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Park S, Hwang D, Yun WS, Kim HK, Huh S. Case Report: Hybrid approach as a Rescue Treatment in a patient with vascular Ehlers-Danlos Syndrome. Front Surg 2023; 10:1268671. [PMID: 37936948 PMCID: PMC10627186 DOI: 10.3389/fsurg.2023.1268671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/10/2023] [Indexed: 11/09/2023] Open
Abstract
Vascular Ehlers-Danlos Syndrome (vEDS) is a rare connective tissue disorder associated with COL3A1 gene mutation encoding type III collagen. Given the possible fatal prognosis if not treated timely, it is important to suspect and diagnose as soon as possible. Despite advances in endovascular technique, access point complications remain a serious challenge in patients with vEDS. Here, we describe a 30-year-old male patient who was diagnosed with vEDS after consecutive events of bilateral iliac vessels at an interval of 3 months: (1) spontaneous dissecting aneurysm of right iliac artery and (2) arteriovenous fistula between left internal iliac artery (IIA) and left common iliac vein. This patient was treated with iliac stent-grafts and overlapping femoral interposition graft (Dacron) in the 1st operation and access artery repair with surgical dissection after coil embolization of IIA and stent-graft insertion into left common to external iliac arteries in the 2nd operation. The patient has been treated with beta-blockers and anticoagulants for the management of vEDS and postoperative deep vein thrombosis, respectively. The stent-grafts in both iliac arteries and the access sites have been well-tolerated without any adverse effects for 14 months following the 2nd operation. In conclusion, given the vascular fragility and the potential for future events, additional vascular manipulation should be avoided unless it is in a life-threatening condition. In particular, meticulous hybrid interventions can be effective treatments.
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Affiliation(s)
- Suehyun Park
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Deokbi Hwang
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Woo-Sung Yun
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Hyung-Kee Kim
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung Huh
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
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2
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Padmanaban V, Yee PP, Koduri S, Zaidat B, Daou BJ, Chaudhary N, Gemmete JJ, Thompson BG, Kazmierczak CD, Cockroft KM, Pandey AS, Wilkinson DA. Neuroendovascular Procedures in Patients with Ehlers-Danlos Type IV: Multicenter Case Series and Systematic Review. World Neurosurg 2023; 170:e529-e541. [PMID: 36402305 DOI: 10.1016/j.wneu.2022.11.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ehlers-Danlos type IV or vascular Ehlers-Danlos syndrome (vEDS) is a rare inherited disorder characterized by profound vascular fragility resulting from defective production of type III procollagen. Cerebrovascular diseases including spontaneous dissections, cerebral aneurysms, and cavernous carotid fistulae are common. Endovascular therapies in this patient population are known to be higher risk, although many studies (before 2000) involved older techniques and equipment. The purpose of this study is to investigate the safety and efficacy of modern neuroendovascular techniques in the treatment of cerebrovascular diseases in patients with vEDS. METHODS We combined a multi-institutional retrospective case series at 3 quaternary-care centers with a systematic literature review of individual case reports and case series spanning 2000-2021 to evaluate the safety and efficacy of neuroendovascular procedure in patients with vEDS with cerebrovascular diseases. RESULTS Fifty-nine patients who underwent 66 neuroendovascular procedures were evaluated. Most of the patients had direct cavernous carotid fistulas (DCCF). Neuroendovascular procedures had a 94% success rate, with a complication rate of 30% and a mortality of 7.5%. CONCLUSIONS Neuroendovascular procedures can be performed with a high rate of success in the treatment of cerebrovascular diseases in patients with vEDS, although special care is required because complication rates and mortality are high. Access site and procedure-related vascular injuries remain a significant hurdle in treating vEDS with cerebrovascular diseases, even with modern techniques.
