Surgical Intervention for Behcet＇s Disease with Aorta Aneurysm and Pseudoaneurysm： Opposite Outcomes in Two Cases

Behcet＇s disease （BD） is a chronic, relapsing autoimmune disorder characterized by oral and genital ulcerations with uveitis, and additional clinical manifestations in multiple organ systems. The occurrence of vascular involvement in BD is reported to be in the range of 5 30%.

Mycotic Aneurysm of Infrarenal Aorta: A Case Report and Review of Literature

Mycotic or infected aneurysms are focal vascular dilatations from inflammation or infection that results in weakening of the blood vessel wall. It poses a high risk of complications such as aneurysm rupture, uncontrolled sepsis and extensive periaortic infection. Symptoms are frequently minimal during the early stages and a high index of suspicion is essential to make the diagnosis. They are more likely to expand rapidly and rupture without surgical intervention. We report a case of a middle-aged man presented with 3-week history of fever, abdominal pain and low back pain. Initially presented as acute pyelonephritis with subsequent findings of liver abscess, right epididymoorchitis and left infrarenal mycotic aneurysm, which rapidly increased in size and underwent successful endovascular surgery.

Images in emergency medicine:giant ascending aortic aneurysm dissection with hemopericardium

Acute chest pain represents a common presentation at emergency department. Aortic dissection in young patients, however, is fortunately rare. We report a case of giant ascending aortic aneurysm with Stanford type A aortic dissection in an otherwise well 22-year-old male patient. Operative aortic valve and root replacement was undertaken with favourable outcome. Histopathologic examination of the resected aorta revealed acute on chronic inflammatory change with Langerhans type giant cells consistent with a diagnosis of giant cell aortitis. While uncommon, emergencies of the aorta may present in young patients. Predisposing conditions are discussed.

Incidental extravascular findings in computed tomographic angiography for planning or monitoring endovascular aortic aneurysm repair: Smoker patients, increased lung cancer prevalence?

AIM To validate the feasibility of high resolution computed tomography(HRCT) of the lung prior to computed tomography angiography(CTA) in assessing incidental thoracic findings during endovascular aortic aneurysm repair(EVAR) planning or follow-up.METHODS We conducted a retrospective study among 181 patients(143 men, mean age 71 years, range 50-94) referred to our centre for CTA EVAR planning or followup. HRCT and CTA were performed before or after 1 or 12 mo respectively to EVAR in all patients. All HRCT examinations were reviewed by two radiologists with 15 and 8 years experience in thoracic imaging. The results were compared with histology, bronchoscopy or follow-up HRCT in 12, 8 and 82 nodules respectively. RESULTS There were a total of 102 suspected nodules in 92 HRCT examinations, with a mean of 1.79 nodules per patient and an average diameter of 9.2 mm(range 4-56 mm). Eightynine out of 181 HRCTs resulted negative for the presence of suspected nodules with a mean smoking history of 10 pack-years(p-y, range 5-18 p-y). Eighty-two out of 102(76.4%) of the nodules met criteria for computed tomography follow-up, to exclude the malignant evolution. Of the remaining 20 nodules, 10 out of 20(50%) nodules, suspected for malignancy, underwent biopsy and then surgical intervention that confirmed the neoplastic nature: 4(20%) adenocarcinomas, 4(20%) squamous cell carcinomas, 1(5%) small cell lung cancer and 1(5%) breast cancer metastasis); 8 out of 20(40%) underwent bronchoscopy(8 pneumonia) and 2 out of 20(10%) underwent biopsy with the diagnosis of sarcoidosis.CONCLUSION HRCT in EVAR planning and follow-up allows to correctly identify patients requiring additional treatments, especially in case of lung cancer.

Thoracic Aortic Aneurysm Revealed by Haemoptysis on a 10-Year-Old Girl at Paediatrics Department of Yalgado Ouedraogo University Hospital

Thoracic aortic aneurysm is a rather rare disorder in children and difficult to diagnose. It is generally linked to congenital heart defects or connective-tissue diseases. Our case is a 10-year-old girl admitted in the pediatric emergency care unit on January 19th, 2015 for massive haemoptysis and severe anaemia. Examination revealed severe anemia and a silent left lung. The Chest X-Ray revealed an abnormal mass on the upper left side of the mediastinum, and left lower lobe consolidation. The thoracic CT scan highlighted a 64 mm aneurysm of the subisthmic aorta with a thin 5 mm hole. It also showed pseudocoarctation of the aorta. Treatment in intensive care consisted of blood transfusion and iron supplement. She was due to travel abroad for cardio vascular surgery, but died on November 2016. Thoracic Aortic Aneurysm in our setting was discovered incidentally. In spite the fact that it is an extreme surgical emergency, in Burkina Faso, treatment can only be possible abroad upon medical evacuation.

