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Daskalov AT. Endovascular Treatment of a Contained Rupture of a Penetrating Aortic Ulcer in a Young Patient. Cureus 2024; 16:e56428. [PMID: 38638720 PMCID: PMC11024580 DOI: 10.7759/cureus.56428] [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] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Penetrating aortic ulcer (PAU) is a component of acute aortic syndromes (AASs), encompassing a range of potentially life-threatening aortic conditions such as dissection, intramural hematoma (IMH), and PAU itself. Ruptured PAU constitutes an emergency requiring surgical intervention. Here, we present a case involving a 47-year-old male patient admitted to our emergency department due to severe abdominal pain, malaise, and tenderness of the abdominal wall, which commenced abruptly several hours prior. An emergency CT scan revealed a large pseudoaneurysm of the infrarenal abdominal aorta, which was found with moderate atherosclerosis and no evidence of other dilated or aneurysmal segments. The patient underwent successful endovascular treatment and was discharged four days later without complications. Follow-up examination after two months demonstrated a patent graft and reduction of the aneurysmal sac.
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Lovell J, Lovelock T, Slater J, Thoo C. Chimney endovascular aortic repair is a viable salvage technique in a paravisceral pseudoaneurysm secondary to acute on chronic pancreatitis. Vascular 2023; 31:1076-1081. [PMID: 35738841 DOI: 10.1177/17085381221111012] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pseudoaneurysms of the abdominal aorta secondary to pancreatitis are an extremely rare clinical entity, however, can result in life threatening complications. OBJECTIVE To describe a chimney endovascular aneurysm repair (Ch-EVAR) for an acute pancreatitis related paravisceral aortic pseudoaneurym. METHOD Prospective data collected from subject. RESULTS We present a case of 23-year-old female who underwent a successful salvage Ch-EVAR for a ruptured paravisceral pseudoaneurysm secondary to acute on chronic pancreatitis. CONCLUSION Ch-EVAR may present a viable temporizing or definitive therapeutic treatment option for a paravisceral pseudoaneurysm, particularly in the setting of acute pancreatitis. Further studies are warranted to elucidate the long term viability of Ch-EVAR grafts in the suprarenal, paravisceral aortic position.
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Affiliation(s)
- Janaka Lovell
- Department of Vascular Surgery, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Thomas Lovelock
- Department of Vascular Surgery, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Jacqueline Slater
- Department of General Surgery, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Catherine Thoo
- Department of Vascular Surgery, Royal Hobart Hospital, Hobart, TAS, Australia
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Kayacı S, Cakir T, Dolgun M, Cakir E, Bozok Ş, Temiz C, Caglar YS. Aortic Injury by Thoracic Pedicle Screw. When Is Aortic Repair Required? Literature Review and Three New Cases. World Neurosurg 2019; 128:216-224. [PMID: 31077895 DOI: 10.1016/j.wneu.2019.04.173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Aortic injury by pedicle screw is rare but can cause serious complications. It has not been clearly determined when aortic repair is necessary in cases of screw impingement without perforation of the aortic wall. In this article, we review the treatment and clinical course of pedicle screw aortic impingement and attempt to clarify this issue. METHODS Cases of aortic injury during thoracic screw procedures were found using a MEDLINE search and analyzed together with 3 new cases that we present. RESULTS Nineteen cases collected from the literature and 3 new cases were included in the study. In 7 of the cases, aortic impingement by the pedicle screw was detected during postoperative follow-up (day 1) radiologic examinations. In the other cases, time to presentation of aortic impingement ranged between 2 weeks and 60 months after fixation. The main indications for thoracic spinal fixation were post-traumatic vertebral fracture and kyphoscoliosis/scoliosis. Repair of the aortic damage ranged from primary repair to stent and tube graft placement by the thoracic endovascular aortic repair method. CONCLUSIONS In cases in which the screw impinges less than 5 mm into the aortic wall, hardware revision without aortic repair may be sufficient if recognized early and there are no sign of aortic leakage in vascular imaging. However, cases with more than 5 mm of screw impingement should undergo aortic repair first, even in the absence of aortic leakage, following by screw revision.
