Aneurysmal intrahepatic porto-capsular vein anastomosis

Two cases of intrahepatic porto-capsular vein anastomosis are described, both of which were complicated by liver cirrhosis and hepatocellular carcinoma. In both cases a branch of the portal vein in the posterior segment of the liver was markedly dilated and directly anastomosed at its periphery with the liver's capsular vein, then connected with the inferior vena cava. One of the two cases underwent partial hepatectomy. Histopathological examination of the resected specimen did not reveal any direct relation between the shunt and the carcinoma. The shunting in both cases appeared to have resulted from portal hypertension complicated by liver cirrhosis.

Iliac artery aneurysm in Marfan's syndrome

A case of iliac artery aneurysm in a young male patient with Marfan's Syndrome is described. The aneurysm was managed by a simple exclusion technique. The occurrence of such an aneurysm suggests that the inherent mural weakness in the syndrome is more widespread in the arterial tree than is generally appreciated. The association of iliac artery aneurysm and Marfan's Syndrome does not seem to have been previously reported.

[Diagnosis and differential diagnosis of hepatic artery aneurysms]

Four cases of intra- and extrahepatic aneurysms of the hepatic artery are discussed concerning the etiology, symptoms, therapy and complication rate. The diagnostic approach and problems in differential diagnosis are specified. Localization of the aneurysm and especially the relationship of the collateral circulation of the hepatic bed are essential to plan the therapy and are based on angiography. Interventional therapeutic techniques are favored for intrahepatic localization. Reconstructive or ablative surgery is indicated to treat the extrahepatic aneurysm.

[A case of tetralogy of Fallot with absent pulmonary valve]

A 3-month-boy weighing 1,968 gm with absent pulmonary valve associated with tetralogy of Fallot, who suffered from severe respiratory distress, underwent emergency operation. Preoperatively, the patient had atelectasis of left lung, since left main bronchus was compressed by aneurysmal dilatation of the main pulmonary artery. Aneurysmorraphy and suspension of the pulmonary artery with retrosternal fascia was performed successfully. This procedure is a simple and useful method of relief from airway obstruction at the first stage for such critically ill infants.

Idiopathic aneurysm of the inferior vena cava. A case report

A 13-year-old girl complained of sudden abdominal pain and shortly thereafter collapsed and died of massive pulmonary embolism. The source of the embolism was an idiopathic aneurysm of the inferior vena cava, which had thrombosed after partial rupture.

Rupture of a splenic artery aneurysm into the pancreatic duct. Case report

A 71-year-old woman was admitted to a local hospital with abdominal pain and repeated haematemeses and melaena. Plain X-ray of the abdomen showed a cystic mass with a calcified wall behind the stomach. No bleeding point in the stomach or duodenum was found at gastroscopy. Over a period of 28 days she had five episodes of gastrointestinal haemorrhage with no drop in blood pressure. She was transferred to the regional hospital 26 days after admission. Angiography showed a splenic artery aneurysm 5 x 10 cm, which at operation was found to have ruptured into the pancreatic duct. The aneurysm, the tail of the pancreas and the spleen were removed, and she made an uneventful recovery.

Inferior vena cava occlusion secondary to aortic aneurysm

A case of inferior vena caval thrombosis secondary to aortic aneurysm is presented with management guidelines. CT scanning, as well as conventional venography and arteriography, is very useful in understanding this process preoperatively. Intraoperative management should prevent pulmonary embolism and should anticipate the possibility of blood loss in excess of that which usually occurs with an uncomplicated aneurysm repair. Detailed review of the literature reveals this is a rare complication of aneurysm disease and a potentially lethal one.

[A case report of transcatheter arterial embolization of hepatic artery aneurysm which ruptured into the duodenum]

We reported a case of right hepatic artery aneurysm which ruptured into the duodenum. At first, bleeding from a submucosal tumor of the duodenum was suspected, but CT and angiography revealed an aneurysm of the right hepatic artery. Transcatheter arterial embolization by the use of coils was performed successfully, with the coils positioned one in the proximal and the other in the distal site of the aneurysm.

False aneurysm of the brachial artery: an unusual complication following accidental puncture by a patient on home haemodialysis

A case is reported of false aneurysm of the brachial artery following accidental puncture during attempted cannulation of the median cubital vein for routine haemodialysis at home. The merits of early diagnosis and prompt surgical repair are discussed.

Aneurysmal dilatation of right ventricular infundibulum and pulmonary trunk without left to right shunting

A young female with aneurysmal dilatation of right ventricular infundibulum and pulmonary trunk with pulmonary hypertension but without left to right shunting is reported. The patient had systolic and diastolic gradients in reverse directions in the right ventricular cavity, leading to intracavitary regurgitation.

[The thrombosed popliteal aneurysm: a problem for the interventional radiologist]

A completely thrombosed aneurysm of the popliteal artery may mimic a simple vascular occlusion both clinically and angiographically. If therapeutical interventions are planned for recanalisation a popliteal aneurysm must be excluded because in such cases vascular surgery is the method of choice. In 11 of 26 patients with an angiographically proven unilateral popliteal occlusion, contrast CT could demonstrate an aneurysm (unilateral n = 7, bilateral n = 4). Real time sonography could confirm unilateral thrombosed aneurysm in 10 of 11 cases; a partially thrombosed contralateral aneurysm was detected in all 4 cases. In contrast to a non-reliable palpable finding both US and or CT are useful in detecting an aneurysmatic degeneration of the popliteal artery. Previous identification of an aneurysm of the abdominal aorta or femoral artery may be helpful in patient selection.

Surgical treatment of isolated iliac artery aneurysm with ureteral obstruction and/or renal failure

Three patients with isolated iliac artery aneurysm with ureteral obstruction and/or renal failure are presented. One patient had a stenotic lesion of the right ureter caused by direct compression of common and internal iliac artery aneurysms. Resection of the aneurysms and graft replacement were successfully performed. The other patients, who had hydroureteronephrosis and renal failure caused by entrapment of the ureters in perianeurysmal fibrosis, were treated surgically by ureterolysis, resection with graft replacement of the common iliac artery aneurysms, and endoaneurysmorraphy of the internal iliac artery aneurysms. One has had a good postoperative course, whereas the other died from a rare complication of rectosigmoid colon perforation caused by direct compression by the graft.

[Acute abdomen caused by rupture of aneurysms of the pancreatico-duodenal arteries. Apropos of a clinical case]

A case of acute abdominal hemorrhage caused by the rupture of several aneurysms of the pancreatoduodenal artery is presented. We discuss the difficulties of the diagnosis and point out the importance of the arteriographic study, as always in vascular lesions. We emphasize the difficulties of the treatment; most cases require surgical approach, going from suture of the aneurysm to cephalic duodenopancreatectomy.

Pseudoaneurysm of the radial artery as a cause of a late compartment syndrome. A case report

Pseudoaneurysm has been reported in the literature as a cause of compartment syndrome. The onset of the subsequent compartment syndrome is usually early. Often, while the compartment syndrome is diagnosed and treated, the pseudoaneurysm is missed. A second operative procedure is then necessary. A 40-year-old woman illustrates an unusual case of a late compartment syndrome, following the development of a radial artery pseudoaneurysm three weeks after a penetrating injury. It is important to investigate the vascular tree in compartment syndromes after a penetrating injury, no matter how late the patient is seen.