Parietal inflammatory infiltrate in peripheral aneurysms of atherosclerotic origin

Clinical and histological analyses were made of 18 consecutive cases of peripheral artery atherosclerotic aneurysms (PAAA) (common, deep femoral and popliteal arteries) and compared to a group of 10 specimens obtained from the atherosclerotic, non aneurysmal femoral arteries of 10 cadavers with similar characteristics to the 18 patients. Although neither the clinical nor the macroscopic morphological data indicated the presence of an inflammatory process in the PAAA, the histological examination revealed the presence of a considerable infiltrate (greater than 11 inflammatory cells/2116 microns2) in a surprisingly high percentage of cases (4 cases, 22.8%). In 5 other cases (27.7%) the presence of lymphomonoplasmonocytic cells, although less pronounced, was greater than normally seen in atherosclerotic arterial walls (greater than 4 and less than 11 inflammatory cells/2116 microns2). The median number of inflammatory cells present in the media and adventitia varied from 2.2 +/- 0.3 to 13.2 +/- 0.3 per 2116 microns2. These values are significantly different compared to the results of atherosclerotic arteries at the same level (P less than 0.001 Mann-Whitney's U test). These findings of lymphomonoplasmocytic infiltrates in the absence of other pathology, together with an analysis of the data in the literature, makes it possible to presume that the inflammation present is associated with atherosclerosis and is more common in aneurysmal rather than stenotic forms. The pathogenesis may be determined by immune reaction phenomena.

Coexistence of extracranial internal carotid artery aneurysm and multiple intracranial aneurysms--case report

A rare case of extracranial internal carotid artery (ICA) aneurysm coexisting with intracranial multiple aneurysms in a 64-year-old female is reported. The three intracranial aneurysms were clipped uneventfully by two-stage craniotomies. The extracranial ICA aneurysm at the infratemporal region was excised through a high cervical route and ICA was reconstructed by an end-to-end direct anastomosis. Ours is the first case reported of extra- and intracranial aneurysms surgically treated successfully.

Histopathological study of balloon embolization: silicone versus latex

Bilateral, symmetrical, experimental aneurysms were produced with anastomosed vein flap in the carotid arteries of 24 mongrel dogs. Aneurysms were occluded with latex or silicone balloons on each side and observed angiographically from 2 weeks to 2 months. A histopathological study was performed subsequently using light and scanning electron microscopy. Rupture after balloon embolization occurred in five aneurysms; all of which were incompletely occluded by a silicone balloon. On subsequent angiograms, four silicone balloons and one latex balloon were found to have migrated into the aneurysm, resulting in aneurysmal expansion. Parent artery occlusion was more common with latex balloons than silicone balloons. Histopathologically, residual fresh thrombi, decreased proliferation of fibroblasts within the aneurysmal cavity, and poor endothelialization were present around the silicone balloon. These results suggest that the intra-aneurysmal organization, as seen in the aneurysm occluded by the silicone balloon, will be delayed because the balloon is not fixed within the aneurysm, and that this free-floating and rotating balloon causes repeated trauma to the aneurysm wall, contributing to subsequent enlargement and rupture of the aneurysm. The superior antithrombogenic nature of silicone may be responsible for the bias of such phenomena toward the silicone balloon.

Abnormalities in the biosynthesis of type III procollagen in cultured skin fibroblasts from two patients with multiple aneurysms

We examined the synthesis of collagenous proteins by cultured skin fibroblasts taken from 14 patients with an abdominal aortic aneurysm and either an aneurysm at a second site (8 patients) or a first order relative with an abdominal aortic aneurysm (6 patients). Fibroblasts were labeled with [3H] proline and, following pepsin digestion of media proteins, the ratio of type I/III collagen was examined by denaturing polyacrylamide gel electrophoresis (SDS-PAGE). With the exception of two patients, the ratio of type I/III collagen in the media of fibroblasts from aneurysm patients was similar to control values (6 controls). In two of the patients, the type I/III collagen ratio was greater than 3 standard deviations from the mean of both control ratios and those of other aneurysm patients. mRNA levels coding for type III procollagen, however, were normal in both patients. Patient #1 (ME) showed reduced type III procollagen on SDS-PAGE analysis of intracellular proteins. Intracellular and media type III procollagen levels were normal in patient #2 (HR), but media type III collagen was reduced by over 50% after digestion with a combination of trypsin and alpha-chymotrypsin for 5 minutes at 36 degrees C. Control type III collagen was only reduced after digestion at 39 degrees C. These data suggest an altered thermal stability of the type III collagen trimer synthesized by this patient, probably due to a mutation in the amino acid sequence. The data presented in this paper suggest that some forms of common abdominal aortic aneurysms may be caused by mutations in the gene coding for type III procollagen.

