially evaluated with a computed tomography angiogram, which revealed a 9-cm aneurysm of the left circumflex coronary artery. Surgical resection of the aneurysm, ligation of the proximal circumflex artery, and bypass using the left internal mammary artery to vascularize the proximal circumflex artery was performed. PMID:26046882

  13. Management of Symptomatic Venous Aneurysm

    PubMed Central

    Gabrielli, Roberto; Rosati, Maria Sofia; Siani, Andrea; Irace, Luigi

    2012-01-01

    Venous aneurysms (VAs) have been described in quite of all the major veins. They represent uncommon events but often life-threatening because of pulmonary or paradoxical embolism. We describe our twelve patients' series with acute pulmonary emboli due to venous aneurysm thrombosis. Our experience underlines the importance of a multilevel case-by-case approach and the immediate venous lower limbs duplex scan evaluation in pulmonary embolism events. Our data confirm that anticoagulant alone is not effective in preventing pulmonary embolism. We believe that all the VAs of the deep venous system of the extremities should be treated with surgery as well as symptomatic superficial venous aneurysm. A simple excision can significantly improve symptoms and prevent pulmonary embolism. PMID:22566766

  14. Management of symptomatic venous aneurysm.

    PubMed

    Gabrielli, Roberto; Rosati, Maria Sofia; Siani, Andrea; Irace, Luigi

    2012-01-01

    Venous aneurysms (VAs) have been described in quite of all the major veins. They represent uncommon events but often life-threatening because of pulmonary or paradoxical embolism. We describe our twelve patients' series with acute pulmonary emboli due to venous aneurysm thrombosis. Our experience underlines the importance of a multilevel case-by-case approach and the immediate venous lower limbs duplex scan evaluation in pulmonary embolism events. Our data confirm that anticoagulant alone is not effective in preventing pulmonary embolism. We believe that all the VAs of the deep venous system of the extremities should be treated with surgery as well as symptomatic superficial venous aneurysm. A simple excision can significantly improve symptoms and prevent pulmonary embolism. PMID:22566766

  15. Thoracic aortic aneurysms and pregnancy.

    PubMed

    Coulon, Capucine

    2015-11-01

    Half of acute aortic dissection in women under the age of 40 occurs during pregnancy or peripartum period. Marfan syndrome is the most common syndromic presentation of ascending aortic aneurysm, but other syndromes such as vascular Ehlers-Danlos syndrome, Loeys-Dietz syndrome and Turner syndrome also have ascending aortic aneurysms and the associated cardiovascular risk of aortic dissection and rupture. Management of aortic root aneurysm has been established in recent recommendations, even if levels of evidence are weak. Pregnancy and postpartum period should be followed very closely and determined to be at high risk. Guidelines suggest that women with aortopathy should be counseled against the risk of pregnancy and about the heritable nature of the disease prior to pregnancy. PMID:26454306

  16. [Thoracoabdominal aortic aneurysm].

    PubMed

    Kalder, J; Kotelis, D; Jacobs, M J

    2016-09-01

    Thoracoabdominal aortic aneurysms (TAAA) are rare events with an incidence of 5.9 cases per 100,000 persons per year. In Germany approximately 940 TAAA procedures are performed annually. The cause of TAAA is mostly degenerative but they can also occur on the basis of an aortic dissection or connective tissue disease (e. g. Marfan's syndrome). Patients often have severe comorbidities and suffer from hypertension, coronary heart disease or chronic obstructive pulmonary disease, mostly as a result of smoking. Operative treatment is indicated when the maximum aortic diameter has reached 6 cm (> 5 cm in patients with connective tissue disease) or the aortic diameter rapidly increases (> 5 mm/year). Treatment options are open surgical aortic repair with extracorporeal circulation, endovascular repair with branched/fenestrated endografts and parallel grafts (chimneys) or a combination of open and endovascular procedures (hybrid procedures). Mortality rates after both open and endovascular procedures are approximately 8 % depending on the extent of the repair. Furthermore, there are relevant risks of complications, such as paraplegia (up to 20 %) and the necessity for dialysis. In recent years several approaches to minimize these risks have been proposed. Besides cardiopulmonary risk evaluation, clinical assessment of patients by the physician with respect to the patient-specific anatomy influences the allocation of patients to one treatment option or another. Surgery of TAAA should ideally be performed in high-volume centers in order to achieve better results. PMID:27558261

  17. Blood blister-like aneurysms: single center experience and systematic literature review.

    PubMed

    Gonzalez, Ana Marcos; Narata, Ana Paula; Yilmaz, Hasan; Bijlenga, Philippe; Radovanovic, Ivan; Schaller, Karl; Lovblad, Karl-Olof; Pereira, Vitor Mendes

    2014-01-01

    Blood blister-like aneurysms (BBAs) are a controversial entity. They arise from non-branching sites on the supraclinoid internal carotid artery (ICA) and are suspected to originate from a dissection. Our aim is to describe the BBA cases seen in our center and to present a systematic review of the literature on BBAs. We analyzed the eleven cases of BBA admitted to our center from 2003 to 2012. We assessed the medical history, treatment modality (endovascular and/or surgery), complications and clinical outcome. The cohort included 8 women and 4 men with a mean age of 53.16 years. Treatment of the BBA consisted of stenting and coiling in 5 patients, stenting only in 4 patients, coiling and clipping in 1 patient, clipping only in 1 patient, and conservative treatment in 1 patient. A good outcome was found in 10 patients, as defined by a modified Rankin Scale (mRS) less than or equal to two at three months. A systematic review of the literature was performed, and 314 reported patients were found: 221 patients were treated with a primarily surgical approach, and 87 patients were treated with a primarily endovascular approach. A rescue or second treatment was required in 46 patients (21%). The overall estimated treatment morbidity rate was 17%, and the mortality rate was 15%. BBAs exhibit more aggressive behavior compared to saccular aneurysms, and more intra-operative complications occur with BBAs, independent of the treatment type offered. They are also significantly more likely to relapse and rebleed after treatment. Endovascular treatment offers a lower morbidity-mortality compared with surgical approaches. Multilayer flow-diverting stents appear to be a promising strategy. PMID:24231267

  18. BIOMECHANICS OF ABDOMINAL AORTIC ANEURYSM

    PubMed Central

    Vorp, David A.

    2009-01-01

    Abdominal aortic aneurysm (AAA) is a condition whereby the terminal aorta permanently dilates to dangerous proportions, risking rupture. The biomechanics of AAA has been studied with great interest since aneurysm rupture is a mechanical failure of the degenerated aortic wall and is a significant cause of death in developed countries. In this review article, the importance of considering the biomechanics of AAA is discussed, and then the history and the state-of-the-art of this field is reviewed - including investigations into the biomechanical behavior of AAA tissues, modeling AAA wall stress and factors which influence it, and the potential clinical utility of these estimates in predicting AAA rupture. PMID:17254589

  19. CFD Modelling of Abdominal Aortic Aneurysm on Hemodynamic Loads Using a Realistic Geometry with CT

    PubMed Central

    Ng, E. Y. K.; Loong, T. H.; Bordone, Maurizio; Pua, Uei; Narayanan, Sriram

    2013-01-01

    The objective of this study is to find a correlation between the abdominal aortic aneurysm (AAA) geometric parameters, wall stress shear (WSS), abdominal flow patterns, intraluminal thrombus (ILT), and AAA arterial wall rupture using computational fluid dynamics (CFD). Real AAA 3D models were created by three-dimensional (3D) reconstruction of in vivo acquired computed tomography (CT) images from 5 patients. Based on 3D AAA models, high quality volume meshes were created using an optimal tetrahedral aspect ratio for the whole domain. In order to quantify the WSS and the recirculation inside the AAA, a 3D CFD using finite elements analysis was used. The CFD computation was performed assuming that the arterial wall is rigid and the blood is considered a homogeneous Newtonian fluid with a density of 1050 kg/m3 and a kinematic viscosity of 4 × 10−3 Pa·s. Parallelization procedures were used in order to increase the performance of the CFD calculations. A relation between AAA geometric parameters (asymmetry index (β), saccular index (γ), deformation diameter ratio (χ), and tortuosity index (ε)) and hemodynamic loads was observed, and it could be used as a potential predictor of AAA arterial wall rupture and potential ILT formation. PMID:23864906

  20. Assessment of Meniere's disease from a radiological aspect – saccular otoconia as a cause of Meniere's disease?

    PubMed Central

    Sunami, Kishiko; Iguchi, Hiroyoshi; Sakamoto, Hiramori; Imoto, Toshio; Rask-Andersen, Helge

    2012-01-01

    Conclusion Significant reduced visualization of the reuniting duct (ductus reuniens; RD), saccular duct (SD) and endolymphatic sinus (ES) in Meniere's disease (MD) compared with normal control ears on three-dimensional (3D) CT imaging suggests the blockage of endolymphatic flow there with radiodense substances, which may be explained by dislodged otoconia from the saccule. These structures could be involved in the pathogenesis of MD. Objective This study was designed to visualize and assess the RD, SD and ES in patients with MD using 3D CT. Methods Sixty-two patients with a definite diagnose of unilateral MD, based on criteria proposed by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), were compared with contralateral ears and normal controls (26 ears) using 3D CT. The RD, SD and ES were scrutinized for patency on 3D CT images. Results MD ears showed loss of continuity of the RD, SD and ES based on evaluation of 3D CT images, and differed significantly from normal healthy control ears (p < 0.01). PMID:22998558

  1. Giant Serpentine Aneurysms: Multidisciplinary Management

    PubMed Central

    Anshun, W.; Feng, L.; Daming, W.

    2000-01-01

    Summary Sixty-five cases of intracranial giant serpentine aneurysms (GSΛs), including 61 cases reported in the literature and four additional cases presented in this study were reviewed. The clinical presentation, possible causes, natural history, and especially management of GSAs are discussed with emphasis on the need for aggressive intervention and multidisciplinary management. PMID:20667180

  2. General Considerations of Ruptured Abdominal Aortic Aneurysm: Ruptured Abdominal Aortic Aneurysm

    PubMed Central

    Lee, Chung Won; Bae, Miju; Chung, Sung Woon

    2015-01-01

    Although development of surgical technique and critical care, ruptured abdominal aortic aneurysm still carries a high mortality. In order to obtain good results, various efforts have been attempted. This paper reviews initial management of ruptured abdominal aortic aneurysm and discuss the key point open surgical repair and endovascular aneurysm repair. PMID:25705591

  3. The coagulopathy associated with aortic aneurysms.

    PubMed Central

    Gétaz, E. P.; Louw, J. H.

    1977-01-01

    The authors in this article record their experience with eight-four patients with abdominal aortic aneurysms. Twenty-seven patients (32%) presented with ruptured aneurysms with an overall mortality of 56%. Of the unruptured aneurysms, 67% were operable with a mortality of 5.3%. The highest mortality amongst the patients with ruptured aneurysms was in the group who was shocked. In the group with ruptured aneurysms, of those in whom platelet counts were performed, 50% were abnormally low, and 56% had evidence of abnormal coagulation. Seventy per cent of those with coagulation abnormalities died. In the unruptured group 28.2% had thrombocytopenia but no other abnormalities of coagulation. All patients undergoint aneurysm resection should have a platelet count and a full clotting screen. Therapy should be directed to normalization of the coagulation system. PMID:593992

  4. Intracranial fungal aneurysm caused by Candida endocarditis.

    PubMed

    Takeda, S; Wakabayashi, K; Yamazaki, K; Miyakawa, T; Arai, H

    1998-01-01

    We describe a 67-year-old man who died 4 days after suffering a subarachnoid hemorrhage. Autopsy revealed a fresh subarachnoid hemorrhage and a ruptured fungal aneurysm near the trifurcation of the right middle cerebral artery. In comparison with 21 previously reported cases in which the fungal aneurysms were proved to be intracranial, the present case had several characteristic features: the causative fungus of the aneurysm was Candida (only one such case has been reported previously). The aneurysm was caused by direct Candida invasion of the arterial wall from the Candida embolus (previously reported aneurysms have been caused by direct invasion of the arterial wall during fungal meningitis). The source of the Candida was endocarditis (the main sources of fungus in previously reported cases have been sinusitis, dental extraction wounds, and some forms of surgery). We describe the features of this rare autopsy case of a ruptured fungal aneurysm caused by Candida originating from endocarditis and review the literature. PMID:9707334

  5. Syphilitic aneurysm of the ascending aorta.

    PubMed

    Paulo, Nelson; Cascarejo, José; Vouga, Luís

    2012-02-01

    Syphilitic aortic aneurysm is a rare occurrence in the antibiotic era, making the diagnose assumption even more infrequent. Nonetheless, this pathology can appear and should be suspected in patients with aortic aneurysm. We report a case of a 57-year old patient who presents with neurosyphilis and, in the following study, a large ascending aorta aneurysm is identified. The authors discuss the diagnostic challenge, the epidemiologic concerns, surgical indication and treatment and subsequent follow-up. PMID:22159251

  6. Practical genetics of thoracic aortic aneurysm.

    PubMed

    Elefteriades, John A; Pomianowski, Pawel

    2013-01-01

    This chapter will provide a practical look at the rapidly evolving field regarding the genetics of thoracic aortic aneurysm. It will start with a look at the history of the genetics of thoracic aortic aneurysm and will then move on to elucidating the discovery of familial patterns of thoracic aortic aneurysm. We will next review the Mendelian genetics of transmission of thoracic aortic aneurysm. We will move on to the molecular genetics at the DNA level and finish with a discussion of the molecular genetics at the RNA level, including a promising investigational "RNA Signature" test that we have been developing at Yale. PMID:23993238

  7. Microsurgical clipping of an unruptured lenticulostriate aneurysm.

    PubMed

    Kalani, M Yashar S; Martirosyan, Nikolay L; Nakaji, Peter; Spetzler, Robert F

    2012-11-01

    Aneurysms of the lenticulostriate artery have been associated with hypertension, vasculopathy, tumors, and arteriovenous malformations. Although several cases of microsurgical treatment of ruptured lenticulostriate artery aneurysms have been reported, to our knowledge there is no published case of microsurgical treatment of an unruptured lenticulostriate artery aneurysm. We report a 66-year-old woman with a history of moyamoya disease, previously treated with a right-sided middle cerebral artery-to-superficial temporal artery bypass who presented with an unruptured aneurysm of a lenticulostriate artery. We report successful microsurgical treatment of this rare lesion and discuss the rationale for our treatment strategy. PMID:22925414

  8. Clipping techniques in cerebral aneurysm surgery.

    PubMed

    Acciarri, Nicola; Toniato, Giovanni; Raabe, Andreas; Lanzino, Giuseppe

    2016-03-01

    The history of cerebral aneurysm surgery owes a great tribute to the tenacity of pioneering neurosurgeons who designed and developed the clips used to close the aneurysms neck. However, until the beginning of the past century, surgery of complex and challenging aneurysms was impossible due to the lack of surgical microscope and commercially available sophisticated clips. The modern era of the spring clips began in the second half of last century. Until then, only malleable metal clips and other non-metallic materials were available for intracranial aneurysms. Indeed, the earliest clips were hazardous and difficult to handle. Several neurosurgeons put their effort in developing new clip models, based on their personal experience in the treatment of cerebral aneurysms. Finally, the introduction of the surgical microscope, together with the availability of more sophisticated clips, has allowed the treatment of complex and challenging aneurysms. However, today none of the new instruments or tools for surgical therapy of aneurysms could be used safely and effectively without keeping in mind the lessons on innovative surgical techniques provided by great neurovascular surgeons. Thanks to their legacy, we can now treat many types of aneurysms that had always been considered inoperable. In this article, we review the basic principles of surgical clipping and illustrate some more advanced techniques to be used for complex aneurysms. PMID:26657306

  9. Saccular Transcriptome Profiles of the Seasonal Breeding Plainfin Midshipman Fish (Porichthys notatus), a Teleost with Divergent Sexual Phenotypes.

    PubMed

    Faber-Hammond, Joshua; Samanta, Manoj P; Whitchurch, Elizabeth A; Manning, Dustin; Sisneros, Joseph A; Coffin, Allison B

    2015-01-01

    Acoustic communication is essential for the reproductive success of the plainfin midshipman fish (Porichthys notatus). During the breeding season, type I males use acoustic cues to advertise nest location to potential mates, creating an audible signal that attracts reproductive females. Type II (sneaker) males also likely use this social acoustic signal to find breeding pairs from which to steal fertilizations. Estrogen-induced changes in the auditory system of breeding females are thought to enhance neural encoding of the advertisement call, and recent anatomical data suggest the saccule (the main auditory end organ) as one possible target for this seasonal modulation. Here we describe saccular transcriptomes from all three sexual phenotypes (females, type I and II males) collected during the breeding season as a first step in understanding the mechanisms underlying sexual phenotype-specific and seasonal differences in auditory function. We used RNA-Seq on the Ion Torrent platform to create a combined transcriptome dataset containing over 79,000 assembled transcripts representing almost 9,000 unique annotated genes. These identified genes include several with known inner ear function and multiple steroid hormone receptors. Transcripts most closely matched to published genomes of nile tilapia and large yellow croaker, inconsistent with the phylogenetic relationship between these species but consistent with the importance of acoustic communication in their life-history strategies. We then compared the RNA-Seq results from the saccules of reproductive females with a separate transcriptome from the non-reproductive female phenotype and found over 700 differentially expressed transcripts, including members of the Wnt and Notch signaling pathways that mediate cell proliferation and hair cell addition in the inner ear. These data constitute a valuable resource for furthering our understanding of the molecular basis for peripheral auditory function as well as a range of

  10. Saccular Transcriptome Profiles of the Seasonal Breeding Plainfin Midshipman Fish (Porichthys notatus), a Teleost with Divergent Sexual Phenotypes

    PubMed Central

    Faber-Hammond, Joshua; Samanta, Manoj P.; Whitchurch, Elizabeth A.; Manning, Dustin; Sisneros, Joseph A.; Coffin, Allison B.

    2015-01-01

    Acoustic communication is essential for the reproductive success of the plainfin midshipman fish (Porichthys notatus). During the breeding season, type I males use acoustic cues to advertise nest location to potential mates, creating an audible signal that attracts reproductive females. Type II (sneaker) males also likely use this social acoustic signal to find breeding pairs from which to steal fertilizations. Estrogen-induced changes in the auditory system of breeding females are thought to enhance neural encoding of the advertisement call, and recent anatomical data suggest the saccule (the main auditory end organ) as one possible target for this seasonal modulation. Here we describe saccular transcriptomes from all three sexual phenotypes (females, type I and II males) collected during the breeding season as a first step in understanding the mechanisms underlying sexual phenotype-specific and seasonal differences in auditory function. We used RNA-Seq on the Ion Torrent platform to create a combined transcriptome dataset containing over 79,000 assembled transcripts representing almost 9,000 unique annotated genes. These identified genes include several with known inner ear function and multiple steroid hormone receptors. Transcripts most closely matched to published genomes of nile tilapia and large yellow croaker, inconsistent with the phylogenetic relationship between these species but consistent with the importance of acoustic communication in their life-history strategies. We then compared the RNA-Seq results from the saccules of reproductive females with a separate transcriptome from the non-reproductive female phenotype and found over 700 differentially expressed transcripts, including members of the Wnt and Notch signaling pathways that mediate cell proliferation and hair cell addition in the inner ear. These data constitute a valuable resource for furthering our understanding of the molecular basis for peripheral auditory function as well as a range of

  11. Hemodynamics of Cerebral Aneurysms: Computational Analyses of Aneurysm Progress and Treatment

    PubMed Central

    Jeong, Woowon; Rhee, Kyehan

    2012-01-01

    The progression of a cerebral aneurysm involves degenerative arterial wall remodeling. Various hemodynamic parameters are suspected to be major mechanical factors related to the genesis and progression of vascular diseases. Flow alterations caused by the insertion of coils and stents for interventional aneurysm treatment may affect the aneurysm embolization process. Therefore, knowledge of hemodynamic parameters may provide physicians with an advanced understanding of aneurysm progression and rupture, as well as the effectiveness of endovascular treatments. Progress in medical imaging and information technology has enabled the prediction of flow fields in the patient-specific blood vessels using computational analysis. In this paper, recent computational hemodynamic studies on cerebral aneurysm initiation, progress, and rupture are reviewed. State-of-the-art computational aneurysmal flow analyses after coiling and stenting are also summarized. We expect the computational analysis of hemodynamics in cerebral aneurysms to provide valuable information for planning and follow-up decisions for treatment. PMID:22454695

  12. Renal failure after ruptured aneurysm.

    PubMed

    Abbott, W M; Abel, R M; Beck, C H; Fischer, J E

    1975-09-01

    The effectiveness of an intravenous nutritional program plus aggressive dialysis was studied in 32 patients with renal failure following ruptured abdominal aortic aneurysm. Each patient was managed postoperatively with a renal failure fluid regimen, consisting of the eight essential amino acids plus dextrose in conjunction with peritoneal dialysis and hemodialysis. This regimen induced salutary metabolic effects temporarily improving the patient's condition in most instances. No technical or septic complications associated with the intravenous dietary therapy occurred. However, the incidence of recovery of renal function was low, and the overall patient survival was only 12.5%. The experience indicates that although this program has been shown to be efficacious in some patients with acute renal failure, it seems of little benefit in those whose renal failure follows ruptured aortic aneurysm. PMID:808197

  13. Cochleo-saccular degeneration in one of three sisters with hereditary deafness, absent gastric motility, small bowel diverticulitis and progressive sensory neuropathy.

    PubMed

    Igarashi, M; MacRae, D; O-Uchi, T; Alford, B R

    1981-01-01

    This is a report of cochleo-saccular degeneration found in temporal bones from a patient who had suffered from slowly progressive and total sensorineural deafness which had an inherited origin. At age 8, this patient began to complain of hearing loss, and by age 10 she was totally deaf. The patient was 1 of 3 female siblings who have suffered from an exactly identical progressive disease: deafness, absent gastric motility, small bowel diverticulitis and ulceration, and sensory neuropathy. The temporal bone pathology found in this case was the degenerative change in the cochlear duct and sacculus. No pathology was found in the utriculus and semicircular canals. PMID:6937848

  14. Time evolution and hemodynamics of cerebral aneurysms

    NASA Astrophysics Data System (ADS)

    Sforza, Daniel M.; Putman, Christopher; Tateshima, Satoshi; Viñuela, Fernando; Cebral, Juan

    2011-03-01

    Cerebral aneurysm rupture is a leading cause of hemorrhagic strokes. Because they are being more frequently diagnosed before rupture and the prognosis of subarachnoid hemorrhage is poor, clinicians are often required to judge which aneurysms are prone to progression and rupture. Unfortunately, the processes of aneurysm initiation, growth and rupture are not well understood. Multiple factors associated to these processes have been identified. Our goal is to investigate two of them, arterial hemodynamics (using computational fluid dynamics) and the peri-aneurysmal environment, by studying a group of growing cerebral aneurysms that are followed longitudinally in time. Six patients with unruptured untreated brain aneurysms which exhibited growth during the observation period were selected for the study. Vascular models of each aneurysm at each observation time were constructed from the corresponding computed tomography angiography (CTA) images. Subsequently, models were aligned, and geometrical differences quantified. Blood flow was modeled with the 3D unsteady incompressible Navier-Stokes equation for a Newtonian fluid, and wall shear stress distribution and flow patterns were calculated and visualized. Analysis of the simulations and changes in geometry revealed asymmetric growth patterns and suggests that areas subject to vigorous flows, i.e. relative high wall shear stress and concentrated streamlines patterns; correspond to regions of aneurysm growth. Furthermore, in some cases the geometrical evolution of aneurysms is clearly affected by contacts with bone structures and calcifications in the wall, and as a consequence the hemodynamics is greatly modified. Thus, in these cases the peri-aneurysmal environment must be considered when analyzing aneurysm evolution.

  15. Correlation Between Aneurysm Size and Hemodynamics in One Individual with Multiple Small Intracranial Aneurysms

    PubMed Central

    Britz, Gavin

    2016-01-01

    Objective A large number of cases are needed in the patient-specific modeling of intracranial aneurysms to establish the statistical significance due to individual variation of risk factors that are difficult to account for. However, these risk factors are critical in hemorrhage risk as demonstrated in large clinical studies. Rupture risks for aneurysms in an individual are easier to compare because these aneurysms are under the same physiological environment, and their only differences are the local hemodynamic factors associated with their anatomic locations. Methods Eight small aneurysms (< 7 mm) from one individual were analyzed using patient-specific hemodynamic modeling. Four scenarios with different perfusion assumptions were performed to account for the flow rate at two smaller communicating arteries. Wall shear stresses (WSS) at these aneurysms were compared to determine their relationship with the aneurysm size. Results Each of the three largest aneurysms is either the most proximal or distal aneurysm in a given artery so that blood pressure does not have a direct influence on aneurysm size. No wall shear stress-derived hemodynamic variables are found to be related to aneurysm size. Discussion A study of multiple aneurysms from one individual offers a unique opportunity to examine various hemodynamic factors without selection biases. Aneurysms greater than 4 mm (Group 1) have a higher product of maximum WSS and area of low WSS; aneurysms smaller than 4 mm (Group 2) have a lower product of maximum WSS and area of low WSS. In addition, aneurysm size is linearly correlated with the flow rate at the parent artery in each group. PMID:27555981

  16. Correlation Between Aneurysm Size and Hemodynamics in One Individual with Multiple Small Intracranial Aneurysms.

    PubMed

    Jou, Liangder; Britz, Gavin

    2016-01-01

    Objective A large number of cases are needed in the patient-specific modeling of intracranial aneurysms to establish the statistical significance due to individual variation of risk factors that are difficult to account for. However, these risk factors are critical in hemorrhage risk as demonstrated in large clinical studies. Rupture risks for aneurysms in an individual are easier to compare because these aneurysms are under the same physiological environment, and their only differences are the local hemodynamic factors associated with their anatomic locations. Methods Eight small aneurysms (< 7 mm) from one individual were analyzed using patient-specific hemodynamic modeling. Four scenarios with different perfusion assumptions were performed to account for the flow rate at two smaller communicating arteries. Wall shear stresses (WSS) at these aneurysms were compared to determine their relationship with the aneurysm size. Results Each of the three largest aneurysms is either the most proximal or distal aneurysm in a given artery so that blood pressure does not have a direct influence on aneurysm size. No wall shear stress-derived hemodynamic variables are found to be related to aneurysm size. Discussion A study of multiple aneurysms from one individual offers a unique opportunity to examine various hemodynamic factors without selection biases. Aneurysms greater than 4 mm (Group 1) have a higher product of maximum WSS and area of low WSS; aneurysms smaller than 4 mm (Group 2) have a lower product of maximum WSS and area of low WSS. In addition, aneurysm size is linearly correlated with the flow rate at the parent artery in each group. PMID:27555981

  17. Analysis of slipstream flow in two ruptured intracranial cerebral aneurysms.

    PubMed

    Imbesi, S G; Kerber, C W

    1999-10-01

    Replicas of ruptured posterior communicating and basilar artery aneurysms were created from cadaveric specimens and then were placed in a circuit of pulsating non-Newtonian fluid. Individual fluid slipstreams were opacified with isobaric dyes, and images were recorded on film. The slipstreams entered the distal aneurysm neck with impact against the distal lateral wall of the aneurysm. They then swirled slowly in a reverse vortical pattern within the aneurysm sac. Fluid exited the aneurysm at the proximal neck. The flow pattern clearly shows the impact zone of entering slipstreams (the point of aneurysm rupture) and provides information pertaining to aneurysm growth and formation. PMID:10543644

  18. Giant Serpentine Aneurysm of the Middle Cerebral Artery

    PubMed Central

    Lee, Seung Joo; Kwun, Byung Duk; Kim, Chang Jin

    2010-01-01

    Giant serpentine aneurysms are rare and have distinct angiographic findings. The rarity, large size, complex anatomy and hemodynamic characteristics of giant serpentine aneurysms make treatment difficult. We report a case of a giant serpentine aneurysm of the right middle cerebral artery (MCA) that presented as headache. Treatment involved a superficial temporal artery (STA)-MCA bypass followed by aneurysm resection. The patient was discharged without neurological deficits, and early and late follow-up angiography disclosed successful removal of the aneurysm and a patent bypass graft. We conclude that STA-MCA bypass and aneurysm excision is a successful treatment method for a giant serpentine aneurysm. PMID:20856671

  19. Idiopathic subvalvular aortic aneurysm masquerading as acute coronary syndrome.

    PubMed

    Natarajan, Balaji; Ramanathan, Sundar; Subramaniam, Natarajan; Janardhanan, Rajesh

    2016-01-01

    Subvalvular aneurysms are the least common type of left ventricular (LV) aneurysms and can be fatal. Subaortic LV aneurysms are much rarer than submitral LV aneurysms and mostly reported in infancy. They can be congenital or acquired secondary to infections, cardiac surgery or trauma. Here, we report a unique presentation of a large, idiopathic subaortic aneurysm in an adult masquerading as an acute coronary syndrome. Diagnosis was made with the help of a CT aortography. Aneurysm was surgically resected with good results. This case highlights the clinical presentation and management of subaortic aneurysms, an important differential for congenital aortic malformations. PMID:27591034

  20. Spontaneous Retroperitoneal Hemorrhage from Adrenal Artery Aneurysm

    SciTech Connect

    Gonzalez Valverde, F.M. Balsalobre, M.; Torregrosa, N.; Molto, M.; Gomez Ramos, M.J.; Vazquez Rojas, J.L.

    2007-04-15

    Spontaneous adrenal hemorrhage is a very rare but serious disorder of the adrenal gland that can require emergent treatment. We report on a 42-year-old man who underwent selective angiography for diagnosis and treatment of retroperitoneal hemorrhage from small adrenal artery aneurysm. This case gives further details about the value of transluminal artery embolization in the management of visceral aneurysm rupture.

  1. Pantopaque simulating thrombosed intracranial aneurysms on MRI

    SciTech Connect

    Lidov, M.W.; Silvers, A.R.; Mosesson, R.E.; Stollman, A.L.; Som, P.M.

    1996-03-01

    A patient is presented in whom iophendylate (Pantopaque) within the basal cisterns closely resembled the appearance on MRI of thrombosed aneurysms of the middle cerebral arteries. The sometimes subtle differences between the appearances on MRI of Pantopaque and aneurysmal clot are discussed to permit accurate diagnosis without resorting to more invasive diagnostic tests, such as cerebral angiography. 5 refs., 4 figs.

  2. [Aneurysm of the femoral and popliteal vein].

    PubMed

    Hansen, L G; Boris, P

    1986-04-01

    Aneurysms of the popliteal and femoral veins are rare and may be seen as casual findings with no clinical manifestations whatsoever. On the other hand they may be potential source of recurrent pulmonary embolism. A case is reported, where an aneurysm of the femoral vein was found in a clinically symptomless woman aged 48. PMID:3715020

  3. Two cases of giant serpentine aneurysm.

    PubMed

    Kumabe, T; Kaneko, U; Ishibashi, T; Kaneko, K; Uchigasaki, S

    1990-06-01

    Giant serpentine aneurysm (GSA) is an entity defined on radiological and pathological grounds as a giant, partially thrombosed aneurysm containing tortuous vascular channels. We have had the opportunity to study two patients with GSAs, which has allowed for a complete comparative anatomical and radiological study. This report emphasizes the etiology of the GSAs. Twenty-two patients with GSAs have been reported in the literature, of which pathological studies were done in 10. In most of these, the aneurysm was found to be filled with an organized thrombus, but in our patients the aneurysm was filled with relatively new clot. The aneurysm enlarged and a change in the tortuous vascular channel was observed over a period of 1 year in the first patient, whereas a globoid aneurysm developed into a GSA in the brief period of just 2 weeks in the second patient. This rapid transformation of a globoid aneurysm into a GSA is of particular interest when the etiology of GSAs is considered. Our patients therefore shed some interesting light on the possible pathophysiology of GSAs. That is, the bloodstream may change dynamically in a giant aneurysm and may become a serpentine channel under conditions that lead to a "Coanda effect." PMID:2362659

  4. Lessons from Animal Models of Arterial Aneurysm

    PubMed Central

    Gertz, S. David; Mintz, Yoav; Beeri, Ronen; Rubinstein, Chen; Gilon, Dan; Gavish, Leah; Berlatzky, Yacov; Appelbaum, Liat; Gavish, Lilach

    2013-01-01

    We review the results from the most common animal models of arterial aneurysm, including recent findings from our novel, laparoscopy-based pig model of abdominal aortic aneurysm, that contribute important insights into early pathogenesis. We emphasize the relevance of these findings for evaluation of treatment protocols and novel device prototypes for mechanism-based prevention of progression and rupture. PMID:26798701

  5. Cardiovascular syphilis with coronary stenosis and aneurysm.

    PubMed

    Tewari, Satyendra; Moorthy, Nagaraja

    2014-01-01

    Cardiovascular manifestations of tertiary syphilis include aortitis, aortic root dilation, aneurysm formation, aortic regurgitation, and coronary ostial stenosis. Coronary ostial lesions have been detected in as many as 26% of patients with syphilitic aortitis. However nonostial coronary stenosis and coronary aneurysms in same patient is rarely described in cardiovascular syphilis. PMID:25634420

  6. Aneurysm of sinus of Valsalva: uncommon presentation.

    PubMed

    Elumalai, Raja Saravanan; Vaidyanathan, Kirthivasan; Nainar, Madhu Sankar; Balasubramaniam, Govini; George, Susan

    2011-12-01

    A 28-year-old man presented with acute onset of chest pain. Transthoracic echocardiography confirmed an aneurysm of the sinus of Valsalva dissecting into the interventricular septum. During the next 12 h, the aneurysm enlarged to involve the entire interventricular septum, and the patient developed features of cardiac tamponade. He underwent successful surgical repair. PMID:22160415

  7. Cerebral aneurysms: Formation, progression and developmental chronology

    PubMed Central

    Etminan, Nima; Buchholz, Bruce A.; Dreier, Rita; Bruckner, Peter; Torner, James C.; Steiger, Hans-Jakob; Hänggi, Daniel; Macdonald, R. Loch

    2015-01-01

    The prevalence of unruptured intracranial aneurysms (UAIs) in the general population is up to 3%. Existing epidemiological data suggests that only a small fraction of UIAs progress towards rupture over the lifetime of an individual, but the surrogates for subsequent rupture and the natural history of UIAs are discussed very controversially at present. In case of rupture of an UIA, the case-fatality is up to 50%, which therefore continues to stimulate interest in the pathogenesis of cerebral aneurysm formation and progression. Actual data on the chronological development of cerebral aneurysm has been especially difficult to obtain and, until recently, the existing knowledge in this respect is mainly derived from animal or mathematical models or short-term observational studies. Here, we highlight the current data on cerebral aneurysm formation and progression as well as a novel approach to investigate the developmental chronology of cerebral aneurysms. PMID:24323717

  8. The Genetic Basis of Aortic Aneurysm

    PubMed Central

    Lindsay, Mark E.; Dietz, Harry C.

    2014-01-01

    Gene identification in human aortic aneurysm conditions is proceeding at a rapid pace and the integration of pathogenesis-based management strategies in clinical practice is an emerging reality. Human genetic alterations causing aneurysm involve diverse gene products including constituents of the extracellular matrix, cell surface receptors, intracellular signaling molecules, and elements of the contractile cytoskeleton. Animal modeling experiments and human genetic discoveries have extensively implicated the transforming growth factor-β (TGF-β) cytokine-signaling cascade in aneurysm progression, but mechanistic links between many gene products remain obscure. This chapter will integrate human genetic alterations associated with aortic aneurysm with current basic research findings in an attempt to form a reconciling if not unifying model for hereditary aortic aneurysm. PMID:25183854

  9. Management of distal left main coronary artery aneurysm.

    PubMed

    Ko, Po-Yen; Chang, Chih-Ping; Lin, Jen-Jyh; Liu, Juhn-Cherng

    2013-12-01

    Aneurysms of the left main coronary artery are extremely rare. The cause of such aneurysms is uncertain. Although the treatment of distal left main aneurysms is very complicated, definitive treatment is necessary because the aneurysm may grow further and cause embolism or rupture. Herein, we report a case of acute myocardial infarction caused by aneurysm of the distal left main coronary artery, which was successfully treated by performing coronary artery bypass surgery, followed by implantation of a polytetrafluoroethylene-covered stent. PMID:22535673

  10. FSI Simulations of Pulse Wave Propagation in Human Abdominal Aortic Aneurysm: The Effects of Sac Geometry and Stiffness

    PubMed Central

    Li, Han; Lin, Kexin; Shahmirzadi, Danial

    2016-01-01

    This study aims to quantify the effects of geometry and stiffness of aneurysms on the pulse wave velocity (PWV) and propagation in fluid–solid interaction (FSI) simulations of arterial pulsatile flow. Spatiotemporal maps of both the wall displacement and fluid velocity were generated in order to obtain the pulse wave propagation through fluid and solid media, and to examine the interactions between the two waves. The results indicate that the presence of abdominal aortic aneurysm (AAA) sac and variations in the sac modulus affect the propagation of the pulse waves both qualitatively (eg, patterns of change of forward and reflective waves) and quantitatively (eg, decreasing of PWV within the sac and its increase beyond the sac as the sac stiffness increases). The sac region is particularly identified on the spatiotemporal maps with a region of disruption in the wave propagation with multiple short-traveling forward/reflected waves, which is caused by the change in boundary conditions within the saccular region. The change in sac stiffness, however, is more pronounced on the wall displacement spatiotemporal maps compared to those of fluid velocity. We conclude that the existence of the sac can be identified based on the solid and fluid pulse waves, while the sac properties can also be estimated. This study demonstrates the initial findings in numerical simulations of FSI dynamics during arterial pulsations that can be used as reference for experimental and in vivo studies. Future studies are needed to demonstrate the feasibility of the method in identifying very mild sacs, which cannot be detected from medical imaging, where the material property degradation exists under early disease initiation. PMID:27478394

  11. FSI Simulations of Pulse Wave Propagation in Human Abdominal Aortic Aneurysm: The Effects of Sac Geometry and Stiffness.

    PubMed

    Li, Han; Lin, Kexin; Shahmirzadi, Danial

    2016-01-01

    This study aims to quantify the effects of geometry and stiffness of aneurysms on the pulse wave velocity (PWV) and propagation in fluid-solid interaction (FSI) simulations of arterial pulsatile flow. Spatiotemporal maps of both the wall displacement and fluid velocity were generated in order to obtain the pulse wave propagation through fluid and solid media, and to examine the interactions between the two waves. The results indicate that the presence of abdominal aortic aneurysm (AAA) sac and variations in the sac modulus affect the propagation of the pulse waves both qualitatively (eg, patterns of change of forward and reflective waves) and quantitatively (eg, decreasing of PWV within the sac and its increase beyond the sac as the sac stiffness increases). The sac region is particularly identified on the spatiotemporal maps with a region of disruption in the wave propagation with multiple short-traveling forward/reflected waves, which is caused by the change in boundary conditions within the saccular region. The change in sac stiffness, however, is more pronounced on the wall displacement spatiotemporal maps compared to those of fluid velocity. We conclude that the existence of the sac can be identified based on the solid and fluid pulse waves, while the sac properties can also be estimated. This study demonstrates the initial findings in numerical simulations of FSI dynamics during arterial pulsations that can be used as reference for experimental and in vivo studies. Future studies are needed to demonstrate the feasibility of the method in identifying very mild sacs, which cannot be detected from medical imaging, where the material property degradation exists under early disease initiation. PMID:27478394

  12. Physical Factors Effecting Cerebral Aneurysm Pathophysiology

    PubMed Central

    Sadasivan, Chander; Fiorella, David J.; Woo, Henry H.; Lieber, Baruch B.

