Intraorbital ophthalmic artery aneurysm: case report

A rare case is presented of a nonruptured aneurysm of the intraorbital ophthalmic artery in which successful resection of the aneurysm resulted in improvement of preoperative progressive signs caused by the mass effect of the aneurysm. The surgical management of this rare entity is discussed with special attention given to the collateral circulation of the ophthalmic artery from the external carotid artery.

Aneurysm of the cervical internal carotid artery associated with Marfan's syndrome--case report

An aneurysm of the internal carotid artery associated with Marfan's syndrome occurred in a 23-year-old female with a 2-year history of a pulsating lesion in the left neck, which progressively increased in size. Left carotid angiography demonstrated a giant saccular aneurysm at the origin of the internal carotid artery. The aneurysm was excised and end-to-end anastomosis performed without postoperative morbidity.

The rat testicular artery: a model of spontaneous aneurysmal-like structure formation

The straight spermatic and highly convoluted testicular arteries were studied by light microscopy in adult and aging normotensive (NT) and spontaneously hypertensive (SHR) rats. In younger rats, on the internal part of bends of the testicular artery, areas lacking the media similar to classical cerebral arterial medial defects were observed. At the same location, in other bends, structurally defective areas (SDA) constituted by or including medial defects but also lacking the internal elastic lamina and which in some cases evaginated, were present. Structurally defective areas were less numerous in SHR than in NT rats at 6 months, suggesting that intrinsic differences may exist between rat strains. In contrast, in old rats, the number of SDA was higher in hypertensive than in normotensive rats, supporting the role of hemodynamics in SDA formation. With age, SDA enlarged in both rat strains, and most of them became structurally similar to aneurysms, ie, lacking the internal elastic lamina and medial cells and with a dilated lumen, supporting the view that medial defects are sites of aneurysmal structure development. In hypertensive rats, fibrin and lipid deposits occurred within these aneurysmal-like structures. In the straight part of the spermatic artery no such structural modifications occurred, suggesting that either hemodynamics and/or structural development, both dependent on arterial geometry, are determinant in SDA formation. The results are discussed in view of the use of the rat testicular artery as a possible model of the formation of spontaneous aneurysmal-like structures relevant to cerebral aneurysms.

Vascular access for hemodialysis: pathologic features of surgically excised ePTFE grafts

We analyzed 52 surgically excised ePTFE grafts used as secondary vascular access in chronic hemodialysis patients, structurally and histopathologically. Pseudoaneurysm formation at the site of repeated venipuncture was the main cause of surgical removal later than two years after implantation. Repeated needle punctures, twice per treatment, two or three times a week may result in a perigraft fibrous tissue capsule directly above areas where the graft was punctured. The delicate microporous structure of the graft wall was shown to be disrupted by needle punctures. The needle puncture sites were filled by surrounding connective tissue, and in one case, capillary formation was observed within the puncture sites. Examination by both light and scanning electron microscopy demonstrated identical patterns of pseudointima on the luminal surface. A thin pannus of endothelium-like cells, confined to the vicinity of the anastomoses, was noted in only four cases. On other areas of the luminal surface without endothelium, a red coagulum incorporating blood cells and fibrin was observed. Histological evidence of acute infection was absent in 61% of the cases and only 27% were considered to be clinically infected. Careful needle puncture technique, systematic rotation of puncture sites, and the use of rigorous aseptic technique are essential in preserving the long-term structural integrity of the vascular access, despite the good mechanical properties and reasonable good resistance to infection of ePTFE grafts.

Aneurysm in the skin: arterial fibromuscular dysplasia

We describe a pulsatile aneurysm in the skin of 16-year-old boy that was found to be a sign of a systemic vascular disease, that is, arterial fibromuscular dysplasia. The patient had aneurysms in the renal, cerebral, coronary, and other arteries; he developed renovascular hypertension and had a cerebrovascular accident and acute myocardial infarction at 17 years of age. This disease has not been previously reported in the dermatologic literature.

True aneurysm of the saphenous vein graft stump associated with CABG in a cardiac transplant patient

Aneurysm of a saphenous vein graft after coronary artery bypass requires surgical resection because of its potential for rupture. This report describes a case of aneurysm formation in a 55-year-old man who underwent coronary artery bypass operation in 1977 and orthotopic heart transplantation 7 years later. A proximal vein graft remnant that had been ligated at the time of transplantation developed into a 5-cm aneurysm. In patients who have undergone previous coronary artery bypass operation, we recommend that the entire vein graft stump be excised and oversewn at the aortosaphenous anastomosis at the time of transplantation.