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Affiliation(s)
- Varun Padmanaban
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Patricia P Yee
- Medical Scientist Training Program, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Sravanthi Koduri
- Department of Neurosurgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Bashar Zaidat
- Department of Neurosurgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Badih J Daou
- Department of Neurosurgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Neeraj Chaudhary
- Department of Neurosurgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA; Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Joseph J Gemmete
- Department of Neurosurgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA; Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - B Gregory Thompson
- Department of Neurosurgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA; Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Chris D Kazmierczak
- Department of Radiology, Oakland University-William Beaumont School of Medicine, Auburn Hills, Michigan, USA
| | - Kevin M Cockroft
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA; Department of Radiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA; Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - D Andrew Wilkinson
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
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3
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Hunter MD, Moon YP, Miller EC, Kulick ER, Boehme AK, Elkind MS. Influenza-Like Illness is Associated with Increased Short-Term Risk of Cervical Artery Dissection. J Stroke Cerebrovasc Dis 2021; 30:105490. [PMID: 33253984 PMCID: PMC10086675 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/10/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Non-traumatic Cervical Artery Dissection (CeAD) is a leading cause of ischemic stroke in the young. Influenza-like illnesses (ILI) trigger ischemic strokes. We hypothesized that influenza and ILI are associated with CeAD. METHODS In a case-crossover study within the New York State (NYS) Department of Health Statewide Planning and Research Cooperative System (2006-2014), we used ICD-9 codes to exclude major trauma and to define CeAD, influenza, and the Centers for Disease Control defined ILI. We estimated the association of ILI and influenza with CeAD by comparing their prevalence in intervals immediately prior (0-30,0-90,0-180, and 0-365 days) to CeAD (case period) to their prevalence exactly one and two years earlier (control periods). Conditional logistic regression models generated odds ratios and 95% confidence intervals (OR, 95% CI). Models were adjusted for NYS estimates of influenza prevalence rates. RESULTS Our sample included 3,610 cases of CeAD (mean age 52±16 years, 54.7% male, 6.2% Hispanic, 9.9% Black, 68.7% White). During case periods, 7.3% had one or more ILI. ILI was more likely within 90 days of CeAD compared to the same time interval one and two years before (0-15 days: adjusted OR 1.88, 95%CI 1.20-2.94; 0-30 days: adjusted OR 1.74, 95%CI 1.22-2.46; 0-90 days: adjusted OR 1.35, 95%CI 1.00-1.81). Influenza trended with CeAD (adjusted OR 1.86, 95%CI 0.37-9.24), but these results were not statistically significant, due to limited instances of confirmed influenza. CONCLUSIONS ILI may increase risk of CeAD for 15 days, and possibly up to three months.
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Affiliation(s)
- Madeleine D Hunter
- Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA; Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA.
| | - Yeseon P Moon
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA; Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA.
| | - Eliza C Miller
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA; Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA.
| | - Erin R Kulick
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA; Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA.
| | - Amelia K Boehme
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA; Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA.
| | - Mitchell Sv Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA; Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA.
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4
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Moramarco LP, Capodaglio CA, Quaretti P, Cionfoli N, Fiorina I, Disabella E, D'agostino AM, Urtis M, Arbustini E. Multivessel endovascular therapy for undiagnosed vascular type Ehlers-Danlos syndrome. Successful percutaneous transcatheter coil embolization of hepatic artery pseudoaneurysm with stenting of right renal and iliac arteries in emergency setting. BJR Case Rep 2020; 6:20200025. [PMID: 33299587 PMCID: PMC7709055 DOI: 10.1259/bjrcr.20200025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/17/2020] [Accepted: 06/21/2020] [Indexed: 11/05/2022] Open
Abstract
Among Ehlers-Danlos syndromes, the vascular type is the most severe because of its vascular complications. Transcatheter embolization of medium-sized arteries has become the first-line therapy for life-threatening hemorrhage. Ongoing multiple lesions causing hemorrhagic or ischemic complications in the acute phase can challenge patient management. Multivessel endovascular treatment has never been reported. In this study, we report successful single-session treatment by coiling of a ruptured pseudoaneurysm of the hepatic artery with stenting of dissected right renal and iliac arteries in a 46-year-old female. Percutaneous transfemoral approach was gained and sealed with a plug-based closure device. Genetic disease was subsequently confirmed by molecular analysis.