    2013-01-01

    Many factors that are either blood-, wall-, or hemodynamics-borne have been associated with the initiation, growth, and rupture of intracranial aneurysms. The distribution of cerebral aneurysms around the bifurcations of the circle of Willis has provided the impetus for numerous studies trying to link hemodynamic factors (flow impingement, pressure, and/or wall shear stress) to aneurysm pathophysiology. The focus of this review is to provide a broad overview of such hemodynamic associations as well as the subsumed aspects of vascular anatomy and wall structure. Hemodynamic factors seem to be correlated to the distribution of aneurysms on the intracranial arterial tree and complex, slow flow patterns seem to be associated with aneurysm growth and rupture. However, both the prevalence of aneurysms in the general population and the incidence of ruptures in the aneurysm population are extremely low. This suggests that hemodynamic factors and purely mechanical explanations by themselves may serve as necessary, but never as necessary and sufficient conditions of this disease’s causation. The ultimate cause is not yet known, but it is likely an additive or multiplicative effect of a handful of biochemical and biomechanical factors. PMID:23549899

  13. Insights on a Giant Aneurysm Treated Endovascularly.

    PubMed

    Graziano, Francesca; Iacopino, Domenico Gerardo; Ulm, Arthur John

    2016-07-01

    Background Endovascular treatment with stent-assisted Guglielmi detachable coils is an accepted method for treating intracranial giant aneurysms that otherwise would require more invasive or destructive treatment or could not be treated at all. Nevertheless, there is a paucity of information concerning inner postcoiling aneurysmal changes in human subjects over the long term. We report a postmortem analysis of a patient with a giant aneurysm at the vertebrobasilar junction (VBJ) who was treated endovascularly and studied pathologically 24 months after treatment. Materials and Method The head was removed at autopsy and prefixed in a 10% neutral buffered formalin solution. The brain was gently removed from the skull base after cutting the intracranial nerves and vascular structures. The giant VBJ aneurysm and its relationship with the brainstem, cranial nerves, and vessels were captured photographically and analyzed. Afterward, under operating microscope guidance, the vertebrobasilar system with the aneurysm was gently and carefully detached from the brainstem and carefully analyzed. Results No complete fibrous obliteration of the aneurysm lumen could be detected in our case, and no endothelialization had taken place 24 months after treatment. Conclusions Our findings agree with those of previous similar reports. Coiling, in particular in large or giant aneurysms, may be burdened by the risk of coil compaction and recanalization, but it has the advantage of not affecting the flow in the perforating arteries. PMID:26296255

  14. Steady flow in abdominal aortic aneurysm models.

    PubMed

    Budwig, R; Elger, D; Hooper, H; Slippy, J

    1993-11-01

    Steady flow in abdominal aortic aneurysm models has been examined for four aneurysm sizes over Reynolds numbers from 500 to 2600. The Reynolds number is based on entrance tube diameter, and the inlet condition is fully developed flow. Experimental and numerical methods have been used to determine: (i) the overall features of the flow, (ii) the stresses on the aneurysm walls in laminar flow, and (iii) the onset and characteristics of turbulent flow. The laminar flow field is characterized by a jet of fluid (passing directly through the aneurysm) surrounded by a recirculating vortex. The wall shear stress magnitude in the recirculation zone is about ten times less than in the entrance tube. Both wall shear stress and wall normal stress profiles exhibit large magnitude peaks near the reattachment point at the distal end of the aneurysm. The onset of turbulence in the model is intermittent for 2000 < Re < 2500. The results demonstrate that a slug of turbulence in the entrance tube grows much more rapidly in the aneurysm than in a corresponding length of uniform cross section pipe. When turbulence is present in the aneurysm the recirculation zone breaks down and the wall shear stress returns to a magnitude comparable to that in the entrance tube. PMID:8309237

  15. Rasmussen's Aneurysm: A Forgotten Entity?

    SciTech Connect

    Keeling, A. N.; Costello, R.; Lee, M. J.

    2008-01-15

    We present the case of a rare entity which is a complication of a disease process that had almost disappeared from the Western World. With the recent resurgence in reported cases of Mycobacterium tuberculosis (TB) in Western communities, it is important to recognize complications and sequelae. A young alcoholic male with confirmed active TB suffered a cardiac arrest following massive haemoptysis. Multidetector computed tomography angiography diagnosed a Rasmussen's aneurysm, confirmed by digital subtraction angiography and then successfully embolized with glue. We outline this rare case and the embolization technique and review previously documented reports.

  16. Transcatheter wiring of abdominal aortic aneurysm

    SciTech Connect

    Rossi, P.; Simonetti, G.; Passariello, R.; Stipa, S.; Cavallaro, A.

    1983-04-01

    A new technique of transcatheder wiring of unresectable aortic aneurysm is described that provides simultaneous transcatheder occlusion of both common iliac arteries followed by exillofemoral bypass. The spring coil used for aortic aneurysm wiring was of our own making. The outer portion of a movable core stainless steel guidewire was bent in a coil shape and introduced into the aneurysm through a 7 French Teflon catheder via the right femoral artery. The same catheder was also used for coil embolus occlusion of both iliac arteries.

  17. Endovascular treatment of popliteal aneurysm.

    PubMed

    de Donato, G; Setacci, F; Galzerano, G; Borrelli, M P; Mascolo, V; Mazzitelli, G; Ruzzi, U; Setacci, C

    2015-08-01

    Although traditional surgical repair by aneurysm exclusion and bypass is still considered the gold standard in the treatment of popliteal artery aneurysms (PAAs), the endovascular repair (ER) has been gaining great interest in the last decades. ER offers several advantages over open bypass, including lower morbidity and mortality, and faster functional recovery, but some concerns about migration, occlusion, or fracture remain when a stent graft is deployed across a joint that undergo constant flexion. This review summarizes the current evidence on ER for PAAs. Level I evidence is still very limited, while the majority of published data come from retrospective studies. Moreover the heterogeneity of PAA morphology seems to play a major role in the outcomes after popliteal endografts placement, so that many anatomical criteria should be taken into account to determine which patient is best treated endovascularly. In conclusion, while it is unlike that endovascular treatment may displace open surgical bypass in the near future, it indeed does provide a feasible option for selected patients with high surgical risk and good anatomical features. PMID:25742934

  18. Genetic Variants Underlying Risk of Intracranial Aneurysms: Insights from a GWAS in Portugal

    PubMed Central

    Abrantes, Patrícia; Santos, Maria M.; Sousa, Inês; Xavier, Joana M.; Francisco, Vânia; Krug, Tiago; Sobral, João; Matos, Mafalda; Martins, Madalena; Jacinto, António

    2015-01-01

    Subarachnoid hemorrhage (SAH) is a life-threatening event that most frequently leads to severe disability and death. Its most frequent cause is the rupture of a saccular intracranial aneurysm (IA), which is a blood vessel dilation caused by disease or weakening of the vessel wall. Although the genetic contribution to IA is well established, to date no single gene has been unequivocally identified as responsible for IA formation or rupture. We aimed to identify IA susceptibility genes in the Portuguese population through a pool-based multistage genome-wide association study. Replicate pools were allelotyped in triplicate in a discovery dataset (100 IA cases and 92 gender-matched controls) using the Affymetrix Human SNP Array 6.0. Top SNPs (absolute value of the relative allele score difference between cases and controls |RASdiff|≥13.0%) were selected for technical validation by individual genotyping in the discovery dataset. From the 101 SNPs successfully genotyped, 99 SNPs were nominally associated with IA. Replication of technically validated SNPs was conducted in an independent replication dataset (100 Portuguese IA cases and 407 controls). rs4667622 (between UBR3 and MYO3B), rs6599001 (between SCN11A and WDR48), rs3932338 (214 kilobases downstream of PRDM9), and rs10943471 (96 kilobases upstream of HTR1B) were associated with IA (unadjusted allelic chi-square tests) in the datasets tested (discovery: 6.84E-04≤P≤1.92E-02, replication: 2.66E-04≤P≤2.28E-02, and combined datasets: 6.05E-05≤P≤5.50E-04). Additionally, we confirmed the known association with IA of rs1333040 at the 9p21.3 genomic region, thus validating our dataset. These novel findings in the Portuguese population warrant further replication in additional independent studies, and provide additional candidates to more comprehensively understand IA etiopathogenesis. PMID:26186006

  19. Infectious or Noninfectious? Ruptured, Thrombosed Inflammatory Aortic Aneurysm with Spondylolysis

    SciTech Connect

    Stefanczyk, Ludomir; Elgalal, Marcin; Papiewski, Andrzej; Szubert, Wojciech; Szopinski, Piotr

    2013-06-15

    Osteolysis of vertebrae due to inflammatory aortic aneurysm is rarely observed. However, it is estimated that up to 10 % of infectious aneurysms coexist with bone tissue destruction, most commonly the vertebrae. Inflammatory aneurysms with no identified infection factor, along with infiltration of adjacent muscle and in particular extensive destruction of bone tissue have rarely been described in the literature. A case of inflammatory aneurysm with posterior wall rupture and inflammatory infiltration of the iliopsoas muscle and spine, together with extensive vertebral body destruction, is presented. The aneurysm was successfully treated with endovascular aneurysm repair EVAR.

  20. Delayed Vasospasm after Aneurysmal Subarachnoid Hemorrhage in Behcet Syndrome

    PubMed Central

    Kim, Jun Hak; Lee, Si-Un; Huh, Choonwoong; Oh, Chang Wan; Bang, Jae Seung

    2016-01-01

    A man visited the emergency room with a headache. Brain computed tomography showed aneurysmal subarachnoid hemorrhage (SAH) and multiple aneurysms. After aneurysm clipping surgery, the patient was discharged. After 5 days, he was admitted to the hospital with skin ulceration and was diagnosed with Behcet syndrome. An angiogram taken 7 weeks after aneurysmal SAH showed intracranial vasospasm. Because inflammation in Behcet syndrome may aggravate intracranial vasospasm, intracranial vasospasm after aneurysmal SAH in Behcet syndrome should be monitored for longer compared to general aneurysmal SAH. PMID:27114963

  1. An unexpected pulmonary arterial aneurysm in a COPD patient.

    PubMed

    Karkoulias, K; Lykouras, D; Nanopoulou, M; Tsiamita, M; Iliopoulos, P; Spiropoulos, K

    2011-01-01

    We present a case of an idiopathic pulmonary artery aneurysm in an asymptomatic patient who was treated for an irrelevant medical condition. Pulmonary artery aneurysms (PAA) are quite rare and can either be congenital or acquired. Congenital aneurysms are usually associated with cardiac malformations leading to pulmonary hypertension. Acquired aneurysms can be idiopathic or associated with infections (tuberculosis, syphilis), trauma, pulmonary valvular stenosis, or collagen diseases. Pulmonary artery aneurysms are not common and an idiopathic pulmonary artery aneurysm is a rare finding that could be diagnosed incidentally. PMID:22145274

  2. General technical considerations for the endovascular management of cerebral aneurysms.

    PubMed

    Eboli, Paula; Ryan, Robert W; Alexander, Michael J

    2014-07-01

    Cerebral aneurysms pose a threat to patients because of their risk of rupture causing subarachnoid hemorrhage, and the goal of treatment is the exclusion of the aneurysm from the circulation to prevent bleeding (in the case of unruptured aneurysms) or rebleeding. This article analyzes the general technical factors associated with the endovascular treatment of cerebral aneurysms. It discusses issues with transarterial access; imaging of aneurysm size, morphology, and regional anatomy to determine the endovascular plan; the techniques for the major endovascular aneurysm devices; and periprocedural management issues to reduce potential treatment-related complications. PMID:24994079

  3. Microcatheter Looping to Facilitate Aneurysm Selection in Coil Embolization of Paraclinoid Aneurysms

    PubMed Central

    Cho, Young Dae; Rhim, Jong Kook; Park, Jeong Jin; Jeon, Jin Sue; Yoo, Roh-Eul; Kim, Jeong Eun; Cho, Won-Sang; Han, Moon Hee

    2015-01-01

    Objective Described herein is a microcatheter looping technique to facilitate aneurysm selection in paraclinoid aneurysms, which remains to be technically challenging due to the inherent complexity of regional anatomy. Materials and Methods This retrospective study was approved by our Institutional Review Board, and informed consent was waived. Microcatheter looping method was employed in 59 patients with paraclinoid aneurysms between January 2012 and December 2013. In the described technique, construction of a microcatheter loop, which is steam-shaped or pre-shaped, based on the direction of aneurysms, is mandatory. The looped tip of microcatheter was advanced into distal internal carotid artery and positioned atop the target aneurysm. By steering the loop (via inner microguidewire) into the dome of aneurysm and easing tension on the microcatheter, the aneurysm was selected. Clinical and morphologic outcomes were assessed with emphasis on technical aspects of the treatment. Results Through this looping technique, a total of 59 paraclinoid aneurysms were successfully treated. After aneurysm selection as described, single microcatheter technique (n = 25) was most commonly used to facilitate coiling, followed by balloon protection (n = 21), stent protection (n = 7), multiple microcatheters (n = 3), and stent/balloon combination (n = 3). Satisfactory aneurysmal occlusion was achieved through coil embolization in 44 lesions (74.6%). During follow-up of 53 patients (mean interval, 10.9 ± 5.9 months), only one instance (1.9%) of major recanalization was observed. There were no complications related to microcatheter looping. Conclusion This microcatheter looping method facilitates safe and effective positioning of microcatheter into domes of paraclinoid aneurysms during coil embolization when other traditional microcatheter selection methods otherwise fail. PMID:26175591

  4. Tubercular mycotic aortic aneurysm: A case report

    PubMed Central

    Kumar, Satish; Babu, NM Sharath; Jaret, Pramod; Sharma, Ashok

    2016-01-01

    Tubercular aneurysms of larger vessels, particularly the aorta is very rare. The first case of tubercular involvement of the aorta in the form of aortitis was reported in 1882 by Weigert and the first case of tubercular mycotic aneurysm of the aorta was reported in 1895. The preoperative diagnosis of tubercular aortic aneurysm is difficult. Even at surgery, determining the tubercular nature of the lesion is problematic. The gross appearance may not be distinctive, and acid-fast stains are unlikely to be performed. We report the case of a young female patient who was started on antitubercular treatment for pleural effusion and was found to have aortic aneurysm, which later on proved to be tubercular in origin. PMID:27051108

  5. Microsurgical technique of symptomatic intracavernous aneurysm.

    PubMed

    Liao, Chih-Hsiang; Lin, Chun-Fu; Hsu, Sanford P C; Chen, Min-Hsiung; Shih, Yang-Hsin

    2015-07-01

    Symptomatic intracavernous aneurysm is rare. Cranial nerves in the cavernous sinus are subjected to the mass effect of an expanding aneurysm. Microsurgical clipping is the treatment of choice to relieve compressive cranial neuropathy. In this video, the authors present a case of intracavernous aneurysm causing diplopia, ptosis, and facial numbness. The patient was operated on via a pretemporal transclinoid-transcavernous approach. The aneurysm was completely obliterated through direct clipping. There were no new-onset neurologic deficits and complications after the operation. Complete recovery of the diplopia, ptosis, and facial numbness was observed at the 6-month postoperative follow up. The video can be found here: http://youtu.be/4w5QUoNIAQM. PMID:26132609

  6. Successful embolization of a suprascapular artery aneurysm.

    PubMed

    Bucci, Federico; P, Plagnol; B, Salvati; R, Capoano; L, Fiengo; A, Redler

    2014-01-01

    A 45-year-old woman was referred to our service because 9 months earlier she had developed a pulsating mass on the right supraclavicular fossa and torticollis. Ultrasounds and computed tomographic arteriography showed the presence of a subclavian collateral artery aneurysm with a diameter of 21 mm. On selective arteriography, an aneurysm of a suprascapular artery arising directly from the right subclavian artery was reported. The presence of thoracic outlet syndrome was excluded. The aneurysm was successfully treated with ethylene-vinyl alcohol polymer, a liquid embolic agent. The patient was discharged on postoperative day 1 in good general condition. After 12 months, control ultrasounds confirmed the complete thrombosis of the aneurysm sac. PMID:21620668

  7. Endovascular repair of thoracic aortic aneurysms.

    PubMed

    Cartes-Zumelzu, F; Lammer, J; Kretschmer, G; Hoelzenbein, T; Grabenwöger, M; Thurnher, S

    2000-03-01

    The standard technique for the treatment of descending thoracic aortic aneurysms is elective open surgical repair with graft interposition. This standard approach, although steadily improving, is associated with high morbidity and substantial mortality rates and implies a major surgical procedure with lateral thoracotomy, use of cardiopulmonary bypass, long operation times and a variety of peri- and postoperative complications. This and the success of the first endoluminal treatment of abdominal aortic aneurysms by Parodi et al. prompted the attention to be thrown on the treatment of descending thoracic aortic aneurysms with endoluminal stent-grafts in many large centres. The aim of this new minimally invasive technique is to exclude the aneurysm from blood flow and in consequence to avoid pressure stress on the aneurysmatic aortic wall, by avoiding a large open operation with significant perioperative morbidity. The potentially beneficial effect of this new treatment approach was evaluated in the course of this study. PMID:10875224

  8. Abdominal aortic aneurysm--the forgotten diagnosis?

    PubMed Central

    Contini, S.; McMaster, P.

    1980-01-01

    A review of all cases of abdominal aortic aneurysm presenting to Addenbrooke's Hospital, Cambridge, in a 4-year period revealed that there were 118 such patients and confirmed the relatively low operative mortality for elective aneurysmal surgery (6.6%) compared with the high mortality (66.6%) for ruptured or leaking abdominal aneurysm. In only 50% of the cases was the correct diagnosis made during the lifetime of the patient; nor was the correct diagnosis always made after admission to hospital. The need for an early and accurate diagnosis of abdominal aneurysms is stressed and an increased awareness of this condition, based on well established clinical features, would undoubtedly reduce the overall mortality. Images Fig. 1 PMID:7393787

  9. Giant intracranial aneurysms: rapid sequential computed tomography

    SciTech Connect

    Pinto, R.S.; Cohen, W.A.; Kricheff, I.I.; Redington, R.W.; Berninger, W.H.

    1982-11-01

    Giant intracranial aneurysms often present as mass lesions rather than with subarachnoid hemorrhage. Routine computed tomographic (CT) scans with contrast material will generally detect them, but erroneous diagnosis of basal meningioma is possible. Rapid sequential scanning (dynamic CT) after bolus injection of 40 ml of Renografin-76 can conclusively demonstrate an intracranial aneurysm, differentiating it from other lesions by transit-time analysis of the passage of contrast medium. In five patients, the dynamics of contrast bolus transit in aneurysms were consistently different from the dynamics in pituitary tumors, craniopharyngiomas, and meningiomas, thereby allowing a specific diagnosis. Dynamic CT was also useful after treatment of the aneurysms by carotid artery ligation and may be used as an alternative to angiographic evaluation in determining luminal patency or thrombosis.

  10. Image-based investigation of hemodynamics and rupture of cerebral aneurysms of a single morphological type: terminal aneurysms

    NASA Astrophysics Data System (ADS)

    Castro, Marcelo; Putman, Christopher; Radaelli, Alessandro; Frangi, Alejandro; Cebral, Juan

    2008-03-01

    In this study, the relationship between hemodynamics patterns and aneurysmal rupture was investigated in cerebral aneurysms of a single morphological type (terminal aneurysms) regardless of their location. Hemodynamics information (intra-aneurysmal velocity and pressure fields and wall shear stress distributions) was derived from image-based computational fluid dynamics models with realistic patient specific anatomies. A total of 41 patient-specific models constructed from 3D rotational angiography images were analyzed. The results suggest that high wall shear stress may be associated with aneurysm rupture and that in turn different flow splitting patterns from the parent artery to the daughter branches and the aneurysm produce different levels of wall shear stress.

  11. Carotid artery aneurysm: last among equals.

    PubMed

    Dhillon, Ajit Kaur; Rowlands, Timothy; McMahon, Greg

    2016-01-01

    A 66-year-old man presented initially with a swelling in the left side of the neck, which was confirmed to be a carotid artery aneurysm on ultrasonography. He was subsequently admitted reporting intermittent episodes of visual loss in the left eye and right arm weakness. Further imaging confirmed multiple, small acute infarcts in the left cerebral hemisphere. The patient underwent open repair of the aneurysm and made an uncomplicated recovery with no persisting neurological deficit. PMID:27190119

  12. [Centralisation of treatment of ruptured aneurysm].

    PubMed

    Akkersdijk, Willem L; Akkersdijk, George J M; Akkersdijk, George P

    2014-01-01

    In the future, patients with a ruptured aneurysm will be treated at fewer hospitals in the Netherlands. Although there is a search for scientific support for this, the reason for centralisation is obvious: reduction of costs and reduction of workload for vascular surgeons during night and weekend shifts. Already there are a number of examples of regionally organised vascular surgeons who treat their patients with a ruptured aneurysm with great satisfaction and with good results. PMID:25563776

  13. Endovascular treatment of frontopolar artery aneurysm.

    PubMed

    Karanam, Lakshmi S Prasanna; Alurkar, Anand; Chakka, Sivaramakrishna

    2016-08-01

    Traumatic intracranial aneurysms are rare and usually present with subarachnoid hemorrhage, intracranial hemorrhage, subdural hematoma, or intraventricular hemorrhage. These are usually not true aneurysms; hence treatment of these cases poses a therapeutic challenge. In this case report, we describe a young Asian male who presented with a ruptured pseudoaneurysm of the distal branch of the anterior cerebral artery. It was treated successfully with endovascular embolization. To our knowledge, there are few reports of this entity in the literature. PMID:27048313

  14. Multiple Intracranial Aneurysms in HIV Infection.

    PubMed

    Dhawan, Sumeet R; Gupta, Anju; Gupta, Vivek; Singhi, Pratibha D

    2016-08-01

    Neurological findings in HIV are common and include cognitive impairment, microcephaly, nonspecific white matter lesions and seizures. Cerebral vasculopathy and stroke are uncommon and may be due to primary HIV vasculopathy or opportunistic infections such as tuberculosis and cryptococcal meningitis. The authors describe a 7-y-old boy who presented with severe headache and was detected to have aneurysmal bleed due to intracranial aneurysm. PMID:27072660

  15. [Diagnostic challenges of aneurysmal subarachnoid hemorrhage].

    PubMed

    Vehviläinen, Juho; Niemelä, Mika; Korja, Miikka

    2016-01-01

    Diagostic approach to aneurysmal subarachnoid hemorrhage (aSAH) is based on computer tomography (CT) imaging, although a lumbar puncture and subsequent cerebrospinal fluid analysis is sometimes necessary. Identification of the ruptured aneurysm is done using angiography. Despite of modern imaging techniques, diagnostic definition of aSAH is still occasionally challenging. We describe three cases in which the diagnosis of aSAH has been delayed, in spite of positive imaging or lumbar puncture findings. PMID:27089620

  16. Intracranial aneurysms: analysis of results of microneurosurgery.

    PubMed Central

    Adams, C B; Loach, A B; O'laoire, S A

    1976-01-01

    Subarachnoid haemorrhage from intracranial aneurysms has a poor prognosis. Operative management of intracranial aneurysms was once considered ineffective. The first 100 cases treated by micorsurgery were analysed to see whether mortality and morbidity were reduced. Modern surgical techniques halved the total mortality but the morbidity was unaltered. Results can be improved by delaying surgery seven days and by treating any hypertension before surgery. PMID:963461

  17. Mycotic aneurysm of the aortic arch.

    PubMed

    Aliaga, L; Cobo, F; Miranda, C; Lara, J

    2000-01-01

    A 61-year-old diabetic woman presented with a mycotic aneurysm of the aortic arch, also involving the left subclavian and vertebral arteries, caused by Staphylococcus aureus. Two months before, she had suffered from staphylococcal septic arthritis in her left knee. The patient was treated with antibiotics and an emergency operation was performed involving aneurysm excision and in situ synthetic graft replacement. She died on the fourth postoperative day from hemorrhagic shock. PMID:10961533

  18. Non coding RNAs in aortic aneurysmal disease

    PubMed Central

    Duggirala, Aparna; Delogu, Francesca; Angelini, Timothy G.; Smith, Tanya; Caputo, Massimo; Rajakaruna, Cha; Emanueli, Costanza

    2015-01-01

    An aneurysm is a local dilatation of a vessel wall which is >50% its original diameter. Within the spectrum of cardiovascular diseases, aortic aneurysms are among the most challenging to treat. Most patients present acutely after aneurysm rupture or dissection from a previous asymptomatic condition and are managed by open surgical or endovascular repair. In addition, patients may harbor concurrent disease contraindicating surgical intervention. Collectively, these factors have driven the search for alternative methods of identifying, monitoring and treating aortic aneurisms using less invasive approaches. Non-coding RNA (ncRNAs) are emerging as new fundamental regulators of gene expression. The small microRNAs have opened the field of ncRNAs capturing the attention of basic and clinical scientists for their potential to become new therapeutic targets and clinical biomarkers for aortic aneurysm. More recently, long ncRNAs (lncRNAs) have started to be actively investigated, leading to first exciting reports, which further suggest their important and yet largely unexplored contribution to vascular physiology and disease. This review introduces the different ncRNA types and focus at ncRNA roles in aorta aneurysms. We discuss the potential of therapeutic interventions targeting ncRNAs and we describe the research models allowing for mechanistic studies and clinical translation attempts for controlling aneurysm progression. Furthermore, we discuss the potential role of microRNAs and lncRNAs as clinical biomarkers. PMID:25883602

  19. Non coding RNAs in aortic aneurysmal disease.

    PubMed

    Duggirala, Aparna; Delogu, Francesca; Angelini, Timothy G; Smith, Tanya; Caputo, Massimo; Rajakaruna, Cha; Emanueli, Costanza

    2015-01-01

    An aneurysm is a local dilatation of a vessel wall which is >50% its original diameter. Within the spectrum of cardiovascular diseases, aortic aneurysms are among the most challenging to treat. Most patients present acutely after aneurysm rupture or dissection from a previous asymptomatic condition and are managed by open surgical or endovascular repair. In addition, patients may harbor concurrent disease contraindicating surgical intervention. Collectively, these factors have driven the search for alternative methods of identifying, monitoring and treating aortic aneurisms using less invasive approaches. Non-coding RNA (ncRNAs) are emerging as new fundamental regulators of gene expression. The small microRNAs have opened the field of ncRNAs capturing the attention of basic and clinical scientists for their potential to become new therapeutic targets and clinical biomarkers for aortic aneurysm. More recently, long ncRNAs (lncRNAs) have started to be actively investigated, leading to first exciting reports, which further suggest their important and yet largely unexplored contribution to vascular physiology and disease. This review introduces the different ncRNA types and focus at ncRNA roles in aorta aneurysms. We discuss the potential of therapeutic interventions targeting ncRNAs and we describe the research models allowing for mechanistic studies and clinical translation attempts for controlling aneurysm progression. Furthermore, we discuss the potential role of microRNAs and lncRNAs as clinical biomarkers. PMID:25883602

  20. Bronchial Artery Aneurysm Embolization with NBCA

    SciTech Connect

    Aburano, Hiroyuki Kawamori, Yasuhiro; Horiti, Yasushi; Kitagawa, Kiyohide; Sanada, Junichiro; Matsui, Osamu

    2006-12-15

    We present a case of asymptomatic bronchial artery aneurysm that formed a fistula with part of the pulmonary artery (there was no definite fistula with the pulmonary vein). We were able to catheterize the feeding vessel but could not reach the aneurysm. We therefore injected a mixture of N-butyl-2-cyanoacrylate (NBCA; Histoacryl, B. Braun, Melsungen, Germany) and iodized oil (Lipiodol; Guerbet, Aulnay-sous-Bois, France) from the feeding vessel. The fistula, aneurysm, and feeding vessel were almost totally occluded. After embolization, the patient coughed a little; there were no other definite side effects or complications. One and 3 months later, on chest CT, the aneurysm was almost completely occupied with hyperattenuating NBCA-Lipiodol embolization. NBCA is a liquid embolization material whose time to coagulation after injection can be controlled by diluting it with Lipiodol. It is therefore possible to embolize an aneurysm, feeding vessels, and efferent vessels (in our case, it was a fistula) by using an NBCA-Lipiodol mixture of an appropriate concentration, regardless of whether the catheter can reach the aneurysm or not.

  1. False-negative indocyanine green videoangiography among complex unruptured middle cerebral artery aneurysms: the importance of further aneurysm inspection.

    PubMed

    Kulwin, Charles; Cohen-Gadol, Aaron A

    2014-10-01

    Successful surgical treatment of cerebral aneurysms requires complete occlusion of the aneurysm lumen while maintaining patency of the adjacent branching and perforating arteries. Intraoperative flow assessment allows aneurysm clip repositioning in the event these requirements are not met, avoiding the risk of postoperative rehemorrhage or infarction. A number of modalities have been proposed for primarily intraoperative qualitative blood flow assessment, including microdoppler ultrasonography, intraoperative digital subtraction angiography (DSA), and more recently noninvasive fluorescent angiography including indocyanine green (ICG) fluorescent imaging. Puncture of the aneurysm dome to exclude aneurysm sac filling may also assess the efficacy of clip placement. Although a high concordance between ICG and DSA has been reported, there remains an important subset of aneurysms for which negative ICG study may erroneously suggest aneurysm occlusion. A high-risk situation for such a false-negative study is an atherosclerotic middle cerebral artery (MCA) aneurysm in which vessel wall plaque interferes with the ICG signal. Furthermore, a decreased flow within the aneurysm may not allow enough emission light for detection under the current technology. In this report, we describe our experience with cases of MCA aneurysms with false-negative ICG-VA studies requiring clip adjustment for optimal surgical treatment and discuss two illustrative cases of MCA aneurysms with intraoperative fluorescence studies that were falsely negative, requiring puncture of the aneurysm to correctly identify incomplete aneurysm occlusion. PMID:24552255

  2. [True aneurysm of the common hepatic artery: a case report].

    PubMed

    Mighri, Mohamed Mongi; Boujelbene, Salah; Trabelsi, Khaled; Zouaoui, Taieb; Khemakhem, Abdelhamid; Abid, Skander; Gzara, Kaouther; Chebbi, Fethi; Touinsi, Hassen; Azzouz, Mohamed Moussadek; Sassi, Sadok

    2004-02-01

    We report a case of hepatic artery aneurysm suggested by the appearance of epigastric mass. The diagnosis was confirmed by doppler sonography and helical CT. Surgical excision of the aneurysm without vascular reconstruction was carried out. PMID:15185605

  3. LDV measurements in lateral model aneurysms of various sizes

    NASA Astrophysics Data System (ADS)

    Liou, T.-M.; Chang, W.-C.; Liao, C.-C.

    Laser Doppler velocimetry (LDV) measurements are presented of three-dimensional flow fields in lateral model aneurysms arising from a straight parent vessel at a 90° angle. The flow considered was pulsatile and the aneurysm wall was rigid. The mean, peak, and minimal Reynolds numbers based on the bulk average velocity and diameter of the parent vessel were 550, 790, and 375, respectively. Comparisons among present in vitro studies, previous in vitro studies, computational simulations, and in vivo studies were made. It was found that the inflow angle into the lateral aneurysm, the maximum wall shear stress acting on the distal lip of the lateral aneurysm, and the intra-aneurysmal vortical motion increased with decreasing aneurysm size. This fact together with the impingement bifurcation of the inflow at the aneurysm dome provide possible hemodynamic factors for the rupture of the lateral aneurysm at small critical size.

  4. Talk to Your Doctor about Abdominal Aortic Aneurysm

    MedlinePlus

    ... español Talk to Your Doctor about Abdominal Aortic Aneurysm Browse Sections The Basics Overview What is AAA? ... doctor about getting screened (tested) for abdominal aortic aneurysm (AAA). If AAA isn't found and treated ...

  5. Genetics Home Reference: familial thoracic aortic aneurysm and dissection

    MedlinePlus

    ... Home Health Conditions familial TAAD familial thoracic aortic aneurysm and dissection Enable Javascript to view the expand/ ... Open All Close All Description Familial thoracic aortic aneurysm and dissection ( familial TAAD ) involves problems with the ...

  6. The experimental study on aneurysm with PIV system

    NASA Astrophysics Data System (ADS)

    Yueshe, Wang; Xiaoqi, Ma; Di, Li

    2013-07-01

    Cerebral aneurysm, a local enlargement of an artery caused by weakness in the wall of a cerebral artery, has the high death rate and disability rate, and is a threat to public health. The forming mechanism of aneurysm is complex, which motivated many researchers to conduct studies in this field. The results indicated that increasing heart frequency can aggravate the oscillation of wall shear stress, and push The growth points of aneurysm along the aneurysm wall, thereby significantly affecting bthe growth and rupture mechanism of aneurysm. In addition, it is found that the curvature of the vessel is the key to induce the secondary vortex in the aneurysm; the secondary vortex increases the magnitude of WSS near the dome of aneurysm, which can cause the rupture of aneurysm dome. there is a linear relationship between the velocity of blood flow and the square root of hear frequency.

  7. Management of Splenic Artery Aneurysms and False Aneurysms with Endovascular Treatment in 12 Patients

    SciTech Connect

    Guillon, R.; Garcier, J.M.; Abergel, A.; Mofid, R.; Garcia, V.; Chahid, T.; Ravel, A.; Pezet, D.; Boyer, L.

    2003-06-15

    Purpose: To assess the endovascular treatment of splenic artery aneurysms and false aneurysms. Methods: Twelve patients (mean age 59 years, range 47-75 years) with splenic artery aneurysm (n = 10) or false aneurysm (n = 2) were treated. The lesion was asymptomatic in 11 patients; hemobilia was observed in one patient. The lesion was juxta-ostial in one case, located on the intermediate segment of the splenic artery in four, near the splenic hilus in six,and affected the whole length of the artery in one patient. In 10 cases, the maximum lesion diameter was greater than 2 cm; in one case 30% growth of an aneurysm 18 mm in diameter had occurred in 6 months;in the last case, two distal aneurysms were associated (17 and 18 mm in diameter). In one case, stent-grafting was attempted; one detachable balloon occlusion was performed; the 10 other patients were treated with coils. Results: Endovascular treatment was possible in 11 patients (92%) (one failure: stenting attempt). In four cases among 11, the initial treatment was not successful (residual perfusion of aneurysm); surgical treatment was carried out in one case, and a second embolization in two. Thus in nine cases (75%) endovascular treatment was successful: complete and persistent exclusion of the aneurysm but with spleen perfusion persisting at the end of follow-upon CT scans (mean 13 months). An early and transient elevation of pancreatic enzymes was observed in four cases. Conclusion: Ultrasound and CT have made the diagnosis of splenic artery aneurysm or false aneurysm more frequent. Endovascular treatment, the morbidity of which is low, is effective and spares the spleen.

  8. EXPERIMENTAL MODELLING OF AORTIC ANEURYSMS

    PubMed Central

    Doyle, Barry J; Corbett, Timothy J; Cloonan, Aidan J; O’Donnell, Michael R; Walsh, Michael T; Vorp, David A; McGloughlin, Timothy M

    2009-01-01

    A range of silicone rubbers were created based on existing commercially available materials. These silicones were designed to be visually different from one another and have distinct material properties, in particular, ultimate tensile strengths and tear strengths. In total, eleven silicone rubbers were manufactured, with the materials designed to have a range of increasing tensile strengths from approximately 2-4MPa, and increasing tear strengths from approximately 0.45-0.7N/mm. The variations in silicones were detected using a standard colour analysis technique. Calibration curves were then created relating colour intensity to individual material properties. All eleven materials were characterised and a 1st order Ogden strain energy function applied. Material coefficients were determined and examined for effectiveness. Six idealised abdominal aortic aneurysm models were also created using the two base materials of the study, with a further model created using a new mixing technique to create a rubber model with randomly assigned material properties. These models were then examined using videoextensometry and compared to numerical results. Colour analysis revealed a statistically significant linear relationship (p<0.0009) with both tensile strength and tear strength, allowing material strength to be determined using a non-destructive experimental technique. The effectiveness of this technique was assessed by comparing predicted material properties to experimentally measured methods, with good agreement in the results. Videoextensometry and numerical modelling revealed minor percentage differences, with all results achieving significance (p<0.0009). This study has successfully designed and developed a range of silicone rubbers that have unique colour intensities and material strengths. Strengths can be readily determined using a non-destructive analysis technique with proven effectiveness. These silicones may further aid towards an improved understanding of the

  9. Rupture of giant vertebrobasilar aneurysm following flow diversion: mechanical stretch as a potential mechanism for early aneurysm rupture.

    PubMed

    Fox, Benjamin; Humphries, William Edward; Doss, Vinodh T; Hoit, Daniel; Elijovich, Lucas; Arthur, Adam S

    2014-01-01

    A patient with a giant symptomatic vertebrobasilar aneurysm was treated by endoscopic third ventriculostomy for obstructive hydrocephalus followed by treatment of the aneurysm by flow diversion using a Pipeline Embolization Device. After an uneventful procedure and initial periprocedural period, the patient experienced an unexpected fatal subarachnoid hemorrhage 1 week later. Autopsy demonstrated extensive subarachnoid hemorrhage and aneurysm rupture (linear whole wall rupture). The patent Pipeline Embolization Device was in its intended location, as was the persistent coil occlusion of the distal left vertebral artery. The aneurysm appeared to rupture in a linear manner and contained a thick large expansile clot that seemed to disrupt or rupture the thin aneurysm wall directly opposite the basilar artery/Pipeline Embolization Device. We feel the pattern of aneurysm rupture in our patient supports the idea that the combination of flow diversion and the resulting growing intra-aneurysmal thrombus can create a mechanical force with the potential to cause aneurysm rupture. PMID:25355741

  10. Rupture of giant vertebrobasilar aneurysm following flow diversion: mechanical stretch as a potential mechanism for early aneurysm rupture.

    PubMed

    Fox, Benjamin; Humphries, William Edward; Doss, Vinodh T; Hoit, Daniel; Elijovich, Lucas; Arthur, Adam S

    2015-11-01

    A patient with a giant symptomatic vertebrobasilar aneurysm was treated by endoscopic third ventriculostomy for obstructive hydrocephalus followed by treatment of the aneurysm by flow diversion using a Pipeline Embolization Device. After an uneventful procedure and initial periprocedural period, the patient experienced an unexpected fatal subarachnoid hemorrhage 1 week later. Autopsy demonstrated extensive subarachnoid hemorrhage and aneurysm rupture (linear whole wall rupture). The patent Pipeline Embolization Device was in its intended location, as was the persistent coil occlusion of the distal left vertebral artery. The aneurysm appeared to rupture in a linear manner and contained a thick large expansile clot that seemed to disrupt or rupture the thin aneurysm wall directly opposite the basilar artery/Pipeline Embolization Device. We feel the pattern of aneurysm rupture in our patient supports the idea that the combination of flow diversion and the resulting growing intra-aneurysmal thrombus can create a mechanical force with the potential to cause aneurysm rupture. PMID:25361560

  11. Endovascular reconstruction of aneurysms with a complex geometry.

    PubMed

    Gupta, Vipul; Parthasarathy, Rajsrinivas; Jha, Ajaya Nand

    2016-01-01

    Conventional endovascular coiling remains the mainstay of treatment for most aneurysms; however, it may not be suitable for aneurysms with a complex geometry and there remains the risk of recanalization. Aneurysms with an unfavorable morphology are difficult to treat through both endovascular and surgical means. Progress in endovascular technology has allowed for the emergence of newer strategies to treat aneurysms with a complex geometry. Better packing density in wide-necked and large aneurysms can be achieved through the balloon remodeling technique. Similarly, a self-expanding stent cannot only act as a scaffold that helps to retain coils but also aids in diverting the blood flow away from the aneurysm sac. Lately, focus has shifted from endosaccular occlusion to endoluminal reconstruction; flow diverters are being increasingly used to treat aneurysms with an unfavorable geometry. However, there is no clear consensus on the best endovascular management strategy in certain subset of aneurysms - large and giant internal carotid aneurysms, blister aneurysms, and fusiform/dissecting aneurysms of the vertebrobasilar artery. We present a review of literature and discuss the current evidence for the various endovascular strategies to treat complex aneurysms. PMID:26954964

  12. 21 CFR 882.4175 - Aneurysm clip applier.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Aneurysm clip applier. 882.4175 Section 882.4175...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4175 Aneurysm clip applier. (a) Identification. An aneurysm clip applier is a device used by the surgeon for holding and applying...

  13. 21 CFR 882.4175 - Aneurysm clip applier.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Aneurysm clip applier. 882.4175 Section 882.4175...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4175 Aneurysm clip applier. (a) Identification. An aneurysm clip applier is a device used by the surgeon for holding and applying...

  14. 21 CFR 882.4175 - Aneurysm clip applier.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Aneurysm clip applier. 882.4175 Section 882.4175...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4175 Aneurysm clip applier. (a) Identification. An aneurysm clip applier is a device used by the surgeon for holding and applying...

  15. 21 CFR 882.4175 - Aneurysm clip applier.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Aneurysm clip applier. 882.4175 Section 882.4175...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4175 Aneurysm clip applier. (a) Identification. An aneurysm clip applier is a device used by the surgeon for holding and applying...

  16. 21 CFR 882.4175 - Aneurysm clip applier.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Aneurysm clip applier. 882.4175 Section 882.4175...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4175 Aneurysm clip applier. (a) Identification. An aneurysm clip applier is a device used by the surgeon for holding and applying...

