Ruptured internal mammary artery aneurysm presenting as massive spontaneous haemothorax in a patient with Ehlers‐Danlos syndrome

Phan, Tri Giang; Sakulsaengprapha, Amporn; Wilson, Michael K.; Wing, R.

doi:10.1111/j.1445-5994.1998.tb02972.x

Cited by 21 publications

(21 citation statements)

References 5 publications

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“…14 The Table describes the location, etiology, and treatment decisions of reported true IMA aneurysms in the literature. [12][13][14][15][16][17][18] Our experience in treating this patient mirrored approaches reported elsewhere for arterial aneurysms in patients with connective tissue disorders, 13,15,16 suggesting that some of these peripheral aneurysms are amenable to endovascular repair. While controversy exists over the role of endovascular interventions in Marfan syndrome and Ehlers-Danlos syndrome, 18,19 the literature has shown promising results for hybrid interventions in aortic aneurysms and dissections in patients with LDS.…”

Section: Discussionsupporting

confidence: 67%

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Endovascular repair of an internal mammary artery aneurysm in a patient with Loeys-Dietz syndrome

Ohman

Charlton-Ouw

Azizzadeh

2012

Journal of Vascular Surgery

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Loeys-Dietz syndrome is a condition that predisposes the development of central and peripheral arterial aneurysms and dissections. The standard approach for treatment of these lesions has been open repair. We present the case of a 34-year-old woman with a previous history of multiple open aortic repairs who presented with a right large internal mammary artery aneurysm. The patient was successfully treated with endovascular coil embolization. This case report demonstrates the feasibility of using endovascular interventions to treat unusual aneurysms in patients with Loeys-Dietz syndrome.

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Section: Discussionsupporting

confidence: 67%

“…While pseudoaneurysms are a known complication of trauma secondary from median sternotomy, 10,11 true aneurysms are associated with connective tissue disorders, 12,13 or vasculitis. 14 The Table describes the location, etiology, and treatment decisions of reported true IMA aneurysms in the literature.…”

Section: Discussionmentioning

confidence: 99%

Endovascular repair of an internal mammary artery aneurysm in a patient with Loeys-Dietz syndrome

Ohman

Charlton-Ouw

Azizzadeh

2012

Journal of Vascular Surgery

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“…Besides aortic aneurysms, peripheral true aneurysms were also reported in association with connective tissue disorders (such as MFS, Ehlers-Danlos syndrome, 13 type I neurofibromatosis, and fibromuscular dysplasia), vasculitis (such as Kawasaki disease, 14 polyarteritis nodosa, 15 and systemic lupus erythematosus), and atherosclerosis. However, IMAs are rarely affected with only two case reports in the literature 16,17 describing true aneurysms of the IMA as a manifestation of MFS.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Repair of Bilateral Internal Mammary Artery Aneurysms in a Patient with Marfan Syndrome—A Case Report