Giant Ascending Aortic Aneurysm: Are There Peculiarities in the Developing World?

Aim: To highlight the imaging features and the peculiarities associated with a giant ascending aortic aneurysm in a typical developing world setting. Presentation of Case: A 78-year-old known hypertensive and asthmatic woman of 25 and 10 years duration respectively. She had an untreated degenerative aortic valve lesion and moderate aortic regurgitation. This case study showed the complex interplay of background untreated aortic valve disease, aortic insufficiency, chronic hypertension, chronic airway obstructive disease and ageing in a case of giant aneurysm of the entire ascending aorta. It also emphasizes the role of imaging in diagnosis and follows up of ascending aortic aneurysm particularly where prevention is key to prevent the high mortality associated with Thoracic aneurysymal rupture. Conclusion: Timely institution of appropriate treatment of aortic valve disease, prevention and adequate control of hypertension is key to prevent the development and the grave prognosis of ascending aortic aneurysm, particularly in the developing world where appropriate medical facilities, expertise and treatment are scarce.

Endovascular treatment of paravisceral mycotic aneurysm: Chimmeny endovascular sealing the end of de road

Open surgery is the elective treatment for mycotic aneurysms of the aorta. This surgery consists of resection of the aneurysm, debridement and revascularization with an in situ or extra-anatomic bypass. Even when surgery has been successful, the morbimortality is raised and the endovascular treatment has become an alternative for specific patients. When mycotic aneurysms involved the visceral arteries, more complex techniques are necessary such as fenestrated endovascular aortic repair or chimmeny endovascular aortic repair and the most frequent complications of this are endoleaks and oclussion the visceral arteries. We present a case of a pacient with a paravisceral abdominal mycotic aneurysms that was result with 2 chimney technique(in the right renal and superior mesenteric arteries) and a single Nellix EVAS(Endologix, Irvine, Calif) of 12 cm long without evidence of endoleaks in the follow-up.

Total Thrombosis of Bifurcated Endoprosthesis: A Rare Complication of Endovascular Treatment of Abdominal Aortic Aneurysm

Background: Aortic stents are a therapeutic alternative to open surgery of abdominal aortic aneurysms. We report a case of treatment of an abdominal aortic aneurysm with a bifurcated stent, complicated by total thrombosis. Aim: The purpose of this presentation was to understand the causes, mechanisms, incidents and accidents that contributed to this complication. Case Presentation: A 48-year-old man patient with a history of high blood pressure, ischemic heart disease, chronic obstructive pulmonary disease, who was found during a surveillance check-up, an infra-renal abdominal aorta aneurysm measured at 56 mm in diameter, asymptomatic but progressive. The indication of an endovascular treatment by the placement of a bifurcated prosthesis was posed and accepted. Thrombosis of the two limbs was intra-operative, upper-end migration without endoleak at 4 months postoperative, total thrombosis of the stent at 13 months postoperatively. Explantation of the stent followed by aortobi-iliac bypass was finally performed in the 15th month. Conclusion: The cardiopulmonary antecedents, the anatomical and evolutionary characteristics of the aneurysm could have played a role in the occurrence of the complications observed in this patient.

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.

With autosomal dominant polycystic kidney disease,aortic dissection follows an abdominal aneurysm ten years later:a case report

A case of aortic dissection with a repaired abdominal aneurysm with prosthetic graft ten years ago in a 45-year-old woman is presented.Stanford type B dissection and multiple renal cysts diagnosed by contrast enhanced CT and an iliac false aneurysm by intraoperational angiography.Four stents were deployed to repair these arterial lesions with one fenestrated.With her only son revealed also with renal cysts by ultrasonogram,the diagnosis of autosomal dominant polycystic kidney disease (ADPKD) was confirmed.