  17. Unruptured sinus of Valsalva aneurysm involving all three sinuses.

    PubMed

    Altarabsheh, Salah Eldien I; Araoz, Philip A; Deo, Salil V; Sundt, Thoralf M

    2011-02-01

    In contrast to generalized aneurysmal dilatation of the aortic root, discrete sinus of Valsalva aneurysm is an uncommon condition most often affecting the right coronary sinus. We recently treated a patient without the known connective tissue disorder having discrete aneurysms of all three sinuses. PMID:21256260

  18. Platelet interaction within giant intracranial aneurysms

    SciTech Connect

    Sutherland, G.R.; King, M.E.; Peerless, S.J.; Vezina, W.C.; Brown, G.W.; Chamberlain, M.J.

    1982-01-01

    Turbulence within intracranial aneurysms may result in tearing of the aneurysmal wall, exposing the subendothelial matrix to circulating platelets. In this study, platelet interaction in giant intracranial aneurysms was evaluated by a dual-isotope technique employing In-labeled platelets and Tc-labeled red blood cells. The use of two isotopes allows the subtraction of the blood pool and the calculation of the ratio indium deposited:indium blood pool (In(D)/In(BP)). A ratio greater than zero indicates platelet deposition within aneurysm. Thirteen patients were evaluated in this way, with platelet deposition demonstrated in six. In these six patients, the ratio In(D)/In(BP) was found to be significantly elevated, with a mean value of 0.96 +/- 0.65. Three of these six patients has symptoms of recurrent transient neurological deficits; one of these three suffered a complete stroke following documentation of platelet deposition. In this case, the aneurysm was obtained at surgery and was found to contain intraluminal platelet aggregation when viewed by scanning electron microscopy. In the remaining seven patients, the ratio IN(D)/In(BP) was found not to be significantly elevated (mean -0.03 and/- 0.06), indicating the absence of active platelet deposition. Two of these patients had prior symptoms of cerebral ischemia; one of these was found to have an ulcer in the ipsilateral internal carotid artery which was probably responsible for thromboembolic events to the hemisphere. The authors conclude that platelet aggregation occurs more frequently than previously recognized in giant intracranial aneurysms, and their data substantiate the hypothesis that platelet metabolic products or thrombi originating from a large aneurysm may embolize to distal cerebral vessels.

  19. Aneurysm

    MedlinePlus

    ... of the gastrointestinal tract. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 24th ed. Philadelphia, PA: ... Diseases of the aorta. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 24th ed. Philadelphia, PA: ...

  20. Endovascular occlusion of intracranial aneurysms with electrically detachable coils: Correlation of aneurysm neck size and treatment results

    SciTech Connect

    Zubillaga, A.F.; Guglielmi, G.; Vinuela, F.; Duckwiler, G.R.

    1994-05-01

    To devise a method to measure aneurysm neck size on angiographic films, and to correlate the sizes obtained with the extent of endovascular aneurysm occlusion, performed with electrically detachable coils. The angiograms of 79 intracranial aneurysms treated by endovascular occlusion using electrically detachable coils were retrospectively analyzed. A method using the average reported caliber of the major intracranial vessels was applied to determine the aneurysm neck sizes on the diagnostic angiograms. The cases were divided into two groups according to neck size, 4 mm being the discriminative value for small and wide necks. The posttreatment angiogram of each case was analyzed to evaluate the degree of occlusion achieved by the technique. Necks were successfully measured in 95% of the aneurysms. Complete aneurysm thrombosis was observed in 85% of the small-necked aneurysms and in 15% of the wide-necked aneurysms. Accurate angiographic measurements of neck diameter can be obtained in most aneurysms. The size of an aneurysm neck correlates well with the results of the endovascular treatment. Small-necked aneurysms can be satisfactorily occluded with this technique. In wide-necked aneurysms this technique should be reserved for lesions having a high surgical risk. 10 refs., 1 fig., 1 tab.

  1. Ultrasound Screening for Abdominal Aortic Aneurysm

    PubMed Central

    2006-01-01

    Executive Summary Objective The aim of this review was to assess the effectiveness of ultrasound screening for asymptomatic abdominal aortic aneurysm (AAA). Clinical Need Abdominal aortic aneurysm is a localized abnormal dilatation of the aorta greater than 3 cm. In community surveys, the prevalence of AAA is reported to be between 2% and 5.4%. Abdominal aortic aneurysms are found in 4% to 8% of older men and in 0.5% to 1.5% of women aged 65 years and older. Abdominal aortic aneurysms are largely asymptomatic. If left untreated, the continuing extension and thinning of the vessel wall may eventually result in rupture of the AAA. Often rupture may occur without warning, causing acute pain. Rupture is always life threatening and requires emergency surgical repair of the ruptured aorta. The risk of death from ruptured AAA is 80% to 90%. Over one-half of all deaths attributed to a ruptured aneurysm take place before the patient reaches hospital. In comparison, the rate of death in people undergoing elective surgery is 5% to 7%; however, symptoms of AAA rarely occur before rupture. Given that ultrasound can reliably visualize the aorta in 99% of the population, and its sensitivity and specificity for diagnosing AAA approaches 100%, screening for aneurysms is worth considering as it may reduce the incidence of ruptured aneurysms and hence reduce unnecessary deaths caused by AAA-attributable mortality. Review Strategy The Medical Advisory Secretariat used its standard search strategy to retrieve international health technology assessments and English-language journal articles from selected databases to determine the effectiveness of ultrasound screening for abdominal aortic aneurysms. Case reports, letters, editorials, nonsystematic reviews, non-human studies, and comments were excluded. Questions asked: Is population-based AAA screening effective in improving health outcomes in asymptomatic populations? Is AAA screening acceptable to the population? Does this affect the

  2. The Asymmetric Vascular Stent: Efficacy in a rabbit aneurysm model

    PubMed Central

    Ionita, Ciprian N; Paciorek, Ann M; Dohatcu, Andreea; Hoffmann, Kenneth R; Bednarek, Daniel R; Kolega, John; Levy, Elad I; Hopkins, L. Nelson; Rudin, Stephen; Mocco, J.

    2009-01-01

    Background and Purpose Development of hemodynamic modifying devices to treat intracranial aneurysms (IAs) is an active area of research. The asymmetric vascular stent (AVS), a stent containing a low porosity patch, is such device. We evaluate AVS efficacy in an in vivo IA model. Methods We created twenty-four elastase rabbit model aneurysms: thirteen treated with the AVS, five treated with standard coronary stents, and six untreated controls. Four weeks following treatment, aneurysms underwent follow-up angiography, cone-beam micro-CT, histologic evaluation, and selective electron microscopy scanning. Results Four rabbits died early in the study: three during AVS treatment and one control (secondary to intra-procedural vessel injury and an unrelated tumor, respectively). AVS-treated aneurysms exhibited very weak or no aneurysm flow immediately after treatment and no flow in all aneurysms at follow-up. Stent-treated aneurysms showed flow both after treatment (5/5) and at follow-up (3/5). All control aneurysms remained patent during the study. Micro-CT scans showed: 9/9 of scanned AVS aneurysms were occluded, (6/9) AVSs were ideally placed and (3/9) the low porosity region partially covered the aneurysm neck; stent-treated aneurysms were 1/5 occluded, 2/5 patent, and 2/5 partially-patent. Histology results demonstrated: for AVS-treated aneurysms, advanced thrombus organization in the (9/9); for stent-treated aneurysms (1/4) no thrombus, (2/4) partially-thrombosed and (1/4) fully-thrombosed; for control aneurysms (4/4) no thrombus. Conclusion The use of AVSs shows promise as a viable new therapeutic in intracranial aneurysm treatment. These data encourage further investigation and provide substantial support to the AVS concept. PMID:19131663

  3. Surgical management of aneurysmal subarachnoid hemorrhage.

    PubMed

    Colby, Geoffrey P; Coon, Alexander L; Tamargo, Rafael J

    2010-04-01

    Aneurysmal subarachnoid hemorrhage (aSAH) is a common and often devastating condition that requires prompt neurosurgical evaluation and intervention. Modern management of aSAH involves a multidisciplinary team of subspecialists, including vascular neurosurgeons, neurocritical care specialists and, frequently, neurointerventional radiologists. This team is responsible for stabilizing the patient on presentation, diagnosing the offending ruptured aneurysm, securing the aneurysm, and managing the patient through a typically prolonged and complicated hospital course. Surgical intervention has remained a definitive treatment for ruptured cerebral aneurysms since the early 1900s. Over the subsequent decades, many innovations in microsurgical technique, adjuvant maneuvers, and intraoperative and perioperative medical therapies have advanced the care of patients with aSAH. This report focuses on the modern surgical management of patients with aSAH. Following a brief historical perspective on the origin of aneurysm surgery, the topics discussed include the timing of surgical intervention after aSAH, commonly used surgical approaches and craniotomies, fenestration of the lamina terminalis, intraoperative neurophysiological monitoring, intraoperative digital subtraction and fluorescent angiography, temporary clipping, deep hypothermic cardiopulmonary bypass, management of acute hydrocephalus, cerebral revascularization, and novel clip configurations and microsurgical techniques. Many of the topics highlighted in this report represent some of the more debated techniques in vascular neurosurgery. The popularity of such techniques is constantly evolving as new studies are performed and data about their utility become available. PMID:20380967

  4. Aneurysm strength can decrease under calcification.

    PubMed

    Volokh, Konstantin Y; Aboudi, Jacob

    2016-04-01

    Aneurysms are abnormal dilatations of vessels in the vascular system that are prone to rupture. Prediction of the aneurysm rupture is a challenging and unsolved problem. Various factors can lead to the aneurysm rupture and, in the present study, we examine the effect of calcification on the aneurysm strength by using micromechanical modeling. The calcified tissue is considered as a composite material in which hard calcium particles are embedded in a hyperelastic soft matrix. Three experimentally calibrated constitutive models incorporating a failure description are used for the matrix representation. Two constitutive models describe the aneurysmal arterial wall and the third one - the intraluminal thrombus. The stiffness and strength of the calcified tissue are simulated in uniaxial tension under the varying amount of calcification, i.e. the relative volume of the hard inclusion within the periodic unit cell. In addition, the triaxiality of the stress state, which can be a trigger for the cavitation instability, is tracked. Results of the micromechanical simulation show an increase of the stiffness and a possible decrease of the strength of the calcified tissue as compared to the non-calcified one. The obtained results suggest that calcification (i.e. the presence of hard particles) can significantly affect the stiffness and strength of soft tissue. The development of refined experimental techniques that will allow for the accurate quantitative assessment of calcification is desirable. PMID:26717251

  5. The spectrum of intracranial aneurysms in pediatrics.

    PubMed

    Kanaan, I; Lasjaunias, P; Coates, R

    1995-03-01

    Intracranial aneurysms are rare in children, accounting for merely 0.5-4.6% of all aneurysms. Several characteristics distinguish them from aneurysms in adults: male predominance; higher incidence of unusual location, such as peripheral or posterior circulation; and a greater number of large and giant aneurysms. These unique features can be attributed to the higher incidence of traumatic, infectious, developmental, and congenital lesions. Subarachnoid hemorrhage is not the exclusive mode of presentation; neuro-compressive signs and symptoms are also frequently seen. The treatment of intracranial aneurysms in pediatrics is dictated by their unusual pathology and liability to rehemorrhage. Although direct clipping has been the standard surgical technique, certain obsolete or innovative procedures should also be considered, such as entrapment, proximal occlusion, and endovascular embolisation, or even, in some cases, the non-invasive treatment of "watch and wait" for a spontaneous thrombosis. Six representative cases from King Faisal Specialist Hospital and Research Centre are reviewed. They reflect the diversity of the problem and the multi-disciplinary approach to the treatment. PMID:7627578

  6. Current strategies for the management of aneurysmal subarachnoid hemorrhage.

    PubMed

    Solomon, R A; Fink, M E

    1987-07-01

    Subarachnoid hemorrhage (SAH) from a ruptured intracranial aneurysm represents a major health issue. Although most people who experience an aneurysmal SAH survive to be admitted to a hospital, less than one third of these patients ever return to their premorbid status. Clearly, morbidity of this magnitude demands reevaluation of the clinical approach to this problem. This article reviews the natural history of aneurysmal SAH, and examines the current therapeutic strategies that have been suggested to improve the outcome. Careful evaluation of the existing data suggests that early aneurysm surgery and aggressive postoperative volume expansion therapy constitute the best presently available approach to patients with ruptured intracranial aneurysms. PMID:3297009

  7. Inflammation and human cerebral aneurysms: current and future treatment prospects

    PubMed Central

    Hudson, Joseph S; Hoyne, Danielle S; Hasan, David M

    2013-01-01

    The formation of cerebral aneurysms and their rupture propensity is of immediate clinical importance. Current management includes observation with expectant management, microsurgical clipping and/or endovascular coiling. The surgical options are invasive and are not without increased risk despite the technological advances. Recent human and animal studies have shown that inflammation plays a critical role in aneurysm formation and progression to rupture. Modulating this inflammatory process may prove to be clinically significant. This review will discuss cerebral aneurysm pathogenesis with a focus on current and future research of potential use of pharmaceutical agents that attenuate inflammation in the aneurysm wall leading to decreased risk of aneurysm rupture. PMID:24376373

  8. Comprehensive Overview of Contemporary Management Strategies for Cerebral Aneurysms.

    PubMed

    Manhas, Amitoz; Nimjee, Shahid M; Agrawal, Abhishek; Zhang, Jonathan; Diaz, Orlando; Zomorodi, Ali R; Smith, Tony; Powers, Ciarán J; Sauvageau, Eric; Klucznik, Richard P; Ferrell, Andrew; Golshani, Kiarash; Stieg, Philip E; Britz, Gavin W

    2015-10-01

    Aneurysmal subarachnoid hemorrhage (SAH) remains an important health issue in the United States. Despite recent improvements in the diagnosis and treatment of cerebral aneurysms, the mortality rate following aneurysm rupture. In those patients who survive, up to 50% are left severely disabled. The goal of preventing the hemorrhage or re-hemorrhage can only be achieved by successfully excluding the aneurysm from the circulation. This article is a comprehensive review by contemporary vascular neurosurgeons and interventional neuroradiolgists on the modern management of cerebral aneurysms. PMID:26072457

  9. Radiological features of uncommon aneurysms of the cardiovascular system

    PubMed Central

    Kalisz, Kevin; Rajiah, Prabhakar

    2016-01-01

    Although aortic aneurysms are the most common type encountered clinically, they do not span the entire spectrum of possible aneurysms of the cardiovascular system. As cross sectional imaging techniques with cardiac computed tomography and cardiac magnetic resonance imaging continue to improve and becomes more commonplace, once rare cardiovascular aneurysms are being encountered at higher rates. In this review, a series of uncommon, yet clinically important, cardiovascular aneurysms will be presented with review of epidemiology, clinical presentation and complications, imaging features and relevant differential diagnoses, and aneurysm management. PMID:27247710

  10. Swine Hybrid Aneurysm Model for Endovascular Surgery Training

    PubMed Central

    Namba, K.; Mashio, K.; Kawamura, Y.; Higaki, A.; Nemoto, S.

    2013-01-01

    Summary The aim of this study was to develop a technically simple swine aneurysm-training model by inserting a silicone aneurysm circuit in the cervical vessels. A silicone aneurysm circuit was created by designing multiple aneurysms in size and configuration on a silicone vessel. Five swine underwent surgical implantation of this circuit in the cervical vessels: one end in the common carotid artery and the other in the external jugular vein. Using this model, an aneurysm coiling procedure was simulated under fluoroscopic guidance, roadmapping and digital subtraction angiography. Creating an aneurysm model for training purposes by this method was technically simple and enabled the formation of a wide variety of aneurysms in a single procedure. The quality of the model was uniform and the model was reproducible. Coiling training using this model resembled a realistic clinical situation. The swine hybrid aneurysm-training model was advantageous from the standpoint of technical simplicity in the creation and variety of aneurysms it provided. The swine hybrid aneurysm model may be an additional option for aneurysm coiling training. PMID:23693037

  11. Swine hybrid aneurysm model for endovascular surgery training.

    PubMed

    Namba, K; Mashio, K; Kawamura, Y; Higaki, A; Nemoto, S

    2013-06-01

    The aim of this study was to develop a technically simple swine aneurysm-training model by inserting a silicone aneurysm circuit in the cervical vessels. A silicone aneurysm circuit was created by designing multiple aneurysms in size and configuration on a silicone vessel. Five swine underwent surgical implantation of this circuit in the cervical vessels: one end in the common carotid artery and the other in the external jugular vein. Using this model, an aneurysm coiling procedure was simulated under fluoroscopic guidance, roadmapping and digital subtraction angiography. Creating an aneurysm model for training purposes by this method was technically simple and enabled the formation of a wide variety of aneurysms in a single procedure. The quality of the model was uniform and the model was reproducible. Coiling training using this model resembled a realistic clinical situation. The swine hybrid aneurysm-training model was advantageous from the standpoint of technical simplicity in the creation and variety of aneurysms it provided. The swine hybrid aneurysm model may be an additional option for aneurysm coiling training. PMID:23693037

  12. Endoport-Assisted Microsurgical Treatment of a Ruptured Periventricular Aneurysm.

    PubMed

    Chen, Ching-Jen; Caruso, James; Starke, Robert M; Ding, Dale; Buell, Thomas; Crowley, R Webster; Liu, Kenneth C

    2016-01-01

    Background and Importance. Ruptured periventricular aneurysms in patients with moyamoya disease represent challenging pathologies. The most common methods of treatment include endovascular embolization and microsurgical clipping. However, rare cases arise in which the location and anatomy of the aneurysm make these treatment modalities particularly challenging. Clinical Presentation. We report a case of a 34-year-old female with moyamoya disease who presented with intraventricular hemorrhage. CT angiography and digital subtraction angiography revealed an aneurysm located in the wall of the atrium of the right lateral ventricle. Distal endovascular access was not possible, and embolization risked the sacrifice of arteries supplying critical brain parenchyma. Using the BrainPath endoport system, the aneurysm was able to be accessed. Since the fusiform architecture of the aneurysm prevented clip placement, the aneurysm was ligated with electrocautery. Conclusion. We demonstrate the feasibility of endoport-assisted approach for minimally invasive access and treatment of uncommon, distally located aneurysms. PMID:27195160

  13. Endoport-Assisted Microsurgical Treatment of a Ruptured Periventricular Aneurysm

    PubMed Central

    Chen, Ching-Jen; Caruso, James; Buell, Thomas; Crowley, R. Webster; Liu, Kenneth C.

    2016-01-01

    Background and Importance. Ruptured periventricular aneurysms in patients with moyamoya disease represent challenging pathologies. The most common methods of treatment include endovascular embolization and microsurgical clipping. However, rare cases arise in which the location and anatomy of the aneurysm make these treatment modalities particularly challenging. Clinical Presentation. We report a case of a 34-year-old female with moyamoya disease who presented with intraventricular hemorrhage. CT angiography and digital subtraction angiography revealed an aneurysm located in the wall of the atrium of the right lateral ventricle. Distal endovascular access was not possible, and embolization risked the sacrifice of arteries supplying critical brain parenchyma. Using the BrainPath endoport system, the aneurysm was able to be accessed. Since the fusiform architecture of the aneurysm prevented clip placement, the aneurysm was ligated with electrocautery. Conclusion. We demonstrate the feasibility of endoport-assisted approach for minimally invasive access and treatment of uncommon, distally located aneurysms. PMID:27195160

  14. A Case of Glucocorticoid Remediable Aldosteronism and Thoracoabdominal Aneurysms

    PubMed Central

    Shahrrava, Anahita; Moinuddin, Sunnan; Boddu, Prajwal; Shah, Rohan

    2016-01-01

    Glucocorticoid remediable aldosteronism (GRA) is rare familial form of primary aldosteronism characterized by a normalization of hypertension with the administration of glucocorticoids. We present a case of GRA and thoracoabdominal aneurysm complicated by multiple aortic dissections requiring complex surgical and endovascular repairs. Registry studies have shown a high rate of intracranial aneurysms in GRA patients with high case fatality rates. The association of thoracoabdominal aneurysms with GRA has not been described, thus far, in literature. Studies have shown that high tissue aldosterone levels concomitant with salt intake have a significant role in the pathogenesis of aneurysms and this may explain the formation of aneurysms in the intracranial vasculature and aorta. The association of GRA with thoracic aortic aneurysms needs to be further studied to develop screening recommendations for early identification and optimal treatment. Also, the early use of mineralocorticoid antagonists may have a significant preventive and attenuating effect in aneurysm formation, an association which needs to be confirmed in future studies. PMID:27366333

  15. Renal interventions during endovascular aneurysm repair.

    PubMed

    Davies, Mark G

    2013-12-01

    Renal insufficiency is a risk factor for mortality and morbidity during endovascular aneurysm repair. Multiple changes in practice have occurred to mitigate renal injury and renal dysfunction. Transrenal fixation does carry an increased risk of a decline in renal function in the medium term. Renal stenting for athero-occlusive disease during endovascular aneurysm repair needs careful consideration, as indications have changed and there are unexpected consequences with early vessel occlusion. The growing number of renal interventions during complex endovascular aneurysm repair with the advent of chimney snorkel/periscope techniques and the introduction of fenestrated grafts has shown the resilience of the intervention with relatively low renal issues (approximately 10%), but has also illustrated the need for additional device development. PMID:25220325

  16. Uterine cirsoid aneurysm: MRI and MRA

    SciTech Connect

    Joja, Ikuo; Asakawa, Mari; Motoyama, Kazumi

    1996-03-01

    Uterine cirsoid aneurysm is uncommon. It is important to make a diagnosis of this disease preoperatively, because repeated curettages may induce life-threatening massive genital bleeding. We present a case of a 51-year-old woman with uterine cirsoid aneurysm in whom MRI and MRA were very useful for the preoperative diagnosis. The radiologic appearances on ultrasonography, CT, conventional SE MRI, MRA, dynamic MRI, and pelvic angiography are presented. Conventional SE T1-weighted and T2-weighted images demonstrated multiple flow voids in the uterus and bilateral adnexal regions. MRA demonstrated a cluster of distinct, tortuous, and coiled vascular channels in the pelvis. MRA could obtain images almost equal to angiography and was considered to be an excellent noninvasive imaging technique for the diagnosis of uterine cirsoid aneurysm. 28 refs., 7 figs

  17. [Abdominal aortic aneurysm and renovascular disease].

    PubMed

    Riambau, Vicente; Guerrero, Francisco; Montañá, Xavier; Gilabert, Rosa

    2007-06-01

    Recent technological advances in the diagnosis and therapy of abdominal aortic aneurysm and renovascular disease are continuing to bring about changes in the way patients suffering from these conditions are treated. The prevalence of both these conditions is increasing. This is due to greater life-expectancy in patients with arteriosclerosis, a pathogenetic factor underlying both conditions. The application of diagnostic imaging techniques to non-vascular conditions has led to the early diagnosis of abdominal aortic aneurysm. Clinical suspicion of reno-vascular disease can be confirmed easily using high-resolution diagnostic imaging modalities such as CT angiography and magnetic resonance angiography. Endovascular intervention is successfully replacing conventional surgical repair techniques, with the result that it may be possible to improve outcome in both conditions using effective and minimally invasive approaches. Future technological developments will enable these endovascular techniques to be applied in the large majority of patients with abdominal aortic aneurysm or renovascular disease. PMID:17580053

  18. Endovascular Aneurysm Repair: Current and Future Status

    SciTech Connect

    Hinchliffe, R. J. Ivancev, K.

    2008-05-15

    Endovascular aneurysm repair has rapidly expanded since its introduction in the early 1990s. Early experiences were associated with high rates of complications including conversion to open repair. Perioperative morbidity and mortality results have improved but these concerns have been replaced by questions about long-term durability. Gradually, too, these problems have been addressed. Challenges of today include the ability to roll out the endovascular technique to patients with adverse aneurysm morphology. Fenestrated and branch stent-graft technology is in its infancy. Only now are we beginning to fully understand the advantages, limitations, and complications of such technology. This paper outlines some of the concepts and discusses the controversies and challenges facing clinicians involved in endovascular aneurysm surgery today and in the future.

  19. Type B Aortic Dissection with Abdominal Aortic Aneurysm Rupture 1 Year after Endovascular Repair of Abdominal Aortic Aneurysm.

    PubMed

    Daniel, Guillaume; Ben Ahmed, Sabrina; Warein, Edouard; Gallon, Arnaud; Rosset, Eugenio

    2016-05-01

    We report a patient who developed a type B aortic dissection and ruptured his aneurysmal sac 1 year after endovascular abdominal aortic aneurysm repair (EVAR), despite standard follow-up. This 79-year-old man was presented to emergency room with acute abdominal pain and an acute lower limb ischemia. Computed tomography scan showed an acute type B aortic dissection feeding the aneurysmal sac of the EVAR. The aneurysm rupture occurred during imaging. Type B aortic dissection is a rare cause of aneurysmal rupture after EVAR. The first postoperative computed tomography scan should maybe include the arch and the descending thoracic aorta to rule out an iatrogenic dissection after EVAR. PMID:26902937

  20. Resolution of third nerve palsy despite persistent aneurysmal mass effect after flow diversion embolization of posterior communicating artery aneurysms.

    PubMed

    Binyamin, Tamar R; Dahlin, Brian C; Waldau, Ben

    2016-09-01

    Posterior communicating artery (PCOM) aneurysms may cause third nerve palsies. The optimal treatment with clipping versus coiling remains controversial. Here we report on two cases of resolution of third nerve palsy after flow diversion embolization of large and giant PCOM aneurysms without adjuvant coil placement. The resolution of third nerve palsy was not preceded by significant shrinkage of the aneurysmal sac on MRI. However, one patient showed resolution of T2-weighted signal abnormalities in the midbrain and mesial temporal lobe despite a similar size of the aneurysm. Therefore, flow diversion embolization of a PCOM aneurysm may resolve oculomotor nerve palsies through decreasing arterial pulsations against the nerve or midbrain. PMID:27183957

  1. Extra-anatomic endovascular repair of an abdominal aortic aneurysm with a horseshoe kidney supplied by the aneurysmal aorta.

    PubMed

    Rey, Jorge; Golpanian, Samuel; Yang, Jane K; Moreno, Enrique; Velazquez, Omaida C; Goldstein, Lee J; Chahwala, Veer

    2015-07-01

    Abdominal aortic aneurysm complicated by a horseshoe kidney (HSK, fused kidney) represents a unique challenge for repair. Renal arteries arising from the aneurysmal aorta can further complicate intervention. Reports exist describing the repair of these complex anatomies using fenestrated endografts, hybrid open repairs (debranching), and open aneurysmorrhaphy with preservation of renal circulation. We describe an extra-anatomic, fully endovascular repair of an abdominal aortic aneurysm with a HSK partially supplied by a renal artery arising from the aneurysm. We successfully applied aortouni-iliac endografting, femorofemoral bypass, and retrograde renal artery perfusion via the contralateral femoral artery to exclude the abdominal aortic aneurysm and preserve circulation to the HSK. PMID:25770382

  2. Imaging of abdominal aortic aneurysms.

    PubMed

    Sparks, Amy R; Johnson, Philip L; Meyer, Mark C

    2002-04-15

    Given the high rate of morbidity and mortality associated with abdominal aortic aneurysms (AAAs), accurate diagnosis and preoperative evaluation are essential for improved patient outcomes. Ultrasonography is the standard method of screening and monitoring AAAs that have not ruptured. In the past, aortography was commonly used for preoperative planning in the repair of AAAs. More recently, computed tomography (CT) has largely replaced older, more invasive methods. Recent advances in CT imaging technology, such as helical CT and CT angiography, offer significant advantages over traditional CT. These methods allow for more rapid scans and can produce three-dimensional images of the AAA and important adjacent vascular structures. Use of endovascular stent grafts has increased recently and is less invasive for the repair of AAAs in selected cases. Aortography and CT angiography can precisely determine the size and surrounding anatomy of the AAA to identify appropriate candidates for the use of endovascular stent grafts. Helical CT and CT angiography represent an exciting future in the preoperative evaluation of AAAs. However, this technology is not the standard of care because of the lack of widespread availability, the cost associated with obtaining new equipment, and the lack of universal protocols necessary for acquisition and reconstruction of these images. PMID:11989632

  3. Factors Influencing the Management of Unruptured Intracranial Aneurysms

    PubMed Central

    Podraza, Katherine M; Luthra, Nijee; Origitano, Thomas C; Schneck, Michael J

    2016-01-01

    Background Deciding how to manage an unruptured intracranial aneurysm can be difficult for patients and physicians due to controversies about management. The decision as to when and how to intervene may be variable depending on physicians’ interpretation of available data regarding natural history and morbidity and mortality of interventions. Another significant factor in the decision process is the patients’ conception of the risks of rupture and interventions and the psychological burden of harboring an unruptured intracranial aneurysm. Objective  To describe which factors are being considered when patients and their physicians decide how to manage unruptured intracranial aneurysms.  Materials & methods  In a retrospective chart review study, we identified patients seen for evaluation of an unruptured intracranial aneurysm. Data was collected regarding patient and aneurysm characteristics. The physician note pertaining to the management decision was reviewed for documented reasons for intervention. Results  Of 88 patients included, 36 (41%) decided to undergo open or endovascular surgery for at least one unruptured intracranial aneurysm. Multiple aneurysms were present in 14 (16%) patients. Younger patients and current smokers were more likely to undergo surgery, but gender and race did not affect management. Aneurysm size and location strongly influenced management. The most common documented reasons underlying the decision of whether to intervene were the risk of rupture, aneurysm size, and risks of the procedure. For 23 aneurysms (21%), there were no factors documented for the management decision.  Conclusion  The risk of rupture of unruptured intracranial aneurysms may be underestimated by currently available natural history data. Major factors weighed by physicians in management decisions include aneurysm size and location, the patient's age, and medical comorbidities along with the risk of procedural complications. Additional data is needed to

  4. Factors Influencing the Management of Unruptured Intracranial Aneurysms.

    PubMed

    Gillani, Rebecca L; Podraza, Katherine M; Luthra, Nijee; Origitano, Thomas C; Schneck, Michael J

    2016-01-01

    Background Deciding how to manage an unruptured intracranial aneurysm can be difficult for patients and physicians due to controversies about management. The decision as to when and how to intervene may be variable depending on physicians' interpretation of available data regarding natural history and morbidity and mortality of interventions. Another significant factor in the decision process is the patients' conception of the risks of rupture and interventions and the psychological burden of harboring an unruptured intracranial aneurysm. Objective  To describe which factors are being considered when patients and their physicians decide how to manage unruptured intracranial aneurysms.  Materials & methods  In a retrospective chart review study, we identified patients seen for evaluation of an unruptured intracranial aneurysm. Data was collected regarding patient and aneurysm characteristics. The physician note pertaining to the management decision was reviewed for documented reasons for intervention. Results  Of 88 patients included, 36 (41%) decided to undergo open or endovascular surgery for at least one unruptured intracranial aneurysm. Multiple aneurysms were present in 14 (16%) patients. Younger patients and current smokers were more likely to undergo surgery, but gender and race did not affect management. Aneurysm size and location strongly influenced management. The most common documented reasons underlying the decision of whether to intervene were the risk of rupture, aneurysm size, and risks of the procedure. For 23 aneurysms (21%), there were no factors documented for the management decision.  Conclusion  The risk of rupture of unruptured intracranial aneurysms may be underestimated by currently available natural history data. Major factors weighed by physicians in management decisions include aneurysm size and location, the patient's age, and medical comorbidities along with the risk of procedural complications. Additional data is needed to define

  5. Bacterial DNA findings in ruptured and unruptured intracranial aneurysms.

    PubMed

    Pyysalo, Mikko J; Pyysalo, Liisa M; Pessi, Tanja; Karhunen, Pekka J; Lehtimäki, Terho; Oksala, Niku; Öhman, Juha E

    2016-05-01

    Objective Chronic inflammation has earlier been detected in ruptured intracranial aneurysms. A previous study detected both dental bacterial DNA and bacterial-driven inflammation in ruptured intracranial aneurysm walls. The aim of this study was to compare the presence of oral and pharyngeal bacterial DNA in ruptured and unruptured intracranial aneurysms. The hypothesis was that oral bacterial DNA findings would be more common and the amount of bacterial DNA would be higher in ruptured aneurysm walls than in unruptured aneurysm walls. Materials and methods A total of 70 ruptured (n = 42) and unruptured (n = 28) intracranial aneurysm specimens were obtained perioperatively in aneurysm clipping operations. Aneurysmal sac tissue was analysed using a real-time quantitative polymerase chain reaction to detect bacterial DNA from several oral species. Both histologically non-atherosclerotic healthy vessel wall obtained from cardiac by-pass operations (LITA) and arterial blood samples obtained from each aneurysm patient were used as control samples. Results Bacterial DNA was detected in 49/70 (70%) of the specimens. A total of 29/42 (69%) of the ruptured and 20/28 (71%) of the unruptured aneurysm samples contained bacterial DNA of oral origin. Both ruptured and unruptured aneurysm tissue samples contained significantly more bacterial DNA than the LITA control samples (p-values 0.003 and 0.001, respectively). There was no significant difference in the amount of bacterial DNA between the ruptured and unruptured samples. Conclusion Dental bacterial DNA can be found using a quantitative polymerase chain reaction in both ruptured and unruptured aneurysm walls, suggesting that bacterial DNA plays a role in the pathogenesis of cerebral aneurysms in general, rather than only in ruptured aneurysms. PMID:26777430

  6. Lipid accumulation, lipid oxidation, and low plasma levels of acquired antibodies against oxidized lipids associate with degeneration and rupture of the intracranial aneurysm wall

    PubMed Central

    2013-01-01

    Background Rupture of a saccular intracranial aneurysm (sIA) causes an often fatal subarachnoid hemorrhage (SAH). Why some sIAs rupture remains unknown. Since sIA walls bear some histological similarities with early atherosclerotic lesions, we hypothesized that accumulation and oxidation of lipids might occur in the sIA wall and might associate with sIA wall degeneration. Tissue samples from sIA fundi (n = 54) were studied with histochemistry and a panel of previously characterized antibodies for epitopes of oxidized LDL (OxLDL). Plasma samples from sIA carriers (n = 125) were studied with ELISA and EIA for IgG and IgM -antibodies against a panel of OxLDL epitopes. Results Lipid accumulation, foam cells, and oxidized lipids were found both in unruptured and ruptured sIA walls. Lipid accumulation associated with wall degeneration (P < 0.001), as did the expression of adipophilin, a marker of lipid ingestion by cells. Lipid accumulation associated also with loss of mural cells (P < 0.001), as did the accumulation of OxLDL (P < 0.001). Plasma IgG antibody titers against OxLDL or malondialdehyde modified LDL were higher in patients with unruptured sIAs than in patients with aneurysmal SAH (P ≤ 0.001). A trend but not statistically significant differences were found in plasma IgM antibodies against oxidized lipids. Conclusions Accumulation of lipids and their oxidation in the sIA wall associates with the degeneration of the sIA wall. Acquired immunity against oxidized lipid epitopes may be protective of lipid associated sIA wall degeneration, but warrants further studies. PMID:24252658

  7. Experimental Models of Abdominal Aortic Aneurysms

    PubMed Central

    Tsui, Janice C

    2010-01-01

    Despite being a leading cause of death in the West, the pathophysiology of abdominal aortic aneurysms (AAA) is still incompletely understood. Pharmacotherapy to reduce the growth of small AAAs is limited and techniques for repairing aneurysms continue to evolve. Experimental models play a key role in AAA research, as they allow a detailed evaluation of the pathogenesis of disease progression. This review focuses on in vivo experimental models, which have improved our understanding of the potential mechanisms of AAA development and contributed to the advancement of new treatments. PMID:21270944

  8. Chronic rupture of abdominal aortic aneurysm.

    PubMed

    Kotsis, Thomas; Thomas, Kotsis; Tympa, Aliki; Aliki, Tympa; Kalinis, Aris; Aris, Kalinis; Vasilopoulos, Ioannis; Ioannis, Vasilopoulos; Theodoraki, Kassiani; Kassiani, Theodoraki

    2011-10-01

    Although the mortality rate after abdominal aortic aneurysm rupture approximates 90% despite the urgent management, a few cases of chronic rupture and delayed repair have been reported in the world literature; anatomic and hemodynamic reasons occasionally allow for the fortunate course of these patients. We report in this article the case of 76-year-old man with a ruptured abdominal aortic aneurysm who was transferred to our facility 4 weeks after his initial hospitalization in a district institution and who finally had a successful open repair. PMID:21620664

  9. Saphenous vein graft aneurysm: an incidental finding

    PubMed Central

    Rana, Omar; Greaves, Kim; Shepherd, David; Parvin, Simon; Swallow, Rosie

    2009-01-01

    Saphenous vein graft aneurysm (SVGA) is an uncommon complication of coronary artery bypass graft surgery (CABG). An 82-year-old man underwent contrast-enhanced computed tomography to investigate aorto-iliac disease. He was coincidentally noted to have an aneurysm of the saphenous vein graft to his right coronary artery. This was visualised on transthoracic echocardiography, computed tomography and coronary angiography. In the absence of symptoms and in view of high surgical risk, conservative management with anticoagulation was chosen. The patient was commenced on warfarin and remains asymptomatic. PMID:21686801

  10. Prenatal diagnosis of ductus arteriosus aneurysm.

    PubMed

    Ganesan, S; Hutchinson, D P; Sampson, A J

    2015-11-01

    The ductus arteriosus holds major functional importance within the fetal circulation, and anomalies within the ductus arteriosus may interfere with the integrity of the fetal circulation. Ductus arteriosus aneurysm, previously considered a rare lesion, is now a well-reported finding in infancy with some reports describing this finding in the prenatal period. Postnatally, most ductus arteriosus aneurysms resolve spontaneously; however, a small group of infants show complications such as connective-tissue disorders, thrombo-embolism, compression of surrounding thoracic structures and life-threatening spontaneous rupture requiring surgical correction. As such, postnatal assessment in this group is recommended. PMID:27433265

  11. Saphenous vein graft aneurysm: A case report

    PubMed Central

    Gurbuz, Ahmet Seyfeddin; Ozturk, Semi; Acar, Emrah; Efe, Suleyman Cagan; Kilicgedik, Alev; Kirma, Cevat

    2016-01-01

    BACKGROUND Saphenous vein graft aneurysms (SVGAs) are rare seen issues after coronary artery bypass graft (CABG) operation which may lead to major complications including compression of adjacent structure, myocardial ischemia, rupture, and even death. CASE REPORT We report a patient with recurrent SVGA and its treatment by percutaneous intervention with a covered stent, the diagnostic and treatment procedure were based on contrast enhanced computed tomography and myocardial perfusion scintigraphy (MPS). CONCLUSION Multimodality imaging is required to demonstrate the true size and complications of the SVGA, the relationship among the adjacent structure, and to assess ischemia and size of myocardial territory supplied by the aneurysmal graft to decide treatment strategy.

  12. Bilateral carotid aneurysms unmasked by severe hypopituitarism.

    PubMed Central

    Michils, A.; Balériaux, D.; Mockel, J.

    1991-01-01

    We describe a patient who initially presented with severe hyponatraemia and grand mal seizures, without any focal neurological symptoms. The final diagnosis was that of giant bilateral carotid aneurysms extending into the sella turcica with anterior hypopituitarism. To the best of our knowledge, this is the first case report of symmetrical carotid aneurysms manifested exclusively by an acute endocrine emergency with none of the concomitant usual focal signs such as headache, failing vision, oculomotor palsy or subarachnoid hemorrhage. Images p286-a Figure 1 PMID:2062778

  13. Aneurysm flow characteristics in realistic carotid artery aneurysm models induced by proximal virtual stenotic plaques: a computational hemodynamics study

    NASA Astrophysics Data System (ADS)

    Castro, Marcelo A.; Peloc, Nora L.; Chien, Aichi; Goldberg, Ezequiel; Putman, Christopher M.; Cebral, Juan R.

    2015-03-01

    Cerebral aneurysms may rarely coexist with a proximal artery stenosis. In that small percent of patients, such coexistence poses a challenge for interventional neuroradiologists and neurosurgeons to make the best treatment decision. According to previous studies, the incidence of cerebral aneurysms in patients with internal carotid artery stenosis is no greater than five percent, where the aneurysm is usually incidentally detected, being about two percent for aneurysms and stenoses in the same cerebral circulation. Those cases pose a difficult management decision for the physician. Case reports showed patients who died due to aneurysm rupture months after endarterectomy but before aneurysm clipping, while others did not show any change in the aneurysm after plaque removal, having optimum outcome after aneurysm coiling. The aim of this study is to investigate the intra-aneurysmal hemodynamic changes before and after treatment of stenotic plaque. Virtually created moderate stenoses in vascular models of internal carotid artery aneurysm patients were considered in a number of cases reconstructed from three dimensional rotational angiography images. The strategy to create those plaques was based on parameters analyzed in a previous work where idealized models were considered, including relative distance and stenosis grade. Ipsilateral and contralateral plaques were modeled. Wall shear stress and velocity pattern were computed from finite element pulsatile blood flow simulations. The results may suggest that wall shear stress changes depend on relative angular position between the aneurysm and the plaque.