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Affiliation(s)
| | | | - Pietro Quaretti
- Unit of Interventional Radiology and Department of Radiology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Nicola Cionfoli
- Unit of Interventional Radiology and Department of Radiology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Ilaria Fiorina
- Unit of Interventional Radiology and Department of Radiology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Eliana Disabella
- Centre for Inherited Cardiovascular Diseases of Cardio-Thoracic-Vascular Surgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | | | - Mario Urtis
- Centre for Inherited Cardiovascular Diseases of Cardio-Thoracic-Vascular Surgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Eloisa Arbustini
- Centre for Inherited Cardiovascular Diseases of Cardio-Thoracic-Vascular Surgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
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5
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Senay BE, Nallani R, Mazaris P, Khan MA. Giant carotid pseudoaneurysm amenable to pipeline stenting in a patient with Ehlers-Danlos type IV. Surg Neurol Int 2019; 10:11. [PMID: 30783542 PMCID: PMC6367946 DOI: 10.4103/sni.sni_343_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/05/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Ehlers–Danlos type IV primarily affects collagen synthesis in the vasculature, increasing the risk of these patients to have dissection and pseudoaneurysm formation. Due to friable vessels, antiplatelet or anticoagulation has been the treatment of choice. However, newer intravascular surgical devices may be promising for future management. Case Description: A 24-year-old man with a history of Ehlers–Danlos type IV with multiple vascular and bleeding complications presented after recurrent, unprovoked presyncopal episodes. Patient was found to have dissection of bilateral internal carotid arteries (ICA) and right vertebral artery. Left ICA pseudoaneurysm was found in the proximal cervical segment. Patient was stabilized as an inpatient and discharged with outpatient follow-up with neurointerventional surgery. Follow-up imaging showed growth of the left ICA aneurysm. Patient elected to have pipeline stenting of the left ICA pseudoaneurysm. The procedure was performed without complication. Patient was discharged on dual antiplatelet therapy. At 7-month follow-up appointment, patient noted no neurological deficits. Follow-up digital subtraction angiogram at 7 months documented near-complete resolution of the pseudoaneurysm secondary to pipeline stenting. Conclusion: Pipeline stent implantation may be a viable corrective surgical option for patients with connective tissue disorders (specifically Ehlers–Danlos type IV) who present with pseudoaneurysm formation.
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Affiliation(s)
- Blake E Senay
- Spectrum Health Neurology Residency Program, Department of Neurology, 221 Michigan St. NE, Ste 402, Grand Rapids, MI 49503, USA.,Michigan State University College of Human Medicine, 15 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Rohit Nallani
- Michigan State University College of Human Medicine, 15 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Paul Mazaris
- Michigan State University College of Human Medicine, 15 Michigan St NE, Grand Rapids, MI, 49503, USA.,Spectrum Health Medical Group, Department of Neurology and Neurosurgery, 25 Michigan St NE, Ste 6100, Grand Rapids, MI, 49503, USA
| | - Muhib A Khan
- Michigan State University College of Human Medicine, 15 Michigan St NE, Grand Rapids, MI, 49503, USA.,Spectrum Health Medical Group, Department of Neurology and Neurosurgery, 25 Michigan St NE, Ste 6100, Grand Rapids, MI, 49503, USA
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6
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Yung MYH, Murray J, Thompson EC. Blunt aortic trauma in a patient with the Ehlers-Danlos syndrome type VI. J Surg Case Rep 2016; 2016:rjw026. [PMID: 26956239 PMCID: PMC4782065 DOI: 10.1093/jscr/rjw026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 24-year-old male with the Ehlers–Danlos syndrome (EDS) type VI (ocular scoliotic) who was kicked in the abdomen presented to the emergency room (ER) with abdominal pain. He was found to have a blunt traumatic aortic injury. The patient was treated nonoperatively. He was stable and discharged home on the eighth day. The patient returned to the ER several days later hypotensive and tachycardic. The patient was taken immediately to the operating room, but vascular repair was not possible. The patient expired. We discuss the challenges of taking care of a patient with EDS and offer suggestions that might improve future patient's outcome.
