Spontaneous rupture of an isolated iliac artery dissection in a young man because of cystic medial degeneration Erdheim-Gsell

Spontaneous isolated iliac artery dissection in a young male: Case report and review of literature

Spontaneous isolated dissection of the iliac artery (SID-IA) is a rare vascular condition typically associated with trauma or connective tissue disorders. We present a unique case of a 39-year-old male without known risk factors or trauma history who presented with lower abdominal pain. Diagnostic imaging revealed SID-IA involving the right external iliac artery with thrombus formation. Despite negative findings for connective tissue disorders, the patient underwent successful endovascular stenting following initial medical management. Vigilance in diagnosis and prompt intervention are crucial in managing SID-IA to prevent complications such as limb ischemia and aneurysm formation. This case emphasizes the importance of considering SID-IA in young patients presenting with abdominal pain, even in the absence of traditional risk factors, and highlights evolving treatment options for this rare condition.

Multiple and Multidirectional Fissure Bleedings in a Patient With a Spontaneous Isolated Dissection of the Iliac Artery

A 63-year-old man with a history of hypertension and dyslipidemia on medication was found to have an enlargement of an asymptomatic iliac artery aneurysm with an ulcer-like projection on computed tomography angiography. The longer and shorter diameter of the right iliac was increased from 24.0 × 18.1 mm to 38.9 × 32.1 mm over four years. Preoperative non-obstructive general angiography revealed multiple, multidirectional fissure bleedings. Fissure bleedings were found where computed tomography angiography appeared normal at the aortic arch. He was diagnosed with spontaneous isolated dissection of the iliac artery and was treated successfully with endovascular treatment.

[Dolichoectasia of the basilar artery caused by cystic medial degeneration, as a cause of neurovascular conflict with damage to the trigeminal, facial and vestibulocochlear nerves]

Cystic medial degeneration (Gsell-Erdheim syndrome, cystic medial necrosis) is considered to be a nonspecific histological manifestation of a group of diseases characterized by degenerative changes in the media, affecting primarily the aorta and adjacent branches, which leads to destruction of the vessel wall, followed by its expansion and, possibly, rupture. The authors describe a case of a 65-year-old female patient with a neurovascular conflict of the three cranial nerves with dolichoectatic basilar artery due to cystic medial degeneration. As a result, the patient has clinical manifestations in the form of hemifacial spasm, trigeminal neuralgia and vestibular paroxysmia. Data from instrumental studies and treatment provided are presented. Neurovascular conflict can be identified in various diseases and is characterized by the complex etiology. The most common clinical manifestations of neurovascular conflict are trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, and vestibular paroxysmia.

Spontaneous Isolated Bilateral Iliac Artery Dissection in a Patient with Relapsing Polychondritis

Introduction

Isolated iliac artery dissection (IAD) is a rare form of arterial dissection. The most commonly known causes of non-traumatic isolated iliac dissection are connective tissue diseases. Relapsing polychondritis (RP) is a rare inflammatory and multisystemic disease, typically affecting cartilage and connective tissue. Cardiovascular complications occur in approximately 25% of patients with RP.

Case description

The first case of spontaneous isolated bilateral iliac artery dissection in a patient with RP is reported. A 48-year-old woman presented with a two year history of severe right leg intermittent claudication (Rutherford category 3). The complaints were initially attributed to joint pathology associated with RP. However, clinical examination and computed tomography angiography led to a diagnosis of bilateral IAD. A dissection in the left common iliac artery (CIA) began at its origin and ended at the origin of the internal iliac artery, with the true and false lumen both comprising half of the entire lumen. The right CIA was completely occluded from its origin to the origin of the right internal iliac artery. The patient was treated endovascularly by bilateral CIA stent placement with covered stent grafts (Bentley BeGraft), 8 × 57 mm on the right side and 8 × 37 mm on the left. The patient recovered pedal pulses, the stent remained patent, and the patient was asymptomatic at the one month follow-up.

Discussion

Early identification of intermittent claudication is necessary to prevent the progression of complications in patients with RP. Vascular surgeons should be aware of IAD as the potential first presentation of underlying systemic disease. Internists should also keep vascular complications in mind in patients with systemic diseases like RP suffering from unexplained complaints in the lower limbs, undertake a basic vascular examination, and make a vascular referral where appropriate.

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First case of spontaneous bilateral isolated iliac artery dissection in patient with RP.

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Long term failure to identify intermittent claudication in a patient with systemic disease.

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Endovascular treatment of bilateral iliac artery dissection.

Spontaneous Isolated Dissection of Iliac Artery Treated with Endovascular Repair: A Case Report

Spontaneous isolated dissection of the iliac artery (SID-IA) is a rare pathologic condition. The predisposing factors and best treatment strategies are still being debated. We present the case of a 59-year-old male with acute right lower limb ischemia characterized by the sudden occurrence of rest pain, hypoesthesia, and paresis. Angiography showed SID-IA extending down to the femoral bifurcation. The patient had no risk factors for SID-IA; however, he survived an electrocution and had arterial hypertension at admission. Endovascular revascularization was successfully performed, with complete restoration of limb blood flow and remission of symptoms. Follow-up ultrasonography at 1 year confirmed stent patency and absence of clinical symptoms. Endovascular stenting is a good therapeutic option for symptomatic SID-IA without rupture.