[A case report of true palmar aneurysm]

True palmar aneurysm is a rare disease of the hand. Only 12 cases of true palmar aneurysm have been reported in Japan. This occurs commonly in the hypothenar region. We experienced a 12-year-old boy who had a aneurysm of the left palmar hand successfully treated by surgery. The clinical diagnosis was established by ultra sound. Vascular reconstruction by end to end anastomosis was performed after excision of aneurysm. Pathology revealed this was true aneurysm.

Behçet's disease revealed by double peripheral arterial involvement

We report the case of a 62-year-old man with Behçet's disease revealed by double aneurysmal involvement of the posterior tibial and popliteal arteries. The diagnosis was suggested because of repeated phlebitis, buccal aphthous ulcerations, and results of human leukocyte antigen gene typing. The different arguments leading to the diagnosis of Behçet's disease and appropriate treatment are presented.

Atherosclerotic aneurysms of the axillary artery. A report of two cases and a review of the literature

Atherosclerotic axillary artery aneurysms are rare. We report two cases of this entity and review the literature with respect to clinical presentation, diagnosis, operative management, and long-term outcome of these lesions.

Bilateral infrapopliteal artery aneurysms

The authors report the case of a 37-year-old man with bilateral posterior tibial artery aneurysms and concomitant collagen vascular disease. The patient initially presented with pain and swelling of the calves. The diagnosis was made by duplex scan and confirmed with arteriography. Diagnostic studies later verified the presence of a lupus-like syndrome. To date, 10 patients with aneurysms of the infrapopliteal arteries have been reported in the literature; four of these have had associated systemic diseases. These reports are reviewed; their clinical manifestations are discussed, and a treatment plan for these uncommon lesions is presented.

Segmental mediolytic arteritis. Clinicopathologic study and three-dimensional analysis

We describe the first recorded case of segmental mediolytic arteritis (SMA) in Japan. A 71-year-old Japanese woman developed sudden abdominal pain and went into shock during hospitalization for treatment of valvular heart disease. Laparotomy revealed a ruptured pseudoaneurysm of the left gastric artery. Histological examination of the resected artery revealed multiple extensive areas of the dilated wall where the media had partially or totally disappeared with or without the intima. These features were typical of those described previously for SMA (1,2). Three-dimensional analysis of the arterial lesions revealed that the residual media formed branches and cavities down the long axis of the artery, indicating that the major cause of the medial disappearance was arterial dissection. Three months later, the patient died of sepsis. Autopsy revealed pseudoaneurysm formation at three different locations in the splenic artery. Histologically, these pseudoaneurysms showed destructive changes in the arterial wall similar to those described above, with organization and thrombosis, and were considered to be the end-stage lesion of SMA. This case is considered to be the fifth adult case of SMA in the literature and the first one showing chronic changes.

Aneurysms of the carotid arteries associated with von Recklinghausen's neurofibromatosis

Aneurysms of both common carotid arteries were seen in a patient with neurofibromatosis. Histologic examination of the involved arteries demonstrated a dense proliferation of spindle cells within the arterial walls accompanied by medial cystic degeneration and disruption of the tunica elastica. These changes were also observed in adjacent, grossly uninvolved segments of the blood vessels. Immunohistochemical analysis of the proliferating cells was positive with antibodies against desmin and muscle-specific actin. The findings demonstrate and confirm the smooth muscle origin of the aberrant proliferated cell population in arteries in a patient with von Recklinghausen's neurofibromatosis.

Ruptured saccular pulmonary artery aneurysm associated with persistent ductus arteriosus

We report a case of rupture of a saccular pulmonary artery aneurysm with fatal hemopericardium in a 29-year-old man who also had persistent ductus arteriosus with severe pulmonary hypertension. Histologic examination of the pulmonary artery showed cystic medionecrosis similar to that observed in patients with ruptured dissecting pulmonary artery aneurysms. The two types of ruptured aneurysms probably only represent different morphological expressions in the same underlying process in which the main contributory factor is pulmonary hypertension.

Magnetic resonance angiography compared to intra-arterial digital subtraction angiography in patients with subarachnoid haemorrhage

In order to evaluate the sensitivity and specificity of magnetic resonance angiography (MRA) in spontaneous subarachnoid haemorrhage, 14 patients with recent haemorrhage verified by CT or lumbar puncture were investigated with both selective intra-arterial digital subtraction angiography (IA-DSA) and MRA by two independent teams, each having the same preangiographic information. The results were compared with each other and whenever possible (all positive cases except one) with those of surgical intervention. Seven patients were identified by MRA and IA-DSA as having a single aneurysm on the circle of Willis, 1 an aneurysm of the posterior inferior cerebellar artery 1 an aneurysm of the internal carotid artery (siphon) and 2 patients with two aneurysms on the circle of Willis. MRA and IA-DSA both failed to demonstrate aneurysms in 2 cases. Three patients had negative results on both methods and no surgical intervention was attempted. The aneurysms ranged from 0.3 to 1.5 cm in size. In most cases there was agreement between MRA and DSA, leading us to believe that, if the proper protocols are followed, MRA is a powerful alternative to other established methods in the detection of intracranial aneurysms. At this stage it will not replace IA-DSA prior to surgery, but the ability to obtain various projections using 3D MRA may improve surgical planning.