[Polyaneurysmal dystrophy (ectatic medial dystrophy)]

Polyaneurysmal dystrophy is a novel form of arteriopathy which specific clinical, angiographic, anatomic and surgical features which distinguish it clearly from multiple atheromasclerotic aneurysm. It should be considered to be a local, multifocal accentuation of megadolicho-arteries, which constitute the lesions during the early stages of the disorder (fairly general elongation of the elastic arteries, with thin walls and regular increase in the caliber and multiple tortuousness). Arterial angiography identifies polyaneurysmal dystrophy; in the context of a twisted and sinuous system of large arteries, multiple spindle-shaped aneurysms can be distinguished which are frequently bilateral and symmetrical. The usual sites are the trunks of the aortic group and internal carotid, the ileo-femoral trunks and terminal aorta. The progress of the disorder is characterized by the possibility of rupture or thrombosis (particularly in the subcrural territory). The treatment is always surgical. The indication for surgery is inevitable in cases of severe ectasia, but may be avoidable in extensive forms of megadolicho-arteries with no clearly defined aneurysm: annual ultrasound monitoring is then called for. The disorder is of constitutional origin (and totally unrelated to atherosclerosis). Delayed dilatation of the aneurysms is due to the hemodynamic forces brought to bear on the fragile walls over a life-time. Multiple aneurysms occur mainly between the ages of 50 and 70 years, with a predominance of aorto-ileac sites in men, even though these subjects do not show any general elastic dysplasia. Half of the 45 patient undergoing surgery were hypertensive.

[A case of retroperitoneal venous aneurysm]

A case of retroperitoneal venous aneurysm is reported. A 73-year-old woman was referred to us with the chief complaint of left abdominal mass. A giant abdominal mass was palpable and diagnostic imaging examination including ultrasound tomography, excretory pyelography, computed tomography, magnetic resonance imaging and angiography revealed a giant cystic mass encircled by calcification in the left retroperitoneal space. Operation for this cystic mass was performed under the preoperative diagnosis of a giant left renal cyst. During operation the mass was located between the left kidney and the left adrenal gland. Because it was difficult to separate the mass from the left kidney the mass was removed with the left kidney. The extirpated tumor measured 15.5 x 15.0 x 9.5 cm and contained old blood clots and red-yellow colored fluid. A histological examination revealed that the tumor wall was composed of smooth muscle and elastic fibers. Therefore, pathological diagnosis was retroperitoneal venous aneurysm. Retroperitoneal venous aneurysm is very rare. To our knowledge, this is the 8th case of retroperitoneal venous aneurysm reported in Japan.

Hypertension due to an aneurysm of the left renal artery in a patient with neurofibromatosis

Arterial lesions in patients with neurofibromatosis are rarely described and in most cases are stenotic. The aneurysmal changes reported in the literature are usually characterized by multiple microaneurysms due to the dysplastic lesions of the artery. We report a case of a single aneurysm of the inferior hilar branch of the left renal artery of a young female with neurofibromatosis. The patient showed hypoperfusion of the renal pole fed by this branch and was hypertensive. The aneurysm had a diameter of 4 cm and showed the histological findings typical of dysplastic lesions of neurofibromatosis. The hypertension and the renal pole hypoperfusion recovered after surgical excision of the aneurysm and end-to-end anastomosis of the hilar branch stumps.

[Rupture of a renal artery aneurysm. Fulminant course, fatal complication of type IV Ehlers-Danlos syndrome in childhood]

A 12 year old girl with joint laxity, hyperelastic and vulnerable skin and tall stature was labeled as "Marfan syndrome". She died unexpectedly from a ruptured aneurysm of the right renal artery. All these features are typical for Ehlers-Danlos syndrome type IV. The diagnostic difficulties and the classification of connective tissue disorders are discussed and further possible complications are reviewed from the literature. The importance of an exact diagnosis is stressed in order to assess the prognosis and start possible therapeutic measures as early as possible.

Sciatic neuropathy associated with persistent sciatic artery

Persistent sciatic artery is a congenital vascular anomaly of the arterial supply to the lower extremity. Thrombosis, distal embolization, aneurysmal dilatation, and rupture of this vessel with compression of the sciatic nerve have been recorded. Although rare in occurrence, complications of persistent sciatic artery should be included in the differential diagnosis of sciatic neuropathy. We present a case of an acute sciatic neuropathy secondary to pseudoaneurysm formation of a persistent sciatic artery. We demonstrate the diagnostic usefulness of magnetic resonance imaging.

[Experimental study of aneurysmal occlusion with fibrin glue]

The authors report an experimental trial of intra-aneurysmal occlusion using fibrin glue. Nowadays, with the development of microsurgical techniques and aneurysmal clips, results of direct radical operations have been improving. But quite a few aneurysms cannot be clipped because of their size, location, broad neck etc. Some authors have treated these aneurysms with innovative techniques (detachable balloon techniques etc). In these methods, the occlusive state of the aneurysms is not always obtainable because of the size of their neck. Besides, it is not always possible to preserve the parent arteries of the aneurysms. Experimental aneurysms in cervical carotid arteries of dogs are treated by direct injection with fibrin glue. During its injection, influx of fibrin glue was prevented by occlusion of the aneurysmal orifices with inflated polyethylene angioplastic balloons. The aneurysms which were completely (100%) filled by the injection of fibrin glue (100% infused group) were totally obliterated in 10 (71%) of the 14 cases. The parent arteries were completely preserved in all instances. Follow-up study demonstrated satisfactory maintenance of this occluded state in the aneurysms in the 100% infused group. In completely occluded cases, all aneurysms maintained this state. On the other hand, 1 of the 4 incompletely obliterated aneurysms recanalized partially. These occluded aneurysms were studied by a light microscope (LM) and a scanning electron microscope (SEM). At day 7 after the occluding procedure, the margin of the aneurysmal orifice was covered by a layer of fibroblasts. At day 21, almost half of the aneurysmal cavity had been substituted with connective tissue. The orifice of the aneurysms was covered with an endothelial layer.(ABSTRACT TRUNCATED AT 250 WORDS)