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Affiliation(s)
- Marco Yat Hang Yung
- Department of Surgery, Joan Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Jennifer Murray
- Department of Surgery, Joan Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Errington C Thompson
- Department of Surgery, Joan Edwards School of Medicine, Marshall University, Huntington, WV, USA
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7
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Emmanuel Y, Gordon-Smith J, McKillop G, Duddy M, Clift P. Late Peripheral Thoracic Aneurysms following Aortic Root Surgery in Patients with Loeys-Dietz Syndrome. J Vasc Interv Radiol 2015; 26:1539-43. [PMID: 26408217 DOI: 10.1016/j.jvir.2015.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 04/18/2015] [Accepted: 04/19/2015] [Indexed: 10/23/2022] Open
Abstract
The Loeys-Dietz syndrome is a multisystem connective tissue disorder characterized by aortopathy, arterial tortuosity, peripheral aneurysms, and skeletal features. The peripheral arteriopathy is an important cause of morbidity and potential mortality. This report presents 2 cases: the first demonstrating a 5-cm pseudoaneurysm of the right internal mammary artery and the second demonstrating a 2.3-cm aneurysm of the left internal mammary artery, each following aortic root surgery. These were successfully treated with percutaneous techniques. No complications were seen at follow-up as long as 2 years. Patients with Loeys-Dietzs syndrome require comprehensive long-term vascular follow-up and are likely to require percutaneous vascular interventions.
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Affiliation(s)
- Yaso Emmanuel
- Departments of Cardiology, Queen Elizabeth Hospital, Birmingham.; Departments of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom..
| | - Jim Gordon-Smith
- Departments of Radiology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Graham McKillop
- Departments of Radiology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Martin Duddy
- Departments ofInterventional Radiology, Queen Elizabeth Hospital, Birmingham
| | - Paul Clift
- Departments of Cardiology, Queen Elizabeth Hospital, Birmingham
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8
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Successful Endovascular Treatment of a Ruptured Superior Mesenteric Artery in a Patient with Ehlers‒Danlos Syndrome. Ann Vasc Surg 2013; 27:975.e1-5. [DOI: 10.1016/j.avsg.2013.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Revised: 12/24/2012] [Accepted: 01/14/2013] [Indexed: 11/24/2022]
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9
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Abstract
OBJECTIVE To provide the collected evidence from all literature reports. BACKGROUND Vascular Ehlers-Danlos syndrome (EDS) is a rare connective tissue disorder with serious hemorrhagic consequences. Most experience on treatment is based on case reports and small case series. METHOD A systematic literature review was performed. PubMed and reference lists were scrutinized. RESULTS A total of 231 patients were identified with no gender preponderance. Aneurysms were present in 40%, often multiple. In 33%, there was an arterial rupture without an underlying aneurysm. Carotidocavernous fistula was seen in 18%. After open surgery the mortality was 30%; after endovascular procedures, it was 24%; in a group of miscellaneous cases, it was 60%; and the overall mortality was 39%. The median age of patients at death was 31 years. The median follow-up time was 12 months (5 days-7 years), but in 20% cases, it was not reported. In only 29 of the 119 recent patients (24%) the mutation was verified with molecular genetic testing. CONCLUSIONS Vascular EDS is a serious disorder with high mortality, which does not seem to have been influenced by new treatment methods. Invasive methods should be used only when necessary, primarily to save the patients' life. Whenever possible, the genetic molecular defect should be identified. The results of this review may be affected by publications bias. Ideally, a prospective registry should be created.