Tuberculous Abdominal Aortic Aneurysm with Alimentary Tract Hemorrhage：A Case Report with Medico-legal Impli-cations

An autopsy case of sudden death induced by alimentary tract hemorrhage was presented,which was caused by the unexpected rupture of clinically unrecognized tuberculous abdominal aortic aneurysm(TAAA).The initial diagnosis was made of the syndrome of coronary heart disease and hypertensive disease.The detailed autopsy showed that the alimentary tract hemorrhage was caused by a sudden rupture of the mass after posture changing was ascertained as the cause of death.The diagnosis of TAAA was determined by the autopsy findings.Analysis for the medical dispute of TAAA was described,and the difficulty of the diagnosis and medico-legal implications were also discussed.

Atherosclerotic Descending Aortic Aneurysms. Pros and Cons of Surgery

Within the last few years, there has been a strong trend to rethink the issue of management of atherosclerotic descending thoracic and abdominal aortic aneurysms (AAAs). When etiopathogenetic associations among changes observed during the progression of the disease were not fully described, surgeons had successfully applied, although traumatic, but a rather radical method to rescue from the rupture threat. As we gained experience and knowledge about long-term outcomes, mostly concerned mortality, we realized that surgery could not be the main tactical approach to AAAs treatment due to its frequent inefficiency and failure to guarantee that the disease would be suppressed including co-morbidities, polymorphic processes and clinical manifestations. It all required more sparing treatment strategies. The situation gave rise to a more argumentative and sparing medical-and-surgical approach to treatment based on a more in-depth understanding of the etiopathogenesis of the disease whereas surgery would remain of prime importance when appropriate. The following has been developed to improve treatment outcomes for AAA: 1) Multifactorial determination of indications for surgical correction with outlining the area of relative and absolute risk of aneurysm rupture;2) Method of conservative treatment aimed to attain and maintain optimal blood pressure, target levels of cholesterol and low-density lipoproteins, as well as reduce oxidative and inflammatory processes in aorta, strengthen its wall, stabilize the disease and control co-morbidities. A four-year follow-up of patients using this developed technology has yielded more preferred results suggesting the need for narrowing indications for surgery to treat AAAs. Another advantage of the sparing approach to treat AAA is economic, due to fewer operations and implantations of stent-grafts, considering the fact that medical treatment should be used in operated subjects, too.

Aortic Root and Ascending Aortic Aneurysm Related to One Case. Reimplantation of the Right Coronary Artery by 8 mm Dacron Tube (Cabrol Hemi Mustache) and Review of the Literature

The aortic aneurysm is the 13th leading cause of death in Western countries. The incidence of thoracic aortic aneurysms is estimated at 4.5 cases per 100,000. The diagnosis is often made on a chest x-ray or other imaging tests, such as an echocardiogram done for other heart diseases. Echocardiography is the first test to assess the diameter of the ascending aorta and its progression over time. Most patients are first assessed and followed up with spiral thoracic computed tomography with injection of contrast medium, supplemented by 3-dimensional reconstruction of the aneurysm in order to improve the accuracy of measurements, identification of its proximal part and distal. When dilation of the ascending aorta reaches the critical diameter of 50 mm, there is a risk of aortic dissection or rupture. Supravalvular aneurysms are treated by replacing the ectatic portion with a Dacron® tube in the supracoronary position. Aortic root aneurysms, including coronary ostia, require tube replacement, reimplantation of coronary ostia, as well as surgery on the aortic valve. In this article, we report a case of aneurysm of the aortic root and the ascending aorta treated by aortic valve replacement and the ascending aorta associated with the Cabrol hemi-mustache technique and we review the literature.

