Successful Surgical Treatment of a Giant Mediastinal False Aneurysm 30 Years after Bentall Operation

False aneurysm occurring after replacement of ascending aorta by a vascular prosthesis is a rare, but life-threatening complication. In spite of advances in endovascular techniques, surgery remains the treatment of choice in the majority of cases. We report the case of a huge pseudoaneurysm caused by late dehiscence of the right coronary ostium-aortic tubular graft anastomosis, occurred 30 years after replacement of aortic valve and ascending aorta by classical Bentall operation. A fistula originating from the aneurysmal sac extended across the sternum into the thoracic subcutaneous soft tissues and gave rise to a pulsatile mass well appreciable on the anterior chest wall. The surgical treatment, consisting of partial resection of the aortic tubular graft and sternal reconstruction was effective and uneventful.

Axillary Vessels and Brachial Plexus Traumas in Abidjan: Lesional Aspects and Surgical Difficulties

Introduction-Objectives: Through the presentation of epidemiological, anatomo-clinical and surgical aspects, we report our experience in the management of traumatic axillary lesions. Materials and Methods: A descriptive retrospective study was based on the medical records of patients who suffered vascular axillary and/or brachial plexus trauma and who underwent surgical repair at the Abidjan Cardiology Institute from January 2008 to June 2022. Epidemiological, anatomo-clinical and surgical data were studied. Results: Thirty-four medical files belonging to 33 men and one woman, aged 32 on average, were collected. The circumstances of occurrence were dominated by the stab wound (n = 22). The combinations of injuries were as follows: associated involvement of the axillary artery and vein (n = 4);isolated involvement of axillary artery (n = 3);isolated involvement of the axillary vein (n = 2);associated involvement of the axillary artery and brachial plexus (n = 17);associated involvement of the axillary artery and vein and brachial plexus (n = 08). Anatomic lesions included acute arterial lesions (n = 29) and arteriovenous fistula (n = 1) and false aneurysms (n = 4). All patients were operated on under general anesthesia;vascular repair included direct suturing (n = 16), arterial and venous bypass using a long saphenous graft (n = 9), prosthetic arterial bypass (n = 5) and prosthetic flattening-graft (n = 4). Brachial plexus surgery consisted of an end-to-end anastomosis of each transected bundle in all cases (n = 25). The medium-term postoperative course was marked by success without functional sequelae in 88.24% of cases (n = 30) and by the persistence of distal paralysis of the thoracic limb after 6 months in 05.88% (n = 2) of all patients, i.e., 8% of patients who presented with brachial plexus injury. Conclusion: The concomitant surgical treatment of these axillary vascular and nerve lesions has given good results. However, if paralysis of the thoracic limb persists after 6 to 12 months, the patient should be referred to a specialist in brachial plexus surgery.

Potentially fatal haemobilia due to inappropriate use of an expanding biliary stent

AIM: To highlight the fatal complication caused by expanding biliary stents and the importance of avoiding use of expanding stent in potentially curable diseases.METHODS: Arteriobiliary fistula is an uncommon cause of haemobilia. We describe a case of right hepatic artery pseudoaneurysm causing arteriobiliary fistula and presenting as severe malena and cholangitis, in a patient with a mesh metal biliary stent. The patient had lymphoma causing bile duct obstruction.RESULTS: Gastroduodenoscopy failed to establish the exact source of bleeding and hepatic artery angiography and selective embolisation of the pseudo aneurysm successfully controlled the bleeding.CONCLUSION: Bleeding from the pseudo aneurysm of the hepatic artery can be fatal. Mesh metal stents in biliary tree can cause this complication as demonstrated in this case.So mesh metal stent insertion should be avoided in potentially benign or in curable conditions. Difficulty in diagnosis and management is discussed along with the review of the literature.

Pseudoaneurysm of gastroduodenal artery following radical gastrectomy for gastric carcinoma patients

We report a rare case of postoperative pseudoaneurysm of the gastroduodenal artery following radical gastrectomy.Surgical trauma to the gastroduodenal artery during regional lymphadenectomy was considered as the cause of the postoperative pseudoaneurysm. The pseudoaneurysm was successfully managed by ligating the bleeding vessel. We should consider the possibility of pseudoaneurysm formation in a patient with gastrointestinal bleeding in the postoperative period following radical gastrectomy with regional lymph node and perivascular lymphatic dissection.

Transcatheter Closure of Multiple Membranous Ventricular Septal Defects with Giant Aneurysms Using Double Occluders in Four Patients

The transcatheter closure of perimembranous ventricular septal defect （pmVSD） has become a promising treatment modality. However, transcatheter closure of multiple pmVSDs with giant aneurysm is still very challenging. We present our preliminary experiences.

ANASTOMOTIC FALSE ANEURYSM FOLLOWING ABDOMINAL AORTIC ANEURYSMECTOMY AND PROSTHETIC GRAFTING

Anastomotic false aneurysm (AFA) of the aorta is a potentially lethal complication after prosthetic grafting. Nineteen aneurysms were encountered in 18 patients within a 30-year period (1960-1991). There were 10 men and 8 women, aged 27?0 years (mean 58 years). In 14 patients, the prostheses were made of silk, in 2 were PTFE, and in 1 each Dacron or silk-Dacron cross-weaved. Patients with an intact AFA had a pulsatile abdominal mass, abdominal pain, an oc culuded graft and peripheral emboli. Five patients were asymptomatic. Clinical onset of AFA varied from 2 weeks to 12 years (mean 5 years). The accurate rate of diagnosis of single plane angiography was 75% (3 of 4), and computed tomography 100% (ten of ten). Ultrasound was used only once and suggested an AFA. Four AFAs were less than 5cm in diameter. Five patients refused operation and died in 2 years from rupture. Operative mortality was 11% (1 of 9). Treatment was resection of AFA and replacement with a new graft. Life-ong follow-p is required for patients with an aortic aneurysm. All ratroperitoneal AFAs should be resected, since the outcome of rupture is poor.