  14. Successful Endovascular Treatment of a Left Common Carotid Artery Aneurysm Following Failed Surgery of a Right Common Carotid Artery Aneurysm

    SciTech Connect

    Cil, Barbaros E. Ucar, Ibrahim; Ozsoy, Fatma; Arat, Anil; Yorgancioglu, Cem; Boeke, Erkmen

    2005-04-15

    Aneurysm of the common carotid artery is a rare and serious disease requiring prompt treatment in order to avoid neurologic complications. A 39-year-old man presented with voice impairment and a pulsatile mass at the right side of his neck and was found by color Doppler examination to have bilateral common carotid artery aneurysms of unknown origin. The right-sided large aneurysm was treated with placement of an 8 mm interposition Gore-Tex graft between the right common and internal carotid arteries. The surgical graft thrombosed 7 days after the surgery but the left-sided aneurysm was successfully treated by a Jostent peripheral stent-graft. Color Doppler examination showed a patent stent and no filling of the aneurysm on his first and sixth-month follow-up. Bilateral common carotid artery aneurysm is an exceptionally unusual condition and endovascular treatment of carotid artery aneurysms with covered stents may become an effective treatment alternative for these lesions.

  15. Sex differences in aneurysm morphologies and clinical outcomes in ruptured anterior communicating artery aneurysms: a retrospective study

    PubMed Central

    Lin, Boli; Chen, Weijian; Ruan, Lei; Chen, Yongchun; Zhong, Ming; Zhuge, Qichuan; Fan, Liang Hao; Zhao, Bing; Yang, Yunjun

    2016-01-01

    Objectives Ruptured anterior communicating artery (ACoA) aneurysms occur more frequently in men. The purpose of the study was to investigate sex difference in aneurysm morphologies and clinical outcomes in patients with ruptured ACoA aneurysms. Setting A tertiary referral hospital. Participants A total of 574 consecutive patients with ACoA aneurysms were admitted to our hospital from December 2007 to February 2015. In all, 474 patients (257 men and 217 women) with ruptured ACoA aneurysms were included in the study. Main outcome measures Aneurysm morphologies were measured using computed tomographic angiography and clinical outcomes were measured with Glasgow coma score at discharge. Results The aneurysm sizes (p=0.001), aneurysm heights (p=0.011), size ratios (p<0.001), flow angles (p=0.047) and vessel angles (p=0.046) were larger in the male patients than in the females. The female patients more often had larger vessel sizes (p=0.002). Multivariate logistic analysis revealed that significant differences in aneurysm morphologies between men and women were aneurysm size (OR 1.1, 95% CI 1.0 to 1.3; p=0.036), aneurysm height (OR 0.8, 95% CI 0. to 0.9; p=0.006) and size ratio (OR 1.4, 95% CI 0.5 to 1.7; p=0.001). There were no statistically significant differences in the outcomes between men and women (OR 1.0, 95% CI 0.6 to 1.7, p=0.857). Conclusions The men were independently associated with larger aneurysm sizes, greater aneurysm heights and larger size ratios. Sex was not a risk factor for poor outcome in patients with ruptured ACoA aneurysms. PMID:27084272

  16. New method for retrospective study of hemodynamic changes before and after aneurysm formation in patients with ruptured or unruptured aneurysms

    PubMed Central

    2013-01-01

    Background Prospective observation of hemodynamic changes before and after formation of brain aneurysms is often difficult. We used a vessel surface repair method to carry out a retrospective hemodynamic study before and after aneurysm formation in a ruptured aneurysm of the posterior communicating artery (RPcomAA) and an unruptured aneurysm of the posterior communicating artery (URPcomAA). Methods Arterial geometries obtained from three-dimensional digital subtraction angiography of cerebral angiograms were used for flow simulation by employing finite-volume modeling. Hemodynamic parameters such as wall shear stress (WSS), blood-flow velocity, streamlines, pressure, and wall shear stress gradient (WSSG) in the aneurysm sac and at the site of aneurysm formation were analyzed in each model. Results At “aneurysm” status, hemodynamic analyses at the neck, body, and dome of the aneurysm revealed the distal aneurysm neck to be subjected to the highest WSS and blood-flow velocity, whereas the aneurysm dome presented the lowest WSS and blood-flow velocity in both model types. More apparent changes in WSSG at the aneurysm dome with an inflow jet and narrowed impaction zone were revealed only in the RPcomAA. At “pre-aneurysm” status, hemodynamic analyses in both models showed that the region of aneurysm formation was subjected to extremely elevated WSS, WSSG, and blood-flow velocity. Conclusions These data suggest that hemodynamic analyses in patients with ruptured or unruptured aneurysms using the vessel surface repair method are feasible, economical, and simple. Our preliminary results indicated that the arterial wall was subjected to elevated WSS, WSSG and blood-flow velocity before aneurysm generation. However, more complicated flow patterns (often with an inflow jet or narrowed impaction zone) were more likely to be observed in ruptured aneurysm. PMID:24195732

  17. Computational analysis of anterior communicating artery aneurysm shear stress before and after aneurysm formation

    NASA Astrophysics Data System (ADS)

    Castro, Marcelo A.; Putman, Christopher M.; Cebral, Juan R.

    2011-12-01

    It is widely accepted that complexity in the flow pattern at the anterior communicating artery (AComA) is associated with the high rate of aneurysm formation at that location observed in large studies. The purpose of this work is to study associations between hemodynamic patterns, and AComA aneurysm initiation by comparing hemodynamics in the aneurysm and the normal model where the aneurysm was computationally removed. Vascular models of both right and left circulation were independently reconstructed from three-dimensional rotational angiography images using deformable models after image registration of both images, and fused using a surface merging algorithm. The geometric models were then used to generate high-quality volumetric finite element grids of tetrahedra with an advancing front technique. For each patient, the second anatomical model was created by digitally removing the aneurysm. It was iteratively achieved by applying a Laplacian smoothing filter and remeshing the surface. Finite element blood flow numerical simulations were performed for both the pathological and normal models under the same personalized pulsatile flow conditions imposed at the inlets of both models. The Navier-Stokes equations were numerically integrated by using a finite-element formulation. It was observed that aneurysms initiated in regions of high and moderate WSS in the counterpart normal models. Adjacent or close to those regions, low WSS portions of the arterial wall were not affected by the disease. These results are in line with previous observations at other vascular locations.

  18. Multiple soft tissue aneurysmal cysts: An occurrence after resection of primary aneurysmal bone cyst of fibula

    PubMed Central

    Karkuzhali, P; Bhattacharyya, Mahuya; Sumitha, P

    2007-01-01

    We report a case of multiple extraosseous aneurysmal cysts occurring in the muscle and subcutaneous plane of postero-lateral aspects of the upper right leg. They appeared about 15 months after resection of aneurysmal bone cyst of the upper end of the fibula. They varied in size from 2 cm to 5 cm. Radiologically they were well-defined lesions with central septate areas surrounded by a rim of calcification. Histologically they showed central cystic spaces separated by septa consisting of fibroblasts, osteoclast type of giant cells and reactive woven bone. Thus they showed histological similarity with aneurysmal bone cysts, but did not show any connection with the bone. Only very few examples of aneurysmal cysts of soft tissue had been described in the past one decade and they were reported in various locations including rare sites such as arterial wall and larynx. Recent cytogenetic analyses have shown abnormalities involving 17p11-13 and/or 16q22 in both osseous and extraosseous aneurysmal cysts indicating its probable neoplastic nature. Our case had unique features like multiplicity and occurrence after resection of primary aneurysmal bone cyst of the underlying bone. PMID:21139755

  19. Partial segregation of posterior crista and saccular fibers to the nodulus and uvula of the cerebellum in mice, and its development

    NASA Technical Reports Server (NTRS)

    Maklad, Adel; Fritzsch, Bernd

    2003-01-01

    The projection of the posterior canal crista and saccular afferents to the cerebellum of embryonic and neonatal mice was investigated using carbocyanine dyes. Anterograde tracing from these two endorgans reveals a partial segregation of these two sets of afferents. The saccule projects predominantly to the uvula, with very minor input to the nodulus. The posterior canal projects mainly to the nodulus and, to a lesser extent, to the uvula. Retrograde tracing from the uvula and nodulus confirms this partial segregation for these two endorgans and extends it to other vestibular endorgans. Uvular injections result in many more labeled fibers in the gravistatic maculae than in the canals' cristae. In contrast, nodular injection reveals many more labeled fibers in the canal cristae than in the gravistatic maculae. This partial segregation may play a role in the information processing in these folia. Our developmental data suggest that the initial segregation at E17 coincides with the formation of the postero-lateral fissure. This embryonic segregation of the primary vestibular mossy fibers to the uvula and nodulus commences long before the maturity of their targets, the granule cells and unipolar brush cells. Thus, the segregation of the primary vestibular projection to the uvula and nodulus does not depend on cues related to the target cells. Rather, the segregation may reflect more global cerebellar patterning mechanisms involving guidance for the vestibular afferent fibers independent of the future target cells.

  20. Molecular basis and genetic predisposition to intracranial aneurysm

    PubMed Central

    Weinsheimer, Shantel; Ronkainen, Antti; Kuivaniemi, Helena

    2014-01-01

    Intracranial aneurysms, also called cerebral aneurysms, are dilatations in the arteries that supply blood to the brain. Rupture of an intracranial aneurysm leads to a subarachnoid hemorrhage, which is fatal in about 50% of the cases. Intracranial aneurysms can be repaired surgically or endovascularly, or by combining these two treatment modalities. They are relatively common with an estimated prevalence of unruptured aneurysms of 2%–6% in the adult population, and are considered a complex disease with both genetic and environmental risk factors. Known risk factors include smoking, hypertension, increasing age, and positive family history for intracranial aneurysms. Identifying the molecular mechanisms underlying the pathogenesis of intracranial aneurysms is complex. Genome-wide approaches such as DNA linkage and genetic association studies, as well as microarray-based mRNA expression studies, provide unbiased approaches to identify genetic risk factors and dissecting the molecular pathobiology of intracranial aneurysms. The ultimate goal of these studies is to use the information in clinical practice to predict an individual's risk for developing an aneurysm or monitor its growth or rupture risk. Another important goal is to design new therapies based on the information on mechanisms of disease processes to prevent the development or halt the progression of intracranial aneurysms. PMID:25117779

  1. Combined Endovascular and Microsurgical Management of Complex Cerebral Aneurysms

    PubMed Central

    Choudhri, Omar; Mukerji, Nitin; Steinberg, Gary K.

    2013-01-01

    Cerebral aneurysms are associated with a 50% mortality rate after rupture and patients can suffer significant morbidity during subsequent treatment. Neurosurgical management of both ruptured and unruptured aneurysms has evolved over the years. The historical practice of using microsurgical clipping to treat aneurysms has benefited in the last two decades from tremendous improvement in endovascular technology. Microsurgery and endovascular therapies are often viewed as competing treatments but it is important to recognize their individual limitations. Some aneurysms are considered complex, due to several factors such as aneurysm anatomy and a patient’s clinical condition. A complex aneurysm often cannot be completely excluded with a single approach and its successful treatment requires a combination of microsurgical and endovascular techniques. Planning such an approach relies on understanding aneurysm anatomy and thus should routinely include 3D angiographic imaging. In patients with ruptured aneurysms, endovascular coiling is a well-tolerated early treatment and residual aneurysms can be treated with intervals of definitive clipping. Microsurgical clipping also can be used to reconstruct the neck of a complex aneurysm, allowing successful placement of coils across a narrow neck. Endovascular techniques are assisted by balloons, which can be used in coiling and testing parent vessel occlusion before sacrifice. In some cases microsurgical bypasses can provide alternate flow for planned vessel sacrifice. We present current paradigms for combining endovascular and microsurgical approaches to treat complex aneurysms and share our experience in 67 such cases. A dual microsurgical–endovascular approach addresses the challenge of intracranial aneurysms. This combination can be performed safely and produces excellent rates of aneurysm obliteration. Hybrid angiographic operating-room suites can foster seamless and efficient complementary application of these two

  2. Genes and Abdominal Aortic Aneurysm

    PubMed Central

    Hinterseher, Irene; Tromp, Gerard; Kuivaniemi, Helena

    2010-01-01

    Abdominal aortic aneurysm (AAA) is a multifactorial disease with a strong genetic component. Since first candidate gene studies were published 20 years ago, nearly 100 genetic association studies using single nucleotide polymorphisms (SNPs) in biologically relevant genes have been reported on AAA. The studies investigated SNPs in genes of the extracellular matrix, the cardiovascular system, the immune system, and signaling pathways. Very few studies were large enough to draw firm conclusions and very few results could be replicated in another sample set. The more recent unbiased approaches are family-based DNA linkage studies and genome-wide genetic association studies, which have the potential of identifying the genetic basis for AAA, if appropriately powered and well-characterized large AAA cohorts are used. SNPs associated with AAA have already been identified in these large multicenter studies. One significant association was of a variant in a gene called CNTN3 which is located on chromosome 3p12.3. Two follow-up studies, however, could not replicate the association. Two other SNPs, which are located on chromosome 9p21 and 9q33 were replicated in other samples. The two genes with the strongest supporting evidence of contribution to the genetic risk for AAA are the CDKN2BAS gene, also known as ANRIL, which encodes an antisense RNA that regulates expression of the cyclin-dependent kinase inhibitors CDKN2A and CDKN2B, and DAB2IP, which encodes an inhibitor of cell growth and survival. Functional studies are now needed to establish the mechanisms by which these genes contribute to AAA pathogenesis. PMID:21146954

  3. The Endovascular Management of Iliac Artery Aneurysms

    SciTech Connect

    Stroumpouli, Evangelia; Nassef, Ahmed; Loosemore, Tom; Thompson, Matt; Morgan, Robert; Belli, Anna-Maria

    2007-11-15

    Background: Isolated aneurysms of the iliac arteries are uncommon. Previously treated by conventional surgery, there is increasing use of endografts to treat these lesions. Purpose: The purpose of this study was to assess the efficacy, safety, and durability of the stent-grafts for treatment of iliac artery aneurysms (IAAs). The results of endografting for isolated IAAs over a 10-year period were analyzed retrospectively. The treatment methods differed depending on the anatomic location of the aneurysms. Twenty-one patients (1 woman, 20 men) underwent endovascular stent-graft repair, with one procedure carried out under emergency conditions after acute rupture. The mean aneurysm diameter was 4.6 cm.Results:The procedural technical success was 100%. There was zero 30-day mortality. Follow-up was by interval CT scans. At a mean follow-up of 51.2 months, the stent-graft patency rate was 100%. Reintervention was performed in four patients (19%): one patient (4.7%) with a type I endoleak and three patients (14.3%) with type II endoleaks.Conclusion:We conclude that endovascular repair of isolated IAAs is a safe, minimally invasive technique with low morbidity rates. Follow-up results up to 10 years suggest that this approach is durable and should be regarded as a first treatment option for appropriate candidates.

  4. Multiple aneurysmal bone cysts in a foal.

    PubMed Central

    Thomas, H L; Livesey, M A; Caswell, J L

    1997-01-01

    Multiple aneurysmal bone cysts (ABCs) are previously unreported in horses. An ABC was diagnosed in the left 3rd metacarpal of a Thoroughbred foal, which partially resolved following surgical curettage. A 2nd ABC developed in the left tibia, 7 wk postoperatively, and the foal was euthanized. Images Figure 1. Figure 2. PMID:9285139

  5. Pulsatile blood flow in Abdominal Aortic Aneurysms

    NASA Astrophysics Data System (ADS)

    Salsac, Anne-Virginie; Lasheras, Juan C.; Singel, Soeren; Varga, Chris

    2001-11-01

    We discuss the results of combined in-vitro laboratory measurements and clinical observations aimed at determining the effect that the unsteady wall shear stresses and the pressure may have on the growth and eventual rupturing of an Abdominal Aortic Aneurysm (AAA), a permanent bulging-like dilatation occurring near the aortic bifurcation. In recent years, new non-invasive techniques, such as stenting, have been used to treat these AAAs. However, the development of these implants, aimed at stopping the growth of the aneurysm, has been hampered by the lack of understanding of the effect that the hemodynamic forces have on the growth mechanism. Since current in-vivo measuring techniques lack the precision and the necessary resolution, we have performed measurements of the pressure and shear stresses in laboratory models. The models of the AAA were obtained from high resolution three-dimensional CAT/SCANS performed in patients at early stages of the disease. Preliminary DPIV measurements show that the pulsatile blood flow discharging into the cavity of the aneurysm leads to large spikes of pressure and wall shear stresses near and around its distal end, indicating a possible correlation between the regions of high wall shear stresses and the observed location of the growth of the aneurysm.

  6. Infected Abdominal Aortic Aneurysm with Helicobacter cinaedi

    PubMed Central

    Iwasawa, Takamasa; Tamura, Atsushi; Lefor, Alan T.

    2016-01-01

    Helicobacter cinaedi is a rare human pathogen which has various clinical manifestations such as cellulitis, bacteremia, arthritis, meningitis, and infectious endocarditis. We report an abdominal aortic aneurysm infected with Helicobacter cinaedi, treated successfully with surgical repair and long-term antimicrobial therapy. PMID:26885430

  7. Endovascular treatment of abdominal aortic aneurysms.

    PubMed

    Buck, Dominique B; van Herwaarden, Joost A; Schermerhorn, Marc L; Moll, Frans L

    2014-02-01

    Patients with abdominal aortic aneurysms (AAAs) are usually treated with endovascular aneurysm repair (EVAR), which has become the standard of care in many hospitals for patients with suitable anatomy. Clinical evidence indicates that EVAR is associated with superior perioperative outcomes and similar long-term survival compared with open repair. Since the randomized, controlled trials that provided this evidence were conducted, however, the stent graft technology for infrarenal AAA has been further developed. Improvements include profile downsizing, optimization of sealing and fixation, and the use of low porosity fabrics. In addition, imaging techniques have improved, enabling better preoperative planning, stent graft placement, and postoperative surveillance. Also in the past few years, fenestrated and branched stent grafts have increasingly been used to manage anatomically challenging aneurysms, and experiments with off-label use of stent grafts have been performed to treat patients deemed unfit or unsuitable for other treatment strategies. Overall, the indications for endovascular management of AAA are expanding to include increasingly complex and anatomically challenging aneurysms. Ongoing studies and optimization of imaging, in addition to technological refinement of stent grafts, will hopefully continue to broaden the utilization of EVAR. PMID:24343568

  8. Ehrlichia Meningitis Mimicking Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    Dredla, Brynn

    2015-01-01

    Thunderclap headache is a sudden and severe headache that can occur after an aneurysmal subarachnoid hemorrhage (SAH). Subarachnoid hemorrhage is a medical emergency that requires prompt attention and hospitalization. Patients with thunderclap headache often undergo a noncontrast head computed tomography (CT) scan to ascertain SAH bleeding and, if the scan is negative, then undergo a lumbar puncture to look for cerebrospinal fluid (CSF) red blood cells (RBCs), which would be consistent with an aneurysmal leak. If the initial CT is negative and CSF is positive for RBCs, patients are usually admitted to the hospital for evaluation of intracranial aneurysm. We encountered a patient with thunderclap headache whose initial head CT was negative for SAH and whose CSF tested positive for RBCs. The patient was referred to our center for evaluation and management of aneurysmal SAH. However, on careful review of the patient’s medical history, serum laboratory values, and spinal fluid values, the patient was diagnosed with Ehrlichia chaffeensis meningitis. While Ehrlichia meningitis is rare, it is important to recognize the clinical clues that could help avoid formal cerebral angiography, a costly and potentially unnecessary procedure. We present how this case represented a cognitive framing bias and anchoring heuristic as well as steps that medical providers can use to prevent such cognitive errors in diagnosis. PMID:27053985

  9. [The aneurysms of the aorta of tuberculous].

    PubMed

    Tijani, Y; Ghannam, A; Elfatemi, B; Elkharroubi, A; Hormat-Allah, M; Elidrissi, R; Elkhloufi, S; Sefiani, Y; Lekehal, B; Elmesnaoui, A; Ammar, F; Bensaid, Y

    2016-04-01

    Tuberculosis is a public health problem in Morocco, which is difficult to eradicate despite the recognized efficiency of health policies. Aortic aneurysm is rare and lethal complication of spontaneous evolution. Pathophysiological characteristics and the difficulty of early diagnosis worsen the prognosis. PMID:26656506

  10. Medical treatment of small abdominal aortic aneurysm.

    PubMed

    Assar, A N

    2012-08-01

    Conventional open repair or endovascular aneurysm repair is indicated for infrarenal abdominal aortic aneurysm (AAA) when the diameter of the latter is ≥ 5.5 cm. This therapeutic strategy is based on results of randomized trials of open repair versus ultrasound surveillance of small AAA (<5.5 cm). Studies of screening for AAA have shown that >90% of aneurysms detected are small aneurysms (<5.5 cm). Despite the low annual risk of rupture of these aneurysms, patients with small AAA are left with a potentially life-threatening disease for which no immediate treatment is available. Hence, medical treatment directed at limiting the expansion of small AAA has emerged as an alternative therapeutic strategy. Randomized trials of doxycycline, roxithromycin, and propranolol in patients with small AAA have been published. The results of the doxycycline and roxithromycin trials suggest that both medications can limit AAA expansion, especially during the first year of treatment. Propranolol did not limit AAA expansion, and the trials were stopped because of its serious side effects. In other studies, statins and indomethacin have also been shown to limit AAA expansion. However, these studies were observational with relatively small numbers of patients. Thus, large randomized controlled trials with long follow-up are needed to objectively assess the efficacy of medications that have shown potential in limiting AAA expansion. In addition, recent evidence of regression of AAA in experimental animal models is likely to change our concepts of the molecular pathogenesis of AAA, and could make medical treatment of small AAA a possibility. PMID:22854530

  11. Aneurysm resection and vascular reconstruction for true aneurysm at the initial segment of splenic artery.

    PubMed

    Wang, Chun-Xi; Han, Li-Na; Liang, Fa-Qi; Chu, Fu-Tao; Jia, Xin

    2015-06-01

    The aneurysms at the initial segment of splenic artery are rare. This paper aimed to investigate the methods to treat the true aneurysm at the initial segment of splenic artery by aneurysmectomy plus vascular reconstruction. Retrospectively reviewed were 11 cases of true aneurysm at the initial segment of splenic artery who were treated in our hospital from January 2000 to June 2013. All cases were diagnosed by color ultrasonography, computer tomography (CT) and angiography. Upon resection of the aneurysm, the auto-vein transplantation was performed in situ between the hepatic artery and the distal part of the splenic artery in 1 case; the artificial vessel bypass was done between the infra-renal aorta and distal portion of the splenic artery in 7 cases; the splenectomy was done in 2 cases; the splenectomy in combination with ligation of multiple small aneurysms were performed in 1 case. All cases were cured and discharged from the hospital 10-14 days after operation. A 1-14 year follow-up showed that 9 cases survived, and 2 cases died, including 1 case who died of acute myocardial infarction 2 years after aorta-splenic artery bypass operation and 1 case who died of acute cerebral hemorrhage 5 years after aneurysm resection and the splenectomy. Among 6 cases receiving aorta-splenic artery bypass, 1 gradually developed stenosis at anatomosed site, which eventually progressed to complete occlusion 2 years to 6 years after operation, without suffering from splenic infarction because the spleen was supplied by the short gastric vessel and its collaterals. The other 5 cases receiving aorta-splenic artery bypass and 1 case undergoing autologous vascular transplantation did not develop stricture or pseudoaneurysm at the stoma. Our study showed that the aneurysmectomy plus vascular reconstruction is a better treatment for aneurysm at the initial segment of splenic artery. PMID:26072086

  12. Flow dynamics in a lethal anterior communicating artery aneurysm.

    PubMed

    Kerber, C W; Imbesi, S G; Knox, K

    1999-01-01

    We describe and analyze the flow dynamics in replicas of a human anterior communicating artery aneurysm. The replicas were placed in a circuit of pulsating non-Newtonian fluid, and flows were adjusted to replicate human physiologic parameters. Individual slipstreams were opacified with isobaric dyes, and images were recorded on film and by CT/MR angiography. When flow in the afferent (internal carotid) and efferent (anterior and middle cerebral) arteries was bilaterally equal, slipstreams rarely entered the aneurysm. When flow in either the afferent or efferent vessels was not symmetrical, however, slipstreams entered the aneurysm neck, impinged upon the aneurysm dome, and swirled within the aneurysm. Unequal flow in carotid or cerebral systems may be necessary to direct pathologic, fluid slipstreams into an aneurysm. PMID:10588134

  13. Aortitis causing rapid growth of a mycotic aortic aneurysm

    PubMed Central

    Williams, Zoheb Berry; Ryden, Lauren E.; Organ, Nicole M.

    2016-01-01

    Mycotic infrarenal aortic aneurysms are rare and often masquerade as other abdominal pathology. We present a case where serial imaging made the diagnosis and provided an insight into the pathophysiology of mycotic aneurysm. A 71-year-old man presents with abdominal pain, rigours and dysuria. Computed tomography reveals an irregular, thickened ectatic abdominal aorta, but cholescintigraphy suggests acalculous cholecystitis. Deterioration prompts repeat radiographical assessment, which demonstrates an increase in the size of the aorta over 10 days. The patient was treated emergently with an open aortic ligation, debridement and extra-anatomical bypass. Infections account for up to 2% of abdominal aortic aneurysms. The rate of growth of mycotic aneurysms is sparsely discussed in the literature and to our knowledge, there are no reports with serial single-modality imaging. The most significant finding was rapid expansion in aneurysm size. While mycotic aneurysm requires urgent treatment, diagnosis can be delayed and difficult. PMID:27009324

  14. Thrombus Volume Change Visualization after Endovascular Abdominal Aortic Aneurysm Repair

    NASA Astrophysics Data System (ADS)

    Maiora, Josu; García, Guillermo; Macía, Iván; Legarreta, Jon Haitz; Boto, Fernando; Paloc, Céline; Graña, Manuel; Abuín, Javier Sanchez

    A surgical technique currently used in the treatment of Abdominal Aortic Aneurysms (AAA) is the Endovascular Aneurysm Repair (EVAR). This minimally invasive procedure involves inserting a prosthesis in the aortic vessel that excludes the aneurysm from the bloodstream. The stent, once in place acts as a false lumen for the blood current to travel down, and not into the surrounding aneurysm sac. This procedure, therefore, immediately takes the pressure off the aneurysm, which thromboses itself after some time. Nevertheless, in a long term perspective, different complications such as prosthesis displacement or bloodstream leaks into or from the aneurysmatic bulge (endoleaks) could appear causing a pressure elevation and, as a result, increasing the danger of rupture. The purpose of this work is to explore the application of image registration techniques to the visual detection of changes in the thrombus in order to assess the evolution of the aneurysm. Prior to registration, both the lumen and the thrombus are segmented

  15. Survivors of ruptured abdominal aortic aneurysm: the iceberg's tip.

    PubMed Central

    Armour, R H

    1977-01-01

    In four and a half years 25 patients in one community suffered a ruptured abdominal aortic aneurysm. Eleven died at home, nine died without operation in hospital, and only five had the aneurysm removed. There were four survivors. A further seven patients might have lived had they had a prompt operation. The average operative mortality for ruptured aneurysms among series reported in British journals is 53%, but the survivors are a small minority of the total number of people in the community whose aneurysms rupture. No basis could be found for the view that replacing an aortic aneurysm with a straight graft (while leaving behind aneurysmal common iliac arteries) lowers the operative mortality. On the contrary, oversimplifying the operation may be hazardous. PMID:922418

  16. Novel Molecular Imaging Approaches to Abdominal Aortic Aneurysm Risk Stratification.

    PubMed

    Toczek, Jakub; Meadows, Judith L; Sadeghi, Mehran M

    2016-01-01

    Selection of patients for abdominal aortic aneurysm repair is currently based on aneurysm size, growth rate, and symptoms. Molecular imaging of biological processes associated with aneurysm growth and rupture, for example, inflammation and matrix remodeling, could improve patient risk stratification and lead to a reduction in abdominal aortic aneurysm morbidity and mortality. (18)F-fluorodeoxyglucose-positron emission tomography and ultrasmall superparamagnetic particles of iron oxide magnetic resonance imaging are 2 novel approaches to abdominal aortic aneurysm imaging evaluated in clinical trials. A variety of other tracers, including those that target inflammatory cells and proteolytic enzymes (eg, integrin αvβ3 and matrix metalloproteinases), have proven effective in preclinical models of abdominal aortic aneurysm and show great potential for clinical translation. PMID:26763279

  17. Design and biocompatibility of endovascular aneurysm filling devices

    PubMed Central

    Rodriguez, Jennifer N.; Hwang, Wonjun; Horn, John; Landsman, Todd L.; Boyle, Anthony; Wierzbicki, Mark A.; Hasan, Sayyeda M.; Follmer, Douglas; Bryant, Jesse; Small, Ward; Maitland, Duncan J.

    2014-01-01

    The rupture of an intracranial aneurysm, which can result in severe mental disabilities or death, affects approximately 30,000 people in the United States annually. The traditional surgical method of treating these arterial malformations involves a full craniotomy procedure, wherein a clip is placed around the aneurysm neck. In recent decades, research and device development have focused on new endovascular treatment methods to occlude the aneurysm void space. These methods, some of which are currently in clinical use, utilize metal, polymeric, or hybrid devices delivered via catheter to the aneurysm site. In this review, we present several such devices, including those that have been approved for clinical use, and some that are currently in development. We present several design requirements for a successful aneurysm filling device and discuss the success or failure of current and past technologies. We also present novel polymeric based aneurysm filling methods that are currently being tested in animal models that could result in superior healing. PMID:25044644

  18. A Case of Giant Right Atrial Aneurysm in a Child.

    PubMed

    Pawar, Ravindra S; Tiwari, Ashish; Suresh, P V; Raj, Vimal; Kaushik, Pradeepkumar

    2016-07-01

    Giant right atrial aneurysm is a rare entity in infants and children. It needs to be distinguished from an atrial diverticulum, which can have similar presentation. Generally, an incidental finding in children, it can present with varied symptoms. We report a case of a giant right atrial aneurysm in an asymptomatic child with a large clot in the dilated right atrium, who underwent successful resection of the atrial aneurysm. PMID:26884450

  19. Common iliac artery aneurysm presenting as acute sciatic nerve compression.

    PubMed Central

    Mohan, S. R.; Grimley, R. P.

    1987-01-01

    Aneurysms of the iliac arteries usually remain silent, but when they rupture the consequences can be dramatic. They produce few clinical signs suggestive of their presence. However, such aneurysms have been found to be the cause of non-vascular clinical situations. Often they present with features of compression on adjacent viscera. We present a case in which a large common iliac artery aneurysm was found to be causing symptoms of acute sciatic nerve compression. PMID:3447118

  20. Endovascular Treatment of Extracranial Internal Carotid Aneurysms Using Endografts

    SciTech Connect

    Baldi, Sebastian Rostagno, Roman D.; Zander, Tobias; Llorens, Rafael; Schonholz, Claudio; Maynar, Manuel

    2008-03-15

    Aneurysms of the extracranial internal carotid artery (EICA) are infrequent. They are difficult to treat with conventional surgery because of their distal extension into the skull base. We report three cases of EICA aneurysms in two symptomatic patients successfully treated with polytetrafluoroethylene self-expanding endografts using an endovascular approach. The aneurysms were located distal to the carotid bifurcation and extended to the subpetrous portion of the internal carotid artery.

  1. Diagnosis of mycotic abdominal aortic aneurysm using 67-gallium citrate

    SciTech Connect

    Blumoff, R.L.; McCartney, W.; Jaques, P.; Johnson, G. Jr.

    1982-11-01

    Mycotic aneurysms of the abdominal aorta are uncommon, but potentially lethal problems. Clinical subtleties may suggest their presence, but in the past, definitive diagnosis has been dependent on surgical exploration or autopsy findings. A case is presented in which 67-gallium citrate abdominal scanning localized the site of sepsis in an abdominal aortic aneurysm and allowed for prompt and successful surgical therapy. This noninvasive technique is recommended as a adjunct in the diagnosis of mycotic abdominal aortic aneurysms.

  2. Recurrent Giant Cell Tumor of Skull Combined with Multiple Aneurysms

    PubMed Central

    Kim, Dae Hwan

    2016-01-01

    Giant cell tumors are benign but locally invasive and frequently recur. Giant cell tumors of the skull are extremely rare. A patient underwent a surgery to remove a tumor, but the tumor recurred. Additionally, the patient developed multiple aneurysms. The patient underwent total tumor resection and trapping for the aneurysms, followed by radiotherapy. We report this rare case and suggest some possibilities for treating tumor growth combined with aneurysm development. PMID:27195256

  3. Immunoglobulin G4-related large thoraco-abdominal aortic aneurysm.

    PubMed

    Sekine, Yuji; Yamamoto, Shin; Fujikawa, Takuya; Sasaguri, Shiro

    2016-07-01

    We report a case of immunoglobulin G4-related large thoraco-abdominal aortic aneurysm in a 38-year old man. Preoperative contrast-enhanced computed tomography revealed that the mid-descending thoracic aorta was extremely enlarged and the maximum diameter of the aneurysm was 92 mm. The patient underwent thoraco-abdominal aortic replacement through a thoraco-abdominal incision under left heart bypass. The postoperative pathological examination diagnosed immunoglobulin G4-related aortic aneurysm. PMID:27059069

  4. Balloon embolization in the treatment of basilar aneurysms.

    PubMed

    Zeumer, H; Brückmann, H; Adelt, D; Hacke, W; Ringelstein, E B

    1985-01-01

    Some vertebro-basilar aneurysm may not be treatable at a reasonable risk by direct clipping. A possible alternative is transvascular obliteration, using the means of modern interventional neuroradiology in combination with neurophysiological monitoring. These possibilities and related difficulties are outlined and discussed and the example of two cases with different types of vertebrobasilar aneurysms (top of the basilar artery and basilar trunk aneurysm) which have been treated by balloon embolization. PMID:4091053

  5. Interposition vein graft for giant coronary aneurysm repair

    NASA Technical Reports Server (NTRS)

    Firstenberg, M. S.; Azoury, F.; Lytle, B. W.; Thomas, J. D.

    2000-01-01

    Coronary aneurysms in adults are rare. Surgical treatment is often concomitant to treating obstructing coronary lesions. However, the ideal treatment strategy is poorly defined. We present a case of successful treatment of a large coronary artery aneurysm with a reverse saphenous interposition vein graft. This modality offers important benefits over other current surgical and percutaneous techniques and should be considered as an option for patients requiring treatment for coronary aneurysms.

  6. Method to Quantify Flow Reduction in Aneurysmal Cavities of Lateral Wall Aneurysms Produced by Stent Implants Used for Flow Diversion

    PubMed Central

    Fujimura, N.; Ohta, M.; Abdo, G.; Ylmaz, H.; Lovblad, K.-O; Rüfenacht, D.A.

    2006-01-01

    Summary Stent implants placed across the neck of cerebral aneurysms are capable of reducing aneurysmal flow when coils are not used for filling the aneurysms. It is important to evaluate the effects of flow reduction caused by stent implants used for the treatment of cerebral aneurysms. Subtracted vortex centers path line method (SVC method) is one of the image post processing methods employed for quantitative flow measurement. We developed a modified SVC method by employing Cinematic Angiography (25 frames/s) and digital video recording (30 frames/s) with a commercial digital camera. We successfully compared the flow effectiveness using a tubular silicon model with a sidewall aneurysm. The result suggests that our modified SVC method is useful for a comparative examination of the effect of aneurysmal flow reduction caused by stent implants. PMID:20569631

  7. Ruptured Gastric Aneurysm in α-1 Antitrypsin Deficiency

    PubMed Central

    Spanuchart, Ittikorn; Scott Gallacher, T.

    2016-01-01

    We present a unique vascular complication of α-1 antitrypsin deficiency (AATD) in a patient with an acute onset of epigastric pain and hemodynamic instability. Abdominal computed tomography angiography detected hemoperitoneum and hematoma within the gastrohepatic ligament with active extravasation. Abdominal angiography revealed left gastric aneurysms. An association between AATD and vascular aneurysms has been suggested to be secondary to unopposed proteolytic activity against arterial structural proteins. The aneurysm formation in aortic, superior mesenteric, inferior mesenteric, and splenic arteries has been reported. We report the first case with ruptured gastric artery aneurysm as a complication of AATD. PMID:27622197

  8. Thrombosis modeling in intracranial aneurysms: a lattice Boltzmann numerical algorithm

    NASA Astrophysics Data System (ADS)

    Ouared, R.; Chopard, B.; Stahl, B.; Rüfenacht, D. A.; Yilmaz, H.; Courbebaisse, G.

    2008-07-01

    The lattice Boltzmann numerical method is applied to model blood flow (plasma and platelets) and clotting in intracranial aneurysms at a mesoscopic level. The dynamics of blood clotting (thrombosis) is governed by mechanical variations of shear stress near wall that influence platelets-wall interactions. Thrombosis starts and grows below a shear rate threshold, and stops above it. Within this assumption, it is possible to account qualitatively well for partial, full or no occlusion of the aneurysm, and to explain why spontaneous thrombosis is more likely to occur in giant aneurysms than in small or medium sized aneurysms.

