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Stafforini NA, Saldana-Ruiz N, DeRoo S, Schwarze U, Sweet MP, Zettervall SL. Multidisciplinary hybrid approach to management of a thoracoabdominal aneurysm in a patient with both Loeys-Dietz and vascular Ehlers-Danlos syndrome. J Vasc Surg Cases Innov Tech 2024; 10:101519. [PMID: 38982994 PMCID: PMC11231742 DOI: 10.1016/j.jvscit.2024.101519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/22/2024] [Indexed: 07/11/2024] Open
Abstract
Loeys-Dietz syndrome and vascular Ehlers-Danlos syndrome are genetic aortopathies that result from abnormal collagen matrix formation associated with vascular complications and early death. Identification of simultaneous COL3A1 and SMAD3 mutations as well as subsequent open and endovascular repair have not been reported. We present a case of a staged complete aortic replacement in a patient with a 7-cm aneurysm of his aortic arch and confirmed genetic mutations for Loeys-Dietz syndrome and vascular Ehlers-Danlos syndrome. This case highlights that, despite increased operative risk, successful staged repair of the entire aorta can be achieved in a patient with multiple severe genetic aortopathies.
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Affiliation(s)
- Nicolas A Stafforini
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Nallely Saldana-Ruiz
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Scott DeRoo
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Ulrike Schwarze
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Matthew P Sweet
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Sara L Zettervall
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA
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Pennetta FF, Ferrer C, Tonidandel L, Coscarella C, Vagnarelli S, Giudice R. Disappearing multiple visceral aneurysms in Vascular Ehlers-Danlos syndrome. Vascular 2023:17085381231162126. [PMID: 36878244 DOI: 10.1177/17085381231162126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVE To assess the complex management of arterial anomalies in Vascular Ehlers-Danlos Syndrome (vEDS). METHODS We report the case of a 34-year-old male, diagnosed with vEDS, who presented with acute intraperitoneal hemorrhage caused by the rupture of a splenic artery aneurysm, treated in emergency with coil embolization and splenectomy. Computed Tomography (CT) scan showed the concomitant presence of right renal artery (RRA) and common hepatic artery (CHA) aneurysms. RESULTS Both aneurysms were conservatively managed and the patient went through serial CT imaging. After 3 months, rapid regression of the vascular abnormalities led to complete disappearing of RRA and CHA aneurysms, confirmed at 24-month imaging follow-up. In the same time span, two pseudoaneurysms developed in other sites used for transarterial access, requiring two secondary interventions. The present case emphasizes the unpredictability of disease's evolution and arterial complications in vEDS. Conservative management of complex lesions such as visceral artery aneurysms, which in this case resulted to be the best strategy, avoided the risks associated with surgical intervention in such fragile tissues. The reported complications underline that operative indications should be carefully weighed in these patients.
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Affiliation(s)
| | - Ciro Ferrer
- Vascular and Endovascular Surgery Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Luca Tonidandel
- Vascular and Endovascular Surgery Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Carlo Coscarella
- Vascular and Endovascular Surgery Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Simone Vagnarelli
- Interventional Radiology Unit, 9262San Giovanni-Addolorata Hospital, Rome, Italy
| | - Rocco Giudice
- Vascular and Endovascular Surgery Unit, San Giovanni-Addolorata Hospital, Rome, Italy
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Iatrogenic Distal Aortic Rupture in a Patient with Vascular Ehlers–Danlos Syndrome. J Vasc Surg Cases Innov Tech 2023; 9:101156. [PMID: 37125345 PMCID: PMC10140053 DOI: 10.1016/j.jvscit.2023.101156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/18/2023] [Indexed: 03/13/2023] Open
Abstract
Vascular Ehlers-Danlos syndrome is a rare inherited connective tissue disorder that can result in significant morbidity and mortality. This report details an iatrogenic aortic rupture during an endovascular approach in the management of critical limb ischemia in a 27-year-old woman who presented with acute onset of severe sensory deficit of the left leg. Conversion to open repair with a midline laparotomy and an aortic-left popliteal bypass was performed. In the endovascular era, we highlight that even minimally invasive therapeutic interventions can have devastating adverse events in patients with vascular Ehlers-Danlos syndrome.