Study on intraluminal embolization with microcoils treating traumatic pseudoaneurysms in common carotid artery in rabbits

Objective: To evaluate the long-term effect of endovascular occlusion with microcoils on traumatic pseudoaneurysms (TPAs) in the common carotid artery in rabbits.Methods: TPAs in the right common carotid artery were surgically made in 16 rabbits. At 3-4 weeks after operation, the survived 12 models were randomly divided into a control group (n=3) with no treatment and an experimental group (n=9), in which TPAs were intraluminally embolized with microcoils and corresponding therapy was given. Three months after embolization, the TPAs were examined with digital subtraction angiography and pathology. Results: The 3 rabbits in the control group all died of rupture of TPA. Among the 9 TPAs occluded with microcoils, 4 were completely occluded, 4 were partially occluded, and 1 was excluded due to the microcoils migrating into the parent artery. Three months after embolization, the 4 TPAs which were completely occluded remained obliterated as determined by digital subtraction angiographic findings. The parent artery remained unobstructed and the structure of the TPAs were replaced by a mass of scar tissues. The 4 TPAs which were partially occluded remained unruptured and the microcoils were compressed.Conclusions: The lumen in TPA can be completely occluded by microcoils and the parent artery is unblocked. Partial occlusion of the lumen can also prevent the rupture of TPA.

Pseudoaneurysm of profunda femoris artery following dynamic hip screw fixation for intertrochanteric femoral fracture

Dynamic hip screw fixation is a com- monly performed procedure for internal fixation of intertro- chanteric femoral fractures. Arterial injury following the operative fixation is a rare but serious event. We present a patient who developed pseudoaneurysm ofprofunda femo- ris artery after internal fixation of intertrochanteric fracture with a dynamic hip screw. The diagnosis was confirmed by angiographic study and it was successfully treated by coil embolization.

Acute femoral artery pseudoaneurysm due to lesser trochanter fragment： an unusual complication of an intertrochanteric fracture

False aneurysm of the femoral artery is a rare complication of intertrochanteric fracture. Most of these situations are due to iatrogenic trauma or the trauma itself and are rarely caused by dislocated bone fragments. Here we report a case of a 72-year-old man who presented acutely with a pseudoaneurysm of the superficial femoral artery from the spike of a lesser trochanter fragment. Percutaneous endovascular treatment of the pseudoaneurysm with a covered stent was undertaken on an urgent basis. Five days later, the patient was operated upon and the lesser trochanter fragment was excised through an anterior incision and the intertrochanteric fracture was fixed using dynamic hip screws. The fracture was united at 10 weeks. At one-year＇s follow-up, there were no graft-related complications. This case illustrates that an intertrochanteric fracture with a dis- placed lesser trochanter fragment can present acutely with bleeding and a pseudoaneurysm of the femoral artery.

Misdiagnosis and management of iatrogenic pseudoaneurysm of vertebral artery after Harms tech- nique of C1-C2 fixation

Harms technique of CI-C2 fixation for atlantoaxial complex becomes more popular due to good fusion rate and low vertebral artery injury （VAI） rate. But considering the unique and variable anatomy of atlanto- axial complex, iatrogenic VAI will result in catastrophic con- sequences and provides particular surgical challenges for surgeons. To our knowledge, comparing with iatrogenic VAI in the screw hole, iatrogenic VAI in the ＂open space＂ is much rarer during the Harms technique of C1-C2 fixation. In this article, we present a case of iatrogenic vertebral artery pseudoaneurysm after Harms technique of posterior C1-C2 fixation. This case of iatrogenic VAI effectively treated by endovascular coil occlusion and external local compressionwas initially misdiagnosed as VAI by pedicle screw perforation. It can be concluded that intraoperative or post- operative computed angiography is very helpful to diag- nose the exact site of VAI and the combination of endovascular coil occlusion as well as external local com- pression can further prevent bleeding and abnormal verte- bral artery flow in the pseudoaneurysm. However, patients treated require further follow-up to confirm that there is no recurrence of the Dseudoaneurysm.

latrogenic aortic pseudoaneurysm following anterior tho- racic spine surgery masquerading as chronic infection

Late vascular complications involving aorta are rare but devastating adversities following anterior thoracic spine operations are present.The current article describes our experience with one such patient who had an iatrogenic pseudoaneurysm of the thoracic aorta,mimicking infection.The patient was treated successfully following concomitant efforts by multidisciplinary experts with shunting.We wish to highlight upon the significance of recognizing the possible sinister consequences of a dangerously prominent spinal implant and the role of a suspicious surgeon in identifying these menacing complications at the right time.

Endovascular repair for a huge vertebral artery pseudoaneurysm caused by Behcet's disease

Behcet＇s disease （BD）, a multisystem chronic autoimmune process of unknown etiology, usually leads to arterial impairment. Isolated case reports have described BD-related arterial dissections, pseudoaneurysms or aneurysms. Recently, we successfully treated a huge vertebral artery pseudoaneurysm （VAPA） in a patient with BD by stent-grafting with preservation of the affected vertebral artery.

Balloon catheterization for hemostasis during the operation of ruptured femoral artery pseudoaneurysm

Pseudoaneurysms of the femoral artery usually progress and can rupture if left untreated. Therefore,intraoperative hemostasis is of the paramount importance in the management of these emergent situations, especially for the patients with poor general health. We present an efficient method of stopping massive bleeding occurring in this patient by balloon catheter.