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Affiliation(s)
- Selim Kayacı
- Department of Neurosurgery, Faculty of Medicine, Erzincan University, Erzincan, Turkey.
| | - Tayfun Cakir
- Department of Neurosurgery, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Muge Dolgun
- Department of Neurosurgery, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Ertugrul Cakir
- Department of Neurosurgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Şahin Bozok
- Department of Cardiovascular Surgery, Faculty of Medicine, Usak University, Usak, Turkey
| | - Cüneyt Temiz
- Department of Neurosurgery, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Yusuf Sukru Caglar
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
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Massara M, Prunella R, Gerardi P, Lillo A, De Caridi G, Serra R, Notarstefano S, Impedovo G. Infrarenal Abdominal Aortic Pseudoaneurysm: Is It a Real Emergency? Ann Vasc Dis 2017. [PMID: 29515707 PMCID: PMC5835426 DOI: 10.3400/avd.cr.17-00048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abdominal aortic pseudoaneurysm is a rare but life-threatening condition that occurs due to penetrating or blunt trauma. Clinical manifestations are variable, and the time interval from the initial trauma to diagnosis is variable. A prompt diagnosis and an aggressive management approach are required to avoid catastrophic complications. Possible treatment options are open surgical repair, endovascular repair, pseudoanerysmal sac thrombosis induction through direct thrombin injection, and coil embolization. Here, we present the case of a 75-year-old man affected by an infrarenal abdominal aortic pseudoaneurysm presenting with abdominal and lumbar pain for 3 days, who was successfully treated with an endograft.
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Affiliation(s)
- Mafalda Massara
- Vascular Surgery Unit, SS, Annunziata Hospital, Taranto, Italy
| | | | | | - Antonio Lillo
- Vascular Surgery Unit, SS, Annunziata Hospital, Taranto, Italy
| | | | - Raffaele Serra
- Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Shahi N, Kwon JJ, Arosemena M, Salvatore DM, DiMuzio PJ, Abai B. Endovascular Repair of Ruptured Infected Arteries as a Temporizing Measure Versus Destination Therapy. Vasc Endovascular Surg 2016; 50:373-9. [DOI: 10.1177/1538574416655894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Mycotic rupture of the arteries is a rare but deadly disorder. Current management typically involves open surgical repair. However, endovascular repair is a potential treatment that can be used to delay open repair, especially in acutely unstable patients. A case report and review of the literature was conducted to determine whether endovascular therapy could be a destination therapy for patients with arterial rupture secondary to infection. Methods: We present the case of a 72-year-old man with a left common iliac artery aneurysm rupture secondary to Salmonella infection treated with endovascular therapy upon initial presentation. A literature review of PubMed yielded 29 patients with ruptured aortic and iliac infected aneurysms that were initially treated with endovascular repair. Results: Majority of the patients (76.7%, 23 of 30) were successfully treated with the endovascular treatment and did not require open revision. These patients were often placed on long-term antibiotics. Conclusion: The literature review supports endovascular repair with a stent graft as a temporizing measure for infected ruptured arteries in an emergent setting and, in select cases, as a destination therapy.