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Eleshra A, Panuccio G, Spanos K, Rohlffs F, Kodolitsch Y, Detter NC, Tsilimparis N, Kölbel T. Endovascular Repair of Postdissection Thoracoabdominal Aortic Aneurysm in Patients With Vascular Ehlers-Danlos Syndrome. J Endovasc Ther 2021; 28:804-811. [PMID: 34152227 DOI: 10.1177/15266028211025038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report endovascular repair of postdissection thoracoabdominal aortic aneurysm (TAAA) in 2 patients with vascular Ehlers-Danlos syndrome (vEDS). CASE REPORTS Case 1. A 56-year-old vEDS male patient with a 50-mm type III TAAA [history of aortic root repair, hemiarch replacement, and thoracic endovascular aortic repair (TEVAR) for acute type A aortic dissection (TAAD) 7 years ago] was treated by a 2-stage procedure; first, cervical debranching of the left subclavian artery and second TEVAR and t-branch. The postoperative course was uneventful. Follow-up computed tomography angiography (CTA) 3.5 years postoperatively demonstrated aortic remodeling with patency of targeted visceral vessels and no endoleak. Case 2. A 47-year-old vEDS male patient presented with a TAAA (diameter of 67 mm). The patient had a history of aortic valve and arch replacement with elephant trunk for acute TAAD, and consequently a TEVAR and candy-plug procedure after a ruptured false lumen (FL) aneurysm of the descending thoracic aorta. He also had a surgical repair by an aorto-bi-iliac graft. Two years later, CTA demonstrated aneurysmal FL dilatation distally to the candy-plug and he was treated with fenestrated EVAR (F-EVAR). CONCLUSION Endovascular repair of postdissection TAAA was feasible and safe with good short-term outcome in 2 patients with vEDS.
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Affiliation(s)
- Ahmed Eleshra
- German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Giuseppe Panuccio
- German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Konstantinos Spanos
- German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Fiona Rohlffs
- German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Yskertvon Kodolitsch
- German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - N Christian Detter
- German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nikolaos Tsilimparis
- German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Rahman Q, Naidu SG, Chong BW, Stone WM. Percutaneous Embolization of an Inferior Mesenteric Artery Aneurysm in a Patient With Type IV Ehlers-Danlos Syndrome. Vasc Endovascular Surg 2019; 53:343-347. [DOI: 10.1177/1538574418824185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ehlers-Danlos syndrome (EDS) refers to a group of genetic disorders involving the connective tissues. Type IV EDS impairs type III collagen that is responsible for vessel integrity. Patients with type IV EDS are susceptible to vascular and visceral complications, including aortic aneurysms, pseudoaneurysms, dissections, and spontaneous rupture of internal organs. Treating aneurysms with open surgery versus endovascular techniques each carry a unique risk-to-benefit ratio that must be applied to each individual carefully. We present a patient with type IV EDS who presented with a rapidly growing inferior mesenteric artery aneurysm. The patient was treated with a percutaneous endovascular technique using coils and n-butyl-cyanoacrylate glue.
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Affiliation(s)
- Qasim Rahman
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Sailen G. Naidu
- Division of Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Brian W. Chong
- Division of Neurointerventional Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - William M. Stone
- Division of Vascular Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
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Karaolanis G, Sensebat Ö, Torsello G, Bisdas T, Donas KP. Late conversion after endovascular abdominal aortic aneurysm repair in a patient with Ehlers-Danlos syndrome. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:1-3. [PMID: 30619980 PMCID: PMC6313834 DOI: 10.1016/j.jvscit.2018.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/30/2018] [Indexed: 11/29/2022]
Abstract
Vascular Ehlers-Danlos syndrome is associated with life-threatening events. The management of the disease is challenging because of the emergency presentation of symptoms and the tissue friability of the aorta. We describe the successful treatment of a late type I endoleak after previous EVAR.