  9. Ruptured Gastric Aneurysm in α-1 Antitrypsin Deficiency.

    PubMed

    Jaruvongvanich, Veeravich; Spanuchart, Ittikorn; Scott Gallacher, T

    2016-07-01

    We present a unique vascular complication of α-1 antitrypsin deficiency (AATD) in a patient with an acute onset of epigastric pain and hemodynamic instability. Abdominal computed tomography angiography detected hemoperitoneum and hematoma within the gastrohepatic ligament with active extravasation. Abdominal angiography revealed left gastric aneurysms. An association between AATD and vascular aneurysms has been suggested to be secondary to unopposed proteolytic activity against arterial structural proteins. The aneurysm formation in aortic, superior mesenteric, inferior mesenteric, and splenic arteries has been reported. We report the first case with ruptured gastric artery aneurysm as a complication of AATD. PMID:27622197

  10. A New Murine Model of Endovascular Aortic Aneurysm Repair

    PubMed Central

    Rouer, Martin; Meilhac, Olivier; Delbosc, Sandrine; Louedec, Liliane; Pavon-Djavid, Graciela; Cross, Jane; Legagneux, Josette; Bouilliant-Linet, Maxime; Michel, Jean-Baptiste; Alsac, Jean-Marc

    2013-01-01

    Endovascular aneurysm exclusion is a validated technique to prevent aneurysm rupture. Long-term results highlight technique limitations and new aspects of Abdominal aortic aneurysm (AAA) pathophysiology. There is no abdominal aortic aneurysm endograft exclusion model cheap and reproducible, which would allow deep investigations of AAA before and after treatment. We hereby describe how to induce, and then to exclude with a covered coronary stentgraft an abdominal aortic aneurysm in a rat. The well known elastase induced AAA model was first reported in 19901 in a rat, then described in mice2. Elastin degradation leads to dilation of the aorta with inflammatory infiltration of the abdominal wall and intra luminal thrombus, matching with human AAA. Endovascular exclusion with small covered stentgraft is then performed, excluding any interactions between circulating blood and the aneurysm thrombus. Appropriate exclusion and stentgraft patency is confirmed before euthanasia by an angiography thought the left carotid artery. Partial control of elastase diffusion makes aneurysm shape different for each animal. It is difficult to create an aneurysm, which will allow an appropriate length of aorta below the aneurysm for an easy stentgraft introduction, and with adequate proximal and distal neck to prevent endoleaks. Lots of failure can result to stentgraft introduction which sometimes lead to aorta tear with pain and troubles to stitch it, and endothelial damage with post op aorta thrombosis. Giving aspirin to rats before stentgraft implantation decreases failure rate without major hemorrhage. Clamping time activates neutrophils, endothelium and platelets, and may interfere with biological analysis. PMID:23851958

  11. Genetic factors involves in intracranial aneurysms – actualities

    PubMed Central

    Mohan, D; Munteanu, V; Coman, T; Ciurea, AV

    2015-01-01

    Intracranial aneurysm (IA) is a common vascular disorder, which frequently leads to fatal vascular rupture leading to subarachnoid hemorrhage (SAH). Although various acquired risk factors associated with IAs have been identified, heritable conditions are associated with IAs formation but these syndromes account for less than 1% of all IAs in the population. Cerebral aneurysm disease is related to hemodynamic and genetic factors, associated with structural weakness in the arterial wall, which was acquired by a specific, often unknown, event. Possibly, the trigger moment of aneurysm formation may depend on the dynamic arterial growth, which is closely related to aging/ atherosclerosis. Genetic factors are known to have an important role in IA pathogenesis. Literature data provide complementary evidence that the variants on chromosomes 8q and 9p are associated with IA and that the risk of IA in patients with these variants is greatly increased with cigarette smoking. Intracranial aneurysms are acquired lesions (5-10% of the population). In comparison with sporadic aneurysms, familial aneurysms tend to be larger, more often located in the middle cerebral artery, and more likely to be multiple. Abbreviations: DNA = deoxyribonucleic acid, FIA = familial Intracranial Aneurysm, GWAS = genome-wide association studies, IL-6 = interleukin-6, ISUIA = International Study of Unruptured Intracranial Aneurysms, IA = Intracranial aneurysm, mRNA = Messager ribonucleic acid, SNPs = single-nucleotide polymorphisms, SMCs = smooth muscle cells, sIAs = sporadic IAs, SAH = subarachnoid hemorrhage, TNF-α = tumor necrosis factor-alpha, COL4A1 = type IV collagen alpha-1 PMID:26351537

  12. Infantile intracranial aneurysm of the superior cerebellar artery.

    PubMed

    Del Santo, Molly Ann; Cordina, Steve Mario

    2016-01-01

    Intracranial aneurysms in the pediatric population are rare. We report a case of a 3-month-old infant who presented with inconsolable crying, vomiting, and sunset eye sign. CT revealed a subarachnoid hemorrhage, with CT angiogram revealing a superior cerebellar artery aneurysm. An external ventricular drain was placed for acute management of hydrocephalus, with definitive treatment by endovascular technique with a total of six microcoils to embolize the aneurysm. Serial transcranial Dopplers revealed no subsequent vasospasm. Although aneurysms in the pediatric population are rare, once the diagnosis is established, early treatment results in better outcomes. PMID:26929222

  13. Stent Application for the Treatment of Cerebral Aneurysms

    PubMed Central

    Kim, Dong Joon; Kim, Dong Ik

    2011-01-01

    Rapid and striking development in both the techniques and devices make it possible to treat most of cerebral aneurysms endovascularly. Stent has become one of the most important tools in treating difficult aneurysms not feasible for simple coiling. The physical features, the dimensions, and the functional characteristics of the stents show considerable differences. There are also several strategies and tips to treat difficult aneurysms by using stent and coiling. Nevertheless, they require much experience in clinical practice as well as knowledge of the stents to treat cerebral aneurysms safely and effectively. In this report, a brief review of properties of the currently available stents and strategies of their application is presented. PMID:22125751

  14. Dissecting thoracic aortic aneurysm associated with tuberculous pleural effusion

    PubMed Central

    Im, Kyong Shil; Choi, Min Kyung; Jeon, Yong Kyoung

    2016-01-01

    We present the case of thoracic aortic aneurysm associated with the tuberculous pleural effusion. An 82-year-old woman underwent emergency stent graft under a diagnosis of dissecting thoracic aortic aneurysm. Preoperative computed tomography revealed right pleural effusion supposed to the hemothorax caused by the dissecting aneurysm. But, the effusion was sanguineous color fluid and it was determined to result from pulmonary tuberculosis. The medical team was exposed to the pulmonary tuberculosis; fortunately no one became infected. Physicians should be aware of the possibility of an infected aortic aneurysm and prepare for pathogen transmission. PMID:27499987

  15. A fractured sirolimus-eluting stent with a coronary aneurysm.

    PubMed

    Kim, Sung Hea; Kim, Hyun Joong; Han, Seong Woo; Jung, Sang Man; Kim, Jun Suk; Chee, Hyun Keun; Ryu, Kyu Hyung

    2009-08-01

    A 55-year-old man had undergone successful percutaneous intervention with a sirolimus-eluting stent, placed in the right coronary artery (2.5 x 33 mm) and distal left circumflex artery (3.0 x 28 mm) without high pressure ballooning. Twelve months later he presented with unstable angina. Angiography revealed two fracture sites on the right coronary artery-deployed stent, with a large aneurysm and an aneurysmal dilatation of the left circumflex artery without stent fracture. Due to the potential risk of aneurysmal rupture, he underwent coronary artery bypass grafting and ligation of the aneurysm. PMID:19632438

  16. [Giant aneurysm of the inter-atrial septum].

    PubMed

    Akoudad, H; Cherti, M; Chaouki, S; Ztot, S; Haddour, L; el Mrabet, I; el Khadiri, A; Benmimoun, E G; Arharbi, A

    1999-01-01

    We report the case of a large atrial septal aneurysm and a review of the literature. Atrial septal aneurysm is found in 1-8% of normal subjects. Its prevalence is higher among patients with ischemic stroke. Transesophageal echocardiography is an optimal tool for the diagnosis of atrial septal aneurysm. The clinical course may be complicated by arterial embolism, but mechanical complications may also occur, as in this case. Due to the lack of general agreement, treatment options should be discussed on an individual basis for patients with atrial septal aneurysm. PMID:10093663

  17. Intracranial mycotic aneurysm caused by Aspergillus--case report.

    PubMed

    Masago, A; Fukuoka, H; Yoshida, T; Majima, K; Tada, T; Nagai, H

    1992-11-01

    A 75-year-old female with chronic renal failure diagnosed as Wegener's granulomatosis was receiving steroids and immunosuppressive agents when subarachnoid hemorrhage developed. Cerebral angiography showed a fusiform aneurysm arising from an angular branch of the left middle cerebral artery. Hemorrhage occurred and the aneurysm was excised by emergency surgery. Microscopic examination of the aneurysm revealed dense infiltration of hyphae identified as Aspergillus. She died of subsequent hemorrhage. Autopsy showed numerous Aspergillus hyphae in the lung. Fungal mycotic aneurysm should be considered in the differential diagnosis of an immunocompromised patient with subarachnoid hemorrhage. PMID:1282683

  18. Mycotic aneurysm of the left subclavian artery: CT findings.

    PubMed

    Visrutaratna, P; Charoenkwan, P; Saeteng, S

    2006-01-01

    Mycotic aneurysms caused by aspergillosis are rare. We report a nine-year-old girl with acute lymphoblastic leukaemia who had invasive pulmonary aspergillosis and subsequently developed a left subclavian artery aneurysm. Prior to the aneurysm, computed tomography (CT) of the chest showed a nodule with an air crescent in the left upper lobe, adhering to the mediastinum and the left subclavian artery. The left subclavian artery was ill-defined and had a small lumen, and it was embedded in the wall of the nodule. 37 days after the chest CT, the patient underwent a left thoracotomy because of massive haemoptysis, at which time a false aneurysm in the left subclavian artery was found. Plication of the aneurysm was performed. On a follow-up CT with multiplanar reconstruction six days after surgery, there were the plicated aneurysm and a small amount of pleural effusion in the upper portion of the left hemithorax, adjacent to the plication. In invasive pulmonary aspergillosis, it is important to be aware of the possibility of mycotic aneurysms, particularly in patients with pulmonary lesions adjacent to mediastinal vessels with ill-defined borders and small lumens, since the aneurysms may increase in size and rupture. CT, particularly multidetector CT, helps in visualisation of mycotic aneurysms. PMID:16397728

  19. Stent-assisted coil embolization of coronary artery aneurysm.

    PubMed

    Terasawa, Akihiro; Yokoi, Tuyoshi; Kondo, Keita

    2013-08-01

    Coronary artery aneurysms are uncommon diseases with potential complications including rupture and ischemia from embolic events or thrombosis. No consensus has been established regarding the optimal therapy for coronary artery aneurysms. Percutaneous catheter-based treatments using membrane-covered stents and coil embolization have been described. However, only few reports of stent-assisted coil embolization for coronary artery aneurysms have been published to date. Therefore, we report a case of coronary artery aneurysm successfully treated with stent-assisted coil embolization. PMID:23913616

  20. Detection of left ventricular aneurysm on two dimensional echocardiography.

    PubMed

    Baur, H R; Daniel, J A; Nelson, R R

    1982-07-01

    The differentiation of left ventricular aneurysm from diffuse left ventricular dilation and hypokinesia may have important therapeutic consequences. Thus the diagnostic accuracy of wide angle two dimensional echocardiography for the detection of left ventricular aneurysm was evaluated in a prospective study of 26 consecutive patients with the clinical suspicion of left ventricular aneurysm referred over a 10 month period. Every patients was examined with two dimensional echocardiography and left ventricular cineangiography, and findings were interpreted by two independent observers. A dilated hypokinetic left ventricle without aneurysm formation on cineangiography in nine patients was identified in all with two dimensional echocardiography. A left ventricular aneurysm on cineangiography in 17 patients was correctly identified in 14 with the two dimensional study, as were the site and extent of the lesion (apical in 12, anterior in 1 and inferior in 1). One apical aneurysm was interpreted on the two dimensional study as apical dyskinesia; one anterior and one posterobasal aneurysm were missed with this technique. Mural thrombi were correctly identified with two dimensional echocardiography in seven of seven patients. It is concluded that two dimensional echocardiography is an accurate noninvasive method that allows differentiation of left ventricular aneurysm from diffuse left ventricular dilation in the majority of patients. It provides information regarding the resectability of the aneurysm and may obviate cineangiography in many cases. PMID:7091001

  1. Sac Angiography and Glue Embolization in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

    SciTech Connect

    Koike, Yuya Nishimura, Jun-ichi Hase, Soichiro Yamasaki, Motoshige

    2015-04-15

    PurposeThe purpose of this study was to demonstrate a sac angiography technique and evaluate the feasibility of N-butyl cyanoacrylate (NBCA) embolization of the ruptured abdominal aortic aneurysm (AAA) sac in emergency endovascular aneurysm repair (EVAR) in hemodynamically unstable patients.MethodsA retrospective case series of three patients in whom sac angiography was performed during emergency EVAR for ruptured AAA was reviewed. After stent graft deployment, angiography within the sac of aneurysm (sac angiography) was performed by manually injecting 10 ml of contrast material through a catheter to identify the presence and site of active bleeding. In two patients, sac angiography revealed active extravasation of the contrast material, and NBCA embolization with a coaxial catheter system was performed to achieve prompt sealing.ResultsSac angiography was successful in all three patients. In the two patients who underwent NBCA embolization for aneurysm sac bleeding, follow-up computed tomography (CT) images demonstrated the accumulation of NBCA consistent with the bleeding site in preprocedural CT images.ConclusionsEVAR is associated with a potential risk of ongoing bleeding from type II or IV endoleaks into the disrupted aneurysm sac in patients with severe coagulopathy. Therefore, sac angiography and NBCA embolization during emergency EVAR may represent a possible technical improvement in the treatment of ruptured AAA in hemodynamically unstable patients.

  2. Influencing factors of immediate angiographic results in intracranial aneurysms patients after endovascular treatment.

    PubMed

    Chen, Jia-Xiang; Lai, Ling-Feng; Zheng, Kuang; Li, Guo-Xiong; He, Xu-Ying; Li, Liang-Ping; Duan, Chuan-Zhi

    2015-09-01

    The purpose of this study was to analyze influencing factors associated with immediate angiographic results in intracranial aneurysms patients after endovascular treatment (EVT), providing theoretical evidence and guidance for clinical treatment of intracranial aneurysms. Totally 529 patients met the inclusive criteria, consisting of 338 males and 191 females. Gender; age; history of hypertension, diabetes, and smoking; intracranial atherosclerosis; rupture status, size and location, features of aneurysmal neck, shapes; vasospasm; treatment modality; and degree of aneurysm occlusion were all carefully and completely recorded. All data were investigated in univariate and multivariate logistic regression model to determine whether they were correlated with the degree of aneurysm occlusion. According to aneurysm size, aneurysms were classified as micro-miniature, miniature, and large aneurysms. There were 451 narrow-neck aneurysms and 78 wide-neck aneurysms. Totally 417 were regular and 112 were irregular. And 125 were un-ruptured aneurysms; 404 were ruptured aneurysms. The modalities of treatment were as follows: embolization with coil (n = 415), stent-assisted coil embolization (n = 89), and balloon-assisted coil embolization (n = 25). Univariate analysis showed that aneurysm size, feature of aneurysm neck, shape, and rupture status might affect the immediate occlusion after EVT. Multivariate logistic regression analysis indicated that ruptured aneurysm, tiny aneurysm, and wide-neck aneurysm were independent influencing factors of complete occlusion of intracranial aneurysm. Aneurysm rupture status, size, feature of aneurysmal neck, and shape might be the independent influencing factors of immediate angiographic results in intracranial aneurysm patients after EVT. Un-ruptured, micro-miniature, narrow-neck, and regular-shaped aneurysms were more probable to be occluded completely. PMID:26100332

  3. Fenestrated endovascular repair of abdominal aortic aneurysms: a less invasive option for the treatment of juxtarenal aortic aneurysms.

    PubMed

    Ehlert, Bryan A; Abularrage, Christopher J

    2016-05-01

    Endovascular aortic aneurysm repair has become the predominant surgical therapy for abdominal aortic aneurysms. Whereas anatomical limitations had become the major contraindication to endovascular treatment, fenestrated stent grafts were developed to overcome such obstacles. Fenestrated endovascular aortic aneurysm repair now provides an additional treatment option for patients felt to be unsuitable for an invasive open repair whose anatomy is not compatible with more traditional stent grafts. We review the evolution of fenestrated endovascular aortic aneurysm repair and compare its safety and efficacy to other endovascular options. PMID:27092859

  4. Complete regression of a symptomatic, mycotic juxtarenal abdominal aortic aneurysm after treatment with fenestrated endovascular aneurysm repair.

    PubMed

    Durgin, Jonathan M; Arous, Edward J; Kumar, Shivani; Robinson, William P; Simons, Jessica P; Schanzer, Andres

    2016-09-01

    Mycotic abdominal aortic aneurysms are rare and present unique challenges when potential treatment options are considered. Although aortic resection with in situ grafting techniques or extra-anatomic reconstruction are the treatments of choice, endovascular aortic repair has emerged as a suitable alternative in critically ill patients. We report the successful endovascular repair of a symptomatic, mycotic juxtarenal aortic aneurysm using a physician-modified fenestrated endograft. In this patient, with >6 months of follow-up, the aneurysm has completely regressed, illustrating that in select patients with complex mycotic aneurysms, endovascular repair combined with appropriate medical management is a viable treatment strategy. PMID:26747681

  5. Rapid virtual stenting for intracranial aneurysms

    NASA Astrophysics Data System (ADS)

    Zhao, Liang; Chen, Danyang; Chen, Zihe; Wang, Xiangyu; Paliwal, Nikhil; Xiang, Jianping; Meng, Hui; Corso, Jason J.; Xu, Jinhui

    2016-03-01

    The rupture of Intracranial Aneurysms is the most severe form of stroke with high rates of mortality and disability. One of its primary treatments is to use stent or Flow Diverter to divert the blood flow away from the IA in a minimal invasive manner. To optimize such treatments, it is desirable to provide an automatic tool for virtual stenting before its actual implantation. In this paper, we propose a novel method, called ball-sweeping, for rapid virtual stenting. Our method sweeps a maximum inscribed sphere through the aneurysmal region of the vessel and directly generates a stent surface touching the vessel wall without needing to iteratively grow a deformable stent surface. Our resulting stent mesh has guaranteed smoothness and variable pore density to achieve an enhanced occlusion performance. Comparing to existing methods, our technique is computationally much more efficient.

  6. Internal Carotid Artery Aneurysm Mimicking Peritonsillar Abscess

    PubMed Central

    Brzost, Jacek; Waniewska, Martyna; Szczepanski, Miroslaw J.

    2015-01-01

    The extracranial internal carotid artery aneurysm (EICAA) is an uncommon arterial lesion. Patients typically present with neurologic symptoms resulting from impaired cerebral perfusion and compression symptoms of cranial nerves. Often EICAA presents as a pulsatile neck mass, which is otherwise asymptomatic. We present a case of an 84-year-old female, who was initially referred to the Emergency Department for Otolaryngology with suspected peritonsillar abscess. The patient had a history of recent upper airway infection and cardiovascular comorbidities, including hypertension and ischaemic stroke complicated by extensive neurologic deficits. Physical examination revealed a compact, nonpulsatile mass in the lateral parapharyngeal space and local erythema of the mucosa. Duplex Doppler Ultrasonography and Computed Tomography revealed an atherosclerotic aneurysm of the right internal carotid artery, measuring 63 × 55 × 88 mm, stretching from the skull base to the angle of the mandible. PMID:26124973

  7. Cardiovocal Syndrome Secondary to an Aortic Aneurysm

    PubMed Central

    Wang, Hsing-Won; Chen, Mei-Chien; Chao, Pin-Zhir; Lee, Fei-Peng

    2016-01-01

    We reported that a 68-year-old man presented to the ENT outpatient department complaining of hoarseness for more than 10 months. Clinical exam identified left vocal palsy in the paramedian position and atrophic vocal folds were noted. Chest radiography revealed a large bulging contour overlying aorta and left hilar shadow. Aortic aneurysm was proved by CT scanning. Contrast-enhanced chest computed tomography for further evaluation showed a broad-based aortic aneurysm at proximal descending aorta, projecting anterolaterally. Cardiovocal syndrome was proved. The syndrome is a rare clinical presentation. While a patient with unilateral vocal palsy is encountered, one might keep in mind the possibility of cardiovocal syndrome especially in an adult who had a cardiovascular disease. PMID:27088024

  8. Cardiovocal Syndrome Secondary to an Aortic Aneurysm.

    PubMed

    Wang, Hsing-Won; Chen, Mei-Chien; Chao, Pin-Zhir; Lee, Fei-Peng

    2016-01-01

    We reported that a 68-year-old man presented to the ENT outpatient department complaining of hoarseness for more than 10 months. Clinical exam identified left vocal palsy in the paramedian position and atrophic vocal folds were noted. Chest radiography revealed a large bulging contour overlying aorta and left hilar shadow. Aortic aneurysm was proved by CT scanning. Contrast-enhanced chest computed tomography for further evaluation showed a broad-based aortic aneurysm at proximal descending aorta, projecting anterolaterally. Cardiovocal syndrome was proved. The syndrome is a rare clinical presentation. While a patient with unilateral vocal palsy is encountered, one might keep in mind the possibility of cardiovocal syndrome especially in an adult who had a cardiovascular disease. PMID:27088024

  9. Symptomatic aneurysm of ductus arteriosus in neonates

    PubMed Central

    Koneti, Nageswara R; Kanchi, Vasudevan; Kandraju, Hemasree; Jaishankar, S

    2011-01-01

    Four neonates presented within 24 hours of birth with stridor, respiratory distress and a weak cry. Clinical examination of the cardiovascular system revealed no abnormality. The transthoracic echocardiogram showed large aneurysm of ductus arteriosus at the aortic isthmus, tapering to a small tortuous channel at the site of pulmonary artery insertion. Computerized tomography scan performed in two of the neonates demonstrated considerable compression of adjacent thoracic structures. One required surgical excision due to persistence of symptoms. Serial echocardiograms in the remaining three babies showed transition through various stages of resolution over a period of 6 weeks to 3 months, resulting in the obliteration of the aneurysm. All babies are doing well during the follow-up. PMID:21976878

  10. Management of Giant Splenic Artery Aneurysm

    PubMed Central

    Akbulut, Sami; Otan, Emrah

    2015-01-01

    Abstract To provide an overview of the medical literature on giant splenic artery aneurysm (SAA). The PubMed, Medline, Google Scholar, and Google databases were searched using keywords to identify articles related to SAA. Keywords used were splenic artery aneurysm, giant splenic artery aneuryms, huge splenic artery aneurysm, splenic artery aneurysm rupture, and visceral artery aneurysm. SAAs with a diameter ≥5 cm are considered as giant and included in this study. The language of the publication was not a limitation criterion, and publications dated before January 15, 2015 were considered. The literature review included 69 papers (62 fulltext, 6 abstract, 1 nonavailable) on giant SAA. A sum of 78 patients (50 males, 28 females) involved in the study with an age range of 27–87 years (mean ± SD: 55.8 ± 14.0 years). Age range for male was 30–87 (mean ± SD: 57.5 ± 12.0 years) and for female was 27–84 (mean ± SD: 52.7 ± 16.6 years). Most frequent predisposing factors were acute or chronic pancreatitis, atherosclerosis, hypertension, and cirrhosis. Aneurysm dimensions were obtained for 77 patients with a range of 50–300 mm (mean ± SD: 97.1 ± 46.0 mm). Aneurysm dimension range for females was 50–210 mm (mean ± SD: 97.5 ± 40.2 mm) and for males was 50–300 mm (mean ± SD: 96.9 ± 48.9 mm). Intraperitoneal/retroperitoneal rupture was present in 15, among which with a lesion dimension range of 50–180 mm (mean ± SD; 100 ± 49.3 mm) which was range of 50–300 mm (mean ± SD: 96.3 ± 45.2 mm) in cases without rupture. Mortality for rupture patients was 33.3%. Other frequent complications were gastrosplenic fistula (n = 3), colosplenic fistula (n = 1), pancreatic fistula (n = 1), splenic arteriovenous fistula (n = 3), and portosplenic fistula (n = 1). Eight of the patients died in early postoperative period while 67 survived. Survival status of the

  11. Acute Aortic Syndromes and Thoracic Aortic Aneurysm

    PubMed Central

    Ramanath, Vijay S.; Oh, Jae K.; Sundt, Thoralf M.; Eagle, Kim A.

    2009-01-01

    Acute and chronic aortic diseases have been diagnosed and studied by physicians for centuries. Both the diagnosis and treatment of aortic diseases have been steadily improving over time, largely because of increased physician awareness and improvements in diagnostic modalities. This comprehensive review discusses the pathophysiology and risk factors, classification schemes, epidemiology, clinical presentations, diagnostic modalities, management options, and outcomes of various aortic conditions, including acute aortic dissection (and its variants intramural hematoma and penetrating aortic ulcers) and thoracic aortic aneurysms. Literature searches of the PubMed database were conducted using the following keywords: aortic dissection, intramural hematoma, aortic ulcer, and thoracic aortic aneurysm. Retrospective and prospective studies performed within the past 20 years were included in the review; however, most data are from the past 15 years. PMID:19411444

  12. Rapid Virtual Stenting for Intracranial Aneurysms

    PubMed Central

    Zhao, Liang; Chen, Danyang; Chen, Zihe; Wang, Xiangyu; Paliwal, Nikhil; Xiang, Jianping; Meng, Hui; Corso, Jason J.; Xu, Jinhui

    2016-01-01

    The rupture of Intracranial Aneurysms is the most severe form of stroke with high rates of mortality and disability. One of its primary treatments is to use stent or Flow Diverter to divert the blood flow away from the IA in a minimal invasive manner. To optimize such treatments, it is desirable to provide an automatic tool for virtual stenting before its actual implantation. In this paper, we propose a novel method, called ball-sweeping, for rapid virtual stenting. Our method sweeps a maximum inscribed sphere through the aneurysmal region of the vessel and directly generates a stent surface touching the vessel wall without needing to iteratively grow a deformable stent surface. Our resulting stent mesh has guaranteed smoothness and variable pore density to achieve an enhanced occlusion performance. Comparing to existing methods, our technique is computationally much more efficient. PMID:27346910

  13. Hepatic artery aneurysm developing after Billroth's operation.

    PubMed

    Fatic, Nikola; Music, Davor; Zornic, Nenad; Radojevic, Nemanja

    2014-05-01

    In this report we review the unusual case of a patient with a common hepatic artery aneurysm presenting 30 years after a Billroth's II resection. A 65-year-old man with epigastric pain and 10 kg of weight loss in the previous 6 months was referred to our clinic. Computed tomography revealed the presence of an aneurysm of the common hepatic artery (HAA) of 35 mm. This HAA was surgically excluded by aneurysmectomy and prosthetic bypass. Intraoperatively we observed extensive peritoneal adhesions and connective tissue formation in the region of the hepatoduodenal and hepatogastric ligaments, and the outer wall of the HAA was tightly affixed to the root of the transverse mesocolon by connective adhesions. Retraction of the adhesions slowly brought about a continued stretching and thinning of the arterial wall likely caused the HAA. PMID:24184460

  14. Understanding the pathogenesis of abdominal aortic aneurysms

    PubMed Central

    Kuivaniemi, Helena; Ryer, Evan J.; Elmore, James R.; Tromp, Gerard

    2016-01-01

    Summary An aortic aneurysm is a dilatation in which the aortic diameter is ≥ 3.0 cm. If left untreated, the aortic wall continues to weaken and becomes unable to withstand the forces of the luminal blood pressure resulting in progressive dilatation and rupture, a catastrophic event associated with a mortality of 50 – 80%. Smoking and positive family history are important risk factors for the development of abdominal aortic aneurysms (AAA). Several genetic risk factors have also been identified. On the histological level, visible hallmarks of AAA pathogenesis include inflammation, smooth muscle cell apoptosis, extracellular matrix degradation, and oxidative stress. We expect that large genetic, genomic, epigenetic, proteomic and metabolomic studies will be undertaken by international consortia to identify additional risk factors and biomarkers, and to enhance our understanding of the pathobiology of AAA. Collaboration between different research groups will be important in overcoming the challenges to develop pharmacological treatments for AAA. PMID:26308600

  15. Small Intracranial Aneurysm Treatment Using Target ® Ultrasoft ™ Coils

    PubMed Central

    Jindal, Gaurav; Miller, Timothy; Iyohe, Moronke; Shivashankar, Ravi; Prasad, Vikram; Gandhi, Dheeraj

    2016-01-01

    Purpose The introduction of small, soft, complex-shaped microcoils has helped facilitate the endovascular treatment of small intracranial aneurysms (IAs) over the last several years. Here, we evaluate the initial safety and efficacy of treating small IAs using only Target® Ultrasoft™ coils. Materials and methods A retrospective review of a prospectively maintained clinical database at a single, high volume, teaching hospital was performed from September 2011 to May 2015. IAs smaller than or equal to 5.0 mm in maximal dimension treated with only Target® Ultrasoft™ coils were included. Results A total of 50 patients with 50 intracranial aneurysms were included. Subarachnoid hemorrhage from index aneurysm rupture was the indication for treatment in 23 of 50 (46%) cases, and prior subarachnoid hemorrhage (SAH) from another aneurysm was the indication for treatment in eight of 50 (16%) cases. The complete aneurysm occlusion rate was 70% (35/50), the minimal residual aneurysm rate was 14% (7/50), and residual aneurysm rate was 16% (8/50). One intraoperative aneurysm rupture occurred. Three patients died during hospitalization from clinical sequelae of subarachnoid hemorrhage. Follow-up at a mean of 13.6 months demonstrated complete aneurysm occlusion in 75% (30/40) of cases, near complete occlusion in 15% (6/40) of cases, and residual aneurysm in 10% (4/40) of cases, all four of which were retreated. Conclusion Our initial results using only Target® Ultrasoft™ coils for the endovascular treatment of small intracranial aneurysms demonstrate initial excellent safety and efficacy profiles. PMID:27403224

  16. First genetic analysis of aneurysm genes in familial and sporadic abdominal aortic aneurysm.

    PubMed

    van de Luijtgaarden, Koen M; Heijsman, Daphne; Maugeri, Alessandra; Weiss, Marjan M; Verhagen, Hence J M; IJpma, Arne; Brüggenwirth, Hennie T; Majoor-Krakauer, Danielle

    2015-08-01

    Genetic causes for abdominal aortic aneurysm (AAA) have not been identified and the role of genes associated with familial thoracic aneurysms in AAA has not been explored. We analyzed nine genes associated with familial thoracic aortic aneurysms, the vascular Ehlers-Danlos gene COL3A1 and the MTHFR p.Ala222Val variant in 155 AAA patients. The thoracic aneurysm genes selected for this study were the transforming growth factor-beta pathway genes EFEMP2, FBN1, SMAD3, TGBF2, TGFBR1, TGFBR2, and the smooth muscle cells genes ACTA2, MYH11 and MYLK. Sanger sequencing of all coding exons and exon-intron boundaries of these genes was performed. Patients with at least one first-degree relative with an aortic aneurysm were classified as familial AAA (n = 99), the others as sporadic AAA. We found 47 different rare heterozygous variants in eight genes: two pathogenic, one likely pathogenic, twenty-one variants of unknown significance (VUS) and twenty-three unlikely pathogenic variants. In familial AAA we found one pathogenic and segregating variant (COL3A1 p.Arg491X), one likely pathogenic and segregating (MYH11 p.Arg254Cys), and fifteen VUS. In sporadic patients we found one pathogenic (TGFBR2 p.Ile525Phefs*18) and seven VUS. Thirteen patients had two or more variants. These results show a previously unknown association and overlapping genetic defects between AAA and familial thoracic aneurysms, indicating that genetic testing may help to identify the cause of familial and sporadic AAA. In this view, genetic testing of these genes specifically or in a genome-wide approach may help to identify the cause of familial and sporadic AAA. PMID:26017485

  17. Parallel multiscale simulations of a brain aneurysm

    SciTech Connect

    Grinberg, Leopold; Fedosov, Dmitry A.; Karniadakis, George Em

    2013-07-01

    Cardiovascular pathologies, such as a brain aneurysm, are affected by the global blood circulation as well as by the local microrheology. Hence, developing computational models for such cases requires the coupling of disparate spatial and temporal scales often governed by diverse mathematical descriptions, e.g., by partial differential equations (continuum) and ordinary differential equations for discrete particles (atomistic). However, interfacing atomistic-based with continuum-based domain discretizations is a challenging problem that requires both mathematical and computational advances. We present here a hybrid methodology that enabled us to perform the first multiscale simulations of platelet depositions on the wall of a brain aneurysm. The large scale flow features in the intracranial network are accurately resolved by using the high-order spectral element Navier–Stokes solver NεκTαr. The blood rheology inside the aneurysm is modeled using a coarse-grained stochastic molecular dynamics approach (the dissipative particle dynamics method) implemented in the parallel code LAMMPS. The continuum and atomistic domains overlap with interface conditions provided by effective forces computed adaptively to ensure continuity of states across the interface boundary. A two-way interaction is allowed with the time-evolving boundary of the (deposited) platelet clusters tracked by an immersed boundary method. The corresponding heterogeneous solvers (NεκTαr and LAMMPS) are linked together by a computational multilevel message passing interface that facilitates modularity and high parallel efficiency. Results of multiscale simulations of clot formation inside the aneurysm in a patient-specific arterial tree are presented. We also discuss the computational challenges involved and present scalability results of our coupled solver on up to 300 K computer processors. Validation of such coupled atomistic-continuum models is a main open issue that has to be addressed in

  18. The vanishing giant abdominal aortic aneurysm.

    PubMed

    Krivoshei, Lian; Halak, Moshe; Schneiderman, Jacob; Silverberg, Daniel

    2011-05-01

    Spontaneous sac size regression of a giant abdominal aortic aneurysm (AAA) is a rare event that has not been previously described. We report a case of an 89-year-old woman with a known 9-cm AAA, which was diagnosed in 2003. The patient had refused any kind of treatment at that time. Recent imaging studies obtained 7 years later revealed an AAA of 4 cm diameter. This is the first recorded case of significant spontaneous AAA sac shrinkage. PMID:21444348

  19. Ultrasound of Primary Aneurysmal Bone Cyst

    PubMed Central

    Glazebrook, Katrina N.; Keeney, Gary L.; Rock, Michael G.

    2014-01-01

    Aneurysmal bone cysts (ABC) are rare, benign, expansile lesions of bone often found in the metaphyses of long bones in pediatric and young adult population. Multiple fluid levels are typically seen on imaging with magnetic resonance imaging (MRI) or computed tomography (CT). We describe a case of a primary ABC in the fibula of a 34-year-old man diagnosed on ultrasound with a mobile fluid level demonstrated sonographically. PMID:24587935

  20. Parallel multiscale simulations of a brain aneurysm

    NASA Astrophysics Data System (ADS)

    Grinberg, Leopold; Fedosov, Dmitry A.; Karniadakis, George Em

    2013-07-01

    Cardiovascular pathologies, such as a brain aneurysm, are affected by the global blood circulation as well as by the local microrheology. Hence, developing computational models for such cases requires the coupling of disparate spatial and temporal scales often governed by diverse mathematical descriptions, e.g., by partial differential equations (continuum) and ordinary differential equations for discrete particles (atomistic). However, interfacing atomistic-based with continuum-based domain discretizations is a challenging problem that requires both mathematical and computational advances. We present here a hybrid methodology that enabled us to perform the first multiscale simulations of platelet depositions on the wall of a brain aneurysm. The large scale flow features in the intracranial network are accurately resolved by using the high-order spectral element Navier-Stokes solver NɛκTαr. The blood rheology inside the aneurysm is modeled using a coarse-grained stochastic molecular dynamics approach (the dissipative particle dynamics method) implemented in the parallel code LAMMPS. The continuum and atomistic domains overlap with interface conditions provided by effective forces computed adaptively to ensure continuity of states across the interface boundary. A two-way interaction is allowed with the time-evolving boundary of the (deposited) platelet clusters tracked by an immersed boundary method. The corresponding heterogeneous solvers (NɛκTαr and LAMMPS) are linked together by a computational multilevel message passing interface that facilitates modularity and high parallel efficiency. Results of multiscale simulations of clot formation inside the aneurysm in a patient-specific arterial tree are presented. We also discuss the computational challenges involved and present scalability results of our coupled solver on up to 300 K computer processors. Validation of such coupled atomistic-continuum models is a main open issue that has to be addressed in future

  1. Parallel multiscale simulations of a brain aneurysm.

    PubMed

    Grinberg, Leopold; Fedosov, Dmitry A; Karniadakis, George Em

    2013-07-01

    Cardiovascular pathologies, such as a brain aneurysm, are affected by the global blood circulation as well as by the local microrheology. Hence, developing computational models for such cases requires the coupling of disparate spatial and temporal scales often governed by diverse mathematical descriptions, e.g., by partial differential equations (continuum) and ordinary differential equations for discrete particles (atomistic). However, interfacing atomistic-based with continuum-based domain discretizations is a challenging problem that requires both mathematical and computational advances. We present here a hybrid methodology that enabled us to perform the first multi-scale simulations of platelet depositions on the wall of a brain aneurysm. The large scale flow features in the intracranial network are accurately resolved by using the high-order spectral element Navier-Stokes solver εκ αr . The blood rheology inside the aneurysm is modeled using a coarse-grained stochastic molecular dynamics approach (the dissipative particle dynamics method) implemented in the parallel code LAMMPS. The continuum and atomistic domains overlap with interface conditions provided by effective forces computed adaptively to ensure continuity of states across the interface boundary. A two-way interaction is allowed with the time-evolving boundary of the (deposited) platelet clusters tracked by an immersed boundary method. The corresponding heterogeneous solvers ( εκ αr and LAMMPS) are linked together by a computational multilevel message passing interface that facilitates modularity and high parallel efficiency. Results of multiscale simulations of clot formation inside the aneurysm in a patient-specific arterial tree are presented. We also discuss the computational challenges involved and present scalability results of our coupled solver on up to 300K computer processors. Validation of such coupled atomistic-continuum models is a main open issue that has to be addressed in future

  2. In vitro analysis of localized aneurysm rupture.

    PubMed

    Romo, Aaron; Badel, Pierre; Duprey, Ambroise; Favre, Jean-Pierre; Avril, Stéphane

    2014-02-01

    In this study, bulge inflation tests were used to characterize the failure response of 15 layers of human ascending thoracic aortic aneurysms (ATAA). Full field displacement data were collected during each of the mechanical tests using a digital image stereo-correlation (DIS-C) system. Using the collected displacement data, the local stress fields at burst were derived and the thickness evolution was estimated during the inflation tests. It was shown that rupture of the ATAA does not systematically occur at the location of maximum stress, but in a weakened zone of the tissue where the measured fields show strain localization and localized thinning of the wall. Our results are the first to show the existence of weakened zones in the aneurysmal tissue when rupture is imminent. An understanding these local rupture mechanics is necessary to improve clinical assessments of aneurysm rupture risk. Further studies must be performed to determine if these weakened zones can be detected in vivo using non-invasive techniques. PMID:24406100

  3. Hybrid Repair of Proximal Subclavian Artery Aneurysm

    PubMed Central

    Morimoto, Kazuki; Fukuda, Tetsuya; Iba, Hiroshi; Tanaka, Hiroshi; Sasaki, Hiroaki; Minatoya, Kenji; Kobayashi, Junjiro

    2015-01-01

    Objective: Conventional open repair for proximal subclavian artery aneurysms (SCAAs) requires cardiopulmonary bypass. However, patients with proximal SCAA can be treated with hybrid repair. Methods: Between 2007 and 2012, we performed hybrid repair to treat six consecutive patients with proximal SCAA (three left SCAAs, one right aberrant SCAA, two right SCAAs). Their median age was 73.5 [70–87] years, and the size of their aneurysm was 33.5 [30–45] mm. Thoracic endovascular aneurysm repair (TEVAR) only was used for one patient with left SCAA, TEVAR and supra-aortic bypass for two with left SCAA and one with right aberrant SCAA, and endovascular repair with reconstruction of the vertebral artery using the saphenous vein graft (SVG) for two with right SCAA. Results: The follow-up duration was 3.7 [0.2–6.8] years. There was no 30-day mortality and only one early complication consisting of a minor stroke after TEVAR for shaggy aorta. Two late deaths occurred, one caused by cerebral infarction due to occlusion of SVG to the dominant vertebral artery 2 months after the operation and the other by aortic dissection 5 years postoperatively. Conclusions: Hybrid repair can be a less-invasive alternative for proximal SCAA. Revascularization of neck vessels and TEVAR should be performed very carefully to prevent neurologic complications. PMID:26131027

  4. Primary aneurysmal bone cyst of coronoid process

    PubMed Central

    Goyal, Amit; Tyagi, Isha; Syal, Rajan; Agrawal, Tanu; Jain, Manoj

    2006-01-01

    Background Aneurysmal bone cysts are relatively uncommon in the facial skeleton. These usually affect the mandible but origin from the coronoid process is even rarer. To the best of our knowledge, this is the first reported case of a coronoid process aneurysmal bone cyst presenting as temporal fossa swelling. Case presentation A 17 year old boy presented with a progressively increasing swelling in the left temporal region developed over the previous 8 months. An expansile lytic cystic lesion originating from the coronoid process of the left mandible and extending into the infratemporal and temporal fossa regions was found on CT scan. It was removed by a superior approach to the infratemporal fossa. Conclusion Aneurysmal bone cyst of the coronoid process can attain enormous dimensions until the temporal region is also involved. A superior approach to the infratemporal fossa is a reasonable approach for such cases, providing wide exposure and access to all parts of the lesion and ensuring better control and complete excision. PMID:16533409

  5. Hemodynamic Influences on Abdominal Aortic Aneurysm Disease: Application of Biomechanics to Aneurysm Pathophysiology

    PubMed Central

    Dua, Monica M.; Dalman, Ronald L.

    2010-01-01

    “Atherosclerotic” abdominal aortic aneurysms (AAAs) occur with the greatest frequency in the distal aorta. The unique hemodynamic environment of this area predisposes it to site-specific degenerative changes. In this review, we summarize the differential hemodynamic influences present along the length of the abdominal aorta, and demonstrate how alterations in aortic flow and wall shear stress modify AAA progression in experimental models. Improved understanding of aortic hemodynamic risk profiles provides an opportunity to modify patient activity patterns to minimize risk of aneurysmal degeneration. PMID:20347049

  6. Diversity in the Strength and Structure of Unruptured Cerebral Aneurysms

    PubMed Central

    Robertson, Anne M.; Duan, Xinjie; Aziz, Khaled M.; Hill, Michael R.; Watkins, Simon C.; Cebral, Juan R.