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Affiliation(s)
- Niti Shahi
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Jeontaik J. Kwon
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Mariano Arosemena
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Dawn M. Salvatore
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Paul J. DiMuzio
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Babak Abai
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
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6
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Acute pancreatitis complicated by rupture of abdominal aortic aneurysm. GASTROENTEROLOGY REVIEW 2016; 11:136-8. [PMID: 27350843 PMCID: PMC4916239 DOI: 10.5114/pg.2016.57820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 06/14/2015] [Indexed: 01/18/2023]
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Corona M, Boatta E, Lucatelli P, Ricœur A, Salvatori FM, Zini C. Aortic pseudoaneurysm rupture secondary to pancreatitis: An endovascular approach. Diagn Interv Imaging 2015; 96:515-7. [PMID: 25704904 DOI: 10.1016/j.diii.2015.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/07/2015] [Accepted: 01/09/2015] [Indexed: 11/19/2022]
Affiliation(s)
- M Corona
- Vascular and interventional radiology unit, Radiology, Oncology and Pathology Department, "Sapienza", University of Rome, Viale Regina Elena 324, 00161 Roma, Italy
| | - E Boatta
- Vascular and interventional radiology unit, Radiology, Oncology and Pathology Department, "Sapienza", University of Rome, Viale Regina Elena 324, 00161 Roma, Italy
| | - P Lucatelli
- Vascular and interventional radiology unit, Radiology, Oncology and Pathology Department, "Sapienza", University of Rome, Viale Regina Elena 324, 00161 Roma, Italy
| | - A Ricœur
- Service de radiologie vasculaire et interventionnelle, CHU de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg, France
| | - F M Salvatori
- Vascular and interventional radiology unit, Radiology, Oncology and Pathology Department, "Sapienza", University of Rome, Viale Regina Elena 324, 00161 Roma, Italy
| | - C Zini
- Vascular and interventional radiology unit, Radiology, Oncology and Pathology Department, "Sapienza", University of Rome, Viale Regina Elena 324, 00161 Roma, Italy.
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Endovascular stenting as treatment for occult perforated abdominal aorta caused by acute necrotizing pancreatitis as rare complication after heart transplantation. Ann Vasc Surg 2014; 28:1794.e9-1794.e11. [PMID: 24704055 DOI: 10.1016/j.avsg.2014.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/04/2014] [Accepted: 03/26/2014] [Indexed: 11/20/2022]
Abstract
With an increase in the population of living cardiac allograft recipients, noncardiac surgery in this group of patients will be a more frequent phenomenon. The postoperative management in these patients is, however, complex. The authors present a case of an abdominal aortic rupture due to the involvement of a necrotizing pancreatitis caused by the side effects of immunosuppressive therapy. A 48-year-old man presented with a necrotizing pancreatitis with accidental affection of the abdominal aortic wall, necessitating emergency repair. Open surgical repair was considered too precarious in a cardiac allograft recipient, aortic stent-graft through endovascular surgery was therefore opted as the preferred procedure. The subsequent postoperative course was uneventful and patient could be discharged.
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10
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Abdominal aortic pseudoaneurysm managed with endovascular stent graft. Surg Laparosc Endosc Percutan Tech 2009; 19:e106-8. [PMID: 19542831 DOI: 10.1097/sle.0b013e3181a493e1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Angioplasty, stenting, endovascular stent grafts, and other minimally interventional techniques are becoming common techniques used for a myriad of vascular pathology. As the technology, comfort level, and technical expertise improve, the envelope of overuse is being approached or possibly superceded. We present an unusual complication of pancreatitis, pseudoaneurysm of the abdominal aorta, which was successfully treated with an endovascular stent graft.
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Endovascular repair of inflammatory abdominal aortic aneurysm: serial changes of periaortic fibrosis demonstrated by CT. ACTA ACUST UNITED AC 2008; 34:523-6. [DOI: 10.1007/s00261-008-9407-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Kakkos SK, Shepard AD. Delayed presentation of aortic injury by pedicle screws: Report of two cases and review of the literature. J Vasc Surg 2008; 47:1074-82. [DOI: 10.1016/j.jvs.2007.11.005] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2007] [Revised: 11/01/2007] [Accepted: 11/01/2007] [Indexed: 10/22/2022]
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Mofidi R, Flett M, Milne A, Chakraverty S. Endovascular repair of an anastomotic leak following open repair of abdominal aortic aneurysm. Cardiovasc Intervent Radiol 2007; 30:1013-5. [PMID: 17533537 DOI: 10.1007/s00270-007-9076-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Revised: 12/19/2006] [Accepted: 01/12/2007] [Indexed: 10/23/2022]
Abstract
This report describes the case of an early postoperative anastomotic leak following elective open repair of an infrarenal abdominal aortic aneurysm which was successfully treated by endovascular stent-grafting. A 71-year-old man underwent open tube graft repair of abdominal aortic aneurysm. Twelve days later he presented with a contained leak from the distal anastomosis, which was confirmed on CT scan. This was successfully treated with a bifurcated aortic stent-graft. This case illustrates the usefulness of the endovascular approach for resolving this rare surgical complication of open repair of abdominal aortic aneurysm and the challenges associated with the deployment of such a device within an aortic tube graft.