基于中国主动脉弓部病变人群的解剖特征分析

目的分析中国主动脉弓部病变人群的解剖特征,为国产化腔内器械的研发提供解剖学依据。方法收集2021年6月1日至2024年1月1日全国17个中心开展的WeFlow-Arch支架系统首个前瞻性多中心研究中的83例主动脉弓部病变患者的数据。根据病变类型分为动脉瘤组67例和溃疡组16例。将术前CT血管造影数据导入专业图像处理软件进行三维重建,基于血管中心线测量并比较主动脉的相关解剖参数,评估Zenith支架和Relay支架在中国患者中的解剖适应性。结果Zenith支架和Relay支架在中国患者中的解剖适应性分别为39.8%和63.9%。动脉瘤组与溃疡组在主动脉弓分型、主动脉直径及距离、弓上分支血管直径及长度、时钟位置及角度、左右股动脉直径、近端主动脉及主动脉整体弯曲指数等解剖指标比较,差异无统计学意义(P>0.05)。动脉瘤组升主动脉弯曲指数明显低于溃疡组(1.17±0.06 vs 1.22±0.08,P=0.010),支架假体近似覆盖区域弯曲指数明显高于溃疡组(2.97±0.46 vs 2.66±0.36,P=0.020)。结论不同主动脉弓部病变在升主动脉和支架覆盖区域的弯曲程度上存在显著差异,需关注其对预后的潜在影响。国外相关器械在中国患者中的解剖适应性较差,研发适合中国患者的国产腔内器械具有重要意义。

主动脉瘤相关基因突变对二叶主动脉瓣患者主动脉病变的影响

目的:主动脉瘤相关基因突变对二叶主动脉瓣(BAV)患者主动脉扩张及瓣膜功能的影响。方法:选取BAV伴主动脉扩张的患者114例,均行超声心动图检查,评估其主动脉窦部、升主动脉、主动脉弓的最大径、瓣膜的功能等;收集患者外周血,对主动脉瘤相关基因进行筛查。依据基因检测结果分为突变组12例和未突变组102例。结果:突变组中,FBN1基因突变7例、COL3A1基因突变2例、MYLK基因突变1例、TGFBR1基因突变1例,TGFBR2基因突变1例;114例存在主动脉瘤72例,发生率63.16%。突变组主动脉瘤发生率(100.00%)显著高于未突变组(58.82%),窦部瘤合并升主动脉动脉瘤发生率(41.67%)显著高于未突变组(5.89%),差异均有统计学意义(χ^(2)=6.154,P=0.013;χ^(2)=11.993,P=0.001)。突变组主动脉瓣反流率(75.00%)显著高于未突变组(34.31%),差异有统计学意义(χ^(2)=5.881,P=0.015)。突变组主动脉窦部平均最大径显著大于未突变组,差异有统计学意义(t=2.905,P=0.014)。突变组中合并主动脉瘤患者主动脉窦部平均最大径大于未突变组,差异有统计学意义(t=2.521,P=0.027)。结论:在BAV伴主动脉扩张中主动脉瘤相关基因发生突变患者的主动脉瘤的发生率高于未突变组,可能是基因突变引起的解剖学异常及血流动力学异常共同导致。

假性动脉瘤破裂死亡患者临床及影像特征

目的探讨假性动脉瘤破裂死亡病例的临床特点和影像学特征,加强认知,提高预防策略和早期诊治意识。资料与方法回顾性分析2016年1月—2021年12月空军军医大学第二附属医院6例假性动脉瘤破裂死亡患者的临床、CT及MRI资料。结果假性动脉瘤CT及MRI表现为突出载瘤动脉的类圆形或不规则形瘤体,并可见破口与载瘤动脉相通,瘤体内可有血栓形成,邻近载瘤动脉可有受压移位、管腔变细或增粗等表现。影像学检查提示6例假性动脉瘤位置、形态、大小、破口大小、与载瘤动脉的关系以及与周围组织结构的关系显示清晰,诊断明确。2例均因误吞枣核、内镜下取出后主动脉弓部假性动脉瘤形成,病1例外伤、1例介入术后导致假性动脉瘤形成,1例病因不明,1例因颅内非特异性感染侵蚀邻近血管壁导致左侧颈内动脉海绵窦段假性动脉瘤形成。6例病例死亡前均有突发呕血或鼻出血症状,提示假性动脉瘤破裂。结论假性动脉瘤破裂死亡率高,CT及MRI可客观显示其影像学特征,具有一定的临床价值。

