Fusiform aneurysms: A review from its pathogenesis to treatment options

Barletta, Enrico Affonso; Ricci, Renato Lazarin; Silva, Renato Di Gugliemo; Gaspar, Ranieri Henrique Moraes Lopes; Araújo, João Flávio Mattos; Neves, Maick Willen Fernandes; Aquino, José Luis Braga de; Belsuzarri, Telmo Augusto Barba

doi:10.4103/sni.sni_133_18

Cited by 38 publications

(22 citation statements)

References 26 publications

(199 reference statements)

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“…Myxoma was suggested to be resected first to prevent systemic emboli and mitral valve obstruction [1,10]. In the meantime, fusiform aneurysm is not suitable for clipping or coiling compared to saccular aneurysm, surgical procedure is still an important intervention [60]. Fortunately, the SAH rate of multiple cerebral fusiform aneurysms related to atrial myxoma was low [27].…”

Section: Discussionmentioning

confidence: 99%

Anesthesia management of atrial myxoma resection with multiple cerebral aneurysms: a case report and review of the literature

et al. 2020

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Background: Embolic stroke is a common complication of atrial myxoma, whereas multiple cerebral aneurysms associated with atrial myxoma is rare. The pathogenesis of the cerebral vascular disease related to an atrial myxoma is still not well known, and there are no guidelines to guide treatment and anesthesia management in such patients. Case presentation: In this report, we present a 38-year-old woman with occasional dizziness and headache diagnosed as multiple cerebral fusiform aneurysms, in whom transthoracic echocardiography revealed a mass attached to the interatrial septum in the left atrium. Myxoma resection was performed in fast track cardiac surgery pathway without neurological complications, and no intervention was carried out on the cerebral aneurysms. She was discharged home 6 days after the procedure for followed-up. Furthermore, we reviewed and analyzed the literature in the PubMed and Google Scholar databases in order to conclude the optimal treatment in such cases. Conclusions: Atrial myxoma-related cerebral aneurysms are always multiple and in a fusiform shape in most occasions. Early resection of myxoma and conservative therapy of aneurysm is an optimal treatment. TEE and PbtO 2 monitoring play an essential role in anesthesia management. Fast track cardiac anesthesia is safe and effective to early evaluate neurological function. Long term follow-up for "myxomatous aneurysms" is recommended. And outcome of most patients is excellent.

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Section: Discussionmentioning

confidence: 99%

Anesthesia management of atrial myxoma resection with multiple cerebral aneurysms: a case report and review of the literature

et al. 2020

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“…A literature review recommended 6 weeks of antibiotic treatment for intracranial vascular mycotic aneurysm and selective intervention based on lack of response to antibiotics. 6 The patient's anatomy must always be assessed and used for surgical plans; radial artery intervention requires adequate perfusion to the hand. Superficial palmar arch anatomy has multiple variations; a complete superficial palmar arch was present in 81.3% of cases in a recent meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

“…A literature review recommended 6 weeks of antibiotic treatment for intracranial vascular mycotic aneurysm and selective intervention based on lack of response to antibiotics. 6 …”

Section: Discussionmentioning

confidence: 99%

Successful nonoperative management of mycotic radial artery pseudoaneurysm in patient with absent superficial palmar arch

Mahoney

Hagino

Masuda

2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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We present the case of a patient in whom a mycotic radial artery false aneurysm developed after removal of a radial arterial line; anatomic constraints precluded simple resection and ligation of the infected artery. The patient was successfully treated nonoperatively by compression bandaging, intravenous antifungals, and serial imaging. This case represents an alternative to standard management of a mycotic aneurysm and demonstrates the importance of an individualized approach to patient care.

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“…та являє собою об'єднаний аналіз публікацій за період з 2003 до 2017 р. (загальна кількість пацієнтів 1556) [10]. Згідно з даними цього дослідження ФА судин головного мозку трапляються частіше у чоловіків (59 %) молодше 50 років.…”

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Experience in the treatment of patients with fusiform aneurysms of cerebral vessels

Shchehlov¹,

Kudelskyi²,

Pastushyn³

et al. 2020

Endovasc. Neurorad.