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10
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Requejo F, Sierre S, Lipsich J, Zuccaro G. Endovascular treatment of post-pharyngitis internal carotid artery pseudoaneurysm with a covered stent in a child: a case report. Childs Nerv Syst 2013; 29:1369-73. [PMID: 23532343 DOI: 10.1007/s00381-013-2083-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 03/15/2013] [Indexed: 12/17/2022]
Abstract
CASE REPORT We report a case of 4-year-old boy patient, who developed after a streptococcal pharyngitis a painful, pulsatile, and growing right-sided mass in the neck. Imaging studies revealed an extracranial right internal carotid artery pseudoaneurysm. The patient was successfully treated with stent-graft deployment. After 18 months of follow-up, the pseudoaneurysm is excluded from the circulation, the carotid artery is patent, and the patient is free from any neurological deficit. DISCUSSION Covered stents might be considered as a valid therapeutic option to treat carotid artery pseudoaneurysms.
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Affiliation(s)
- Flavio Requejo
- Department of Interventional Radiology, Hospital Nacional de Pediatría Prof. J.P. Garrahan, Combate de Pozos 1881 (1254), Buenos Aires, Argentina.
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11
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Lum YW, Brooke BS, Arnaoutakis GJ, Williams TK, Black JH. Endovascular Procedures in Patients With Ehlers–Danlos Syndrome: A Review of Clinical Outcomes and Iatrogenic Complications. Ann Vasc Surg 2012; 26:25-33. [DOI: 10.1016/j.avsg.2011.05.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 04/27/2011] [Accepted: 05/28/2011] [Indexed: 10/17/2022]
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12
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Mortani Barbosa EJ, Pyeritz RE, Litt H, Desjardins B. Vascular Ehlers-Danlos syndrome presenting as rapidly progressive multiple arterial aneurysms and dissections. Am J Med Genet A 2011; 155A:3090-4. [DOI: 10.1002/ajmg.a.34332] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 09/07/2011] [Indexed: 11/06/2022]
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13
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Stevic I, Chan HH, Chan AK. Carotid artery dissections: Thrombosis of the false lumen. Thromb Res 2011; 128:317-24. [DOI: 10.1016/j.thromres.2011.06.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 06/16/2011] [Accepted: 06/24/2011] [Indexed: 11/30/2022]
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14
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Park JK. Ehlers-Danlos Syndrome Type IV and the Management of Its Vascular Complication. Vasc Specialist Int 2011. [DOI: 10.5758/kjves.2011.27.2.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jong Kwon Park
- Department of Surgery, Inje University College of Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
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15
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Alaraj A, Wallace A, Amin-Hanjani S, Charbel FT, Aletich V. Endovascular implantation of covered stents in the extracranial carotid and vertebral arteries: Case series and review of the literature. Surg Neurol Int 2011; 2:67. [PMID: 21697983 PMCID: PMC3115199 DOI: 10.4103/2152-7806.81725] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 04/26/2011] [Indexed: 12/14/2022] Open
Abstract
Background: Covered stents are used endovascularly to seal arterial wall defects while preserving vessel patency. This report describes our experience with the use of covered stents to treat cervical pathology, and a review of the literature in regards to this topic is presented. Case Description: Two patients presenting with the carotid blowout syndrome and one patient with a vertebrojugular fistula were treated with covered stents. This allowed for preservation of the vessel and was a treatment alternative to cerebral bypass. Conclusion: Covered stents provide a viable means of preserving the cervical vessels in selected patients; however, long-term follow-up is necessary to determine stent patency and permanency of hemostasis.
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Affiliation(s)
- Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, College of Medicine, Chicago IL, USA
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16
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Rahme RJ, Adel JG, Bendok BR, Bebawy JF, Gupta DK, Batjer HH. Association of Intracranial Aneurysm and Loeys-Dietz Syndrome: Case Illustration, Management, and Literature Review. Neurosurgery 2011; 69:E488-92; discussion E492-3. [DOI: 10.1227/neu.0b013e318218cf55] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE:
Loeys-Dietz syndrome (LDS) is a newly described connective tissue disease associated with aortic aneurysms. A strong association between LDS and intracranial aneurysms has not yet been documented in the literature. We present the first detailed report of an intracranial aneurysm finding in an LDS patient.