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Affiliation(s)
| | - Özgun Sensebat
- Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany
| | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany
| | - Theodosios Bisdas
- Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany
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Eagleton MJ. Arterial complications of vascular Ehlers-Danlos syndrome. J Vasc Surg 2016; 64:1869-1880. [PMID: 27687326 DOI: 10.1016/j.jvs.2016.06.120] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/30/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Vascular Ehlers-Danlos syndrome (EDS) is a relatively rare genetic syndrome that occurs owing to disorders in the metabolism of fibrillary collagen. These defects affect the soft connective tissues resulting in abnormalities in the skin, joints, hollow organs, and blood vessels. Patients with these defects frequently present at a young age with spontaneous arterial complications involving the medium-sized arteries. Complications involving the hollow organs, such as spontaneous colonic perforation, are observed as well. Given the fragility of the soft tissue, open and endovascular intervention on patients with vascular EDS is fraught with high complication rates. METHODS A PubMed search was performed to identify manuscripts published related to vascular EDS. This search included more than 747 articles. These findings were cross-referenced using key terms, including endovascular, embolization, surgery, genetics, pathophysiology, connective tissue disorders, vascular complications, systematic review, type III collagen, and COL3A1. RESULTS The references in key articles and review articles were evaluated for additional resources not identified in the PubMed search. Care must be taken to balance the risk of intervention vs the risk of continued observation. Life-threatening hemorrhage, however, mandates intervention. CONCLUSIONS With careful, altered approaches to tissue handling, endovascular approaches may provide a safer option for managing the arterial complications observed in patients with vascular EDS. Additional hope may also be found in the use of pharmacologic agents that reduce the incidence and severity of the arterial complications.
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Affiliation(s)
- Matthew J Eagleton
- Department of Vascular Surgery, Cleveland Clinic Lerner College of Medicine-CWRU, Cleveland, Ohio.
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O'Brien D, White S, Wilson D, Haworth K, Williams A. Thoracic aortopathies in the military patient. J ROY ARMY MED CORPS 2015; 161:230-6. [PMID: 26243806 DOI: 10.1136/jramc-2015-000496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 06/27/2015] [Indexed: 01/16/2023]
Abstract
Thoracic aortic disease is an important contributor to arterial disease and therefore, mortality in the UK. It has close associations with hypertension, atherosclerosis and genetic conditions such as Marfan syndrome. The cardiovascular consequences of acute aortic dissection or the rupture of a thoracic aneurysm are life threatening with a 1% increase in mortality per hour with a type A aortic dissection and a high 30-day mortality rate. The clinical diagnosis can be difficult for the general physician as the symptoms can mimic more common conditions such as acute coronary syndrome, pulmonary embolism or acute abdomen. The investigations that carry the highest sensitivity and specificity, CT, transoesophageal echocardiography and MRI are not usually first-line investigations in most patients so a high index of clinical suspicion is key. The management of acute aortic syndromes involves good initial resuscitation and early discussion with the cardiothoracic surgeons. Given the serious consequences of acute aortic syndromes, it is important for all military doctors to be aware of these presentations and to appreciate the difficulties that can be encountered when trying to accurately diagnose them. Routine medicals, particularly entrance medicals, present a unique clinical opportunity to recognise the clinical features that would warrant further investigation and specialist advice.
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Affiliation(s)
- David O'Brien
- Acute Medicine, Firmly Health NHS Foundation Trust, Slough, Berkshire, UK
| | - S White
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, West Midlands, UK
| | - D Wilson
- Paediatric Cardiology, University Hospital of Wales, Cardiff, UK
| | - K Haworth
- Occupational Medicine, HQ ARTD, Upavon, UK
| | - A Williams
- Department of Cardiology, Royal Gwent Hospital, Newport, UK
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Ng E, Tewksbury R, Choong AM, Walker PJ, Aziz M. Non-aneurysmal abdominal aortic rupture in a patient with Marfan syndrome. Asian Cardiovasc Thorac Ann 2015; 24:703-6. [PMID: 26113733 DOI: 10.1177/0218492315593225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aortic rupture in the presence of aneurysmal disease is well understood and extensively described in the literature. However, aortic rupture in a non-aneurysmal aorta is far less common. In the few reported cases, perforations are believed to result from a penetrating atheromatous ulcer of the aorta. We describe a rare case of non-aneurysmal aortic rupture in a 68-year-old man with Marfan syndrome and a history of proximal aortic surgery. The urgent need for hemorrhage control precluded any consideration of an endovascular repair.
