Spontaneous false aneurysm of the gastroduodenal artery in a hemophilic patient ruptured into the duodenum: case report

Nouira, Kais; Nouira, Yassine; Yahmed, A. Ben; Bedioui, H.; Abid, Hakima; Menif, E.

doi:10.1007/s00261-005-0352-2

Cited by 4 publications

(4 citation statements)

References 4 publications

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“…Nouira et al [15] reported a case of a spontaneous gastroduodenal artery false aneurysm ruptured into the duodenum in a patient with haemophilia. The diagnosis was confirmed by spiral CT and magnetic resonance angiography.…”

Section: Nonmusculoskeletal Pseudoaneurysmsmentioning

confidence: 98%

Pseudoaneurysms in haemophilia

Rodríguez-Merchán

2013

Blood Coagulation &Amp; Fibrinolysis

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The incidence of bleeding as a result of a pseudoaneurysm in haemophilia is very low. The diagnosis should be suspected if the patient has a history of arterial trauma. Pseudoaneurysms can appear anywhere where trauma occurs. This can include arterial access for catheterization, blunt trauma or penetrating trauma. The diagnosis should be confirmed using Duplex ultrasonography, computed tomography (CT) angiogram or conventional angiogram. Many options exist for the treatment of pseudoaneurysms. Although surgery was the gold standard treatment in the past (surgical ligation with or without distal bypass), several less invasive treatment options are popular today. They include covered stent, ultrasound probe compression and ultrasound-guided thrombin injection. So far, only 14 pseudoaneurysms have been reported in patients with haemophilia: nine were located in the musculoskeletal system (four in the hand, four in the knee, one in the ankle), whereas five were non-musculoskeletal. Early diagnosis and treatment of this complication is vital. Endovascular treatment offers a minimally invasive treatment option. If arterial embolization fails to solve the pseudoaneurysm, open vascular surgery with surgical ligation with or without distal bypass should be performed. Whatever the procedure, a correct surgical haemostasis must be achieved by the infusion of factor concentrate (recombinant or plasma-derived) at the right dose and tranexamic acid. The advent of activated prothrombin complex concentrates and recombinant factor VIII (rFVIIa) has made invasive procedures possible in haemophilia patients with high-titre inhibitors.

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Section: Nonmusculoskeletal Pseudoaneurysmsmentioning

confidence: 98%

Pseudoaneurysms in haemophilia

Rodríguez-Merchán

2013

Blood Coagulation &Amp; Fibrinolysis

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“…They are often asymptomatic, and in 75% of all reported cases, they are diagnosed incidentally. 3 The most serious complication involves rupturing, which occurs in 20% to 80% of all reported cases. 1,2 In fact, gastroduodenal artery aneurysms are considered extremely rare and develop most often after pancreatitis or after pancreatic intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Because of the potential risk of rupture, which is given as 20% to 80%, 1,2 asymptomatic nonarteriosclerotic aneurysms should also be treated. 3 Two therapeutic options are available for treatment; endovascular therapy is the preferred therapy for visceral aneurysms, 4…”

Section: Case Reportmentioning

confidence: 99%

Successful Coil Embolization of a Ruptured Gastroduodenal Artery Aneurysm

Kueper¹,

Ludescher

Koenigsrainer³

et al. 2008

Vasc Endovascular Surg

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Aneurysms of the gastroduodenal artery are rare. Reported here is the case of a 60-year-old woman suffering from the covered rupturing of a twin aneurysm of the gastroduodenal artery. The patient presented herself in the surgical emergency unit with abdominal discomfort. Diagnostics showed free fluid in the abdominal cavity together with anemia of 9.9 g/dL. A computed tomography scan and an angiography revealed the covered rupturing of a twin aneurysm of the gastroduodenal artery, which was treated by endovascular coiling of the gastroduodenal and pancreaticoduodenal arteries. The patient's hemoglobin level remained stable after treatment, and she was released from the hospital after 18 days. Visceral artery aneurysms are rare. Although endovascular therapy is preferred in cases involving active bleeding, surgery remains the primary therapy in those cases in which bleeding becomes uncontrollable.