腔内隔绝术治疗高风险腹主动脉瘤

目的评价腔内隔绝术治疗外科高风险腹主动脉瘤(AAA)的疗效及安全性。方法51例AAA患者行腔内隔绝术。按国际血管外科/心血管外科(SVS/ISCVS)手术风险评估方法分级,1级(较低风险)30例,2～3级(高风险)21例。根据术前CT及DSA资料合理选择支架。术后定期临床及CT影像随访,观察并发症及瘤体形态学变化。结果覆膜支架均顺利置入,技术成功率100%,术中及术后30 d无死亡。所有患者术后平均随访(29.1±20.5)个月,死亡1例(术后36 d),死因不详。主要并发症5例(9.8%),包括分支支架内血栓形成2例,股动脉切口局部并发症2例(血栓形成及淋巴管瘘),支架单臂脱位导致内漏增多1例。术后少量内漏10例(19.6%),其中5例随访期自行消失。结论腔内隔绝术治疗AAA,特别是外科高风险患者,近中期疗效满意。

急性Stanford A型主动脉夹层动脉瘤手术死亡风险因素研究

目的探讨急性Stanford A型主动脉夹层动脉瘤手术死亡风险因素。方法选取2009年10月—2016年1月云南省第一人民医院收治的急性Stanford A型主动脉夹层动脉瘤患者167例,根据手术结果分为手术成功组(n=131)和术后死亡组(n=36)。采用回顾性研究方法,收集两组患者的一般资料[包括性别、年龄、是否吸烟、是否行经皮冠状动脉介入术(PCI)、是否行胸部手术及有无慢性阻塞性肺疾病(COPD)、外周血管疾病、胸痛、恶心/呕吐、腹痛、低血压]、实验室检查指标(包括血红蛋白、血小板)及术中停循环时间、弓部处理方式。结果两组性别、吸烟率、PCI率及外周血管疾病、恶心/呕吐发生率间差异无统计学意义(P>0.05),而年龄、胸部手术率及COPD、胸痛、腹痛、低血压发生率间差异有统计学意义(P<0.05)。两组血红蛋白水平间差异无统计学意义(P>0.05),而血小板计数及其分布间差异有统计学意义(P<0.05)。两组术中停循环时间分布及弓部处理方式间差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄、胸部手术、胸痛、腹痛、低血压、血小板计数、术中停循环时间、术中弓部处理方式是急性Stanford A型主动脉夹层动脉瘤手术死亡的风险因素(P<0.05)。结论患者的年龄越大,既往行胸部手术,术前出现胸痛、腹痛和低血压,术前血小板计数偏低,术中停循环时间延长及弓部采用三分支吻合方式增加了急性Stanford A型主动脉夹层动脉瘤手术死亡风险。

裸支架在腹主动脉瘤腔内隔绝术后近端内漏治疗中的应用

目的 探讨应用裸支架治疗腹主动脉瘤腔内隔绝术后近端内漏的价值和安全性。方法 使用裸支架法治疗原发性内漏 3例 ,继发性内漏 1例。 1例裸支架在肾动脉下固定 ,3例跨双侧肾动脉开口固定。结果 裸支架均成功置入 ,近端内漏完全消除 ,术后未观察到肾功能受损、裸支架移位和近端内漏复发等并发症。结论 使用裸支架法治疗近端内漏 ,是一种安全、有效、可行的选择。

DeBakey Ⅲ型夹层动脉瘤的治疗

目的：分析与总结我院收治的ＤｅＢａｋｅｙⅢ型夹层动脉瘤患者３５例的治疗经验与效果。方法：本组男性３２例，女性３例，男女比例为１０∶１，年龄２１～６４岁，平均５２．０±３．２岁。全部患者均经Ｘ线胸片，数子减影血管造影术，计算机断层摄影术，磁共振成像检查证实诊断，动脉瘤的直径４．６～９．０ｃｍ，平均５．１±２．２ｃｍ。全组患者中２１例进行了手术治疗（手术组），其中１７例行人造血管部分降主动脉替换术，２例行升主动脉及腹主动脉转流手术，２例行主动脉折叠手术。１４例未行手术（非手术组）。结果：手术组死亡３例（术中出血１例，住院死亡２例）。非手术组８例在住院期间动脉瘤破裂（６例死亡，２例包裹后出院，半年后因动脉瘤再次破裂死亡）；２例随访３年存活；１例失访；３例自动出院。结论：目前对ＤｅＢａｋｅｙⅢ型夹层动脉瘤的治疗尚存在不同意见，本组患者结果表明手术治疗优于非手术治疗（Ｐ＜０．０５）。