Upper extremity aneurysm in infants

We report a 2-month-old female infant with a false aneurysm of the brachial artery and an 8-month-old male infant with a true aneurysm of a common digital artery. These traumatic aneurysms in the upper extremity are extremely rare in infants. In the former infant, reanastomosis of the brachial artery was performed. In the latter infant, simple excision was successful.

Endometrial venous aneurysms in three New Zealand white rabbits

Hematuria in rabbits has been associated with uterine adenocarcinoma, uterine polyps, renal infarction, urolithiasis, cystitis, bladder polyps, and pyelonephritis. Three adult female New Zealand White rabbits (Oryctolagus cuniculus) developed apparent hematuria, as suggested by blood in their excreta pans. They had been immunized with antigen-adjuvant emulsions, but had uneventful clinical histories. Physical examination disclosed no abnormalities, and laboratory tests, including hematology, serum chemistries, urinalyses, urine cultures, ultrasonography, and intravenous pyelography disclosed mild anemia, hematuria, and proteinuria in two of the rabbits. Antibiotic therapy failed to alleviate clinical signs. Two rabbits were euthanized because of persistent urogenital bleeding and the third rabbit underwent exploratory laparotomy and ovariohysterectomy. Multiple endometrial venous aneurysms were present in the uteri of all rabbits and urogenital bleeding was attributed to episodic bleeding from these lesions. Varices and aneurysms of uterine subserosal and myometrial venous plexuses, but not of endometrial vessels in women have been reported. To our knowledge, endometrial venous aneurysms have not been reported in animals previously. Our findings indicate that the differential diagnoses for sporadic apparent hematuria in female rabbits should include endometrial aneurysms.

A true aneurysm of a collateral branch of a proper digital artery

An idiopathic true aneurysm of a collateral branch of the proper radial digital artery of the index finger was treated by ligation and resection. The proper digital artery remained in continuity without interruption, and the patient's symptoms were relieved.

Pulmonary arterial aneurysms

Over a period of 12 years, two cases of pulmonary arterial aneurysms were encountered in our autopsy data of 13 cases of congenital heart defects with right-sided infective endocarditis. Pulmonary arterial aneurysms are rare lesions and may be categorized as central or peripheral. Although early reports implicated tuberculosis as a major aetiologic factor, pulmonary arterial aneurysms are generally associated with congenital heart disease.

Aneurysmal peroneal nerve compression

Vascular compression syndromes of the peroneal nerve are rare. The case history of a patient with a peroneal nerve compression caused by a true anterior tibial artery aneurysm is reported. The surgical excision of the aneurysm resulted in marked improvement.

Surgical treatment of solitary peripheral pulmonary artery aneurysm associated with ventricular septal defect

In the case presented a solitary peripheral pulmonary artery aneurysm occurred in a woman with ventricular septal defect (VSD). During the operation of repairing the VSD under cardiopulmonary bypass, the pulmonary artery aneurysm (PAA) suddenly ruptured into the bronchus and a large amount of air entered the pulmonary artery and right ventricle when the anesthetist inflated the lungs. The air in the right ventricle could not be evacuated completely, so we had to remove the lobe where the aneurysm was located. The operation was successful and the postoperative course was uncomplicated.

[An aneurysm of the extracranial carotid. A report of an interesting clinical case]

One case of extracranial carotid artery aneurysm observed is reported. This uncommon and interesting vascular disorder is still under discussion even if the present tendency is to treat it actively by reconstructive surgical procedures that make it possible to avoid the natural aneurysm complications with a low risk of postoperative neurological lesions.

The Charcôt-Bouchard aneurysm controversy: impact of a new histologic technique

For over a century a controversy has existed about the prevalence and significance of Charcôt-Bouchard (C-B) aneurysms, especially regarding their relationship to intracerebral hemorrhage (ICH) in man. We reassessed C-B aneurysms by staining thick brain sections from 35 hypertensives and 20 normotensives with the alkaline phosphatase (AP) endothelial stain followed by light microscopy and high-resolution microradiography. Charcôt-Bouchard aneurysms were conspicuously absent in both groups which included four cases of hypertensive ICH. The three-dimensional perspective and enhanced ability to trace vessels with these techniques helped to identify arteriolar coils and twists that can be mistaken for aneurysms when demonstrated by injection methods. Routine brain pathologic sections from 2,800 autopsies over a decade showed rare examples of parenchymal aneurysms. We conclude that elimination in our study of a) injection artifacts and b) misinterpretations shows that C-B aneurysms are uncommon and have little relationship to ICH. Despite this, and in view of the original contribution of Charcôt and Bouchard, the occasional examples of brain parenchymal aneurysms should continue to bear their names.