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Affiliation(s)
- Eugene Ng
- Department of Vascular and Endovascular Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia Discipline of Surgery, School of Medicine, University of Queensland, St. Lucia, Australia
| | - Robert Tewksbury
- Department of Vascular and Endovascular Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia Discipline of Surgery, School of Medicine, University of Queensland, St. Lucia, Australia
| | - Andrew Mtl Choong
- Department of Vascular and Endovascular Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia Discipline of Surgery, School of Medicine, University of Queensland, St. Lucia, Australia School of Medicine, Griffith University, Gold Coast, Australia
| | - Philip J Walker
- Department of Vascular and Endovascular Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia Discipline of Surgery, School of Medicine, University of Queensland, St. Lucia, Australia
| | - Maged Aziz
- Department of Vascular and Endovascular Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia Discipline of Surgery, School of Medicine, University of Queensland, St. Lucia, Australia
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Pajak M, Majos MA, Szubert W, Stefanczyk L, Majos A. Acute brain ischemia as a complication of the Ehlers-Danlos syndrome, the case series. Vascular 2013; 22:341-5. [PMID: 24081809 DOI: 10.1177/1708538113505519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Vascular type of Ehlers-Danlos syndrome involves many severe complications leading not only to organ-specific symptoms but often ends in a sudden death. The aim of this paper was to present a diagnostic possibilities and its efficiency rate in patients with vascular complications of Ehlers-Danlos syndrome who suffered from artery dissection resulting in acute brain or limb ischemia. We analysed three patients with diagnosed Ehlers-Danlos syndrome who were referred to radiology department for diagnostic imaging of affected vascular beds, each experienced brain ischemia. The paper also aims at offering some general recommendations for patients suffering from possible complications of type IV Ehlers-Danlos syndrome basing on our own experience and available literature data.
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Affiliation(s)
- Michal Pajak
- Department of Radiology and Imaging Diagnostic, Medical University of Lodz, Poland
| | - Marcin A Majos
- Department of Radiology and Imaging Diagnostic, Medical University of Lodz, Poland
| | - Wojciech Szubert
- Department of Radiology and Imaging Diagnostic, Medical University of Lodz, Poland
| | - Ludomir Stefanczyk
- Department of Radiology and Imaging Diagnostic, Medical University of Lodz, Poland
| | - Agata Majos
- Department of Radiology and Imaging Diagnostic, Medical University of Lodz, Poland
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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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Burcharth J, Rosenberg J. Gastrointestinal surgery and related complications in patients with Ehlers-Danlos syndrome: a systematic review. Dig Surg 2012; 29:349-57. [PMID: 23095510 DOI: 10.1159/000343738] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 04/08/2012] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Ehlers-Danlos syndrome (EDS) is a rare inherited group of connective tissue diseases characterized by joint hypermobility, skin hyperextensibility and bruising tendency. Common features of patients with EDS include vascular and gastrointestinal perforations. The purpose of this systematic review is to address gastrointestinal diseases and the complications associated with surgical treatment of diseases relating to the gastrointestinal system in patients with EDS. METHODS PubMed search including the Medical Subject Heading (MeSH) terms 'Ehlers-Danlos Syndrome' and 'Gastrointestinal Diseases', and an Embase search including the Map Term to Subject Heading 'Ehlers-Danlos Syndrome' with 'AND' function of the keyword 'Gastrointestinal'. RESULTS The literature search resulted in inclusion of 53 articles after application of eligibility criteria. The primary results drawn from the literature was that spontaneous ruptures of vessels and spontaneous perforations of the sigmoid colon occur in patients with EDS. CONCLUSION Surgery in patients with EDS is associated with a high risk of complications, which is why preoperative indications should be considered. Optimal therapy for these patients includes the awareness that EDS is a systemic disease involving fragility, bleeding and spontaneous perforations from almost all organ systems. Often, a nonsurgical approach can be the best choice for these patients, depending on the condition.
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Sala Almonacil VA, Zaragozá García JM, Gómez Palonés FJ, Plaza Martínez Á, Ortíz Monzón E. Endovascular repair of an iliac arteriovenous fistula secondary to perforation from a common iliac aneurysm in a patient with Ehler-Danlos syndrome. Ann Vasc Surg 2012; 26:861.e11-5. [PMID: 22794344 DOI: 10.1016/j.avsg.2012.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 01/02/2012] [Accepted: 01/08/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Type IV Ehler-Danlos syndrome (EDS) patients are prone to life-threatening vascular complications. Surgical management of those complications is challenging owing to vessel wall fragility, which may result in hemorrhagic events and high mortality rates. Here we report a case of left common iliac aneurysm perforation of the ipsilateral iliac vein repaired using endovascular technique in a patient with EDS. METHOD AND RESULTS A 54-year-old patient presented with heart failure symptoms that evolved over 1 week in association with left leg edema and steal syndrome due to a perforation of the left iliac vein caused by a left common iliac aneurysm. A thrombosed right common iliac aneurysm and several other visceral and peripheral aneurysms were discovered on computed tomographic scan at admission. An aortouniiliac stent graft was used to seal the fistula. After 18 months of follow-up, the patient remained asymptomatic. CONCLUSIONS We suggest that endovascular therapy is useful to manage vascular complications in patients with EDS.