CLINICAL PRESENTATION:
The patient is a 20-year-old female recently diagnosed with LDS and found to harbor 2 incidental intracranial aneurysms on a screening magnetic resonance angiography: a 3-mm right carotid ophthalmic aneurysm and an 8-mm partially fusiform paraclinoid carotid artery aneurysm. A standard left pterional craniotomy was performed. Intraoperative adenosine was used instead of temporary clipping because her vessels were extremely friable. After reconstruction, an intraoperative indocyanine green angiogram was obtained, confirming complete aneurysmal obliteration and internal carotid artery patency.
CONCLUSION:
This is the first detailed report of a clear association between intracranial aneurysms and LDS. An association between LDS and intracranial aneurysms, if substantiated in a larger study, has implications for aneurysm screening in this population. Such an association may shed light on mechanisms of aneurysm formation, growth, and rupture.
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Affiliation(s)
- Rudy J. Rahme
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joseph G. Adel
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bernard R. Bendok
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John F. Bebawy
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dhanesh K. Gupta
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - H. Hunt Batjer
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Machet L, Hüttenberger B, Georgesco G, Doré C, Jamet F, Bonnin-Goga B, Giraudeau B, Maruani A, Laure B, Vaillant L. Absence of inferior labial and lingual frenula in Ehlers-Danlos syndrome: a minor diagnostic criterion in French patients. Am J Clin Dermatol 2010; 11:269-73. [PMID: 20143893 DOI: 10.2165/11530090-000000000-00000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Ehlers-Danlos syndrome (EDS) is a heterogenous group of diseases that can be potentially life threatening in the vascular form. The diagnosis is mainly based on a clinical score including many items that demonstrate skin, mucosa, joint, and vessel involvement. The score is particularly helpful in hypermobile and classical forms but can be normal in the vascular type. The absence of the lingual and inferior labial frenula was reported to be a useful diagnostic tool in a series of 12 patients with classical and hypermobile EDS. However, two further reports have contested the value of this sign. OBJECTIVE To determine the diagnostic value of the absence of inferior labial or lingual frenula in EDS. METHODS Patients with EDS were prospectively recruited from November 2006 to April 2007 in a French tertiary center. Each patient was examined to check for the presence or absence of the oral frenula and matched with two controls seen from February to May 2007. RESULTS Forty-three patients (ratio female/male of 2.07 : 1, mean age 31 years, range 4-63 years), 4 with classical EDS, 19 with hypermobile EDS, and 20 with vascular-type EDS, were included and matched with 86 controls. The sensitivity of the absence of the inferior labial frenulum was 42% (95% CI 27, 58) and for the lingual frenulum was 53.5% (95% CI 38, 69). The specificity was 99% (95% CI 94, 100) and 98% (95% CI 92, 100), respectively. In the vascular group, 13 of 20 patients were affected (sensitivity = 65% [95% CI 41, 85]; specificity = 97% [95% CI 87, 100]; odds ratio = 72 [95% CI 8, 645]). Inter-observer agreement was excellent (kappa value 0.91). CONCLUSION The absence of the inferior labial frenulum or lingual frenulum is a specific sign of EDS that can be easily checked by a physician. It can be helpful in the early diagnosis of the disease, including the vascular type, in affected families. It can also be helpful to distinguish between joint hypermobility syndrome and the hypermobile type of EDS in patients with joint hypermobility.
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Affiliation(s)
- Laurent Machet
- INSERM U930/CNRS ERL 3106, Université François Rabelais, Tours, France.
