Bilateral subclavian arterial aneurysm and ruptured abdominal aorta pseudoaneurysm in Behçet's disease

Ruptured Suprarenal Abdominal Aortic Pseudoaneurysm with Superior Mesenteric and Celiac Arteries Occlusion, Revealing Behçet's Disease: A Case Report

Behçet’s disease (BD) is a multisystemic, chronic autoimmune inflammatory vasculitic disease with an unknown etiology. Although the literature reports that vascular involvement occurs in 7% to 38% of all BD cases, the arteries are rarely involved; however, arterial involvement is usually associated with significant mortality and morbidity. We report the case of a young female patient who presented to the emergency department with severe abdominal pain and a history of weight loss. The patient was evaluated using computed tomography angiography, which revealed a ruptured suprarenal aortic pseudoaneurysm with occlusion of both the superior mesenteric and celiac arteries. Urgent surgery was performed with aortic repair with an interposition graft and superior mesenteric artery embolectomy. The patient’s clinical history and radiological imaging findings were strongly suggestive of the diagnosis of BD with vascular involvement.

Huge Popliteal Arterial Aneurysms in Behçet's Syndrome: Is Ligation an Alternative Treatment?

Behçet's syndrome is a multisystemic disease characterized by relapsing uveitis, oral and genital ulcerations, and vascular system involvement. The vascular involvement is seen as venous occlusion, arterial occlusion, and aneurysm formation in this disease, and the surgical treatment of a Behçet's aneurysm has technical difficulties. In this report, we suggest that the huge popliteal artery aneurysm in Behçet's syndrome can be treated by ligation of the popliteal artery.

A 58-year-old male patient was admitted to our clinic because of an infrapopliteal great mass at the left leg. Color Doppler ultrasonography and arteriography revealed a 71 × 54 mm aneurysmal dilatation at the distal popliteal artery. Surgery did not reveal any suitable arterial formation for bypass to the distal area of the popliteal artery and tibial arteries. For this reason, we applied ligation of aneurysmal dilatation at the distal popliteal artery. The patient tolerated the operation well and had no signs of ischemia during the postoperative period.

In conclusion, especially in aneurysm of arteries such as the popliteal artery, which has critical importance for maintaining distal perfusion, ligation may be a treatment method if there are no other alternatives.

A giant left ventricular pseudoaneurysm in Behçet's disease: a case report

Behçet's disease is a chronic autoimmune disease with vascular complications that are most frequently manifested as thromboembolism in veins and pseudoaneurysm in arteries. We report the case of a 13-year-old boy admitted for clinical and biological signs of rheumatic fever associated with chest pain. The clinical examination found heart sounds with a discrete systolic murmur of mitral regurgitation. The electrocardiogram showed a microvoltage with diffuse repolarisation disorder. Biologically, he had inflammatory syndrome. Transthoracic echocardiography showed circumferential pericardial effusion with anterosepto-apical hypokinesia of the left ventricle with systolic dysfunction, and a minimal mitral regurgitation. The patient was treated by corticotherapy and antibiotherapy. The outcome was marked by orogenital aphthous ulceration and decreased visual acuity related to intermediate uveitis. The retinal angiography showed a vasculitis. The late appearance of this symptom led to the right diagnosis of Behçet's syndrome. Transthoracic echocardiography showed a hypokinetic dilated cardiomyopathy left ventricular with septo apical and anterior akinesia and severe systolic dysfunction, with a defect of the inferior septal with a collar communicating the left ventricle with a giant pseudo aneurysm. Magnetic resonance imaging showed a giant pseudoaneurysm communicating with the left ventricle. The coronary computed tomography was normal. The patient had undergone surgical treatment for the pseudoaneurysm with good outcomes.

Rapidly evolving large extracranial vertebral artery pseudoaneurysm in Behçet's disease: Case report and review of the literature

Behçet's disease is a multisystem chronic autoimmune disease of unknown etiology with a wide spectrum of symptoms and organ system involvement. Arterial manifestations, particularly of the extracranial vertebral arteries, are rare. We report an unusual case of an African American patient with Behçet's disease, who presented with bilateral spontaneous vertebral artery pseudoaneurysms. The patient underwent successful endovascular parent vessel occlusion with detachable coils and on follow-up had complete clinical and angiographic signs of recovery.

Successful Stent Implantation for Aortoiliac Bifurcation Stenosis in a Young Patient with Behçet's Disease

Behçet's disease (BD) is a multisystem vascular inflammatory disease. BD can affect blood vessels of nearly all sizes and types. Arterial involvement is a rare but serious condition in the course of BD. Here, we report a case of stenosis at the iliac artery bifurcation which was treated with percutaneous balloon angioplasty and stent implantation in a 37-year-old patient with BD.

Aortic transection and diverting bypass as treatment of repetitive recurrent abdominal aortic false aneurysm rupture in a patient with Behcet's disease

Abdominal aortic false aneurysms in patients with Behcet's disease have been reported frequently and repaired successfully by various procedures; however, anastomotic false aneurysms have often been reported to occur after the operation. In this article, we report a case of four-time repetitive, recurrent suprarenal abdominal aortic false aneurysm ruptures that lasted for 7 years. The location of this aneurysm was not easy to repair not only by open surgical procedures but by endovascular stent because the aortic defect was too close to the visceral arterial branches. The last operation consisted of primary repair of aortic defect, transection of abdominal aorta at the level of supraceliac aorta with end closure, and a thoracic aorta to abdominal aorta bypass with Dacron graft. An 8-year follow-up revealed no more abdominal aortic aneurysm recurrence.

