Elective Treatment of Middle Colic Artery Aneurysm

Nishimura, Kazuhiko; Hamasaki, Takahiko; Ota, Rikako; Ohno, Takashi; Kodama, Wataru; Uchida, Naotaka; Hayashi, Eiichi; Fukino, Shunsuke

doi:10.3400/avd.cr.14-00058

Cited by 10 publications

(8 citation statements)

References 6 publications

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“…HE staining of the aneurysm showed marked atheromatous degeneration in the intima, while EVG staining revealed a decrease of elastic fibers in the tunica media, being consistent with the results of Chemla et al 3 and Tetik et al 4 We previously reported that the pathological hallmark of a middle colic artery aneurysm is considered to be remodeling of the arterial wall, involving fragmentation and a decrease of elastic fibers in the tunica media. 8 In the present case, pathological findings similar to the degeneration of elastic fibers were shown. Although the case has been quite limited, the pathological findings indicated that degenerated elastic fibers can probably play an important role in a true BA aneurysm as well as a middle colic artery aneurysm.…”

Section: Discussionsupporting

confidence: 77%

A Case of True Brachial Artery Aneurysm with Severe Left Upper Limb Ischemia

2016

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Upper extremity aneurysms are relatively rare compared with other peripheral arterial aneurysms, and most are false aneurysms.1 Especially, true brachial artery (BA) aneurysms are rare. Although the majority of the BA aneurysms are thought to be the result of trauma, 2 their natural history and incidence are still unclear. Case ReportAlthough a 65-year-old man underwent the creation of a radiocephalic arteriovenous fistula at the left wrist in 2004 at another hospital, the fistula was occluded and so he underwent fistula creation at the right wrist in 2005. Moreover, he noticed a mass just above the left elbow joint that had slowly grown since 2010. However, he was referred to our hospital due to the mass measuring approximately 4 Â 4 cm with rest pain and slight ulceration of the left second and third fingers in 2015. He underwent hemodialysis three times a week and had a medical history of cerebral hemorrhage, type B aortic dissection, hypertension, atrial flutter, and chronic pancreatitis. The patient's height was 171 cm and body weight was 54 kg. The patient's blood pressure in the left upper arm was 122/79 mm Hg and pulse was 75/minute, while the pressure in the left forearm was not measured. Physical examination was unremarkable except for the mass just above the left elbow joint and left hemiplegia as well as no pulse of the left BA, radial, and ulnar arteries, respectively. Laboratory examination showed amylase, 198 IU/L; alkaline phosphatase, 583 IU/L; lactate dehydrogenase, 260 IU/L; total cholesterol, 266 mg/dL; blood urea nitrogen, 47.8 mg/dL; creatinine, 8.23 mg/dL, prothrombin time and international normalized ratio, 1.63, and C-reactive protein, 3.80 mg/dL. Ultrasound showed a left upper limb thrombosed mass just above the left elbow joint. Enhanced computed tomography revealed the left patent proximal BA and ulnar artery as well as the fusiform thrombosed mass measuring 3 Â 3 cm at the distal BA (►Fig. 1A-C). Cardiac ultrasound showed an almost normal left ventricular function (ejection fraction: 52%) and mild aortic regurgitation. Thus, we diagnosed him with a left BA aneurysm with severe upper limb ischemia. In a supine position, after we harvested the left great saphenous vein (GSV) of a medial thigh, the proximal and distal BAs were exposed (►Fig. 2). As the distal BA mostly showed a calcified intima, excision of the aneurysm and BA replacement were performed with a GSV graft after endarterectomy at the distal anastomosis. The wall of the fusiform aneurysm measuring 3.4 Â 2.0 cm was solid without adhesion around the tissues (►Fig. 3A). Keywords► upper limb ischemia ► true brachial artery aneurysm ► arteriovenous fistula AbstractBrachial artery (BA) aneurysms are rare, and most are false aneurysms. Although true BA aneurysms have been reported, most have been reported without symptoms. A 65-yearold man was referred due to a left upper limb mass with rest pain and slight ulceration of the left second and third fingers. As enhanced computed tomography revealed the patency of only the left proxi...

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Section: Discussionsupporting

confidence: 77%

A Case of True Brachial Artery Aneurysm with Severe Left Upper Limb Ischemia

2016

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“…Reported methods for diagnosing SAM. (A) A total of 121 cases were identified from the 66 case reports 4,5,8–10,13,22–81 with unique diagnostic strategies. For publications detailing multiple patients, a case was counted as unique if the diagnostic strategy was specifically based on that patient’s presentation and was considered redundant and only recorded once if the same strategy was applied to multiple patients in the report.…”

Section: Discussionmentioning

confidence: 99%

“…A total of 126 unique cases were identified from 66 different case reports and case studies (Supplementary Table 1). 4,5,8–10,13,22–81…”

Section: Methodsmentioning

confidence: 99%

Segmental arterial mediolysis (SAM): Systematic review and analysis of 143 cases

et al. 2019

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Segmental arterial mediolysis (SAM) is a rare but serious nonatherosclerotic, noninflammatory vasculopathy of unknown etiology that often results in dissection, aneurysm, occlusion, or stenosis of, primarily, the abdominal arteries. Current literature lacks consensus on diagnostic criteria and management options for SAM. This review summarizes 143 cases and aims to advance appropriate recognition and management of SAM. Literature review of all relevant SAM case studies from 2005 to 2018 yielded 126 individual SAM cases from 66 reports. We identified 17 additional SAM cases from our center, bringing our analysis to 143 patients. Patients with SAM were most commonly men (68%) in their 60s. Hypertension (43%), tobacco use (12%), and hyperlipidemia (12%) were common comorbidities. Abdominal pain (80%) and intraabdominal bleeding (50%) were the most common presenting symptoms. Computed tomography was the most frequently used imaging method (78%), and histology was available in 44% of cases. The most commonly affected vessels were the superior mesenteric (53%), hepatic (45%), celiac (36%), renal (26%), and splenic (25%) arteries with aneurysm (76%), dissection (61%), and arterial rupture (46%). Treatments included coil embolization (28%), abdominal organ surgery (24%), open arterial repair (21%), and medical management (20%). Case-specific treatment modalities yielded symptom relief in the vast majority (91%) of patients, with a mortality rate of 7%.

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“…1,111 These benefits are balanced with a risk of intestinal necrosis, perforation, and late stricture requiring reoperation in addition to primary technical failures and failed hemostasis in the setting of rupture. [189][190][191][192][193] Regression of aneurysms resulting from polyarteritis nodosa after cytotoxic or immunosuppressive treatment is well documented. 107 As such, medical therapy should be considered first line for these patients with nonruptured, asymptomatic aneurysms, with repeated arteriography staged at 3 to 4 months to ascertain regression.…”

Section: 1mentioning

confidence: 99%