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“…In a series of seven haemophilic patients with periarticular aneurysms, conservative treatment with FVIII concentrates administration resulted in bleeding with serious clinical consequences [2]. Recently, a fatal case of a ruptured false aneurysm of the gastroduodenal artery in a haemophilic patient was published [3]. These findings lead, in many cases, to the decision to surgically electively treat haemophilic patients with lesions that may result in life‐threatening bleeding, as aneurysm rupture.…”

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confidence: 99%

True radial artery aneurysm in a mild haemophilia A patient

et al. 2007

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Congenital haemophilia A is not associated with arterial aneurysms. Although the exact incidence of these lesions is unknown, they are extremely dangerous, especially in haemophilic patients, as their rupture leads to an emergency situation of fatal arterial bleeding. History of arterial trauma is the usual cause for pseudoaneurysms, whereas true aneurysms exist without previous trauma and therefore are more difficult to be diagnosed. We present the case of a radial aneurysm in a patient with mild haemophilia A that underwent uneventful surgical resection. Histological examination confirmed the diagnosis of a true radial artery aneurysm which is the first in the literature in these patient population, to our knowledge.In summary, our case concerns a 45-year-old man had been diagnosed with mild haemophilia A (FVIIIc ¼ 15 IU mL )1 ) at the age of 20 due to postoperative bleeding after appendicectomy. For that bleeding episode he was given fresh frozen plasma and on follow-up he was found to have a good response to desmopressin (DDAVP) -2 h after the subcutaneous injection of 0.3 lg kg )1 bodyweight (bw) of DDAVP the FVIIIc level increased to 55 IU mL )1 . Thus, the s.c. injection of DDAVP was the standard treatment for the mild to moderate bleeding episodes after trauma. Since 2004, when the diagnosis of arterial hypertension was made, for one bleeding episode in 2005 recombinant FVIII concentrates (rFVIII) were given to treat a severe haematoma of the left thigh, after trauma. The patient has not been infected with the hepatitis B, C or HIV virus, and no inhibitor to FVIII has been identified.Since his last visit, 3 months before, he had no complaints concerning his hand. At that time he first noticed a small painless mass in his hand without erythema and he thought that it was a ganglion. The patient had no history of penetrating or mechanical trauma. At presentation the patient showed a painful palpable mass of his right wrist with strong arterial pulses. The mass was 2 · 3 cm in size, it could be pushed, giving the impression of emptying, and after pressure removal it reappeared again. Manual finger occlusion of his radial artery at the wrist stopped the pulsation of the mass. Because of clinical suspicion of an arterial aneurysm, the patient was referred to the division of Vascular Surgery. The clinical diagnosis was then confirmed by an angiogram through the branchial artery, after the bolus administration of 20 units kg )1 bw of rFVIII. Surgical excision of the aneurysm was then planned. Preoperatively, he was given 30 units kg )1 bw of rFVIII and FVIIIc level increased to 87 IU mL )1 . Under general anaesthesia, the proximal to the aneurysm radial artery was free dissected, as well as, the distal to the aneurysm finger arteries (for the first and second finger). The aneurysm was excised (Figs 1a and 1b), the artery of the first finger was ligated and the artery of the second finger was anastomosed to the radial artery. rFVIII (20 units kg )1 bw) was repeated at 12, 24, 36 and 48 h and then once daily for an...

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Spontaneous false aneurysm of the gastroduodenal artery in a hemophilic patient ruptured into the duodenum: case report

Cited by 4 publications

References 4 publications

Pseudoaneurysms in haemophilia

Pseudoaneurysms in haemophilia

Successful Coil Embolization of a Ruptured Gastroduodenal Artery Aneurysm

True radial artery aneurysm in a mild haemophilia A patient

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