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Hagspiel KD, Bonatti H, Sabri S, Arslan B, Harthun NL. Metachronous Bilateral Posterior Tibial Artery Aneurysms in Ehlers-Danlos Syndrome Type IV. Cardiovasc Intervent Radiol 2010; 34:413-8. [DOI: 10.1007/s00270-010-9929-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 05/28/2010] [Indexed: 11/29/2022]
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Endovascular Treatment of Complications of Femoral Arterial Access. Cardiovasc Intervent Radiol 2010; 33:457-68. [PMID: 20162284 DOI: 10.1007/s00270-010-9820-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 01/19/2010] [Indexed: 10/19/2022]
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Kim YK, Schulman S. Cervical artery dissection: pathology, epidemiology and management. Thromb Res 2009; 123:810-21. [PMID: 19269682 DOI: 10.1016/j.thromres.2009.01.013] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 01/16/2009] [Accepted: 01/19/2009] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cervical artery dissection is often treated with anticoagulants to prevent ischemic stroke. The risk-benefit ratio of anticoagulation versus antiplatelet therapy is unclear. OBJECTIVES To provide an educational review of current data on the disease to explain the rationale for the treatment options and to explore the results of management studies in order to determine if anticoagulation is justified. METHODS We searched the databases MEDLINE and EMBASE as well as bibliographies for information on anticoagulants and antiplatelet agents in cervical, i.e. carotid and/or vertebral artery, dissection. RESULTS There are no randomized controlled trials on the treatment. One systematic review from 2003 identified 20 case series or cohort studies. We identified 9 additional studies with a total of 1,033 patients. Of those, 731 received anticoagulation sometimes followed by platelet inhibition vs. 282 patients treated with antiplatelet agents alone. The rate of ischemic stroke was 2.3% vs. 6.9% and bleeding complications were reported in 0.7% vs. 0%. CONCLUSION It cannot be excluded that there is a net benefit from anticoagulant therapy in cervical dissection, but the studies are flawed by considerable bias. Very ill patients at a high risk of ischemic stroke may have been given aspirin due to fear of hemorrhagic complications. A randomized controlled trial is planned and will be crucial to resolve this issue.
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Affiliation(s)
- Yang-Ki Kim
- Department of Medicine, McMaster University, Hamilton ON, Canada
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Singhal M, Gupta V, Singh P, Lal A, Behra A, Khandelwal N. Iatrogenic life-threatening pseudoaneurysms of extracranial internal carotid artery after fine-needle aspiration of cervical lymph nodes: report of two cases in children. Cardiovasc Intervent Radiol 2009; 32:1260-3. [PMID: 19205796 DOI: 10.1007/s00270-009-9506-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 12/23/2008] [Accepted: 01/06/2009] [Indexed: 10/21/2022]
Abstract
Two children younger than 10 sought care for large, tense pulsatile swelling in the neck after fine-needle aspiration of cervical lymph nodes that resulted in severe respiratory distress. Computed tomographic angiography confirmed the presence of large pseudoaneurysms that caused a mass effect, leading to compression of surrounding vessels and airway. Pseudoaneurysms were successfully treated by coil embolization in one patient and surgical ligation of the internal carotid artery in the other.
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Affiliation(s)
- Manphool Singhal
- Department of Radiodiagnosis and Interventional Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Stent-graft repair of a large cervical internal carotid artery pseudoaneurysm causing dysphagia. Cardiovasc Intervent Radiol 2008; 32:558-62. [PMID: 18797966 DOI: 10.1007/s00270-008-9421-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 07/17/2008] [Accepted: 07/22/2008] [Indexed: 10/21/2022]
Abstract
Pseudoaneurysms of the cervical internal carotid artery (ICA) are rare and most frequently result from trauma, infection, or sometimes spontaneously. They have the potential to cause life-threatening hemorrhage; thus, their immediate management is necessary. Endovascular treatment by stent graft placement in the affected artery appears to be a safe and effective treatment option. We present a case of a child who presented with neck swelling and dysphagia caused by a ruptured cervical ICA pseudoaneurysm which was managed by stent graft placement.
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