2014

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A 43-year-old male patient with a history of Marfan syndrome (MFS), aortic and mitral valve replacement, and endstage dilated cardiomyopathy requiring heart transplantation 4 years back initially presented to an outside hospital with a respiratory tract infection. As part of his evaluation, he had a chest computed tomography (CT) which incidentally revealed bilateral internal mammary artery (IMA) true aneurysms. He was subsequently referred to our institution for further evaluation.A dedicated CT angiogram at our institution demonstrated a large, proximal right internal mammary artery (RIMA) aneurysm measuring 3.5 Â 3.4 cm followed by a second aneurysm in the middle third of the RIMA measuring 2 Â 2 cm. In addition, the left internal mammary artery (LIMA) showed a 9 mm focal aneurysmal dilatation at its origin with a bilobed aneurysm measuring 1.5 Â 1.5 cm proximally and 1.3 Â 1.2 cm distally (►Figs. 1 and 2A).Given the patient history of multiple thoracotomies, he was deemed to be a high-risk surgical candidate and referred for endovascular repair in September 2011.The patient was brought to the cardiac catheterization laboratory where we first obtained 6 French (Fr) right brachial artery access and performed IMA angiography. With the JR 4 catheter engaged in the RIMA, we then wired the vessel with a 0.035" glidewire. Next, we used a glide catheter to help steer the glidewire past the aneurysms. This allowed us to position the glide catheter in the distal RIMA and to exchange our glidewire for a stiff 3-mm Amplatzer wire (Cook Medical, Bloomington, Indiana) We subsequently advanced a 7 Fr Â 90 cm destination sheath just proximal to the more distal aneurysm. Finally, we delivered four sequential iCAST covered stents (Atrium, Hudson, New Hampshire), 5 Â 59 mm, 6 Â 22 mm, 7 Â 59 mm, and 7 Â 38 mm, successfully excluding the aneurysms (►Fig. 3A, B).One year later (December 2012), the patient was brought back to the catheterization laboratory to treat the enlarging LIMA aneurysm. We obtained 6 Fr left brachial artery access and used a similar strategy to position and deploy a 7 Â 59 mm iCAST covered stent, delivered through a 7 Fr Â 90 cm destination sheath, and we successfully excluded the LIMA aneurysm (►Fig. 3C, D).Follow-up CT angiogram, done in February 2013, demonstrated complete resolution of the RIMA aneurysm and marked decrease in size of the LIMA aneurysm (►Fig. 2B, C). Keywords► Marfan syndrome ► internal mammary artery aneurysm ► wall graft stent ► covered stent AbstractMarfan syndrome (MFS) is an autosomal dominant condition that is caused by abnormal synthesis of connective tissue. The syndrome classically affects the ocular, musculoskeletal, and cardiovascular systems. The most common cardiovascular manifestations include mitral valve prolapse/regurgitation and aortic aneurysms at high risk of rupture and dissection. However, internal mammary artery (IMA) true aneurysms are rarely reported. In this case report, we describe a 43-year-old male patient with MFS and three previous thoracotomies referred f...

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“…Those we could identify were associated with vasculitis (7), hereditary connective tissue diseases (8,9), type 1 neurofibrinomatosis (10), fibromuscular dysplasia (11), or atherosclerosis. Clinically, our case seems to be idiopathic because the patient had neither an inflammatory nor connective tissue disease.…”

Section: Discussionmentioning

confidence: 99%

“…Aneurysms of the IMA caused by non-iatrogenic etiologies such as vasculitis (e.g., Kawasaki disease (7), polyarteritis nodosa, and systemic lupus erythematosus), connective tissue diseases (e.g., Marfan syndrome (8) and Ehlers-Danlos syndrome (9)), type 1 neurofibrinomatosis (10), fibromuscular dysplasia (11), atherosclerosis, and idiopathic causes are very rare. Given that IMA aneurysms often rupture and cause hemothorax, their existence can be life-threatening (8)(9)(10). We herein report a case of idiopathic IMA aneurysm in which detection of an abnormal shadow following chest radiography enabled diagnosis and preventive surgery before a life-threatening event.…”

Section: Introductionmentioning

confidence: 93%

Aneurysm of the Internal Mammary Artery with Cystic Medial Degeneration

et al. 2012

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We herein report the histopathology of a rare case of an idiopathic internal mammary artery aneurysm in a 61-year-old asymptomatic woman. Chest radiography during an annual medical check-up incidentally revealed the aneurysm, which was initially mistaken for a mediastinal tumor. Given that a rupture of the aneurysm could have been life-threatening, it was removed surgically, and found to possess a paper-thin arterial wall with cystic medial degeneration.

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Ruptured internal mammary artery aneurysm presenting as massive spontaneous haemothorax in a patient with Ehlers‐Danlos syndrome

Cited by 21 publications

References 5 publications

Endovascular repair of an internal mammary artery aneurysm in a patient with Loeys-Dietz syndrome

Endovascular repair of an internal mammary artery aneurysm in a patient with Loeys-Dietz syndrome

Endovascular Repair of Bilateral Internal Mammary Artery Aneurysms in a Patient with Marfan Syndrome—A Case Report

Aneurysm of the Internal Mammary Artery with Cystic Medial Degeneration

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