[Pseudoaneurysm of the common digital artery]

Palmar aneurysms are very rare. The authors report a case of pseudoaneurysm in an 18 year old waiter. The mechanism was puncture by a chip of porcelain. The diagnostic errors, clinical and pathological criteria are recalled and the literature concerning this problem is reviewed.

Bilateral pulmonary aneurysm in Behçet's disease (a case report)

While investigating a chest opacity in Behcet's disease possibility of pulmonary aneurysm should be considered. Contrast enhanced CT is a safe diagnostic method which is useful in confirming or excluding the presence of an aneurysm in such cases. We report here the first case of bilateral pulmonary aneurysms in Behcet's disease.

A scanning electron microscopic study of arterial endothelial repair under turbulent flow conditions

In order to study the role of hemodynamic factors on the healing and native morphology of endothelium in vivo, turbulent arterial flow was created using a loop bypass model, with and without occlusion in the recipient vessel. In this model, several different patterns of turbulent arterial blood flow resulted. The scanning electron microscope (SEM) was used to evaluate endothelial morphology in the area of the anastomoses at 3 and 14 days post-operatively. Morphological changes in the native endothelium along the recipient vessel correlated well with the direction of blood flow and predicted patterns of turbulence. The morphology of the native endothelium was altered to reflect the direction and pattern (laminar versus turbulent) of blood flow by 3 days postoperatively. Based on endothelial morphology, very narrow zones of separation could be demonstrated between areas of laminar and turbulent blood flow. The degree of reendothelialization across the suture itself was greatly variable at 3 days and there seemed to be no relationship to the location of turbulent flow.

Spontaneous rupture of an aneurysm of the left gastroepiploic artery

This report describes the successful surgical treatment of a ruptured aneurysm of the left gastroepiploic artery. These aneurysms represent a very small fraction of visceral aneurysms.

Rupture of a giant splenic artery aneurysm. Report of an autopsy case

We describe an autopsy case of a 61-year-old woman with von Recklinghausen's disease, who died suddenly following intraperitoneal hemorrhage due to the rupture of a giant splenic artery aneurysm. The aneurysm measured 16 x 13 x 5.5 cm--much larger than those in most previous reports. The pancreatic body, which was pressed by the aneurysm, was widely atrophic. In general, splenic artery aneurysms are more frequent in pregnant women or patients with portal hypertension. The pathogenesis of this aneurysm is presumed to be arterial dysplasia, focal arterial inflammation, or portal hypertension, unlike other aneurysms due to arteriosclerosis or syphilis. Since the patient had not been pregnant and had not had liver cirrhosis or arteriosclerosis, the pathogenic factor could not be determined in this case. The relationship between the genesis of the aneurysm and von Recklinghausen's disease was not clear either.

False aneurysm of a digital artery. A case report

Traumatic aneurysms of a digital artery are rare, and only 11 cases have been reported in the literature. This paper describes the aetiology, physical appearances, investigation and management of a false aneurysm of the digital artery of the left little finger.

[A case of bronchial artery aneurysm demonstrating a mass shadow on chest X-ray film]

A 66-year-old woman was admitted on May 13, 1989, because of an abnormal round shadow in the right hilum on chest X-ray film. Bronchoscopy revealed a stenosis of the right B8 caused by a bulging lesion. An aortogram showed a large meandering bronchial artery and a saccular aneurysm. The aneurysm was about 25 mm in diameter and associated with a bronchopulmonary anastomosis. It was surgically removed by right lower lobectomy. Pathological examination proved that the resected lesion was an arterial aneurysm. Patchy arteriosclerotic change was present in the intima of the aneurysm, but there was no evidence of inflammatory change in the arterial wall and the adjacent alveoli and bronchi. Twenty-six cases of bronchial artery aneurysm have been previously reported in the literature, but this is the first case that appeared as a solitary nodule on conventional chest X-ray.

Hepatic artery aneurysm in corticosteroid-treated, adult Kawasaki's disease

We describe a single case of Kawasaki's disease (mucocutaneous lymph node syndrome) with the rare complication of a hepatic artery aneurysm which was surgically repaired. Unusual features include arterial aneurysmal formation in the hepatic arteries rather than in coronary arteries, the unusual morphology of the hepatic artery aneurysm, and the expansion of the aneurysm after corticosteroid therapy.

Unusual complication of femoro-popliteal saphenous vein bypass--aneurysm formation

An aneurysm as an unusual complication of saphenous vein bypass for femoro-popliteal occlusive disease is reported. The aneurysm developed 1 year following the bypass procedure. A diagnosis of Behçet's disease based on microscopic immunological examination and the clinical picture was suspected following successful aneurysmectomy.