    2015-01-01

    Intracranial aneurysms are pathological enlargements of brain arteries that are believed to arise from progressive wall degeneration and remodeling. Earlier work using classical histological approaches identified variability in cerebral aneurysm mural content, ranging from layered walls with intact endothelium and aligned smooth muscle cells, to thin, hypocellular walls. Here, we take advantage of recent advances in multiphoton microscopy, to provide novel results for collagen fiber architecture in 15 human aneurysm domes without staining or fixation as well as in 12 control cerebral arteries. For all aneurysm samples, the elastic lamina was absent and the abluminal collagen fibers had similar diameters to control arteries. In contrast, the collagen fibers on the luminal side showed great variability in both diameter and architecture ranging from dense fiber layers to sparse fiber constructs suggestive of ineffective remodeling efforts. The mechanical integrity of eight aneurysm samples was assessed using uniaxial experiments, revealing two sub-classes (i) vulnerable unruptured aneurysms (low failure stress and failure pressure), and (ii) strong unruptured aneurysms (high failure stress and failure pressure). These results suggest a need to refine the end-point of risk assessment studies that currently do not distinguish risk levels among unruptured aneurysms. We propose that a measure of wall integrity that identifies this vulnerable wall subpopulation will be useful for interpreting future biological and structural data. PMID:25632891

  7. Embolization of Large Aneurysms with Long Wire Coils

    SciTech Connect

    Golzarian, Jafar; Dussaussois, Luc; Ait Said, Kamel; Abada, Hicham T.; Dereume, Jean P.; Struyven, Julien

    2002-01-15

    The authors report the experience of using long coils of 2 m length in the management of large aneurysms. Knowledge of the characteristics of these coils is of value for correct placement. These coils are safe and cost-effective for excluding large aneurysms.

  8. Sexual intercourse and cerebral aneurysmal rupture: potential mechanisms and precipitants.

    PubMed

    Reynolds, Matthew R; Willie, Jon T; Zipfel, Gregory J; Dacey, Ralph G

    2011-04-01

    Aneurysmal subarachnoid hemorrhage (SAH) is a significant cause of death in young and middle-aged individuals and causes tremendous morbidity in affected patients. Despite the identification of various risk factors, the series of events leading to the formation, growth, and rupture of intracranial aneurysms is poorly understood. Cerebral aneurysm rupture has been associated with sexual intercourse and other forms of physical exercise. In fact, multiple case series reported that coitus was the immediate preceding activity in 3.8-14.5% of patients suffering from aneurysmal SAH. This may be related to the large elevations in mean arterial blood pressure that occur in both males and females during sexual intercourse (130-175 and 125-160 mm Hg, respectively). While coitus and physical exercise share important physiological similarities, each may differentially affect the probability that a preformed aneurysm will rupture. In this literature review and synthesis, the authors analyze the physiological human response to sexual intercourse in an effort to delineate those factors that may precipitate aneurysmal rupture. The authors' analysis is based on the original data collected by Masters and Johnson. To the authors' knowledge, this is the first review to address the link between sexual intercourse and intracranial aneurysmal rupture. While actual measurements of the physiological variables relevant to SAH were not performed in this article, the authors make reasonable assumptions based on the available data to help elucidate the mechanism of sexually induced aneurysmal rupture. PMID:20540599

  9. Preoperative evaluation of a patient for abdominal aortic aneurysm repair.

    PubMed Central

    Chonchubhair, A. N.; Cunningham, A. J.

    1998-01-01

    Coexistent cardiovascular disease is common in patients presenting for repair of aortic aneurysms. However, preoperative cardiac evaluation prior to abdominal aortic aneurysm (AAA) surgery remains contentious with significant variations in practice between countries, institutions and individual anesthetists. The following case report raises some everyday issues confronting clinical anesthetists. PMID:10604782

  10. Can release of urinary retention trigger abdominal aortic aneurysm rupture?

    PubMed Central

    Luhmann, Andreas; Powell-Bowns, Matilda; Elseedawy, Emad

    2013-01-01

    Only 50% of abdominal aortic aneurysms present with the classic triad of hypotension, back pain and a pulsatile abdominal mass. This variability in symptoms can delay diagnosis and treatment. We present the case of a patient presenting with a unique combination of symptoms suggesting that decompression of urinary retention can lead to abdominal aortic aneurysm rupture. PMID:24964430

  11. [Isolated true aneurysm of the deep femoral artery].

    PubMed

    Salomon du Mont, L; Holzer, T; Kazandjian, C; Saucy, F; Corpataux, J M; Rinckenbach, S; Déglise, S

    2016-07-01

    Aneurysms of the deep femoral artery, accounting for 5% of all femoral aneurysms, are uncommon. There is a serious risk of rupture. We report the case of an 83-year-old patient with a painless pulsatile mass in the right groin due to an aneurysm of the deep femoral artery. History taking revealed no cardiovascular risk factors and no other aneurysms at other localizations. The etiology remained unclear because no recent history of local trauma or puncture was found. ACT angiography was performed, revealing a true isolated aneurysm of the deep femoral artery with a diameter of 90mm, beginning 1cm after its origin. There were no signs of rupture or distal emboli. Due to unsuitable anatomy for an endovascular approach, the patient underwent open surgery, with exclusion of the aneurysm and interposition of an 8-mm Dacron graft to preserve deep femoral artery flow. Due to their localization, the diagnosis and the management of aneurysms of the deep femoral artery can be difficult. Options are surgical exclusion or an endovascular approach in the absence of symptoms or as a bridging therapy. If possible, blood flow to the distal deep femoral artery should be maintained, the decision depending also on the patency of the superficial femoral artery. In case of large size, aneurysms of the deep femoral artery should be treated without any delay. PMID:27289256

  12. Intracranial Aneurysms: Review of Current Treatment Options and Outcomes

    PubMed Central

    Seibert, Brad; Tummala, Ramachandra P.; Chow, Ricky; Faridar, Alireza; Mousavi, Seyed A.; Divani, Afshin A.

    2011-01-01

    Intracranial aneurysms are present in roughly 5% of the population, yet most are often asymptomatic and never detected. Development of an aneurysm typically occurs during adulthood, while formation and growth are associated with risk factors such as age, hypertension, pre-existing familial conditions, and smoking. Subarachnoid hemorrhage, the most common presentation due to aneurysm rupture, represents a serious medical condition often leading to severe neurological deficit or death. Recent technological advances in imaging modalities, along with increased understanding of natural history and prevalence of aneurysms, have increased detection of asymptomatic unruptured intracranial aneurysms (UIA). Studies reporting on the risk of rupture and outcomes have provided much insight, but the debate remains of how and when unruptured aneurysms should be managed. Treatment methods include two major intervention options: clipping of the aneurysm and endovascular methods such as coiling, stent-assisted coiling, and flow diversion stents. The studies reviewed here support the generalized notion that endovascular treatment of UIA provides a safe and effective alternative to surgical treatment. The risks associated with endovascular repair are lower and incur shorter hospital stays for appropriately selected patients. The endovascular treatment option should be considered based on factors such as aneurysm size, location, patient medical history, and operator experience. PMID:21779274

  13. INFLAMMATORY ABDOMINAL AORTIC ANEURYSM--A FORM OF CHRONIC PERIAORTITIS.

    PubMed

    Pop, Corina; Nemeş, Roxana Maria; Jantea, Petruţa; Tomescu, Alina; Postolache, Paraschiva

    2015-01-01

    Chronic periaortitis represents a unique pathogenic concept for three entities: Inflammatory Abdominal Aortic Aneurysm, Idiopathic Retroperitoneal Fibrosis and Perianeurysmal Retroperitoneal Fibrosis. The fundamental meaning of an inflammatory reaction to advanced atherosclerosis has been developed on the bottom of clinical and histological features. The triad of abdominal pain, weight loss and elevated inflammatory markers: erythrocyte sedimentation rate/C-reactive protein in patients with abdominal aortic aneurysms revealed on contrast-enhanced computer tomography is highly suggestive for inflammatory aneurysm. We report a case of a heavy-smoker adult male presented with suddenly abdominal symptoms suggestive for mesenteric ischemia which have proved to be due to inflammatory abdominal aortic aneurysm. The most favorable management of patients with inflammatory aneurysm is ambiguous. Surgical approach seems reasonable even supposing inflammatory aneurysm emerges less likely to rupture than the atherosclerotic variant. Corticosteroids are used in inoperable inflammatory aneurysm, even if is well known that this treatment does not change the long-term outcome of the disease. Surgical-open or Endovascular Repair of the aneurysm is the elective treatment. PMID:26793850

  14. Femoral mycotic aneurysm presenting as arthritis and purpura.

    PubMed

    Feldman, C; Mason, P; Jones, R R; Kelley, C

    1985-11-01

    A case is described with recurrent arthritis and skin rash confined to the right lower limb and exacerbated on each occasion by exercise. Investigation established this to be due to a mycotic aneurysm of the right common femoral artery. Treatment with excision and grafting and antibiotics resulted in full recovery. Mycotic aneurysm and the unusual presenting features in this case are discussed. PMID:3840709

  15. Mechanisms of Healing in Coiled Intracranial Aneurysms: A Review of the Literature.

    PubMed

    Brinjikji, W; Kallmes, D F; Kadirvel, R

    2015-07-01

    Recanalization of intracranial aneurysms following endovascular coiling remains a frustratingly common occurrence. An understanding of the molecular and histopathologic mechanisms of aneurysm healing following coil embolization is essential to improving aneurysm occlusion rates. Histopathologic studies in coiled human and experimental aneurysms suggest that during the first month postcoiling, thrombus formation and active inflammation occur within the aneurysm dome. Several months following embolization, the aneurysm is excluded from the parent vessel by formation of a neointimal layer, which is often thin and discontinuous, across the aneurysm neck. Numerous coil modifications and systemic therapies have been tested in animals and humans in an attempt to improve the aneurysm-healing process; these modifications have met with variable levels of success. In this review, we summarize the histopathologic and molecular biology of aneurysm healing and discuss how these findings have been applied in an attempt to improve angiographic outcomes in patients with intracranial aneurysms. PMID:25430855

  16. Mechanisms of Healing in Coiled Intracranial Aneurysms: A Review of the Literature

    PubMed Central

    Brinjikji, Waleed; Kallmes, David F; Kadirvel, Ramanathan

    2016-01-01

    Summary Recanalization of intracranial aneurysms following endovascular coiling remains a frustratingly common occurrence. An understanding of the molecular and histopathological mechanisms of aneurysm healing following coil embolization is essential to improving aneurysm occlusion rates. Histolopathologic studies in coiled human and experimental aneurysms suggest that during the first month post-coiling, thrombus formation and active inflammation occur within the aneurysm dome. Several months following embolization, the aneurysm is excluded from the parent vessel by formation of a neointimal layer, which is often thin and discontinuous, across the aneurysm neck. Numerous coil modifications and systemic therapies have been tested in animals and humans in an attempt to improve the aneurysm healing process; these modifications have met with variable levels of success. In this review, we summarize the histopathologic and molecular biology of aneurysm healing and discuss how these findings have been applied in an attempt to improve angiographic outcomes in patients harboring intracranial aneurysm. PMID:25430855

  17. Aneurysmal Bone Cyst: An Uncommon Secondary Event in Calcaneal Chondroblastoma.

    PubMed

    Barman, Sandip; Diwaker, Preeti; Bansal, Divya; Wadhwa, Neelam; Singh, Gurvinder

    2016-06-01

    Chondroblastoma is an uncommon benign bone tumour, involvement of epiphysis of long bones is typical. Chondroblastoma of the calcaneum is uncommon and its association with secondary aneurysmal bone cyst is even rarer. Only two cases of calcaneal chondroblastoma associated with secondary aneurysmal bone cyst have been reported till date. A 22-year-old male presented to the department of orthopaedics with complains of pain and swelling in the left heel since the last 10 months. On clinico-radiological grounds differentials considered were giant cell tumour of bone and aneurysmal bone cyst. In view of the histopathological findings of bone curettage and results of special stain and immunohistochemical marker, final diagnosis of chondroblastoma with secondary aneurysmal bone cyst, left calcaneum was rendered. Although rare, chondroblastoma should always be considered in osteolytic lesions of calcaneum. The identification of secondary aneurysmal bone cyst component is important as it has higher chances of recurrence than usual chondroblastoma. PMID:27504302

  18. Aneurysmal Bone Cyst: An Uncommon Secondary Event in Calcaneal Chondroblastoma

    PubMed Central

    Barman, Sandip; Bansal, Divya; Wadhwa, Neelam; Singh, Gurvinder

    2016-01-01

    Chondroblastoma is an uncommon benign bone tumour, involvement of epiphysis of long bones is typical. Chondroblastoma of the calcaneum is uncommon and its association with secondary aneurysmal bone cyst is even rarer. Only two cases of calcaneal chondroblastoma associated with secondary aneurysmal bone cyst have been reported till date. A 22-year-old male presented to the department of orthopaedics with complains of pain and swelling in the left heel since the last 10 months. On clinico-radiological grounds differentials considered were giant cell tumour of bone and aneurysmal bone cyst. In view of the histopathological findings of bone curettage and results of special stain and immunohistochemical marker, final diagnosis of chondroblastoma with secondary aneurysmal bone cyst, left calcaneum was rendered. Although rare, chondroblastoma should always be considered in osteolytic lesions of calcaneum. The identification of secondary aneurysmal bone cyst component is important as it has higher chances of recurrence than usual chondroblastoma. PMID:27504302

  19. A case of a huge gastroepiploic arterial aneurysm.

    PubMed

    Ikeda, Hirokuni; Takeo, Masahiko; Mikami, Ryuuichi; Yamamoto, Mistuo

    2015-01-01

    An 85-year-old man complaining of vague abdominal discomfort was admitted to our hospital. A pulsatile 8 × 7-cm mass in the right upper abdomen was noticed on clinical examination. Computed tomography of the abdomen showed a huge arterial aneurysm in the right gastroepiploic artery, and the left gastroepiploic artery was meandering and expanding. An image diagnosis of gastroepiploic arterial aneurysm (GEAA) was made. Because of the huge size of the aneurysm and the predicted high risk of perforation, surgical intervention was planned. The aneurysm was identified in the greater curve and was found to adhere firmly to the transverse colon. Partial resection of the stomach, aneurysmectomy and partial resection of the transverse colon were performed. Clinically, splanchnic arterial aneurysms are rare. Among them, GEAA is especially rare. We report a rare case of a huge GEAA that was treated successfully by surgery. PMID:26246477

  20. Multiple Intracranial Aneurysms Associated with Behçet's Disease

    PubMed Central

    Ha, Sangwoo; Kim, Jaeho; Kim, Chong-gue

    2016-01-01

    Behçet's disease is an inflammatory disorder involving multiple organs. Its cause is still unknown, but vasculitis is the major pathologic characteristic. The common vascular lesions associated with Behçet's disease are aneurysm formation, arterial or venous occlusive diseases, and varices. Arterial aneurysms mostly occur in large arteries. Intracranial aneurysms hardly occur with Behçet's disease. We would like to present a 41-year-old female patient with Behçet's disease who showed symptoms of severe headache due to subarachnoid hemorrhage. Brain computed tomography revealed multiple aneurysms. We also present a literature review of intracranial arterial aneurysms associated with Behçet's disease. PMID:27114964

  1. Flow in experimental berry aneurysms: method and model.

    PubMed

    Kerber, C W; Heilman, C B

    1983-01-01

    This study addresses two basic questions: What are the flow dynamics in aneurysms? Can these flows be modified to enhance retention of adhesive? Using Pyrex glass bifurcations, fluid flow was studied in a variety of aneurysms placed at varying positions around the bifurcations. Indicators injected into the slipstreams were recorded and studied both by stop-frame high-speed movie analysis and with 35 mm slides. Even at low-flow rates, a central slipstream strikes the apex of bifurcations, and may be partly responsible for the initial production of berry aneurysms. A low-pressure zone occurs at the lateral angle of bifurcations, probably explaining the formation of endovascular cushions. Flow into symmetrically placed narrow neck aneurysms did not occur. Indicator entered the aneurysm in a turbulent fashion only when there was orifice (lip) asymmetry. Both lip asymmetry and rapid flow favor intraaneurysmal turbulent flow. PMID:6410748

  2. Ruptured Total Intrameatal Anterior Inferior Cerebellar Artery Aneurysm

    PubMed Central

    Kim, Hyung Cheol; Chang, In Bok; Lee, Ho Kook

    2015-01-01

    Among the distal anterior inferior cerebellar artery (AICA) aneurysms, a unique aneurysm at the meatal loop inside the internal auditory meatus is extremely rare. The authors report a case of surgically treated total intrameatal AICA aneurysm. A 62-year-old female patient presenting with sudden bursting headache and neck pain was transferred to our department. Computed tomography and digital subtraction angiography showed subarachnoid hemorrhage at the basal, prepontine cistern and an aneurysm of the distal anterior inferior cerebellar artery inside the internal auditory meatus. Surgery was performed by retrosigmoid craniotomy with unroofing of the internal auditory meatus. The aneurysm was identified between the seventh and eighth cranial nerve in the meatus and was removed from the canal and clipped with a small straight Sugita clip. After operation the patient experienced transient facial paresis and tinnitus but improved during follow up. PMID:26361531

  3. Mycotic aneurysm of the distal aortic arch caused by Aspergillus.

    PubMed

    Hosono, Mitsuharu; Hattori, Koji; Shibata, Toshihiko; Sasaki, Yasuyuki; Hirai, Hidekazu; Suehiro, Shigefumi

    2006-04-01

    We describe an unusual case of a thoracic aortic aneurysm caused by Aspergillus. A 70-year-old man underwent prednisolone and Ara-C treatments for a myelodysplastic syndrome. Blood examination revealed pancytopenia. Under these treatments, an aneurysm presented at the distal aortic arch. He underwent resection of the aneurysm with a graft repair covered by a pedicled omentum flap, followed by prolonged administration of micafungin and itraconazole for a mycotic aneurysm. The postoperative course was favorable without complications. Serum C-reactive protein became negative and he was discharged 2 months after the surgery. However, 4 months after the surgery, he died from worsening of the myelodysplastic syndrome. The prognosis for patients with mycotic aneurysms is poor due to their immunocompetent condition arising from underlying diseases. Therefore, in addition to prompt treatment with antifungal agents combined with surgical debridement, control of the underlying disease is essential for improving the outcome. PMID:16642922

  4. Posterior spinal artery aneurysm rupture after ‘Ecstasy’ abuse

    PubMed Central

    Johnson, Jeremiah; Patel, Shnehal; Saraf-Lavi, Efrat; Aziz-Sultan, Mohammad Ali; Yavagal, Dileep R

    2014-01-01

    Posterior spinal artery (PSA) aneurysms are a rare cause of subarachnoid hemorrhage (SAH). The commonly abused street drug 3,4-methylenedioxymethamphetamine (MDMA) or ‘Ecstasy’ has been linked to both systemic and neurological complications. A teenager presented with neck stiffness, headaches and nausea after ingesting ‘Ecstasy’. A brain CT was negative for SAH but a CT angiogram suggested cerebral vasculitis. A lumbar puncture showed SAH but a cerebral angiogram was negative. After a spinal MR angiogram identified abnormalities on the dorsal surface of the cervical spinal cord, a spinal angiogram demonstrated a left PSA 2 mm fusiform aneurysm. The patient underwent surgery and the aneurysmal portion of the PSA was excised without postoperative neurological sequelae. ‘Ecstasy’ can lead to neurovascular inflammation, intracranial hemorrhage, SAH and potentially even de novo aneurysm formation and subsequent rupture. PSA aneurysms may be treated by endovascular proximal vessel occlusion or open surgical excision. PMID:24994748

  5. Pulmonary artery aneurysms in Behçet's disease.

    PubMed

    Yilmaz, Sema; Cimen, Kadriye Akar

    2010-08-01

    Behçet's disease is the most common cause of pulmonary artery aneurysms. Pulmonary artery aneurysms are rare, but they are life-threatening because of their high tendency to rupture. However, there is also a chance that the aneurysms may completely resolve with immunosuppressive therapy. A 30-year-old man was admitted with chest pain, painful oral and genital ulcers, skin rash, weakness, and intermittent hemoptysis. He had a history of Behçet's disease for 6 years. The chest radiography showed a round opacity superior part of hilus on right. The helical thoracic computed tomography (CT) angiography demonstrated pulmonary aneurysms associated with Behçet's disease. The patient was successfully treated with colchicine, corticosteroids, and cyclophosphamide. A discussion about pulmonary artery aneurysms associated with Behçet's disease is provided in this case. PMID:19693504

  6. Endovascular treatment of multiple aneurysms complicating Cogan syndrome.

    PubMed

    Angiletta, Domenico; Wiesel, Paola; Pulli, Raffaele; Marinazzo, Davide; Bortone, Alessandro Santo; Regina, Guido

    2015-02-01

    To report the use of endografts to manage multiple aneurysms due to Cogan syndrome (CS). A 38-year-old woman with descending thoracic aorta and right common carotid artery aneurysms due to CS was treated with endovascular grafts. After 4 years, angio computed tomography scan demonstrated complete exclusion of the aneurysms with no signs of endoleak, whereas echo color Doppler showed patency of the carotid graft, no signs of restenosis, no progression of the disease in the landing zones, and complete aneurysm exclusion. Endovascular repair seems to have favorable long-term outcomes and should be considered a viable alternative to surgery in unfit for open surgery patients, even if they are young, and when the aneurysm size and location would pose a higher risk of perioperative and postoperative complications after an open surgical procedure. PMID:25462550

  7. Successful Occlusion of a Ruptured Aortic Aneurysm Using the Amplatzer Vascular Plug: A Technical Note

    SciTech Connect

    Zander, Tobias Baldi, Sebastian; Rabellino, Martin; Blasco, Oscar; Febles, Tomas; Wisniewska, Katarzyna; Maynar, Manuel

    2011-02-15

    Ruptured abdominal aortic aneurysm is related with a 100% mortality rate if left untreated. Even with surgical intervention or endovascular repair, mortality is still extremely high. However, there are conditions in which neither open surgical aneurysm repair nor endovascular aneurysm repair can be considered a viable therapeutic option because of comorbidities or anatomic reasons. We report a case of successful endovascular treatment in a patient with ruptured abdominal aortic aneurysm by occluding the abdominal aneurysm using the Amplatzer Vascular Plug (AVP II).

  8. Subarachnoid hemorrhage caused by a fungal aneurysm of the vertebral artery as a complication of intracranial aneurysm clipping. Case report.

    PubMed

    Piotrowski, W P; Pilz, P; Chuang, I H

    1990-12-01

    Intracranial aneurysms are an uncommon manifestation of fungal infection. A case is described in which the formation of an aneurysm followed an intracranial intraoperative Aspergillus infection attributable to a long period of preoperative antibiotic medication and immunosuppressive therapy with steroids. PMID:2230983

  9. Enlarged Parent Artery Lumen at Aneurysmal-Neck Segment in Wide-Necked Distal Internal Carotid Artery Aneurysms

    PubMed Central

    Lee, Jong Won; Woo, Jung Min; Lim, Ok Kyun; Jo, Ye-eun; Kim, Jae Kyun; Kim, Eun Sang

    2015-01-01

    Purpose Hypothesizing that the parent artery (PA) diameter of the aneurysm-neck segment is larger than those of normal segments, especially in wide-necked aneurysm cases, we conducted 3D angiographic analyses in wide-necked aneurysm cases focusing on the luminal morphologic change of the PA. Materials and Methods Under the approval of local IRB, we enrolled 26 patients with distal internal carotid artery (ICA) aneurysms, which were treated with stent assisted coiling. The PA diameters along the centerline were measured at 6 points with built-in software by two observers. Those 6 points were P1 and P2 proximally, P3 and P4 at the aneurysm ostium margins, and P5 and P6 distally. We performed an ANOVA test and a Bonferroni method for post hoc analyses. Linear regression analysis was performed to find any morphologic influencing factors. Results There were 20 distal ICA aneurysms out of 26 consecutive cases after exclusion. The differences in diameter at each point were statistically significant (p<0.0001). On post hoc analyses, the difference between P4 and P5 was significant both in maximum and mean PA diameters (p<0.0001 and p<0.001, respectively). Multivariate analyses failed to reveal any morphological influencing factor. Conclusion PAs harboring a wide-necked aneurysm requiring stent assistance for coiling showed significant enlargement of the lumen, especially at the distal transition segment of the aneurysm ostium and the PA. PMID:26389011

  10. Aneurysm Study of Pipeline in an Observational Registry (ASPIRe)

    PubMed Central

    Kallmes, David F.; Brinjikji, Waleed; Boccardi, Edoardo; Ciceri, Elisa; Diaz, Orlando; Tawk, Rabih; Woo, Henry; Jabbour, Pascal; Albuquerque, Felipe; Chapot, Rene; Bonafe, Alain; Dashti, Shervin R.; Almandoz, Josser E. Delgado; Given, Curtis; Kelly, Michael E.; Cross, DeWitte T.; Duckwiler, Gary; Razack, Nasser; Powers, Ciaran J.; Fischer, Sebastian; Lopes, Demetrius; Harrigan, Mark R.; Huddle, Daniel; Turner, Raymond; Zaidat, Osama O.; Defreyne, Luc; Pereira, Vitor Mendes; Cekirge, Saruhan; Fiorella, David; Hanel, Ricardo A.; Lylyk, Pedro; McDougall, Cameron; Siddiqui, Adnan; Szikora, Istvan; Levy, Elad

    2016-01-01

    Background and Objective Few prospective studies exist evaluating the safety and efficacy of the Pipeline Embolization Device (PED) in the treatment of intracranial aneurysms. The Aneurysm Study of Pipeline In an observational Registry (ASPIRe) study prospectively analyzed rates of complete aneurysm occlusion and neurologic adverse events following PED treatment of intracranial aneurysms. Materials and Methods We performed a multicenter study prospectively evaluating patients with unruptured intracranial aneurysms treated with PED. Primary outcomes included (1) spontaneous rupture of the Pipeline-treated aneurysm; (2) spontaneous nonaneurysmal intracranial hemorrhage (ICH); (3) acute ischemic stroke; (4) parent artery stenosis, and (5) permanent cranial neuropathy. Secondary endpoints were (1) treatment success and (2) morbidity and mortality at the 6-month follow-up. Vascular imaging was evaluated at an independent core laboratory. Results One hundred and ninety-one patients with 207 treated aneurysms were included in this registry. The mean aneurysm size was 14.5 ± 6.9 mm, and the median imaging follow-up was 7.8 months. Twenty-four aneurysms (11.6%) were small, 162 (78.3%) were large and 21 (10.1%) were giant. The median clinical follow-up time was 6.2 months. The neurological morbidity rate was 6.8% (13/191), and the neurological mortality rate was 1.6% (3/191). The combined neurological morbidity/mortality rate was 6.8% (13/191). The most common adverse events were ischemic stroke (4.7%, 9/191) and spontaneous ICH (3.7%, 7/191). The complete occlusion rate at the last follow-up was 74.8% (77/103). Conclusions Our prospective postmarket study confirms that PED treatment of aneurysms in a heterogeneous patient population is safe with low rates of neurological morbidity and mortality. Patients with angiographic follow-up had complete occlusion rates of 75% at 8 months. PMID:27610126

  11. Another late complication after endovascular aneurysm repair: aneurysmal degeneration at the iliac artery landing site.

    PubMed

    Agu, Obekieze; Boardley, Dee; Adiseshiah, Mohan

    2008-01-01

    The purpose of this article is to describe a hitherto underreported late complication of infrarenal endovascular aneurysm repair (EVAR), namely type Ib endoleakage resulting from aneurysmal degeneration at the iliac artery landing site. In a prospectively recorded audit, between 1994 and 2007, 297 patients underwent EVAR. All cases that developed iliac artery aneurysm (IAA) were studied. Ten cases of IAA in seven patients (2.4% of the cohort) developed 5 to 9 years after EVAR. Eight of the 10 involved the lower landing site of the stent graft. Landing site diameter before EVAR was 12 mm (range 10-15 mm). Three IAAs presented as emergencies with rapidly expanding sacs and impending rupture. All cases underwent further endovascular intervention with no < 30-day mortality. Iliac artery landing site aneurysm formation after EVAR occurs uncommonly after 5 or more years. It should be regarded as an indication for intervention prior to type Ib endoleakage development. The need for lifelong surveillance is highlighted. PMID:19344588

  12. Persistent Aneurysm Growth Following Pipeline Embolization Device Assisted Coiling of a Fusiform Vertebral Artery Aneurysm: A Word of Caution!

    PubMed Central

    Kerolus, Mena; Lopes, Demetrius K.

    2015-01-01

    The complex morphology of vertebrobasilar fusiform aneurysms makes them one of the most challenging lesions treated by neurointerventionists. Different management strategies in the past included parent vessel occlusion with or without extra-intracranial bypass surgery and endovascular reconstruction by conventional stents. Use of flow diversion has emerged as a promising alternative option with various studies documenting its efficacy and safety. However, there are various caveats associated with use of flow diversion in patients with fusiform vertibrobasilar aneurysms especially in patients presenting with acute subarachnoid hemorrhage (SAH). We report a rare case of persistent aneurysmal growth after coiling and placement of the Pipeline Embolization Device (PED; ev3, Irvine, California, USA) for SAH from a fusiform vertebral artery aneurysm. As consequences of aneurysm rupture can be devastating especially in patients with a prior SAH, the clinical relevance of recognizing and understanding such patterns of failure cannot be overemphasized as highlighted in the present case. PMID:25763295

  13. Neuropsychological assessments in patients with aneurysmal subarachnoid hemorrhage, perimesencephalic SAH, and incidental aneurysms.

    PubMed

    Krajewski, Kara; Dombek, Susanne; Martens, Tobias; Köppen, Johannes; Westphal, Manfred; Regelsberger, Jan

    2014-01-01

    Subarachnoid hemorrhage (SAH) is known to be associated with long-term cognitive deficits. Neurosurgical manipulation on the brain itself has been reported to have influence on neuropsychological sequelae. The following is a comparative study on perimesencephalic and aneurysmal subarachnoid hemorrhage patients as well as elective aneurysm patients that was carried out to determine the isolated and combined impact of surgical manipulation and hemorrhage, respectively, on long-term neuropsychological outcome. Inclusion criteria were good neurological recovery at discharge (modified Rankin Scale 0 or 1) without focal neurological deficit. Standardized psychological testing covered attention, memory, executive functions, and mood. Thirteen aneurysmal SAH patients, 15 patients undergoing elective clipping, and 14 patients with perimesencephalic SAH were analyzed. Standardized neuropsychological testing and social/professional history questionnaires were performed 2 years (mean) after discharge. Memory impairment and slower cognitive processing were found in the aneurysmal and perimesencephalic SAH groups, while elective aneurysm patients showed signs of impaired attention. However, compared with norm data for age-matched healthy controls, all groups showed no significant test results. In contrast, signs of clinical depression were seen in 9/42 patients, 45 % of all patients complained of stress disorders and 55 % of patients were unable to work in their previous professions. Nearly normal neuropsychological test results on long-term follow-up in SAH patients were unexpected. However, a 50 % rate of unemployment accompanied with stress disorders and depression manifests insufficient social and workplace reintegration. Therefore, even more specific rehabilitation programs are required following inpatient treatment to attain full recovery. PMID:23949148

  14. A study of the hemodynamics of anterior communicating artery aneurysms

    NASA Astrophysics Data System (ADS)

    Cebral, Juan R.; Castro, Marcelo A.; Putman, Christopher M.

    2006-03-01

    In this study, the effects of unequal physiologic flow conditions in the internal carotid arteries on the intra-aneurysmal hemodynamics of anterior communicating artery aneurysms were investigated. Patient-specific vascular computational fluid dynamics models of five cerebral aneurysms were constructed from bilateral 3D rotational angiography images. The aneurysmal hemodynamics was analyzed under a range of physiologic flow conditions including the effects of unequal mean flows and phase shifts between the flow waveforms of the left and right internal carotid arteries. A total of five simulations were performed for each patient, and unsteady wall shear stress (WSS) maps were created for each flow condition. Time dependent curves of average WSS magnitude over selected regions on the aneurysms were constructed and used to analyze the influence of the inflow conditions. It was found that mean flow imbalances in the feeding vessels tend to shift the regions of elevated WSS (flow impingement region) towards the dominating inflow jet and to change the magnitude of the WSS peaks. However, the overall qualitative appearance of the WSS distribution and velocity simulations is not substantially affected. In contrast, phase differences tend to increase the temporal complexity of the hemodynamic patterns and to destabilize the intra-aneurysmal flow pattern. However, these effects are less important when the A1 confluence is less symmetric, i.e. dominated by one of the A1 segments. Conditions affecting the flow characteristics in the parent arteries of cerebral aneurysms with more than one avenue of inflow should be incorporated into flow models.

  15. The Effect of Hemodynamics on Cerebral Aneurysm Morphology

    NASA Astrophysics Data System (ADS)

    Metcalfe, Ralph; Mantha, Aishwarya; Karmonik, Christof; Strother, Charles

    2004-11-01

    One of the difficulties in applying principles of hemodynamics to the study of blood flow in aneurysms are the drastic variations in possible shape of both the aneurysms and the parent arteries in the region of interest. We have taken data from three para-opthalmic internal carotid artery aneurysms using 3D-digital subtraction angiography (3D-DSA) and performed CFD simulations of steady and unsteady flows through the three different cases using the same pressure gradients and pulsatile flow waveforms (based on the Ku model for flow through the Carotid bifurcation). We have found that the total pressure differential within the aneurysms is consistent with the direction of flow, and that the dynamic pressure gradient within the aneurysm is very small compared with the static pressure variations. Wall shear stresses were highest near regions of sharp arterial curvature, but always remained low inside the aneurysm. These results suggest a more complex role for hemodynamics in aneurysm generation, growth and rupture.

  16. Diverticula of Kommerell and Aberrant Subclavian Arteries Complicated by Aneurysms

    SciTech Connect

    Fisher, R. G. Whigham, C. J.; Trinh, C.

    2005-06-15

    This is a retrospective evaluation of the incidence of aberrant subclavian arteries (ASAs) and diverticula of Kommerell, as well as the occurrence and significance of associated aneurysms. Thoracic aortograms obtained during a 12.5-year period were reviewed, seeking the presence of aberrant right and left subclavian arteries (ARSAs/ALSAs), diverticula of Kommerell, and the incidence of associated aortic aneurysms. Several cases were evaluated with computed tomography concomitantly. Results were correlated with a literature review. Twenty-two ASAs were identified. Nineteen were on the right (ARSAs) and three were on the left (ALSAs). A diverticulum of Kommerell (DOK) was also present on the right in seven and on the left in three. Five of these patients had complicating aneurysms. Four of these were associated with ARSAs and their diverticula. Two were atherosclerotic; one was a limited dissection and one of uncertain etiology was ruptured. One additional aneurysm (atherosclerotic) involved an ALSA/DOK. The patient with the ruptured aneurysm died in surgery; three were managed conservatively because of concomitant disease; and one is being followed because of the small size (2.5 cm) of the aneurysm. ARSAs are relatively uncommon and ALSAs are rare. Both ARSA and ALSA are frequently associated with a DOK. Aneurysms rarely involve ASAs (with or without a DOK), but they are associated with a high mortality rate if they are not discovered before rupture. Early diagnosis plus surgical and/or endovascular management can be lifesaving.

  17. Vortex dynamics in ruptured and unruptured intracranial aneurysms

    NASA Astrophysics Data System (ADS)

    Trylesinski, Gabriel; Varble, Nicole; Xiang, Jianping; Meng, Hui

    2013-11-01

    Intracranial aneurysms (IAs) are potentially devastating pathological dilations of arterial walls that affect 2-5% of the population. In our previous CFD study of 119 IAs, we found that ruptured aneurysms were correlated with complex flow pattern and statistically predictable by low wall shear stress and high oscillatory shear index. To understand flow mechanisms that drive the pathophysiology of aneurysm wall leading to either stabilization or growth and rupture, we aim at exploring vortex dynamics of aneurysmal flow and provide insight into the correlation between the previous predictive morphological parameters and wall hemodynamic metrics. We adopt the Q-criterion definition of coherent structures (CS) and analyze the CS dynamics in aneurysmal flows for both ruptured and unruptured IA cases. For the first time, we draw relevant biological conclusions concerning aneurysm flow mechanisms and pathophysiological outcome. In pulsatile simulations, the coherent structures are analyzed in these 119 patient-specific geometries obtained using 3D angiograms. The images were reconstructed and CFD were performed. Upon conclusion of this work, better understanding of flow patterns of unstable aneurysms may lead to improved clinical outcome.

  18. Perianeurysmal edema as a predictive sign of aneurysmal rupture.

    PubMed

    Pahl, Felix Hendrik; de Oliveira, Matheus Fernandes; Ferreira, Nelson Paes Fortes Diniz; de Macedo, Leonardo Lopes; Brock, Roger Schmidt; de Souza, Valéria Cardoso

    2014-11-01

    Subarachnoid hemorrhage following intracranial aneurysmal rupture is a major cause of morbidity and mortality. Several factors may affect the probability of rupture, such as tobacco and alcohol use; size, shape, and location of the aneurysm; presence of intraluminal thrombus; and even the sex of the patient. However, few data correlate such findings with the timing of aneurysmal rupture. The authors report 2 cases of middle-age women with headache and MRI findings of incidental aneurysms. Magnetic resonance imaging showed evidence of surrounding parenchymal edema, and in one case there was a clear increase in edema during follow-up, suggesting a progressive inflammatory process that culminated with rupture. These findings raise the possibility that bleb formation and an enlargement of a cerebral aneurysm might be associated with an inflammatory reaction of the aneurysm wall resulting in perianeurysmal edema and subsequent aneurysmal rupture. There may be a temporal link between higher degree of edema and higher risk for rupture, including risk for immediate rupture. PMID:25036206

  19. Computer Simulation of Flow Dynamics in Paraclinoidal Aneurysms

    PubMed Central

    Kobayashi, N.; Miyachi, S.; Okamoto, T.; Kojima, T.; Hattori, K.; Qian, S.; Takeda, H.; Yoshida, J.

    2005-01-01

    Summary Endovascular treatment, which is very useful method especially for paraclinoidal aneurysms, has the limitations of coil compaction and recanalization, which are difficult to predict. We tried to understand flow dynamic features, one of the important factors of such problems, using computer flow dynamics (CFD) simulations. CFD simulations were made in paraclinoidal aneurysm model of different size and protruded directions. Flow patterns, flow velocities and pressure are analyzed. Although the pressure on the aneurismal orifice is highest in the aneurysm protruding vertically upward, the flow velocity is highest in the superior-medial protruding one. Significant difference is not observed in either flow patterns, flow velocities or pressures on the aneurismal orifices between the sizes of aneurismal sac. Among paraclinoidal aneurysms, an aneurysm protruding to superior-medially receives the most severe haemodynamic stresses at the orifice and the aneurysm size does not cause significant differences in the aspect of flow dynamics. It should be considered in the treatment of such aneurysms. PMID:20584475

  20. Aneurysmal Subarachnoid Hemorrhage and Neuroinflammation: A Comprehensive Review

    PubMed Central

    Lucke-Wold, Brandon P.; Logsdon, Aric F.; Manoranjan, Branavan; Turner, Ryan C.; McConnell, Evan; Vates, George Edward; Huber, Jason D.; Rosen, Charles L.; Simard, J. Marc

    2016-01-01

    Aneurysmal subarachnoid hemorrhage (SAH) can lead to devastating outcomes including vasospasm, cognitive decline, and even death. Currently, treatment options are limited for this potentially life threatening injury. Recent evidence suggests that neuroinflammation plays a critical role in injury expansion and brain damage. Red blood cell breakdown products can lead to the release of inflammatory cytokines that trigger vasospasm and tissue injury. Preclinical models have been used successfully to improve understanding about neuroinflammation following aneurysmal rupture. The focus of this review is to provide an overview of how neuroinflammation relates to secondary outcomes such as vasospasm after aneurysmal rupture and to critically discuss pharmaceutical agents that warrant further investigation for the treatment of subarachnoid hemorrhage. We provide a concise overview of the neuroinflammatory pathways that are upregulated following aneurysmal rupture and how these pathways correlate to long-term outcomes. Treatment of aneurysm rupture is limited and few pharmaceutical drugs are available. Through improved understanding of biochemical mechanisms of injury, novel treatment solutions are being developed that target neuroinflammation. In the final sections of this review, we highlight a few of these novel treatment approaches and emphasize why targeting neuroinflammation following aneurysmal subarachnoid hemorrhage may improve patient care. We encourage ongoing research into the pathophysiology of aneurysmal subarachnoid hemorrhage, especially in regards to neuroinflammatory cascades and the translation to randomized clinical trials. PMID:27049383

  1. Syphilis as a Cause of Thoracic Aortic Aneurysm.

    PubMed

    Roberts, William C; Barbin, Clay M; Weissenborn, Matthew R; Ko, Jong M; Henry, A Carl

    2015-10-15

    In 2009, we described morphologic findings in 22 patients having resection of an ascending aortic aneurysm in the previous 11 years at the Baylor University Medical Center, and histologic examination of the aneurysmal wall disclosed classic findings of syphilitic aortitis. The major purpose of that extensively illustrated report was to describe the characteristic gross features of the aneurysm such that syphilitic aortitis might be better recognized at operation and appropriate antibiotics administered postoperatively. The aim of the present study was to emphasize that syphilis remains a major cause of ascending aortic aneurysm. From January 1, 2009, to December 31, 2014, we studied additional 23 patients who had resection of an ascending aortic aneurysm that again histologically had classic features of syphilitic aortitis. All 23 patients were found to have syphilitic aortitis grossly and histologically. The aneurysm involved the ascending portion of aorta in all 23, the arch portion in 12, and the descending thoracic portion in 10. In conclusion, syphilis has far from disappeared. It remains a major cause of ascending aortic aneurysm. PMID:26307174

  2. Intra-aneurysmal thrombus modification after flow-diversion.

    PubMed

    Zanaty, Mario; Jabbour, Pascal M; Bou Sader, Roula; Chalouhi, Nohra; Tjoumakaris, Stavropoula; Rosenwasser, Robert H; Fernando Gonzalez, L

    2015-01-01

    Flow diversion has been successfully used to treat large and giant intracranial aneurysms that present with mass effect. We conducted a retrospective review, evaluating the modification of thrombi in this aneurysm type after treatment with the Pipeline Embolization Device (ev3 Endovascular, Plymouth, MN, USA) and the effects of these modifications on symptoms. Eight patients, seven of whom were female, harbored eight partially thrombosed large or giant aneurysms. Five of the eight aneurysms presented with symptomatic mass effect. At 1 year follow-up, complete occlusion occurred in 75% (6/8) of patients. On average, the longest thrombus diameter measured 22.31 mm before treatment and 14.05 mm 1 year afterwards. Seven of the eight thrombi regressed, as did their aneurysms. All six patients with shrunken thrombi had tremendous symptom improvement and became asymptomatic in the following year. The current findings seem to reflect the size variation of the intra-aneurysmal thrombus rather than the size of the aneurysm itself. PMID:25192591

  3. Rectal strictures following abdominal aortic aneurysm surgery.

    PubMed Central

    Lane, T. M.; Bentley, P. G.

