Isolated abdominal aortic dissection is a rare clinical disease representing only 1.3% of all dissections. There are a few case series reported in the literature. The causes of this pathology can be spontaneous, iatrogenic, or traumatic. Most patients are asymptomatic and symptoms are usually abdominal or back pain, while claudication and lower limb ischemia are rare. Surgical and endovascular treatment are two valid options with acceptable results. We herein describe nine cases of symptomatic spontaneous isolated abdominal aortic dissection, out of which four successfully were treated with an endovascular approach between July 2003 and July 2013. All patients were men, smokers, symptomatic (either abdominal or back pain or lower limb ischemia), with a history of high blood pressure, with a medical history negative for concomitant aneurysmatic dilatation or previous endovascular intervention. Diagnosis of isolated abdominal aortic dissection were established by contrast-enhanced computed tomography angiography (CTA) of the thoracic and abdominal aorta. All nine patients initially underwent medical treatment. In four symptomatic cases, non-responsive to medical therapy, bare-metal stents or stent grafts were successfully positioned. All patients completed a CTA follow-up of at least 12 months, during which they remained symptom-free. Endovascular management of this condition is associated with a high rate of technical success and a low mortality; therefore, it can be considered the treatment of choice when it is feasible.
R enal artery aneurysms (RAAs) are relatively rare with an estimated incidence of 0.1% in the general population, rupture incidence of about 30%, and a consequent death rate of 80% (1). The gold standard of treatment is open surgery, but it is associated with a high risk of nephrectomy (29%), mortality (1.6%), and morbidity (12%). Nowadays, an endovascular approach such as coil embolization or stent-graft with coil embolization is an alternative in the treatment of narrow neck RAAs; however, when facing complex wide-necked aneurysms or complex aneurysm bifurcation, a surgical aneurysmectomy may be required. Recently, stent-assisted coil embolization with preservation of renal blood flow, has become a realistic alternative to surgery in wide-necked, saccular or extraparenchymal aneurysms.The aim of this study is to report our experience in the treatment of wide-necked complex RAAs through the stent-assisted detachable coil embolization technique in three patients. One case required a stent-assisted coil embolization with waffle-cone technique due to a wide-necked bifurcation RAA. TechniqueLaboratory investigations including complete blood count, renal and liver function tests, electrocardiography, chest radiography, and ultrasonographic evaluation of the carotid artery, abdominal aorta, and visceral arteries were carried out prior to the procedures. All aneurysms were treated under local anesthesia using a transfemoral approach. After positioning the femoral sheath, an intravenous bolus of 5000 IU of heparin was dispensed. Stent-assisted coil embolization was performed using the Solitaire AB stent nitinol self-expandable electrolytic detachment (Covidien-EV3) and Concerto Axium coils controlled release system (Covidien-EV3). Because of its featured trait of a closed-cell stent with high radial force, Solitaire AB stent does not permit the coils' prolapse and migration, preserving a good blood flow. On the other hand, detachable coils are repositionable, allowing an extremely precise deployment and subsequent embolization of different size aneurysms. After the procedure, the patients were monitored for 48 hours and were discharged with the administration of double antiplatelet therapy, which included acetylsalicylic acid (100 mg daily) and clopidogrel (75 mg daily) for six months. After six months, clopidogrel treatment was interrupted and only acetylsalicylic acid (100 mg daily) was maintained. Case 1A 64-year-old man was admitted to the outpatient clinic for evaluation of a left saccular RAA, diagnosed on CT-scan during routine follow-up of left hemicolectomy for colorectal I N T E R V E N T I O N A L R A D I O LO G Y T E C H N I C A L N OT E ABSTRACTRenal artery aneurysms (RAAs) are rare with an estimated incidence of 0.1% in the general population, and they represent approximately 25% of all visceral aneurysms. The gold standard of treatment is open surgery, but it is associated with a high risk of nephrectomy, mortality, and morbidity. Less invasive endovascular therapies are becoming increasingly common for...
The usual manifestation of brachial artery aneurysms is the incidental finding of a swelling of the arm, combined with paresthesia or pain in some cases. The etiology is often traumatic or secondary to drug abuse. Pathophysiology of brachial artery dilation in these cases is not completely clear. We herein describe a case of a 61-year-old male presenting with a giant, painful, pulsatile mass on his left arm. He was submitted to a cadaveric kidney transplant in 2005. He had a functioning arteriovenous fistula (AVF) on his right arm, and a spontaneously thrombosed radiocephalic AVF on his left arm. The aneurysm was surgically resected, sparing the median nerve that was totally entrapped and an inverted segment of the basilic vein interposed. At the follow-up, the patient did not present neurological or ischemic disturbs, and the vein graft maintained its patency.
In our experience and with the evidence observed in the literature, open surgery with GSV interposition is the safest treatment in infected carotid PAs. The endovascular approach must be performed only in proven noninfectious cases. A bridge technique with the insertion of a stent followed by open surgery repair can be an option in emergency cases.
We herein report an uncommon case of a life-threatening retroperitoneal hematoma after a bone marrow biopsy. Two hours after iliac crest bone harvesting, the patient experienced syncope and severe hypotension. Urgent contrast-enhanced computed tomography demonstrated extravasation from the superior gluteal artery. Transcatheter coil embolization was performed successfully, without complications. Life-threatening complications caused by retroperitoneal bleeding after bone marrow biopsy are very rare. There are few reports on the use of endovascular treatment in the management of life-threatening hemorrhagic complications after bone marrow biopsy.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.