Double-Targeted Knockdown of miR-21 and CXCR4 Inhibits Malignant Glioma Progression by Suppression of the PI3K/AKT and Raf/MEK/ERK Pathways

Currently, miR-21 and CXCR4 are being extensively investigated as two key regulators in glioma malignancy. In this study, we investigated the combined effects of these two factors on glioma progression. Herein, the expression of miR-21 and CXCR4 was increased in tumor tissues and cell lines. Inhibition of miR-21, CXCR4, and miR-21 and CXCR4 together all reduced the migration, invasiveness, proliferation, and enhanced apoptosis in glioma cells, as well as reduced tumor volume and mass in xenograft model. The inhibition effect was strongest in double-targeted knockdown of miR-21 and CXCR4 group, whose downstream pathways involved in AKT axis and ERK axis activation. In conclusion, our findings reported that double-targeted knockdown of miR-21 and CXCR4 could more effectively inhibit the proliferation, migration, invasion, and growth of transplanted tumor and promote cell apoptosis, which were involved in the PI3K/AKT and Raf/MEK/ERK signaling pathways.

Iliac Arteries Dissection with a Rapid Dilatation as Debut of Fibromuscular Dysplasia

We report a case of a 38-year-old male diagnosed with fibromuscular dysplasia (FMD) and a dissection of both common iliac arteries without aortic involvement. It was revealed after an inguinal hematoma and a pelvic pain, which are not the typical FMD presentation. Surgical treatment was performed after a rapid iliac growth in the first month control computed tomography angiography. Although the clinical course of this entity is relatively benign, rupture of the common iliac artery has also been described.

Spontaneous Isolated Common Iliac Artery Dissection Treated with Self-Expandable Stent in a 38-year-old Patient: A Case Report

INTRODUCTION

Isolated iliac artery dissection (ISIAD) without the involvement of the aorta is a rare medical condition.

REPORT

A case of a 38-year-old man with sudden onset of rest pain and paraesthesia on the right lower limb (RLL) is presented. Upon admission, the RLL was pulseless, with mild paraesthesia in the foot. The patient underwent computed tomography angiography, which revealed isolated common iliac artery (CIA) dissection followed by endovascular treatment (stenting) of the CIA dissection, with an instant therapeutic effect. Hospital stay was uneventful. The patient was discharged on the third post-procedural day.

DISCUSSION

Endovascular treatment of ISIAD is a viable treatment modality, with low periprocedural complications, mortality, and morbidity. Owing to its mini-invasiveness, it is a viable treatment modality.

Symptomatic Type B Intramural Aortic Hematoma as a Complication of Retrograde Right Common Iliac Artery Dissection

PURPOSE

To report the endovascular treatment of a spontaneous iliac artery dissection (IAD) involving iliac bifurcation, complicated by a type B intramural aortic hematoma (IMH).

CASE REPORT

A 38-year-old female patient came to our institution referring an acute ascending back pain. The angio computed tomography scan showed the presence of a retrograde right IAD with entry tear at the iliac bifurcation and a concomitant aortic IMH. After hypogastric embolization with a vascular plug, self-expanding stent graft was placed to cover the iliac entry tear. At 12 months, the patient was asymptomatic and the angio computed tomography scan showed the patency of the iliac graft without IMH.

CONCLUSIONS

Endovascular treatment of spontaneous IAD is a safe and effective option in symptomatic patient complicated with type B IMH.

Multiple arterial thromboses due to cystic medial degeneration Erdheim-Gsell: A case report

RATIONALE

Cystic medial degeneration Erdheim-Gsell is a vascular pathology mainly of the large vessels, which is mostly associated with Marfan syndrome or Ehlers-Danlos syndrome. The clinical findings of this entity are aneurysms of the aorta or large peripheral arteries which usually present in an acute setting due to rupture of an aneurysm.

PATIENT CONCERNS

We present a case of a 43-year-old Caucasian male with histologically proven cystic medial degeneration of the lower limb vessels mimicking peripheral artery occlusive disease. Despite antiplatelet and anticoagulant treatment, the patient suffered multiple vascular stenosis and occlusions.

DIAGNOSES

Multiple arterial stenoses and thromboses leading to peripheral artery occlusive disease caused by cystic medial degeneration Erdheim-Gsell.

INTERVENTIONS

Multiple surgical and endovascular interventions including bypass graft and intra-arterial thrombolysis as well as oral antiplatelet and anticoagulant therapy.

OUTCOME

Despite dual antiplatelet therapy, anticoagulant therapy with rivaroxaban and multiple surgical and endovascular interventions, the patient developed recurrent arterial thromboses. The patient did not suffer further thrombotic events since clopidogrel and phenprocoumon were administered.

LESSONS

Clinical presentation of cystic medial degeneration Erdheim-Gsell mimicking peripheral artery occlusive disease is very unusual. Due to the fragile vessel wall, patients with cystic medial degeneration might have a higher risk to develop arterial thromboses, even under antiplatelet therapy or anticoagulant treatment.

Spontaneous iliac artery dissection treated with a combination of covered and self-expandable stents to preserve hypogastric patency

A 56-year-old man presented with abdominal pain in the left lower quadrant. Computed tomography angiography showed the presence of an iliac axis dissection.

Two Viabahn (W. L. Gore & Associates, Flagstaff, Ariz) covered stents were placed, starting from the beginning of the left common iliac artery to the iliac bifurcation, closing the proximal dissection tear in the left common iliac artery. A self-expandable EverFlex stent (EV3-Covidien, Plymouth, Minn) was then placed, bridging the covered stent and the left external iliac artery, covering the re-entry tear.

There were no postoperative complications. During follow-up, we observed a progressive and complete thrombosis of the false lumen in 12 months.