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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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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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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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Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA, Timaran CH, Upchurch GR, Veith FJ. The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg 2009; 50:S2-49. [PMID: 19786250 DOI: 10.1016/j.jvs.2009.07.002] [Citation(s) in RCA: 453] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 07/06/2009] [Accepted: 07/06/2009] [Indexed: 02/08/2023]
Affiliation(s)
- Elliot L Chaikof
- Department of Surgery, Emory University, Atlanta, Ga 30322, USA.
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Iida Y, Obitsu Y, Komai H, Shigematsu H. Successful coil embolization for rupture of the subclavian artery associated with Ehlers-Danlos syndrome type IV. J Vasc Surg 2009; 50:1191-5. [DOI: 10.1016/j.jvs.2009.05.064] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2009] [Revised: 05/29/2009] [Accepted: 06/30/2009] [Indexed: 11/30/2022]
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Contemporary management of vascular complications associated with Ehlers-Danlos syndrome. J Vasc Surg 2009; 51:131-8; discussion 138-9. [PMID: 19879095 DOI: 10.1016/j.jvs.2009.08.019] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 08/04/2009] [Accepted: 08/04/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVES There has been debate regarding the safety of performing elective procedures in patients with vascular manifestations associated with Ehlers-Danlos syndrome (EDS). The purpose of this study was to review the surgical management and clinical outcomes of EDS patients undergoing vascular procedures at a tertiary medical center with multimodality expertise in connective tissue disorders. METHODS All patients with EDS undergoing endovascular and open vascular procedures at a single-institution academic medical center from 1994 to 2009 were retrospectively reviewed. Clinical data were evaluated including patient demographics, length of stay (LOS), and mortality outcomes during hospital course and long-term follow-up. RESULTS A total of 40 patients with EDS were identified, including individuals diagnosed with classic (n = 15), hypermobility (n = 16), and vascular (n = 9) types of EDS. These patients collectively underwent 45 endovascular and 18 open procedures for vascular disease during the time period, including embolization (n = 37), angioplasty (n = 8), arterial bypass (n = 5), and aortic aneurysm repair (n = 13). All cases were performed electively, except for one (2%) urgent endovascular and one (5%) emergent open procedure. Endovascular procedures were associated with a median LOS (interquartile range [IQR]) of 2 (1 to 3) days with no procedure-related mortality or in-hospital deaths among all EDS types, whereas open vascular procedures had median LOS (IQR) of 6 (5 to 8) days with one (6%) in-hospital death occurring in a vascular EDS patient. Survival free of any complication at 5 years was 85% and 54% following endovascular and open procedures, respectively. CONCLUSIONS The elective surgical management of vascular disorders in EDS patients using open and endovascular procedures has been associated with good outcomes. Our results suggest that vascular interventions in these EDS patients can be safely performed and should not be withheld until rupture or acute symptoms arise.
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Khalique Z, Lyons OTA, Clough RE, Bell RE, Reidy JF, Schwarze U, Byers PH, Taylor PR. Successful endovascular repair of acute type B aortic dissection in undiagnosed Ehlers-Danlos syndrome type IV. Eur J Vasc Endovasc Surg 2009; 38:608-9. [PMID: 19695909 DOI: 10.1016/j.ejvs.2009.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Accepted: 07/14/2009] [Indexed: 11/17/2022]
Abstract
A 61-year-old man presented with an acute type B aortic dissection for which a stent-graft was introduced. He remains complication-free 4 years onwards and has since been diagnosed with Ehlers-Danlos syndrome type IV (EDS IV). His particular mutation is predicted to result in lesser levels of normal collagen and may explain his favourable outcome from endovascular intervention. Understanding the genotype-phenotype correlation may influence the choice of therapy offered to patients with EDS IV.
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Affiliation(s)
- Z Khalique
- Department of Vascular Surgery, Guy's & St Thomas' NHS Foundation Trust, London, UK
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Lipinski MJ, Lipinski SE, Kripalani S, Friesen LD, Uthlaut BS, Braddock SR. An unusual presentation of Ehlers-Danlos syndrome vascular type with deep vein thrombosis: A case for multidisciplinary management. Am J Med Genet A 2009; 149A:698-701. [DOI: 10.1002/ajmg.a.32687] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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