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Objective – to analyze there sults of treatment of patients with fusiform aneurysms (FA) depending on localization and type of surgery.Materials and methods. In the period from 2007 to 2019 127 patients with intracranial fusiform cerebral aneurysms underwen treatment in Scientific and Practical Center of Endovascular Neuroradiology of the National Academy of Medical Sciences of Ukraine. 133 fusiform aneurysms were identified. The following neuroimaging methods were used to diagnose FA: magnetic resonance imaging, multispiral computed tomography and cerebral selective angiography according to Seldinger. In this study, patients with fusiform aneurysms are divided according to localization in the FA of the carotid poolsand the FA of the vertebrobasilar basin. Patients with FA of carotid basins were 56 (27 (29 (51.8 %) men and 48.2 %) women). The average age of patients was 45.2 year. 31 (55.3 %) patients were operated. Patients with FA in the vertebrobasilar basin were 71 (43 (60.6 %) men and 28 (39.4 %) women). The average age of patients was 54.5 year. It was operated 48 (67.6 %) patients.Results. It was possible to completely eliminate FA from the bloodstream intraoperative in 16 (51.6 %) patients. In the early postoperative period in this group 5 (16.1 %) patients had a decrease in disease symptoms, in 3 (9.6 %) patients neurological symptoms increased. In other patients the dynamics of neurological manifestations remained unchanged. There were nofatal out comes in either the early or late post operative period. According to the extended Glasgow outcome scale at the time of discharge from the hospital 22 (71 %) patients had > 5 points, 9 (29 %) – 4 points. In the period from 3 to 5 weeks 2 symptomatic thromboses of flow-directingstents were noted, in the form of clinical manifestations of ischemic stroke. In the period from 3 to 6 months 22 (71 %) patients underwent control examination. Angiographically in 19 (86.3 %) revealed a completes hut down of FA from the bloodstream, in 3 (13.7 %) – decrease of volume of FA > 65 %. Clinical symptoms completely regressed in 16 (72.7 %) patients, partially regressed – in 3 (13.7 %), increased – in 2 (13.6 %). In the period from 12 to 18 months 7 (31.8 %) patients underwent control examination. Total FA shut down from the bloodstream was detected in 5 (71.4 %) patients, in 2 (28.6 %) aneurysms decreased by 80 %. Eighteen-month survival was 100 %.It was possible to intraoperatively switch off FA in the vertebrobasilar basin from the bloodstream in 11 (22.9 %) cases. In the early postoperative period a partial regression of neurological symptoms was observed in 7 (14.5 %) patients. In 10 (20.8 %) cases a new or increasing neurological deficit was observed after intracranial stent implantation, which partially regressed against the background of conservative treatment. Four (8.3 %) deaths were recorded in the early postoperative period. The clinical results of 48 patients on the Glasgo woutcome scale at the time of discharge were > 5 points in 27 (56.2 %) patients, 4 points – in 17 (35.4 %) and 1 points – in 4 (8.3 %). In the period from 3 to 6 months 19 (39.5 %) patients underwent control examination. Angiographically in 14 (73.7 %) patients the aneurysm was completely turned off from the blood circulation, in 2 (10.5 %) the decrease in the volume of the aneurysm was > 70 %, in 3 (15.8 %) patients the decrease in the volume of the aneurysm was 47–64 %. Clinical symptoms regressed in 7 (36.8 %) patients, a decrease in neurological deficit was noted in 2 (10.5 %) patients, an increase in neurological deficit in 3 (15.8 %) patients. Three deaths were recorded. In the period from 12 to 18 months, 12 (25 %) patients underwent control examination. Angiographically in 10 (83.3 %) patients FA was excluded totally from the bloodcirculation, in 2 (16.7 %) – the volume of aneurysm was reduced by 80 %. Clinical symptoms regressed in 8 (66.6 %) patients and increased in 1 (8.3 %). During the control period 2 patients died. The 18-month survival rate was 89.5 %, 5 (10.5 %) patients died.Conclusions. Fusiform aneurysms are more common in people of working age, more common in men. A more unfavorable course of the disease occursin patients with symptomatic FA of the vertebrobasilar basin, due to the compression and dysfunction of the brainstem and stem structures. Deconstructive methods for eliminating FA from the bloodstream provide long-termsatis factory treatment results, butrequire careful selection of patients for such in terventions. Endovascular treatment should be considered as the main treatment, asitentails fewer risks for the patient. For aneurysms that cannot be treated with endovascular methods, microsurgical treatments hould be considered. The main forsuccess ful treatment of patients with fusiform aneurysms is th ecareful selection of patients and individual approach to the choice of treatment based on the shape, location and size of the FA.

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Fusiform aneurysms: A review from its pathogenesis to treatment options

Cited by 38 publications

References 26 publications

Anesthesia management of atrial myxoma resection with multiple cerebral aneurysms: a case report and review of the literature

Anesthesia management of atrial myxoma resection with multiple cerebral aneurysms: a case report and review of the literature

Successful nonoperative management of mycotic radial artery pseudoaneurysm in patient with absent superficial palmar arch

Experience in the treatment of patients with fusiform aneurysms of cerebral vessels

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