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Crisp J, Ahmad M, Crockett S, Mohamed A, Hamady M, Bernstein O, Shalhoub J. Spontaneous bilateral superficial femoral artery pseudoaneurysms and a unilateral posterior tibial artery aneurysm in an immunocompromised patient. Clin Case Rep 2024; 12:e8686. [PMID: 38515996 PMCID: PMC10954564 DOI: 10.1002/ccr3.8686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/28/2024] [Accepted: 02/07/2024] [Indexed: 03/23/2024] Open
Abstract
Key Clinical Message The presence of multiple pseudoaneurysms in a patient should prompt investigations for the underlying etiologies including autoimmune and immunosuppressive disease processes. Treatment options include open repair and endovascular stenting. Abstract Pseudoaneurysms (also known as false aneurysms) are atypical dilatations or outpouchings from a vessel which are not always contained by the three layers of a normal vessel wall, namely the intima, media, and adventitia. These are distinct from a true aneurysm which has a wall comprising all three layers. The underlying etiology for both true aneurysms and pseudoaneurysm can vary. We present the rare case of bilateral superficial femoral artery pseudoaneurysms, of unknown etiology and a concurrent posterior tibial artery saccular aneurysm in a patient with Human Immunodeficiency Virus (HIV) infection and multiple comorbidities. This was managed using a combination of endovascular covered stent grafts and open surgical repair technique. The patient is doing well on follow-up a year later with no post-operative infections. A literature review of the existing reports of superficial femoral artery pseudoaneurysms and posterior tibial artery aneurysms and their management is also reported.
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Affiliation(s)
- Jonathan Crisp
- Department of Vascular SurgeryImperial College Healthcare NHS TrustLondonUK
| | - Manal Ahmad
- Department of Vascular SurgeryImperial College Healthcare NHS TrustLondonUK
- Department of Surgery and CancerImperial College LondonLondonUK
| | - Stephen Crockett
- Department of Vascular SurgeryImperial College Healthcare NHS TrustLondonUK
- Department of Surgery and CancerImperial College LondonLondonUK
| | - Abdulla Mohamed
- Department of Vascular SurgeryImperial College Healthcare NHS TrustLondonUK
| | - Mohamad Hamady
- Department of Vascular SurgeryImperial College Healthcare NHS TrustLondonUK
- Department of Surgery and CancerImperial College LondonLondonUK
- Department of RadiologyImperial College Healthcare NHS TrustLondonUK
| | - Ondina Bernstein
- Department of Vascular SurgeryImperial College Healthcare NHS TrustLondonUK
- Department of Surgery and CancerImperial College LondonLondonUK
- Department of RadiologyImperial College Healthcare NHS TrustLondonUK
| | - Joseph Shalhoub
- Department of Vascular SurgeryImperial College Healthcare NHS TrustLondonUK
- Department of Surgery and CancerImperial College LondonLondonUK
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Chesneau B, Edouard T, Dulac Y, Colineaux H, Langeois M, Hanna N, Boileau C, Arnaud P, Chassaing N, Julia S, Jondeau G, Plancke A, Khau Van Kien P, Plaisancié J. Clinical and genetic data of 22 new patients with SMAD3 pathogenic variants and review of the literature. Mol Genet Genomic Med 2020; 8:e1132. [PMID: 32154675 PMCID: PMC7216810 DOI: 10.1002/mgg3.1132] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 01/07/2020] [Indexed: 12/23/2022] Open
Abstract
Background Pathogenic SMAD3 variants are responsible for a cardiovascular phenotype, mainly thoracic aortic aneurysms and dissections. Precocious identification of the vascular risk such as aortic dilatation in mutated patients has a major impact in terms of management, particularly to avoid dissection and sudden death. These vascular damages are classically associated with premature osteoarthritis and skeletal abnormalities. However, variable expressivity and incomplete penetrance are common with SMAD3 variants. Methods To investigate the clinical variability observed within SMAD3 patients, we reviewed the phenotypic and genetic data of 22 new patients from our Centre and of 133 patients reported in the literature. From this cohort of 155 mutated individuals, we first aimed to delineate an estimated frequency of the main clinical signs associated with SMAD3 pathogenic variants and, then, to look for genotype‐phenotype correlations, mainly to see if the aortic phenotype (AP) could be predicted by the SMAD3 variant type. Results We showed, herein, the absence of correlation between the SMAD3 variant type and the occurrence of an AP in patients. Conclusion Therefore, this report brings additional data for the genotype‐phenotype correlations of SMAD3 variants and the need to explore in more detail the effects of genetic modifiers that could influence the phenotype.
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Affiliation(s)
- Bertrand Chesneau
- Service de génétique médicale, Hôpital Purpan, CHU de Toulouse, Toulouse, France.,Centre de Référence du syndrome de Marfan et des syndromes apparentés, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | - Thomas Edouard
- Centre de Référence du syndrome de Marfan et des syndromes apparentés, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | - Yves Dulac
- Centre de Référence du syndrome de Marfan et des syndromes apparentés, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | - Hélène Colineaux
- Département d'épidémiologie, d'économie de la santé et de santé publique, CHU de Toulouse, Toulouse, France.,LEASP UMR1027, INSERM, Université Toulouse III, Toulouse, France
| | - Maud Langeois
- Service de génétique médicale, Hôpital Purpan, CHU de Toulouse, Toulouse, France.,Centre de Référence du syndrome de Marfan et des syndromes apparentés, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | - Nadine Hanna
- Centre de Référence pour le syndrome de Marfan et apparentés, AP-HP, Hôpital Bichat, Faculté Paris Diderot, LVTS INSERM U1148, Paris, France
| | - Catherine Boileau
- Centre de Référence pour le syndrome de Marfan et apparentés, AP-HP, Hôpital Bichat, Faculté Paris Diderot, LVTS INSERM U1148, Paris, France
| | - Pauline Arnaud
- Centre de Référence pour le syndrome de Marfan et apparentés, AP-HP, Hôpital Bichat, Faculté Paris Diderot, LVTS INSERM U1148, Paris, France
| | - Nicolas Chassaing
- Service de génétique médicale, Hôpital Purpan, CHU de Toulouse, Toulouse, France
| | - Sophie Julia
- Service de génétique médicale, Hôpital Purpan, CHU de Toulouse, Toulouse, France
| | - Guillaume Jondeau
- Centre de Référence pour le syndrome de Marfan et apparentés, AP-HP, Hôpital Bichat, Faculté Paris Diderot, LVTS INSERM U1148, Paris, France
| | - Aurélie Plancke
- UF de Génétique Médicale et Cytogénétique, Centre Hospitalier Régional Universitaire de Nîmes, Nîmes, France
| | - Philippe Khau Van Kien
- UF de Génétique Médicale et Cytogénétique, Centre Hospitalier Régional Universitaire de Nîmes, Nîmes, France
| | - Julie Plaisancié
- Service de génétique médicale, Hôpital Purpan, CHU de Toulouse, Toulouse, France.,Centre de Référence du syndrome de Marfan et des syndromes apparentés, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
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