    2000-01-01

    Rectal stricture formation is a rare complication of aortic aneurysm repair. Two case are described here. A combination of hypotension, a compromised internal iliac circulation and poor collateral supply following inferior mesenteric artery ligation can result in acute ischaemic proctitis--an infrequently described clinical entity. Ulceration and necrosis are the sequelae of prolonged ischaemia and fibrous stricture formation may result. One patient responded to dilatation and posterior mid-rectal myotomy; the other failed to respond to conservative measures and eventually had an end colostomy fashioned following intractable symptoms. PMID:11103163

  4. Chylous Ascites after Abdominal Aortic Aneurysm Repair

    PubMed Central

    Ohki, Shinichi; Kurumisawa, Soki

    2015-01-01

    A 73-year-old man was transferred for treatment of abdominal aortic aneurysm. He had no history of abdominal surgeries. Grafting between the infra-renal abdominal aorta and the bilateral common iliac arteries was performed. Proximal and distal cross clamps were applied for grafting. He developed chylous ascites on the 5th post-operative day, 2 days after initiation of oral intake. Fortunately, he responded to treatment with total parenteral hyper-alimentation for 10 days, followed by a low-fat diet. There was no recurrence of ascites. PMID:27087873

  5. Chylous Ascites after Abdominal Aortic Aneurysm Repair.

    PubMed

    Ohki, Shinichi; Kurumisawa, Soki; Misawa, Yoshio

    2016-01-01

    A 73-year-old man was transferred for treatment of abdominal aortic aneurysm. He had no history of abdominal surgeries. Grafting between the infra-renal abdominal aorta and the bilateral common iliac arteries was performed. Proximal and distal cross clamps were applied for grafting. He developed chylous ascites on the 5th post-operative day, 2 days after initiation of oral intake. Fortunately, he responded to treatment with total parenteral hyper-alimentation for 10 days, followed by a low-fat diet. There was no recurrence of ascites. PMID:27087873

  6. Aortic Aneurysm: Etiopathogenesis and Clinicopathologic Correlations

    PubMed Central

    2016-01-01

    Aortic aneurysm (AA) is one of the life-threatening aortic diseases, leading to aortic rupture of any cause including atherosclerotic and non-atherosclerotic diseases. AA is diagnosed in a variable proportion of patients with dilated aorta by imaging modality. The etiopathogenesis of AA remains unclear in many aortic diseases. Furthermore, although it may be difficult to explain all phenotypes of patients even if genetic mutation could be identified in some proteins such as smooth muscle cell α-actin (ACTA2), myosin heavy chain 11 (MYH11) or SMAD3, individualized consideration of these factors in each patient is essential on the basis of clinicopathological characteristics. PMID:27375798

  7. Aneurysm, arachnoiditis and intrathecal Au (gold)

    SciTech Connect

    Pence, D.M.; Kim, T.H.; Levitt, S.H. )

    1990-05-01

    This report is a 20-year follow-up of 14 patients treated with external beam craniospinal irradiation and intrathecal gold (10-45 mCi) for medulloblastoma. Six of the patients died within 2 years of treatment from persistent disease. No patients are alive without complications. Six of eight surviving patients developed arachnoiditis and cauda equina syndrome within 5 to 10 years of treatment. Seven of eight survivors developed aneurysms and/or cerebrovascular accidents 9 to 20 years after treatment. Four of the cerebrovascular events were fatal. Intrathecal gold pools in the basal cisterns and cauda equina delivering an extremely inhomogeneous dose throughout the neuroaxis. Its use is discouraged.

  8. [Pulmonary artery aneurysm. A case report].

    PubMed

    Palma Nieto, J C; Sciaccaluga Morelli, C; Antón Martínez, J; Ramos del Amo, V M

    1999-02-01

    The pulmonary artery aneurysm is a rare clinical entity that presents a low incidence and prevalence, of difficult diagnosis to be presented with poorly specific symptoms or also without symptoms, being detected in radiological studies as a widening or mediastinal mass. It can be uni or bilateral and presenting itself isolated or in the context of other sicknesses. The diagnosis of certainty is based in the realization of Echo-Doppler and other studies as a tomography or a magnetic resonance, the therapeutic option being so difficult, and according to cases, by an expectant or aggressive attitude. PMID:10073101

  9. Interleukin-6 as a Prognostic Biomarker in Ruptured Intracranial Aneurysms

    PubMed Central

    Kao, Hung-Wen; Kuo, Chen-Ling; Huang, Ching-Shan; Tseng, Wan-Min; Lin, Ching-Po

    2015-01-01

    Background Interleukin-6 (IL-6), a proinflammatory cytokine, was found to surge in the cerebral spinal fluid after aneurysmal subarachnoid hemorrhage (SAH). We hypothesized that the plasma level of IL-6 could be an independent biomarker in predicting clinical outcome of patients with ruptured intracranial aneurysm. Methods We prospectively included 53 consecutive patients treated with platinum coil embolization of the ruptured intracranial aneurysm. Plasma IL-6 levels were measured in the blood samples at the orifices of the aneurysms and from peripheral veins. The outcome measure was the modified Rankin Scale one month after SAH. Multiple logistic regression analyses were used to evaluate the associations between the plasma IL-6 levels and the neurological outcome. Results Significant risk factors for the poor outcome were old age, low Glasgow Coma Scale (GCS) on day 0, high Fisher grades, and high aneurysmal and venous IL-6 levels in univariate analyses. Aneurysmal IL-6 levels showed modest to moderate correlations with GCS on day 0, vasospasm grade and Fisher grade. A strong correlation was found between the aneurysmal and the corresponding venous IL-6 levels (ρ = 0.721; P<0.001). In the multiple logistic regression models, the poor 30-day mRS was significantly associated with high aneurysmal IL-6 level (OR, 17.97; 95% CI, 1.51–214.33; P = 0.022) and marginally associated with high venous IL-6 level (OR, 12.71; 95% CI, 0.90–180.35; P = 0.022) after adjusting for dichotomized age, GCS on day 0, and vasospasm and Fisher grades. Conclusions The plasma level of IL-6 is an independent prognostic biomarker that could be used to aid in the identification of patients at high-risk of poor neurological outcome after rupture of the intracranial aneurysm. PMID:26176774

  10. Clinical Features and Treatment of Distal Intracranial Aneurysms.

    PubMed

    Mou, Kejie; Zhou, Zheng; Yin, Jinbo; Yang, Hui; Liu, Jun

    2016-05-01

    To analyze the clinical characteristics, therapies, and outcomes of distal intracranial aneurysms, the authors retrospectively studied the clinical and imaging data of 18 patients with distal intracranial aneurysms. There were 10 males and 8 females, aged from 11 months to 59 years (mean, 40.4 ± 11.4 years). All patients were diagnosed by digital subtract angiography. Aneurysm locations were as follows: distal anterior cerebral artery (n = 5), distal middle cerebral artery (n = 2), distal posterior cerebral artery (n = 6), distal posterior inferior cerebellar artery (n = 3), distal anterior inferior cerebellar artery (n = 1), and distal superior cerebellar artery (n = 1). Endovascular embolization was performed on 16 patients, including coil embolization on 10 patients and embolization using Glubran 2 surgical glue on 6 patients, and 7 of the 16 patients also underwent parent artery occlusion. Aneurysms were all completely embolized at the first phase for these 16 patients. The other 2 patients underwent craniotomy with hematoma evacuation and complete aneurysm clipping. Postoperatively, 14 patients showed a good recovery, 2 patients had neurological deficits, 1 patient had seizures and was managed with drugs, 1 patient developed hydrocephalus, and a ventriculo-peritoneal shunt was performed. Follow-up angiographies showed no aneurysm recurrence. Clinical manifestations of distal intracranial aneurysms are varied. Their treatment should follow the principle of individual choice. Endovascular embolization is an effective way to treat distal intracranial aneurysms; and for those with intracranial hematoma, craniotomy with hematoma evacuation and aneurysm clipping may be a feasible treatment. PMID:26982109

  11. Morphological and Hemodynamic Analysis of Mirror Posterior Communicating Artery Aneurysms

    PubMed Central

    Wu, Xi; Wu, Yongfa; Jiang, Che; Wang, Shengzhang; Huang, Qinghai; Liu, Jianmin

    2013-01-01

    Background and Purpose Hemodynamic factors are commonly believed to play an important role in the pathogenesis, progression, and rupture of cerebral aneurysms. In this study, we aimed to identify significant hemodynamic and morphological parameters that discriminate intracranial aneurysm rupture status using 3-dimensional-angiography and computational fluid dynamics technology. Materials and Methods 3D-DSA was performed in 8 patients with mirror posterior communicating artery aneurysms (Pcom-MANs). Each pair was divided into ruptured and unruptured groups. Five morphological and three hemodynamic parameters were evaluated for significance with respect to rupture. Results The normalized mean wall shear stress (WSS) of the aneurysm sac in the ruptured group was significantly lower than that in the unruptured group (0.52±0.20 versus 0.81±0.21, P = .012). The percentage of the low WSS area in the ruptured group was higher than that in the unruptured group (4.11±4.66% versus 0.02±0.06%, P = .018). The AR was 1.04±0.21 in the ruptured group, which was significantly higher than 0.70±0.17 in the unruptured group (P = .012). By contrast, parameters that had no significant differences between the two groups were OSI (P = .674), aneurysm size (P = .327), size ratio (P = .779), vessel angle (P = 1.000) and aneurysm inclination angle (P = 1.000). Conclusions Pcom-MANs may be a useful disease model to investigate possible causes of aneurysm rupture. The ruptured aneurysms manifested lower WSS, higher percentage of low WSS area, and higher AR, compared with the unruptured one. And hemodynamics is as important as morphology in discriminating aneurysm rupture status. PMID:23383184

  12. Surgical clipping is still a good choice for the treatment of paraclinoid aneurysms.

    PubMed

    Pahl, Felix Hendrik; Oliveira, Matheus Fernandes de; Brock, Roger Schmidt; Lucio, José Erasmo Dal Col; Rotta, José Marcus

    2016-04-01

    Paraclinoid aneurysms are lesions located adjacent to the clinoid and ophthalmic segments of the internal carotid artery. In recent years, flow diverter stents have been introduced as a better endovascular technique for treatment of these aneurysms. Method From 2009 to 2014, a total of 43 paraclinoid aneurysms in 43 patients were surgically clipped. We retrospectively reviewed the records of these patients to analyze clinical outcomes. Results Twenty-six aneurysms (60.5%) were ophthalmic artery aneurysms, while 17 were superior hypophyseal artery aneurysms (39.5%). The extradural approach to the clinoid process was used to clip these aneurysms. One hundred percent of aneurysms were clipped (complete exclusion in 100% on follow-up angiography). The length of follow-up ranged from 1 to 60 months (mean, 29.82 months). Conclusion Surgical clipping continues to be a good option for the treatment of paraclinoid aneurysms. PMID:27097005

  13. Lattice Boltzmann Modeling of Thrombosis in Giant Aneurysms

    NASA Astrophysics Data System (ADS)

    Chopard, B.; Ouared, R.; Ruefenacht, D. A.; Yilmaz, H.

    We propose a numerical model of blood flow and blood clotting whose purpose is to describe thrombus formation in cerebral aneurysms. We identify possible mechanisms that can cause occurence of spontaneous thrombosis in unruptured giant intracranial aneurysms. Our main claim is that, under normal conditions, there is a low shear rate threshold below which thrombosis starts and growths. This assumption is supported by several evidences from literature. The proposed mechanisms are incorporated into a Lattice Boltzmann (LB) model for blood flow and platelets adhesion and aggregation. Numerical simulations show that the low shear rate threshold assumption together with aneurysm geometry account well for the observations.

  14. Multilocular True Ulnar Artery Aneurysm in a Pediatric Patient.

    PubMed

    Stalder, Mark W; Sanders, Christopher; Lago, Mary; Hilaire, Hugo St

    2016-01-01

    Ulnar artery aneurysms are an exceedingly rare entity in the pediatric population and have no consistent etiologic mechanism. We present the case of a 15-year-old male with a multilocular ulnar artery aneurysm in the setting of no antecedent history of trauma, no identifiable connective tissue disorders, and no other apparent etiological factors. Furthermore, the patient's arterial palmar arch system was absent. The aneurysm was resected, and arterial reconstruction was successfully performed via open surgical approach with cephalic vein interposition graft. We believe this treatment modality should be considered as the primary approach in all of these pediatric cases in consideration of the possible pitfalls of less comprehensive measures. PMID:27104094

  15. Variant PTA Terminating in Cerebellar Artery, Associated with Multiple Aneurysms

    PubMed Central

    Hwang, Yeong Uk

    2016-01-01

    Persistent trigeminal artery (PTA) is one of the remnant fetal anastomoses between the carotid artery and basilar artery. PTAs are classified according to angiographic appearance and various connection. Among them, those directly terminating in the cerebellar arteries are rare subtype. In addition, aneurysms of the PTA are unusual in the literature and have not previously accompanied this subtype of PTA connecting cerebellar artery. We present the first case of an aneurysm of the PTA which is directly terminating in the cerebellar arteries and combined with multiple aneurysms. PMID:27446623

  16. Variant PTA Terminating in Cerebellar Artery, Associated with Multiple Aneurysms.

    PubMed

    Hwang, Yeong Uk; Kim, Jin Woo

    2016-01-01

    Persistent trigeminal artery (PTA) is one of the remnant fetal anastomoses between the carotid artery and basilar artery. PTAs are classified according to angiographic appearance and various connection. Among them, those directly terminating in the cerebellar arteries are rare subtype. In addition, aneurysms of the PTA are unusual in the literature and have not previously accompanied this subtype of PTA connecting cerebellar artery. We present the first case of an aneurysm of the PTA which is directly terminating in the cerebellar arteries and combined with multiple aneurysms. PMID:27446623

  17. Percutaneous Endoluminal Bypass of Iliac Aneurysms with a Covered Stent

    SciTech Connect

    Ruebben, Alexander; Tettoni, Serena; Muratore, Pierluigi; Rossato, Dennis; Savio, Daniele; Rabbia, Claudio

    1998-07-15

    To evaluate the feasibility of percutaneous treatment of iliac aneurysms, a covered stent was inserted in nine men suffering from common iliac artery aneurysms (six cases), external iliac aneurysms (one case), or pseudoaneurysms (two cases). Placement of the stent was successful in all patients. In one patient, an endoprosthesis thrombosed after 15 days, but was successfully treated by thrombolysis and additional stent placement. At the follow-up examinations (mean period 22 months) all stent-grafts had remained patent. No late leakage or stenosis was observed.

  18. Ruptured ileocolic artery aneurysm: an unusual cause of hemoperitoneum.

    PubMed

    Siddiqui, Zakaur R; Yousif, Omer F; Halliday, Mark W; Hubaishah, Nasser A; Adam, Khalid A

    2012-01-01

    Ruptured aneurysm of a branch of ileocolic artery is a rare finding and is an unusual cause of haemoperitoneum. Rapid diagnosis, and surgical or endovascular intervention are necessary to avoid devastating consequences and high mortality rates following an emergency operation after rupture. Resection is a good choice for surgical intervention for some aneurysms that are not suitable for endovascular repair. This report describes the case of a middle-aged man with a ruptured superior mesenteric artery branch aneurysm and his subsequent surgical management. PMID:23006464

  19. Ruptured Ileocolic Artery Aneurysm: An Unusual Cause of Hemoperitoneum

    PubMed Central

    Siddiqui, Zakaur R.; Yousif, Omer F.; Halliday, Mark W.; Hubaishah, Nasser A.; Adam, Khalid A.

    2012-01-01

    Ruptured aneurysm of a branch of ileocolic artery is a rare finding and is an unusual cause of haemoperitoneum. Rapid diagnosis, and surgical or endovascular intervention are necessary to avoid devastating consequences and high mortality rates following an emergency operation after rupture. Resection is a good choice for surgical intervention for some aneurysms that are not suitable for endovascular repair. This report describes the case of a middle-aged man with a ruptured superior mesenteric artery branch aneurysm and his subsequent surgical management. PMID:23006464

  20. Endovascular coil embolization of unruptured posterior communicating artery aneurysm.

    PubMed

    Binning, Mandy; Hakma, Zakaria; Veznedaroglu, Erol

    2014-07-01

    The patient is a 60-year-old woman who presented to her primary care physician with new onset of headache. She was neurologically intact without cranial nerve deficit. An outpatient CT angiogram (CTA) revealed no subarachnoid hemorrhage, but showed a right-sided posterior communicating artery aneurysm measuring 11 mm by 10 mm. Digitally subtracted cerebral angiography confirmed these measurements and showed that the aneurysm was amenable to endovascular coil embolization. The patient underwent aneurysm coiling without complication and was discharged to home on postoperative Day 1. The video can be found here: http://youtu.be/MjOc3Zpv2K8 . PMID:24983726

  1. Huge Interatrial Septal Aneurysm: A Coincidental but Rather Fatal Finding

    PubMed Central

    Tzimas, Petros; Papadopoulos, Georgios

    2011-01-01

    We report the case of a patient with a huge interatrial septal aneurysm as an intraoperative coincidental finding that led to a fatal outcome. The patient was admitted to our hospital in order to undergo elective coronary artery bypass grafting because he suffered from severe coronary artery disease. We intraoperatively diagnosed by transesophageal echocardiography a huge interatrial septal aneurysm mimicking a right atrial tumor. The aneurysm was initially resected and then coronary artery bypass grafting was successfully performed but the patient never achieved a successful separation from cardiopulmonary bypass probably because of massive embolic events. PMID:21317987

  2. Aneurysm growth after late conversion of thoracic endovascular aortic repair

    PubMed Central

    Hayashi, Ichiro; Haijima, Norimasa

    2015-01-01

    A 69-year-old man underwent thoracic endovascular aortic repair of a descending aortic aneurysm. Three years later, he developed impending rupture due to aneurysmal expansion that included the proximal landing zone. Urgent open surgery was performed via lateral thoracotomy, and a Dacron graft was sewn to the previous stent graft distally with Teflon felt reinforcement. Postoperatively, four sequential computed tomography scans demonstrated that the aneurysm was additionally increasing in size probably due to continuous hematoma production, suggesting a possibility of endoleaks. This case demonstrates the importance of careful radiologic surveillance after endovascular repair, and also after partial open conversion. PMID:27489673

  3. Ruptured and unruptured mycotic superior mesenteric artery aneurysms.

    PubMed

    Sharma, Gaurav; Semel, Marcus E; McGillicuddy, Edward A; Ho, Karen J; Menard, Matthew T; Gates, Jonathan D

    2014-11-01

    Aneurysms of the superior mesenteric artery (SMA) and branches thereof are uncommon but have a high rate of rupture and mortality relative to other visceral artery aneurysms. Historically, the predominant etiology has been infectious; with a renewed rise in intravenous drug abuse rates in the last decade, we hypothesize a resurgence in septic embolic complications may occur in the coming years. Here, we describe the presentation and management of 2 cases of intravenous drug users presenting with infectious endocarditis and SMA main trunk and branch aneurysms, one of which was ruptured. In addition, we review the literature on these rare clinical entities. PMID:25017769

  4. Successful Exclusion of Subclavian Aneurysms with Covered Nitinol Stents

    SciTech Connect

    Szeimies, Ulrike; Kueffer, Georg; Stoeckelhuber, Beate; Steckmeier, Bernd

    1998-05-15

    Two cases of percutaneous endoluminal exclusion of a subclavian aneurysm with a Dacron-coated nitinol stent are presented. One subclavian aneurysm followed trauma; the other was due to thoracic outlet stenosis which was caused by a cervical rib. In both patients the aneurysm was excluded successfully. The follow-up periods were 22 and 14 months, respectively. Stenoses at the stent graft occurred in both patients; one was treated by balloon angioplasty. In selected patients, endoluminal grafting could be an alternative to surgery; however, stent graft designs need to be improved and long-term follow-up is awaited.

  5. Impending rupture in an aortic arch aneurysm by Candida infection.

    PubMed

    Minami, H; Wakita, N; Kawanishi, Y; Kitano, I; Sakata, M

    2001-03-01

    A 68-year-old man was hospitalized with the complaints of left back pain and fever. He had a history of using steroids to treat uveitis for about thirty years. Computed tomography on the chest demonstrated an impending rupture in an aortic arch aneurysm, which was consequently surgically excised. Candida albicans was identified in the wall of the aneurysm, so fluconazole and itraconazole were administered. The patient was discharged at 120 days after surgery without recrudescence of the candida. To our knowledge, this is the fifteenth case of a successfully treated aneurysm caused by candida infection. PMID:11305059

  6. Fahr's Syndrome Associated with Multiple Intracranial Aneurysms: A Case Report.

    PubMed

    Eroglu, Umit; Kahilogullari, Gökmen; Demirel, Altan; Arat, Anıl; Unlu, Agahan

    2016-01-01

    Fahr's Syndrome is characterized by the presence of intracerebral, bilateral and symmetrical calcifications located in bilateral basal ganglia, thalamus, and cerebellum. The etiology is not exactly known. The authors reported a very rare case who had Fahr's Syndrome and intracerebral aneurysms simultaneously. The patient was female and presented with headache. Her examinations revealed aneurysms on the middle cerebral artery, internal carotid artery and ophthalmic artery. That is the first case reported in the literature having multiple intracranial aneurysms and Fahr's Syndrome together. PMID:27400114

  7. Giant aortic aneurysm in a child with Takayasu arteritis.

    PubMed

    Halaweish, Ihab; Patel, Himanshu; Si, Ming-Sing

    2016-03-01

    Takayasu arteritis is a chronic, idiopathic, granulomatous vasculitis involving the aorta, its major branches, and occasionally the pulmonary arteries. Although rare in children, it is the third most common vasculitis in the paediatric population. Although aneurysmal disease has been reported in adults with Takayasu arteritis, it is a rare entity in children. We present the case of a 10-year-old boy with a giant ascending and arch aneurysm that necessitated follow-up surgery for a new aneurysm and occlusive disease. This is also the first published case involving endovascular aortic graft placement for the management of vascular sequela of Takayasu arteritis in a child. PMID:26365418

  8. Aneurysmal Neck Clipping as the Primary Treatment Option for Both Ruptured and Unruptured Middle Cerebral Artery Aneurysms

    PubMed Central

    Choi, Jai Ho; Park, Jung Eon; Kim, Myeong Jin; Kim, Bum Su

    2016-01-01

    Objective Although middle cerebral artery (MCA) aneurysms are less amenable to coil embolization, an increasing number of studies support favorable endovascular treatment for them. The purpose of this study is to compare the outcomes of two different treatments (surgery versus coiling) and evaluate the benefits of surgical clipping for MCA aneurysms. Methods Here we retrospectively analyzed the outcomes of 178 ruptured and unruptured MCA aneurysms treated in patients between September 2008 and April 2012. Parameters assessing treatment outcomes include degree of aneurysm occlusion, presence of regrowth, clinical status, and complications. Results Among 178 MCA aneurysms, 153 were treated surgically. After a mean follow-up of 12 months, the surgery group showed a clinically significant complete occlusion rate (98%) compared with the coiling group (56%) (p<0.001). Follow-up radiologic evaluation showed a higher regrowth rate (four of 16 cases) in the coiling group than in the surgery group (one of 49 cases) (p=0.003). There was no statistically significant difference in favorable clinical outcome rate between the two groups. The procedure-related permanent morbidity and mortality rates were 2% (three of 153 cases) in the surgery group and 0% (0 of 25 cases) in the coiling group. Conclusion Compared to endovascular treatment, surgical neck clipping for both ruptured and unruptured MCA aneurysms results in a significantly higher complete obliteration rate and less regrowth. Therefore, even in this endovascular era, we still recommend surgical clipping as the primary treatment option for MCA aneurysms rather than coil embolization. PMID:27226859

  9. True Aneurysm of the Proximal Brachial Artery

    PubMed Central

    Ramakrishna, Pinjala; Mahapatra, Sandeep; Rajesh, Ratna

    2013-01-01

    A 35-year-old farmer presented with complaints of pain in the right upper limb for 1 month and bluish discoloration of the right-hand finger tips with tingling and numbness. He sustained injury to the right upper limb while lifting a heavy object 1 mo previously. There was an ovoid swelling of 4 × 2 cm on the medial aspect of the right arm, 12 cm above the medial epicondyle at the level of the armpit with visible pulsations. There was distal neurovascular deficit. Duplex scan of the right upper limb arterial system revealed a pseudoaneurysm of the proximal right brachial artery, with dampened monophasic flow in the ulnar artery and no flow in the radial artery. Spiral computed tomography angiogram showed the presence of an echogenic periarterial lesion in the proximal brachial artery suggestive of pseudoaneurysm or an extrinsic compression by hematoma. Distal brachial artery was found to have filled with thrombus, with non-opacification of the radial and the distal ulnar artery. The patient was posted for excision of the aneurysmal arterial segment. A 5-cm-long reversed segment of vein graft was interposed in between the cut ends of the brachial artery. Histopathology: Specimen shows a part of the vessel wall composed of intimal, medial, and adventitial layers with intraluminal thrombus showing evidence of recanalization suggestive of true aneurysm of the brachial artery. PMID:26798692

  10. Molecular Imaging of Experimental Abdominal Aortic Aneurysms

    PubMed Central

    Ramaswamy, Aneesh K.; Hamilton, Mark; Joshi, Rucha V.; Kline, Benjamin P.; Li, Rui; Wang, Pu; Goergen, Craig J.

    2013-01-01

    Current laboratory research in the field of abdominal aortic aneurysm (AAA) disease often utilizes small animal experimental models induced by genetic manipulation or chemical application. This has led to the use and development of multiple high-resolution molecular imaging modalities capable of tracking disease progression, quantifying the role of inflammation, and evaluating the effects of potential therapeutics. In vivo imaging reduces the number of research animals used, provides molecular and cellular information, and allows for longitudinal studies, a necessity when tracking vessel expansion in a single animal. This review outlines developments of both established and emerging molecular imaging techniques used to study AAA disease. Beyond the typical modalities used for anatomical imaging, which include ultrasound (US) and computed tomography (CT), previous molecular imaging efforts have used magnetic resonance (MR), near-infrared fluorescence (NIRF), bioluminescence, single-photon emission computed tomography (SPECT), and positron emission tomography (PET). Mouse and rat AAA models will hopefully provide insight into potential disease mechanisms, and the development of advanced molecular imaging techniques, if clinically useful, may have translational potential. These efforts could help improve the management of aneurysms and better evaluate the therapeutic potential of new treatments for human AAA disease. PMID:23737735

  11. Endovascular Management of Thoracic Aortic Aneurysms

    SciTech Connect

    Fattori, Rossella Russo, Vincenzo; Lovato, Luigi; Buttazzi, Katia; Rinaldi, Giovanni

    2011-12-15

    The overall survival of patients with thoracic aortic aneurysm (TAA) has improved significantly in the past few years. Endovascular treatment, proposed as an alternative to surgery, has been considered a therapeutic innovation because of its low degree of invasiveness, which allows the treatment of even high-surgical risk patients with limited complications and mortality. A major limitation is the lack of adequate evidence regarding long-term benefit and durability because follow-up has been limited to just a few years even in the largest series. The combination of endovascular exclusion with visceral branch revascularization for the treatment of thoraco-abdominal aortic aneurysms involving the visceral aorta has also been attempted. As an alternative, endografts with branches represent a technological evolution that allows treatment of complex anatomy. Even if only small numbers of patients and short follow-up are available, this technical approach, which has with limited mortality (<10%) and paraplegia rates, to expand endovascular treatment to TAA seems feasible. With improved capability to recognize proper anatomy and select clinical candidates, the choice of endovascular stent-graft placement may offer a strategy to optimize management and improve prognosis.

  12. MicroRNAs in Abdominal Aortic Aneurysm.

    PubMed

    Adam, Matti; Raaz, Uwe; Spin, Joshua M; Tsao, Philip S

    2015-01-01

    Abdominal aortic aneurysms (AAA) are an important source of morbidity and mortality in the U.S. and worldwide. Treatment options are limited, with open surgery or endovascular repair remaining the only curative treatments. Classical cardiovascular medications have generally failed to prevent or significantly alter AAA formation or progression. Therefore, there is a tremendous need for better therapeutic approaches. With increasing knowledge of microRNA (miR) regulation in the context of cardiovascular disease, and with improving technical options permitting alteration of miRexpression levels in vitro and in vivo, we are offered a glimpse into the diagnostic and therapeutic possibilities of using miRs to treat vascular pathobiology. This review focuses on the role of miRs in aneurysmal disease of the abdominal aorta, summarizing recent publications regarding this topic, and outlining known effects of relevant miRs in AAA formation, including miR-21 and miR-29b. Despite there being only limited studies available, several other miRs also display clear potential for alteration of the disease process including miR-26a, the miR-17-92-cluster, miRs-221/222, miR-133 and miR-146a. While studies have shown that miRs can regulate the activity and interplay of vascular inflammatory cells, endothelial cells, smooth muscle cells and fibroblasts, all key elements leading to AAA formation, much work remains to be done. PMID:23713862

  13. Ruptured aneurysms of sinuses of Valsalva

    PubMed Central

    Jugdutt, B. I.; Fraser, R. S.; Rossall, R. E.; Lee, S. J. K.

    1974-01-01

    At least one additional cardiac lesion was present in 18 consecutive patients with ruptured aneurysms of the sinuses of Valsalva who were investigated between 1956 and 1973 at the University of Alberta Hospital. Clinical diagnosis was made in 78% (14/18) of the patients. Confirmation at cardiac catheterization, operation or autopsy was obtained in all but one. The main sites of rupture were the right ventricle (seven cases), right atrium (five) and left ventricle (five). Fifty percent (9/18) are alive and well following prompt operative repair, an average of 8.2 years later (range, six months to 15 years). Replacement of the aortic valve was associated with a high mortality (50% early, 13% late, total 63%) which could be explained by the higher operative risk in this group of very ill patients. Eight patients (44.4%) had had bacterial endocarditis prior to presentation and this may have played a significant role in the rupture of the sinus of Valsalva aneurysm. ImagesFIG. 4FIG. 5 PMID:4278257

  14. Arterial reconstruction for atypical mycotic aneurysms.

    PubMed

    Malinowski, Michael J; Halandras, Pegge

    2013-01-01

    Our case involves a 67-year-old man with a  post lung transplantation status for idiopathic pulmonary fibrosis, who was initially referred to our institution for treatment of left hip septic arthritis due to Pseudallescheria boydii infection. One month following total hip arthroplasty, he noticed left upper thigh swelling with duplex imaging consistent with a 7-cm mid-superficial femoral artery aneurysm with popliteal vein compression and associated deep venous thrombosis. During operative resection, exploration of his contralateral saphenous vein showed inadequate conduit for use. Therefore, we proceeded with proximal and distal clamp control with intraoperative arterial shunting followed by cryoarterial reconstruction after complete aneurysm sac resection and debridement. Intraoperative arterial wall cultures remained negative for bacterial pathogens; however, final operative fungal cultures once again grew Pseudallescheria boydii. Our case highlights the complexity of adequate source control with effective arterial reconstruction in these immunosuppressed patient populations, particularly with fungal organisms that historically have poor therapeutic response to medical therapy alone. PMID:23047819

  15. Aneurysm in a Large Sporadic Renal Angiomyolipoma

    PubMed Central

    Al Omran, Bedoor; Ansari, Naseem

    2016-01-01

    Angiomyolipomas (AMLs) are the most common mesenchymal renal neoplasms and are classified as neoplasms of perivascular epithelioid cells (PEComa). AML is usually a benign neoplasm arising most often in the kidney although it has been described in a wide variety of sites. Most patients are adults, and one-third suffer from tuberous sclerosis. We describe a case of renal AML in a 54-year-old Bahraini woman who presented to the Bahrain Defence Force Hospital with right flank pain and hematuria, and who was known to have rheumatoid arthritis but had no cutaneous or other stigmata of tuberous sclerosis. It is the largest AML reported in Bahrain and is also striking for the fact that it contained an intratumoral aneurysm that ruptured causing symptoms leading to the radiological diagnosis of renal mass. Furthermore, the occurrence of an aneurysm in sporadic AML, as in our case, is rare since the large majority tend to be seen in association with tuberous sclerosis. PMID:27162594

  16. An unusual combination of a tuberculous aneurysm of the thoracic aorta and a degenerative aneurysm of the infrarenal abdominal aorta.

    PubMed

    Avaro, Jean-Philippe; Amabile, Philippe; Paule, Philippe; Peloni, Jean-Michel; Piquet, Philippe

    2011-07-01

    Tuberculous aneurysms of the aorta are rare and give rise to various issues related to their diagnosis and treatment. In this article, we report on an exceptional case concerning a patient who presented with a false tuberculous aneurysm of the thoracic aorta and a degenerative aneurysm of the infrarenal abdominal aorta concomitantly. A discussion on how we approached the diagnosis and devised a therapeutic strategy that allowed us to treat this dual aortic disease effectively has also been provided. The discussion includes details of the order of treatment and the choice between an endovascular and a surgical approach. PMID:21724110

  17. Endovascular Treatment of Multiple HIV-related Aneurysms Using Multilayer Stents

    SciTech Connect

    Euringer, Wulf; Suedkamp, Michael; Rylski, Bartosz; Blanke, Philipp

    2012-08-15

    Complex peripheral aneurysm anatomy with major artery branches in the immediate vicinity and mycotic aneurysm often impede endovascular management using covered stent grafts. The Cardiatis Multilayer Stent (Cardiatis, Isnes, Belgium) is a recently approved innovative stent system for peripheral aneurysm management. Its multilayer design aims at decreasing mean velocity and vorticity within the aneurysm sac to cause thrombus formation while maintaining patency of branching vessels due to laminar flow. We present a case of bilateral subclavian artery aneurysms and perivisceral aortic aneurysms in an AIDS patient successfully treated with the Cardiatis Multilayer Stent at 18 months' follow-up.

  18. Bilateral Giant Coronary Artery Aneurysms Complicated by Acute Coronary Syndrome and Cardiogenic Shock.

    PubMed

    Chiu, Peter; Lynch, Donald; Jahanayar, Jama; Rogers, Ian S; Tremmel, Jennifer; Boyd, Jack

    2016-04-01

    Giant coronary aneurysms are rare. We present a 25-year-old woman with a known history of non-Kawasaki/nonatherosclerotic bilateral coronary aneurysms. She was transferred to our facility with acute coronary syndrome complicated by cardiogenic shock. Angiography demonstrated giant bilateral coronary aneurysms and complete occlusion of the left anterior descending (LAD) artery. Emergent coronary artery bypass grafting was performed. Coronary artery bypass grafting is the preferred approach for addressing giant coronary aneurysms. Intervention on the aneurysm varies in the literature. Aggressive revascularization is recommended in the non-Kawasaki/nonatherosclerotic aneurysm patient, and ligation should be performed in patients with thromboembolic phenomena. PMID:27000621

  19. Cerebral aneurysms: relations between geometry, hemodynamics and aneurysm location in the cerebral vasculature

    NASA Astrophysics Data System (ADS)

    Passerini, Tiziano; Veneziani, Alessandro; Sangalli, Laura; Secchi, Piercesare; Vantini, Simone

    2010-11-01

    In cerebral blood circulation, the interplay of arterial geometrical features and flow dynamics is thought to play a significant role in the development of aneurysms. In the framework of the Aneurisk project, patient-specific morphology reconstructions were conducted with the open-source software VMTK (www.vmtk.org) on a set of computational angiography images provided by Ospedale Niguarda (Milano, Italy). Computational fluid dynamics (CFD) simulations were performed with a software based on the library LifeV (www.lifev.org). The joint statistical analysis of geometries and simulations highlights the possible association of certain spatial patterns of radius, curvature and shear load along the Internal Carotid Artery (ICA) with the presence, position and previous event of rupture of an aneurysm in the entire cerebral vasculature. Moreover, some possible landmarks are identified to be monitored for the assessment of a Potential Rupture Risk Index.

  20. Synchronous colorectal malignancy and abdominal aortic aneurysm treated with endovascular aneurysm repair followed by laparoscopic colectomy.

    PubMed

    Kawai, Kazushige; Sunami, Eiji; Tanaka, Junichiro; Tanaka, Toshiaki; Kiyomatsu, Tomomichi; Nozawa, Hiroaki; Kazama, Shinsuke; Kanazawa, Takamitsu; Hosaka, Akihiro; Ishihara, Soichiro; Yamaguchi, Hironori; Shigematsu, Kunihiro; Watanabe, Toshiaki

    2015-04-01

    Although the incidence of synchronous abdominal aortic aneurysm (AAA) and malignancies is increasing, there has been no clear consensus in the surgical treatment of such patients. The focus on surgical treatments with minimal invasiveness, such as endovascular aneurysm repair (EVAR) for AAA and laparoscopic colectomy for colorectal cancer, has increased; however, the clinical applicability of combination treatment with EVAR and laparoscopic colectomy has not been established. A 61-year-old man was diagnosed with AAA, advanced sigmoid colon cancer, and coronary artery stenosis. Because the patient also had chronic renal failure with nephrotic syndrome, among several other comorbidities, surgery was considered to be associated with high risks in this patent. Sequential treatments with percutaneous coronary intervention, EVAR, and laparoscopic colectomy were successfully performed. Staged treatment of EVAR followed by laparoscopic colectomy may be a promising strategy for high-risk patients with AAA associated with malignancy. PMID:25875539

  1. Synchronous Colorectal Malignancy and Abdominal Aortic Aneurysm Treated With Endovascular Aneurysm Repair Followed by Laparoscopic Colectomy

    PubMed Central

    Kawai, Kazushige; Sunami, Eiji; Tanaka, Junichiro; Tanaka, Toshiaki; Kiyomatsu, Tomomichi; Nozawa, Hiroaki; Kazama, Shinsuke; Kanazawa, Takamitsu; Hosaka, Akihiro; Ishihara, Soichiro; Yamaguchi, Hironori; Shigematsu, Kunihiro; Watanabe, Toshiaki

    2015-01-01

    Although the incidence of synchronous abdominal aortic aneurysm (AAA) and malignancies is increasing, there has been no clear consensus in the surgical treatment of such patients. The focus on surgical treatments with minimal invasiveness, such as endovascular aneurysm repair (EVAR) for AAA and laparoscopic colectomy for colorectal cancer, has increased; however, the clinical applicability of combination treatment with EVAR and laparoscopic colectomy has not been established. A 61-year-old man was diagnosed with AAA, advanced sigmoid colon cancer, and coronary artery stenosis. Because the patient also had chronic renal failure with nephrotic syndrome, among several other comorbidities, surgery was considered to be associated with high risks in this patent. Sequential treatments with percutaneous coronary intervention, EVAR, and laparoscopic colectomy were successfully performed. Staged treatment of EVAR followed by laparoscopic colectomy may be a promising strategy for high-risk patients with AAA associated with malignancy. PMID:25875539

  2. [ANEURYSMAL TYPE RENAL ARTERIOVENOUS FISTULA WITH GIANT VENOUS ANEURYSM, MIMICKING RENAL CELL CARCINOMA: A CASE REPORT].