[Aortic abdominal aneurysm rupture leading to a massive gastrointestinal bleeding in a patient with Behçet's disease]

INTRODUCTION

Arterial involvement in Behçet's disease is rare, present in 2-8% of cases. Aortic aneurysms represent the most frequent arterial lesions encountered in this disease and are associated with high mortality.

CASE REPORT

We report the exceptional observation of an abdominal aortic aneurysm ruptured to the duodenum, responsible of a massive gastro intestinal bleeding in a patient with Behçet's disease requiring an emergent surgical intervention. The outcome was favorable.

DISCUSSION

The clinical presentation of abdominal aortic aneurysms in Behçet's disease is often atypical leading to an important diagnosis delay and favours the rupture of the aneurysm.

Subclavian artery pseudoaneurysm in Behcet's disease

Behcet's disease (BD) is an autoimmune, multisystemic, and chronic inflammatory disease. Although it affects all systems, involvement of the vascular system is of vital importance. Pseudoaneurysm ruptures in the arteries are the major causes of sudden deaths in BD. Although pseudoaneurysms in aorta and pulmonary arteries are rare, it is even more rare in the subclavian arteries. In our case, a pulsatile mass in the right clavicular area was determined to be associated with BD and this case is presented because subclavian artery pseudoaneurysm is seen rarely in BD.

The surgical treatment of arterial aneurysms in Behçet disease: A report of 16 patients

OBJECTIVE

The aim of this article is to report our experience in the surgical treatment of arterial aneurysms in patients with Behçet disease.

METHODS

From October 2001 through May 2004, 18 arterial aneurysms were diagnosed in 16 Behçet patients. All patients were male. The patients ranged in age from 24 to 52 years (mean, 37.4 +/- 5.2 years). There were six abdominal aortic, three common femoral, two iliac, two popliteal, two superficial femoral, and two anterior tibial aneurysms and one subclavian artery aneurysm. All patients but four were in remission at the time of diagnosis. Those 4 patients received immunosuppressive therapy before the surgical intervention to induce remission. After hospital discharge, all patients were followed up regularly at 3-month intervals. The mean duration of follow-up was 17 +/- 4.2 months (range, 6-24 months).

RESULTS

All patients underwent a successful surgical intervention. During the study period, we performed five aortic tube graft interpositions, two aortofemoral bypasses, one aortobifemoral bypass, three common femoral artery graft interpositions, and two femoropopliteal bypasses. The popliteal artery (n = 2), anterior tibial artery (n = 2), and subclavian artery (n = 1) aneurysms were repaired primarily. There was no in-hospital mortality. One patient with an abdominal aortic aneurysm had to undergo reoperation because of postoperative bleeding. The postoperative hospital stay was 8.5 +/- 4.3 days. Two patients were lost to follow-up. During the follow-up period, two false aneurysms of the common femoral artery were repaired with a graft interposition procedure. Another patient who had undergone an aortic tube graft interposition was readmitted 9 months later with an external iliac artery aneurysm. The external iliac artery was ligated through a retroperitoneal approach, and femorofemoral bypass was performed. In addition, one femoropopliteal interposition graft was occluded, without disabling ischemia.

CONCLUSIONS

Although aneurysmal disease is rare in Behçet disease, it can complicate the clinical picture and cause life-threatening complications. We believe that the establishment of remission before the surgical intervention decreases the incidence of postoperative complications. Because recurrence at the site of anastomosis is possible, prolonged monitoring is required.

Emergency operation for distal aortic arch aneurysm in Behcet’s disease

Arterial complications of Behcet's disease rarely affect the thoracic aorta, and the incidence of aortic arch aneurysm is especially low. We present a patient who developed a rapidly expanding aneurysm of the distal aortic arch after 20 years of treatment of Behcet's disease. Emergency total arch replacement was performed with a favorable outcome. Graft anastomosis to the normal aorta involving all three layers, wrapping of the anastomotic sites with wide felt strips, as well as strict management of systemic inflammation are essential for prevention of late complications associated with graft anastomosis sites.

A large left ventricular pseudoaneurysm in Behçet's disease: a case report

BACKGROUND

Behçet's disease is a collagen-vascular disease most commonly seen in Asia and Mediterranean area. Different organs and systems including cardiovascular system could be involved. Pseudoaneurysm is the most common form of arterial involvement in Behçet's disease; however, cardiac pseudoaneurysm is rare.

CASE PRESENTATION

A rare case of 13 years old boy with a 4-year history of Behçet's disease with development of a huge left ventricular pseudoaneurysm is reported who had been admitted because of cough, chills, fever, and chest pain. Findings obtained on echocardiography, magnetic resonance imaging, chest computed tomography and coronary angiography confirmed a left ventricular pseudoaneurysm. There was no complication for next 24 months follow up period after surgical treatment.

CONCLUSION

Considering its fatality and nonspecific manifestations, one should consider cardiac pseudoaneurysms as a potential risk in any patient with Behçet's disease.

Covered stents for true subclavian aneurysms in patients with degenerative connective tissue disorders

PURPOSE

To report the endovascular repair of rare true aneurysms of the subclavian artery in patients with degenerative connective tissue disorders.

CASE REPORTS

Two patients, one with Marfan syndrome and the other with idiopathic cystic medial necrosis, presented with 3 subclavian artery aneurysms. A Wallgraft and 2 Viabahn covered stents were used to successfully exclude these aneurysms. After 3 months, the Wallgraft thrombosed, but the contralateral Viabahn remained patent at the most recent examination 13 months after treatment. The other patient with the unilateral aneurysm had a patent Viabahn stent-graft at 10 months.

CONCLUSIONS

Patients with degenerative connective tissue disorders may benefit from less invasive treatment with stent-grafts. The more flexible Viabahn stent-graft may be better able to adapt to arterial tortuosity. However, the long-term results of this new technique have not yet been established.