    PubMed

    Nagumo, Yoshiyuki; Komori, Hiroka; Rii, Jyunryo; Ochi, Atsuhiko; Suzuki, Koichiro; Shiga, Naoki; Ota, Tomonori

    2015-04-01

    A 39-year-old man was referred to our clinic for a 7 cm tumor in the right kidney, found by simple CT scan. It was suspected as renal cell carcinoma accompanying tumor emboli in the inferior vena cava by enhanced CT scan. For further evaluation of the tumor emboli, color Doppler ultrasound and enhanced MRI was performed. They showed a large cystic lesion with high velocity turbulent flow and flow voids in T2-weighted imaging, it seemed as giant venous aneurysm of the right renal vein. Subsequently, angiography revealed aneurysmal type renal arteriovenous fistula (AVF), transarterial embolization (TAE) of the arterial feeder with coils was performed on the same day. After 6 months from embolization, there was no recurrences or reinterventions. Color Doppler ultrasound and MRI are beneficial in distinguishing vascular disease from neoplastic disease which may sometimes mimick in other diagnostic imaging studies. In addition TAE seems to be an effective treatment for the AVF. PMID:26415363

  3. Staged Management of a Ruptured Internal Mammary Artery Aneurysm

    PubMed Central

    Kwon, O Young; Kim, Gun Jik; Oh, Tak Hyuk; Lee, Young Ok; Lee, Sang Cjeol; Cho, Jun Yong

    2016-01-01

    The rupture of an internal mammary artery (IMA) aneurysm in a patient with type 1 neurofibromatosis (NF-1) is a rare but life-threatening complication requiring emergency management. A 50-year-old man with NF-1 was transferred to the emergency department of Kyungpook National University Hospital, where an IMA aneurysmal rupture and hemothorax were diagnosed and drained. The IMA aneurysmal rupture and hemothorax were successfully repaired by staged management combining endovascular treatment and subsequent video-assisted thoracoscopic surgery (VATS). The patient required cardiopulmonary cerebral resuscitation, the staged management of coil embolization, and a subsequent VATS procedure. This staged approach may be an effective therapeutic strategy in cases of IMA aneurysmal rupture. PMID:27066438

  4. Gastrointestinal bleeding and obstructive jaundice: Think of hepatic artery aneurysm

    PubMed Central

    Vultaggio, Fabrice; Morère, Pierre-Henri; Constantin, Christophe; Christodoulou, Michel; Roulin, Didier

    2016-01-01

    Hemobilia is an uncommon and potential life-threatening condition mainly due to hepato-biliary tree traumatic or iatrogenic injuries. Spontaneously ruptured aneurysm of the hepatic artery is seldom described. We report the case of an 89-year-old woman presenting with abdominal pain, jaundice and gastrointestinal bleeding, whose ultrasound and computed tomography revealed a non-traumatic, spontaneous aneurysm of the right hepatic artery. The oeso-gastro-duodenoscopy and colonoscopy did not reveal any bleeding at the ampulla of Vater, nor anywhere else. Selective angiography confirmed the diagnosis of hepatic artery aneurysm and revealed a full hepatic artery originating from the superior mesenteric artery. The patient was successfully treated by selective embolization of microcoils. We discuss the etiologies of hemobilia and its treatment with selective embolization, which remains favored over surgical treatment. Although aneurysm of the hepatic artery is rare, especially without trauma, a high index of suspicion is needed in order to ensure appropriate treatment. PMID:27358680

  5. Anesthetic considerations for endovascular abdominal aortic aneurysm repair

    PubMed Central

    Kothandan, Harikrishnan; Haw Chieh, Geoffrey Liew; Khan, Shariq Ali; Karthekeyan, Ranjith Baskar; Sharad, Shah Shitalkumar

    2016-01-01

    Aneurysm is defined as a localized and permanent dilatation with an increase in normal diameter by more than 50%. It is more common in males and can affect up to 8% of elderly men. Smoking is the greatest risk factor for abdominal aortic aneurysm (AAA) and other risk factors include hypertension, hyperlipidemia, family history of aneurysms, inflammatory vasculitis, and trauma. Endovascular Aneurysm Repair [EVAR] is a common procedure performed for AAA, because of its minimal invasiveness as compared with open surgical repair. Patients undergoing EVAR have a greater incidence of major co-morbidities and should undergo comprehensive preoperative assessment and optimization within the multidisciplinary settings. In majority of cases, EVAR is extremely well-tolerated. The aim of this article is to outline the Anesthetic considerations related to EVAR. PMID:26750684

  6. Vortex dynamics in ruptured and unruptured intracranial aneurysms

    NASA Astrophysics Data System (ADS)

    Trylesinski, Gabriel

    Intracranial aneurysms (IAs) are a potentially devastating pathological dilation of brain arteries that affect 1.5-5 % of the population. Causing around 500 000 deaths per year worldwide, their detection and treatment to prevent rupture is critical. Multiple recent studies have tried to find a hemodynamics predictor of aneurysm rupture, but concluded with distinct opposite trends using Wall Shear Stress (WSS) based parameters in different clinical datasets. Nevertheless, several research groups tend to converge for now on the fact that the flow patterns and flow dynamics of the ruptured aneurysms are complex and unstable. Following this idea, we investigated the vortex properties of both unruptured and ruptured cerebral aneurysms. A brief comparison of two Eulerian vortex visualization methods (Q-criterion and lambda 2 method) showed that these approaches gave similar results in our complex aneurysm geometries. We were then able to apply either one of them to a large dataset of 74 patient specific cases of intracranial aneurysms. Those real cases were obtained by 3D angiography, numerical reconstruction of the geometry, and then pulsatile CFD simulation before post-processing with the mentioned vortex visualization tools. First we tested the two Eulerian methods on a few cases to verify their implementation we made as well as compare them with each other. After that, the Q-criterion was selected as method of choice for its more obvious physical meaning (it shows the balance between two characteristics of the flow, its swirling and deformation). Using iso-surfaces of Q, we started by categorizing the patient-specific aneurysms based on the gross topology of the aneurysmal vortices. This approach being unfruitful, we found a new vortex-based characteristic property of ruptured aneurysms to stratify the rupture risk of IAs that we called the Wall-Kissing Vortices, or WKV. We observed that most ruptured aneurysms had a large amount of WKV, which appears to agree with

  7. Gastrointestinal bleeding and obstructive jaundice: Think of hepatic artery aneurysm.

    PubMed

    Vultaggio, Fabrice; Morère, Pierre-Henri; Constantin, Christophe; Christodoulou, Michel; Roulin, Didier

    2016-06-27

    Hemobilia is an uncommon and potential life-threatening condition mainly due to hepato-biliary tree traumatic or iatrogenic injuries. Spontaneously ruptured aneurysm of the hepatic artery is seldom described. We report the case of an 89-year-old woman presenting with abdominal pain, jaundice and gastrointestinal bleeding, whose ultrasound and computed tomography revealed a non-traumatic, spontaneous aneurysm of the right hepatic artery. The oeso-gastro-duodenoscopy and colonoscopy did not reveal any bleeding at the ampulla of Vater, nor anywhere else. Selective angiography confirmed the diagnosis of hepatic artery aneurysm and revealed a full hepatic artery originating from the superior mesenteric artery. The patient was successfully treated by selective embolization of microcoils. We discuss the etiologies of hemobilia and its treatment with selective embolization, which remains favored over surgical treatment. Although aneurysm of the hepatic artery is rare, especially without trauma, a high index of suspicion is needed in order to ensure appropriate treatment. PMID:27358680

  8. Staged Management of a Ruptured Internal Mammary Artery Aneurysm.

    PubMed

    Kwon, O Young; Kim, Gun Jik; Oh, Tak Hyuk; Lee, Young Ok; Lee, Sang Cjeol; Cho, Jun Yong

    2016-04-01

    The rupture of an internal mammary artery (IMA) aneurysm in a patient with type 1 neurofibromatosis (NF-1) is a rare but life-threatening complication requiring emergency management. A 50-year-old man with NF-1 was transferred to the emergency department of Kyungpook National University Hospital, where an IMA aneurysmal rupture and hemothorax were diagnosed and drained. The IMA aneurysmal rupture and hemothorax were successfully repaired by staged management combining endovascular treatment and subsequent video-assisted thoracoscopic surgery (VATS). The patient required cardiopulmonary cerebral resuscitation, the staged management of coil embolization, and a subsequent VATS procedure. This staged approach may be an effective therapeutic strategy in cases of IMA aneurysmal rupture. PMID:27066438

  9. Relationship between Postmenopausal Estrogen Deficiency and Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    Tabuchi, Sadaharu

    2015-01-01

    Aneurysmal subarachnoid hemorrhage (SAH) is one of the most severe forms of stroke, which results from the rupture of a cerebral aneurysm. SAH is the only type of stroke with a female predominance, suggesting that reproductive factors may play a significant role in the etiology. Estrogen has important effects on vascular physiology and pathophysiology of cerebral aneurysm and SAH and, thus, potential therapeutic implications. There have been growing bodies of epidemiological and experimental studies which support the hypothesis of a significant relationship between estrogen deficiency and cerebral aneurysm formation with subsequent SAH. This hypothesis is the focus of this review as well as possible pathology-based therapeutics with regard to aspects of molecular pathophysiology, especially related to women's health. PMID:26538819

  10. Portal vein aneurysm demonstrated by blood pool SPECT.

    PubMed

    Fukui, H; Kashiwagi, T; Kimura, K; Goto, M; Takei, Y; Kasahara, A; Kawano, S; Fusamoto, H; Kozuka, T; Kamada, T

    1992-11-01

    Portal vein aneurysms are rare and are occasionally suggested by ultrasound and usually confirmed by invasive angiography. Such a case was diagnosed by scintigraphic studies, most importantly blood pool SPECT, which clearly separates it from hepatic cysts. PMID:1424375

  11. Left ventricular pseudoaneurysm versus aneurysm a diagnosis dilemma

    PubMed Central

    Bisoyi, Samarjit; Dash, Anjan K.; Nayak, Debashish; Sahoo, Satyajit; Mohapatra, Raghunath

    2016-01-01

    Free wall rupture of the left ventricle (LV) is a rare but life-threatening complication of acute myocardial infaction. Very rarely such rupture may be contained by the adhering pericardium creating a pseudoaneurysm. This condition warrants for an emergency surgery. Left ventricular aneurysm is the discrete thinning of the ventricular wall (<5 mm) with akinetic or dyskinetic wall motion causing an out-pouching of the ventricle. Given the propensity for pseudoaneurysms to rupture leading to cardiac tamponade, shock, and death, compared with a more benign natural history for true aneurysms, accurate diagnosis of these conditions is important. True aneurysm, usually, calls for an elective surgery. Clinically differentiating the two conditions remains a challenge. We report the case of a patient with LV pseudoaneurysm, initially diagnosed as true aneurysm at our institution. We have attempted to review the existing literature and discussed the characteristic findings of each entity. PMID:26750696

  12. Bilateral anterior cerebral artery aneurysm due to mucormycosis.

    PubMed

    Kasliwal, Manish K; Reddy, Vemuru Sunil K; Sinha, Sumit; Sharma, Bhawani S; Das, Prasenjit; Suri, Vaishali

    2009-01-01

    True mycotic aneurysms are extremely rare cerebrovascular lesions with a dismal prognosis. They mostly follow fungal meningitis or septicaemia and herald their presence with the development of subarachnoid haemorrhage. The authors report an extremely rare occurrence of bilateral anterior cerebral artery aneurysms caused by mucormycosis. The infection was diagnosed after investigation of prolonged fever following transsphenoidal surgery. The aneurysm was diagnosed after a subarachnoid haemorrhage and the patient finally died. The present case highlights an atypical presentation of fungal infection that can perplex the best of clinicians and thus delay diagnosis. As subarachnoid haemorrhage due to true mycotic aneurysmal rupture is uniformly associated with a fatal outcome, the authors speculate that a high index of suspicion should be maintained when a neurosurgical patient is predisposed to fungal infection. This approach, combined with the empirical institution of antifungal drugs, provides the only chance of survival. PMID:19013802

  13. MicroRNAs, fibrotic remodeling, and aortic aneurysms.

    PubMed

    Milewicz, Dianna M

    2012-02-01

    Aortic aneurysms are a common clinical condition that can cause death due to aortic dissection or rupture. The association between aortic aneurysm pathogenesis and altered TGF-β signaling has been the subject of numerous investigations. Recently, a TGF-β-responsive microRNA (miR), miR-29, has been identified to play a role in cellular phenotypic modulation during aortic development and aging. In this issue of JCI, Maegdefessel and colleagues demonstrate that decreasing the levels of miR-29b in the aortic wall can attenuate aortic aneurysm progression in two different mouse models of abdominal aortic aneurysms. This study highlights the relevance of miR-29b in aortic disease but also raises questions about its specific role. PMID:22269322

  14. Suggested Connections between Risk Factors of Intracranial Aneurysms: A Review

    PubMed Central

    Cebral, Juan R.; Raschi, Marcelo

    2013-01-01

    The purpose of this article is to review studies of aneurysm risk factors and the suggested hypotheses that connect the different risk factors and the underlying mechanisms governing the aneurysm natural history. The result of this work suggests that at the center of aneurysm evolution there is a cycle of wall degeneration and weakening in response to changing hemodynamic loading and biomechanic stress. This progressive wall degradation drives the geometrical evolution of the aneurysm until it stabilizes or ruptures. Risk factors such as location, genetics, smoking, co-morbidities, and hypertension seem to affect different components of this cycle. However, details of these interactions or their relative importance are still not clearly understood. PMID:23242844

  15. Spondylodiscitis and an aortic aneurysm due to Campylobacter coli.

    PubMed

    Lemaire, Xavier; Dehecq, Caroline; Cattoen, Christian; Garnier, Laurence Destrieux; Bournet, Béatrice Sarraz; Yazdanpanah, Yazdan; Senneville, Eric

    2010-01-01

    Campylobacter coli is a rare cause of bacteremia. We report here the first case of C.coli spondylodiscitis complicated by an aortic aneurysm. Outcome was favourable with surgery and antibiotic therapy. PMID:20132561

  16. CT of ruptured aneurysm of aberrant right subclavian artery.

    PubMed

    Vega, A; Ortíz, A; Longo, J M; Pagola, M A

    1987-01-01

    This paper presents the first description of a ruptured aneurysm of an aberrant right subclavian artery. CT clearly demonstrated the vascular malformation as well as the existence of a bilateral hemothorax. PMID:3102065

  17. Patients with abdominal aortic aneurysm have a high prevalence of popliteal artery aneurysms.

    PubMed

    Tuveson, Viktoria; Löfdahl, Hedvig E; Hultgren, Rebecka

    2016-08-01

    Patients with abdominal aortic aneurysms (AAA) are more prone to develop popliteal artery aneurysms (PAA), but the prevalence is not well known. Our aim was to investigate the prevalence of PAA in patients with AAA, and to determine whether a certain risk factor profile is more commonly found in patients with concurrent aneurysms. All AAA patients (ICD code I71.3, I71.4) attending the outpatient clinic at the Karolinska University Hospital between 2011 and 2013 were included in the study cohort (n=465); 48% (225) had been subjected to an ultrasound or computed tomography scan of their popliteal arteries. In these patients, three definitions of PAA were considered (⩾ 10.5, ⩾ 12, ⩾ 15 mm), although the overall analysis is based on PAA ⩾ 12 mm. The mean age was 70.7 years (SD 7.5), 89% were men, and the mean AAA diameter was 47 mm (SD 14). The prevalence of PAA was 19% (n=43) by definition ⩾ 12 mm, and 11% (n=25) with 15 mm. Claudication was more frequently found in AAA patients with PAA than patients without PAA. Sensitivity between clinical examination and radiology was 26%, and the specificity for clinical examination was 90%. In conclusion, owing to the high prevalence of PAA in AAA patients, described by us and others, the low cost and risks associated with ultrasound and the poor sensitivity at clinical examination, all women and men with AAA should undergo one radiological examination of their popliteal arteries. PMID:27216869

  18. Expression of fibrinolytic genes in atherosclerotic abdominal aortic aneurysm wall. A possible mechanism for aneurysm expansion.

    PubMed Central

    Schneiderman, J; Bordin, G M; Engelberg, I; Adar, R; Seiffert, D; Thinnes, T; Bernstein, E F; Dilley, R B; Loskutoff, D J

    1995-01-01

    Expansion of atherosclerotic abdominal aortic aneurysm (AAA) has been attributed to remodeling of the extracellular matrix by active proteolysis. We used in situ hybridization to analyze the expression of fibrinolytic genes in aneurysm wall from eight AAA patients. All specimens exhibited specific areas of inflammatory infiltrates with macrophage-like cells expressing urokinase-type plasminogen activator (u-PA) and tissue-type PA (t-PA) mRNA. Type 1 PA inhibitor (PAI-1) mRNA was expressed at the base of the necrotic atheroma of all specimens and also within some of the inflammatory infiltrates where it frequently colocalized in regions containing u-PA and t-PA mRNA expressing cells. However, in these areas, the cellular distribution of the transcripts for t-PA and u-PA extended far beyond the areas of PAI-1 expression. These observations suggest a local ongoing proteolytic process, one which is only partially counteracted by the more restricted expression of PAI-1 mRNA. An abundance of capillaries was also obvious in all inflammatory infiltrates and may reflect local angiogenesis in response to active pericellular fibrinolysis. The increased fibrinolytic capacity in AAA wall may promote angiogenesis and contribute to local proteolytic degradation of the aortic wall leading to physical weakening and active expansion of the aneurysm. Images PMID:7615837

  19. Considerations for patients undergoing endovascular abdominal aortic aneurysm repair.

    PubMed

    Ullery, Brant W; Lee, Jason T

    2014-09-01

    Endovascular aneurysm repair has taken over open surgery as the primary strategy for treatment of patients with abdominal and thoracic aneurysms. The minimally invasive nature of these techniques requires alterations in preoperative workup, intraoperative management, and familiarity with unique complications that can occur. Familiarity from the anesthetic standpoint of endovascular techniques, including treatment of patients with fenestrated, chimney, snorkel, and periscope grafts, is necessary for the contemporary cardiac anesthesiologist. PMID:25113729

  20. Computational study of anterior communicating artery hemodynamics before aneurysm formation

    NASA Astrophysics Data System (ADS)

    Castro, Marcelo A.; Putman, Christopher M.; Cebral, Juan R.

    2012-03-01

    It is widely accepted that complexity in the flow pattern at the anterior communicating artery (AComA) is associated with the high rate of aneurysm formation in that location observed in large studies. A previous computational hemodynamic study showed a possible association between high maximum intraaneurysmal wall shear stress (WSS) at the systolic peak with rupture in a cohort of AComA aneurysms. In another study it was observed a connection between location of aneurysm blebs and regions of high WSS in models where blebs were virtually removed. However, others reported associations between low WSS and either rupture or blister formation. The purpose of this work is to study associations between hemodynamic patterns and AComA aneurysm initiation by comparing hemodynamics in the aneurysm and the normal model where the aneurysm was computationally removed. Vascular models of both right and left circulation were independently reconstructed from three-dimensional rotational angiography images using deformable models, and fused using a surface merging algorithm. The geometric models were then used to generate high-quality volumetric finite element grids of tetrahedra with an advancing front technique. For each patient, the second anatomical model was created by digitally removing the aneurysm. It was iteratively achieved by applying a Laplacian smoothing filter and remeshing the surface. Finite element blood flow numerical simulations were performed. It was observed that aneurysms initiated in regions of high and moderate WSS in the counterpart normal models. Adjacent or close to those regions, low WSS portions of the arterial wall were not affected by the disease.

  1. Treatment of Vertebro-Basilar Dissecting Aneurysms Using Intravascular Stents

    PubMed Central

    Yamasaki, S.; Hashimoto, K.; Kawano, Y.; Yoshimura, M.; Yamamoto, T.; Hara, M.

    2006-01-01

    Summary Endovascular surgery is an established primary therapeutic modality for dissecting aneurysms at vertebro-basilar arteries. Intravascular stents can be used to treat the dissecting aneurysms for which simple obliteration procedures cannot be used. In such cases, stent implantation alone or a combination of stents and coils need to be selected properly by taking into consideration the site and shape of dissections. In this report, three patterns of stent application are described and their method of selection is discussed. PMID:20569619

  2. [The aneurysms of digestive system arteries: three cases].

    PubMed

    Tijani, Y; Chtata, H; Elkaoui, H; Hatim, A; Drissi, M; Abissegue, Y; Taberkant, M

    2015-04-01

    The aneurysms of digestive arteries are a rare pathological entity, with a risk of rupture associated to a high mortality rate, often asymptomatic, then they are discovered incidentally during a exam for other diagnostic purposes. We report three cases of digestive aneurysms, one of celiac trunk, one of mesenteric artery on behçet disease, and one of splenic artery, which were treated surgically with success. PMID:24856656

  3. [False hydatic aneurysm of the thoraco-abdominal aorta].

    PubMed

    El Mesnaoui, A; Bensaïd, Y; Ammar, A; El Yagoubi, M; Benabderrazik, T; Benjelloun, A; Benyahia, B

    1996-07-01

    Arterial complications of hydatic disease are rarely encountered. We report a false hydatic aneurysm of the thoracoabdominal aorta revealed by ischemic embolism of the lower limbs. Surgical treatment included aorto-aortic prosthesis and albendazol for 6 months. Results at 18 months are excellent with negative hydatic serology. In endemic areas, hydatic disease is a possible cause of false aneurysms. Long-term surveillance is required after curative surgery and medical treatment. PMID:8999043

  4. Mycotic pseudo-aneurysm of the extracranial carotid artery.

    PubMed

    Desimpelaere, J; Seynaeve, P; Kockx, M; Appel, B; Gyselinck, J; Mortelmans, L

    1997-08-01

    A rare case of mycotic pseudo-aneurysm of the common carotid artery as a complication in an immunosuppressed paediatric patient is presented. Treatment of pseudo-aneurysms of the common carotid artery is generally considered to be an emergency, necessitating quick and accurate diagnosis. In patients with septicemia, angiography has to be avoided. We were able to provide the surgeon with the exact diagnosis and accurate topographical information with helical CT with 3D reformation. PMID:9351308

  5. [False aneurysm on dacron prosthesis, 20 years after aortofemoral bypass].

    PubMed

    Illuminati, G; Bertagni, A; Nasti, A G; Montesano, G

    2001-10-01

    A 85-year-old male developed a false, non septic, non anastomotic aneurysm, 20 years after right aorto-femoral Dacron grafting for claudication. On account of the proximity to the femoral anastomosis, and the association with a profunda femoris stenosis, a conventional surgical repair was preferred to an endovascular treatment. The patient underwent a successful aneurysm resection followed by PTFE interposition between the primary graft and the profunda femoris artery, with uneventful recovery. PMID:11692765

  6. Successful Reconstruction of Asymptomatic Bilateral External Carotid Artery Aneurysms.

    PubMed

    Loja, Melissa N; Pevec, William C

    2016-04-01

    True aneurysms of the external carotid artery (ECA) are extremely rare with an unknown incidence and natural history. We present the successful operative management of an asymptomatic 65-year-old man found to have bilateral internal carotid artery stenosis and bilateral ECA aneurysms. His bilateral carotid arteries were reconstructed with bifurcated interposition grafts in a staged fashion. The patient recovered without sequelae and continues to be asymptomatic 1 year after reconstruction. We present the operative management of this rare case. PMID:26802292

  7. Giant atrial septal aneurysm originating from the right coronary artery.

    PubMed

    Osada, Hiroaki; Kanemitsu, Naoki; Meshii, Katsuaki; Ohnaka, Motoaki

    2016-08-01

    Giant coronary artery aneurysm is a rare clinical entity and its involvement in the interatrial space is extremely rare. We here report the rare surgical case of a 67-year old man with giant right coronary artery aneurysm located in the atrial septum with fistula formation to the right atrium, complicated with congestive heart failure, rapid atrial fibrillation and left atrial appendage thrombus. The patient eventually recovered fully without sequelae. PMID:27118290

  8. Wall Mechanical Properties and Hemodynamics of Unruptured Intracranial Aneurysms

    PubMed Central

    Cebral, Juan R.; Duan, Xinjie; Chung, Bong Jae; Putman, Christopher; Aziz, Khaled; Robertson, Anne

    2016-01-01

    Purpose To investigate the relationship between the intra-aneurysmal hemodynamic conditions and the mechanical properties of the wall in human aneurysms. Methods A total of eight unruptured aneurysms were analyzed. Computational fluid dynamics (CFD) models were constructed from pre-operative 3D rotational angiography images. The aneurysms were clipped and the domes were resected and mechanically tested to failure with a uniaxial testing system under multi-photon microscopy. Linear regression analysis was performed to explore possible correlations between hemodynamic quantities and the failure characteristics and stiffness of the wall. Results The ultimate strain was negatively correlated to aneurysm inflow rate (p=0.021), mean velocity (p=0.025), and mean wall shear stress (p=0.039). It was also negatively correlated to inflow concentration, oscillatory shear index and measures of the complexity and instability of the flow; however these trends did not reach statistical significance. The wall stiffness at high strains was positively correlated to inflow rate (p=0.014), mean velocity (p=0.008), inflow concentration (p=0.04), flow instability (p=0.006), flow complexity (p=0.019), wall shear stress (p=0.002) and oscillatory shear index (p=0.004). Conclusions In a study of 8 unruptured intracranial aneurysms, ultimate strain is negatively correlated with aneurysm inflow rate, mean velocity and mean wall shear stress. Wall stiffness is positively correlated with aneurysm inflow rate, mean velocity, wall shear stress, flow complexity and stability, and oscillatory shear index. These trends and the impact of hemodynamics on wall structure and mechanical properties should be further investigated in larger studies. PMID:26228891

  9. Bilateral mycotic aneurysm of the superior gluteal artery.

    PubMed

    Bouarhroum, Abdellatif; El Khloufi, Samir; El Hassani, Rachid; Bensaid, Younes

    2009-01-01

    Gluteal artery aneurysms are rare and mostly secondary to blunt or penetrating trauma. As an absolute rarity, we report an exceptional presentation of bilateral mycotic aneurysm of the superior gluteal artery in a 16-year-old boy associated with bacterial endocarditis. The left pseudoaneurysm was ruptured and treated using open surgery; 1 week later, the right location was successfully treated by embolization. PMID:19540714

  10. Mycotic aneurysm of the thoracic aorta caused by Aspergillus fumigatus.

    PubMed

    Rose, H D; Stuart, J L

    1976-07-01

    A 54-year-old diabetic patient had unexplained fever and embolic occlusion of the splenic, right renal, right hypogastric, right superficial femoral, and left popliteal arteries. Aspergillus fumigatus was recovered from a femoral clot. An aortogram revealed a mycotic aneurysm of the thoracic aorta to be the source of the infected emboli. Surgical excision of the aneurysm and therapy with amphotericin B were unsuccessful. PMID:776547

  11. Extensive arterial aneurysm formation proximal to ligated arteriovenous fistula.

    PubMed Central

    Graham, J M; McCollum, C H; Crawford, E S; DeBakey, M E

    1980-01-01

    As a result of abnormal flow patterns and hyperdynamic flow in arteries proximal to an arteriovenous fistula a particular susceptibility to atherosclerotic changes and aneurysmal deterioration develops. In the following report two patients are presented in which chronic arteriovenous fistulas existed for 15 and 33 years prior to correction. Each patient developed extensive and progressive aneurysmal dilation of the proximal arterial tree and subsequently required surgical resection and graft replacement. Images Fig. 1. Fig. 2. Fig. 3. PMID:6444798

  12. TREATMENT OF A CEREBRAL DISSECTING ANEURYSM IN ANTERIOR CIRCULATION: REPORT OF 11 SUBARACHNOID HEMORRHAGE CASES

    PubMed Central

    OYAMA, HIROFUMI; KITO, AKIRA; MAKI, HIDEKI; HATTORI, KENICHI; NODA, TOMOYUKI; WADA, KENTARO

    2012-01-01

    ABSTRACT This report presents 8 cases of internal carotid artery aneurysms, 1 case of a middle cerebral artery aneurysm, and 2 cases of anterior cerebral artery aneurysms, together with a discussion of the treatment of aneurysms in anterior circulation. All cases showed subarachnoid hemorrhage. Two of the 8 internal carotid artery aneurysms were trapped with a low-flow bypass; however, both patients died of an immediate hemodynamic infarction or vasospasm-induced infarction. Five of the 8 internal carotid artery aneurysms were trapped after revascularization with high flow bypass. Four of those patients were self-supporting at discharge, but one patient was discharged in a vegetative state due to the sacrifice of arterial branches which were included in the dissecting portion. One case of the dissecting aneurysm in the M2 portion of the middle cerebral artery was trapped after low-flow bypass. This patient was self-supporting at discharge. In 2 cases of anterior cerebral artery aneurysms, the lesions were first wrapped with Bemsheets, and then the aneurysmal clip was applied on the wrapped dome. Trapping following high-flow bypass is the best method for treating a dissecting aneurysm in the internal carotid artery. Trapping also can be used to treat a dissecting aneurysm of the middle cerebral artery, after low-flow bypass. Clipping on the wrapped aneurysm can also be performed successfully in the anterior cerebral artery aneurysm. PMID:23092105

  13. Utility of Balloon-Assisted Guglielmi Detachable Coiling in the Treatment of Cerebral Aneurysms

    PubMed Central

    Mangiafico, S.; Cellerini, M.; Villa, G.; Nistri, M.; Pandolfo, C.; Ammannati, F.; Mennonna, P.; Giordano, GP.

    2002-01-01

    Summary Balloon-assisted Guglielmi detachable coiling (BAGDC) is a new technical option developed to allow endovascular treatment of wide-necked aneurysms. Aim of the following work is to report a single center experience of BADGC of aneurysms with assessment of its efficacy and safety. BAGDC of wide-necked aneurysms (SNR close to 1) was retrospectively evaluated in 37 patients (28 females, nine males, mean age: 56.6 yrs, range: 27-81 yrs) who underwent the procedure between january 1999 and january 2002 for a total of 45 procedures on 41 aneurysms. Twenty-nine patients presented with SAH from an acutely ruptured aneurysm. In two patients BAGDC failed whereas 35 patients successfully underwent BADGC (39 aneurysms). Twenty-nine patients (31 aneurysms) were available for angiographic follow-up (mean: 10 mo, range: 3-24 mo). At the last angiographic follow-up 29/33 aneurysms (87%) resulted stable and occluded (22 aneurysms with dense and seven with loose packing of the sac and the neck), two aneurysms showed regrowth, one aneurysm showed a neck remnant and another one a sac and neck remnant. Complications directly related to the procedure occurred in five patients (three perforations, one thromboembolism, one femoral AV) with a mortality and morbility rate of 2.7 and 5.4 respectively. BAGDC is a promising adjunct to treatment of wide-necked aneurysms broadening the spectrum of indications for endovascular treament of challenging aneurysms. PMID:20594481

  14. Junctional Internal Carotid Artery Aneurysms: The Schrödinger's Cat of Vascular Neurosurgery

    PubMed Central

    Carlson, Andrew P.; Loveren, Harry R. van; Youssef, A. Samy; Agazzi, Siviero

    2014-01-01

    Objectives Despite advances in neuroimaging, it is not always definitive whether a paraclinoid aneurysm is intradural or entirely extradural. We illustrate the potential use of surgical exploration in these aneurysms that we refer to as “junctional” aneurysms. Methods Retrospective review of eight patients with unruptured aneurysms who underwent a planned surgical exploration of a junctional aneurysm. Results Of the eight patients, three underwent exploration of the aneurysm during surgery for a different aneurysm. All three of these were found to be extradural. Five patients underwent a craniotomy for the exclusive purpose of clarifying the location of the aneurysm. Two of these cases were found to be intradural and were clipped. Two cases were found to be extradural. In one patient, the initially extradural aneurysm was converted into an intradural aneurysm during removal of the anterior clinoid process, necessitating surgical clipping. One transient third nerve palsy was observed. Discussion Until further progress in neuroimaging allows clinicians to determine unequivocally the exact anatomical location of a paraclinoid aneurysm, we advocate the use of the term junctional aneurysm to reflect the clinical uncertainty inherent in management decisions made regarding these aneurysms. We have illustrated a strategy of surgical exploration in select patients. PMID:25844299

  15. Design and biocompatibility of endovascular aneurysm filling devices

    DOE PAGESBeta

    Rodriguez, Jennifer N.; Hwang, Wonjun; Horn, John; Landsman, Todd L.; Boyle, Anthony; Wierzbicki, Mark A.; Hasan, Sayyeda M.; Follmer, Douglas; Bryant, Jesse; Small, Ward; et al

    2014-08-04

    We report that the rupture of an intracranial aneurysm, which can result in severe mental disabilities or death, affects approximately 30,000 people in the United States annually. The traditional surgical method of treating these arterial malformations involves a full craniotomy procedure, wherein a clip is placed around the aneurysm neck. In recent decades, research and device development have focused on new endovascular treatment methods to occlude the aneurysm void space. These methods, some of which are currently in clinical use, utilize metal, polymeric, or hybrid devices delivered via catheter to the aneurysm site. In this review, we present several suchmore » devices, including those that have been approved for clinical use, and some that are currently in development. We present several design requirements for a successful aneurysm filling device and discuss the success or failure of current and past technologies. Lastly, we also present novel polymeric based aneurysm filling methods that are currently being tested in animal models that could result in superior healing.« less

  16. Design and biocompatibility of endovascular aneurysm filling devices

    SciTech Connect

    Rodriguez, Jennifer N.; Hwang, Wonjun; Horn, John; Landsman, Todd L.; Boyle, Anthony; Wierzbicki, Mark A.; Hasan, Sayyeda M.; Follmer, Douglas; Bryant, Jesse; Small, Ward; Maitland, Duncan J.

    2014-08-04

    We report that the rupture of an intracranial aneurysm, which can result in severe mental disabilities or death, affects approximately 30,000 people in the United States annually. The traditional surgical method of treating these arterial malformations involves a full craniotomy procedure, wherein a clip is placed around the aneurysm neck. In recent decades, research and device development have focused on new endovascular treatment methods to occlude the aneurysm void space. These methods, some of which are currently in clinical use, utilize metal, polymeric, or hybrid devices delivered via catheter to the aneurysm site. In this review, we present several such devices, including those that have been approved for clinical use, and some that are currently in development. We present several design requirements for a successful aneurysm filling device and discuss the success or failure of current and past technologies. Lastly, we also present novel polymeric based aneurysm filling methods that are currently being tested in animal models that could result in superior healing.

  17. Computational Hemodynamics Framework for the Analysis of Cerebral Aneurysms

    PubMed Central

    Mut, Fernando; Löhner, Rainald; Chien, Aichi; Tateshima, Satoshi; Viñuela, Fernando; Putman, Christopher; Cebral, Juan

    2010-01-01

    Assessing the risk of rupture of intracranial aneurysms is important for clinicians because the natural rupture risk can be exceeded by the small but significant risk carried by current treatments. To this end numerous investigators have used image-based computational fluid dynamics models to extract patient-specific hemodynamics information, but there is no consensus on which variables or hemodynamic characteristics are the most important. This paper describes a computational framework to study and characterize the hemodynamic environment of cerebral aneurysms in order to relate it to clinical events such as growth or rupture. In particular, a number of hemodynamic quantities are proposed to describe the most salient features of these hemodynamic environments. Application to a patient population indicates that ruptured aneurysms tend to have concentrated inflows, concentrated wall shear stress distributions, high maximal wall shear stress and smaller viscous dissipation ratios than unruptured aneurysms. Furthermore, these statistical associations are largely unaffected by the choice of physiologic flow conditions. This confirms the notion that hemodynamic information derived from image-based computational models can be used to assess aneurysm rupture risk, to test hypotheses about the mechanisms responsible for aneurysm formation, progression and rupture, and to answer specific clinical questions. PMID:21643491

  18. Partially Polyurethane-Covered Stent for Cerebral Aneurysm Treatment

    PubMed Central

    Rangwala, Hussain S.; Ionita, Ciprian N.; Rudin, Stephen; Baier, Robert E.

    2009-01-01

    Partially polyurethane-covered stent (PPCS) is proposed for the treatment of cerebral aneurysms. The PPCSs were observed to substantially modify the flow entering the aneurysm in a patient-specific aneurysm phantom (PSAP). These stents can act as flow modulators and the polyurethane (PU) membrane can provide a smooth scaffold for restoring the structural integrity of the diseased vessel. Partial coating of the stent aids in sealing only the entrance to the aneurysm while keeping the perforators around the aneurysm open and patent. Biocompatibility of the PU membrane was monitored using contact angle measurements to show that critical surface tension (CST) values remained in the thromboresistant range of 20–30 mN/m. Stent flexibility, stiffness, and pressure–diameter relationship showed no significant change after asymmetric PU film application. No delamination of the PU membrane from the stent was observed within the working strains of the stent. The flow modulating capability of the PPCS was monitored by intentionally orienting the stent to cover either the proximal or the distal regions along the neck of the PSAP. Time density curves (TDCs) compared the relative metrics of input rate, washout rate, residence time, and influx in the aneurysm before and after the stent placement. PMID:18837459

  19. Traumatic Intracranial Aneurysm Formation following Closed Head Injury

    PubMed Central

    Miley, Jefferson T; Rodriguez, Gustavo J; Qureshi, Adnan I

    2008-01-01

    Background: Traumatic intracranial aneurysms are rare conditions that can be a result of non-penetrating head trauma. We report the occurrence of intracranial aneurysms in patients with traumatic brain injury. Methods: All diagnostic cerebral angiograms performed in patients with traumatic brain injury at a level I trauma center from January 2006 to July 2007 were reviewed. Results: Diagnostic cerebral angiography was performed in 74 patients with the diagnosis of closed head injury. A total of 4 traumatic intracranial pseudoaneurysms were found in 4 patients, two in the supraclinoid segment of the internal carotid artery, one in the cavernous segment of the internal carotid artery and one in the paraophthalmic segment of the internal carotid artery. Two patients were treated with coil embolization. One patient had follow up imaging on which there was no change in the size and morphology of the aneurysm. Conclusion: Intracranial aneurysms can develop in patients with closed head injury presumably related to shear or rotational injury. It is unclear whether these aneurysms should be classified as traumatic intracranial aneurysms or pseudoaneurysms, but the pathological findings frequently reveal disruption of the three vascular layers fulfilling the definition of pseudoaneurysm. For these reason we favor the name of post-traumatic intracranial pseudoaneurysms. PMID:22518228

  20. Sensitivity of Quantified Intracranial Aneurysm Geometry to Imaging Modality

    PubMed Central

    Ramachandran, Manasi; Retarekar, Rohini; Harbaugh, Robert E.; Hasan, David; Policeni, Bruno; Rosenwasser, Robert; Ogilvy, Christopher; Raghavan, Madhavan L.

    2013-01-01

    The objective of this study is to assess the sensitivity of intracranial aneurysm geometry to the modality of imaging. Four imaging modalities—3D rotational angiography (3DRA), computed tomography angiography (CTA), contrast enhanced magnetic resonance angiography (CE-MRA), and time-of-flight magnetic resonance angiography (TOF-MRA)—were assessed using data from a flow phantom and human subjects. A silicone flow phantom of the head and neck arteries with a 10 mm ACOM aneurysm was imaged using all four modalities under steady flow conditions. Three human subjects with mid to large sized intracranial aneurysm who had a 3DRA scan and one of CTA, CE-MRA, or TOF-MRA performed within a day were also studied. The aneurysm and contiguous vasculature were segmented for all available scans and geometric measures of their size (5 indices) and shape (6 indices) were estimated and compared. Visually, the size and shape of segmented 3D models of the aneurysms were similar across scan modalities for both the human subjects and the flow phantom. Consequently, the computed indices were consistent across modalities in the key morphometric indices. In conclusion, quantified indices of 3D geometry of the mid to large sized intracranial aneurysms investigated in this small study population are not sensitive to scanning modality. PMID:24151529