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Affiliation(s)
- R Mofidi
- Department of Vascular Surgery and Radiology, Ninewells Hospital, Dundee DD1 9SY, UK.
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Rückert RI, Pirlich M, Rogalla P, Ismail M, Müller JM. Successful endovascular treatment of infrarenal aortic rupture after chemotherapy of a mesenchymal periaortic tumor. Eur J Vasc Endovasc Surg 2006; 33:302-5. [PMID: 17097896 DOI: 10.1016/j.ejvs.2006.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Accepted: 09/17/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To report the first successful endovascular repair of a non-aneurysmal aortic rupture due to periaortic tumour regression. CASE REPORT A 58-year-old man developed spontaneous infrarenal aortic rupture following chemotherapy which led to regression of a periaortic mesothelioma that had been diagnosed during explorative laparotomy 11 months earlier. Stent-graft placement was performed with intentional conversion of a bifurcated (Zenith, COOK) into an aorto-uni-iliac system. No complications were encountered during a 40 months follow-up. CONCLUSION Endovascular repair should be considered as a treatment option in non-aneurysmal aortic rupture.
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Affiliation(s)
- R I Rückert
- Department of Surgery, Franziskus-Krankenhaus Berlin, Berlin, Germany.
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Matsushita M, Ikezawa T. Factors affecting the regression of surgically replaced abdominal aortic aneurysms. Surg Today 2006; 36:147-50. [PMID: 16440161 DOI: 10.1007/s00595-005-3118-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2005] [Accepted: 05/24/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE After endovascular therapy for abdominal aortic aneurysms, aneurysm sac shrinkage is considered to be the best marker of successful treatment. Such shrinkage, however, is infrequent and the rate of shrinkage is variable because of endoleaks. To investigate the factors that influence such contraction, the aneurysm sac regression after a conventional surgical replacement of the abdominal aortic aneurysm in an inclusion fashion was studied. METHODS Abdominal aortic aneurysms that measured 5 cm in diameter or larger were studied in 35 patients who underwent surgical replacement. The aneurysm sac was closed anterior to the prosthesis. Of the 35 cases, 4 aneurysms were inflammatory and 10 had aneurysm wall circumferential calcification of greater than 40%. Computed tomography was performed preoperatively, and at 1 week, and then 3 months postoperatively. RESULTS The maximum major and minor diameters of the aneurysmal sac decreased significantly from 1 week to 3 months after surgery (major diameter: 49 +/- 12 to 32 +/- 8 mm and minor diameter: 39 +/- 10 to 26 +/- 7 mm). In inflammatory aneurysms, the maximum major and minor diameters were significantly larger at 3 months postoperatively, in comparison to nonspecific aneurysms. Among the 31 patients with nonspecific aneurysms, the maximum major diameter was significantly larger in those with aneurysmal calcification of greater than 40% of its circumference at 3 months postoperatively, in comparison to noncalcified aneurysms. CONCLUSIONS The surgically repaired abdominal aortic aneurysm contraction tends to develop over 3 months, and inflammation, thickening, and calcification of the aneurysm wall are all considered to influence the regression of the aneurysm.
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Affiliation(s)
- Masahiro Matsushita
- Department of Vascular Surgery, Aichi Cardiovascular and Respiratory Center, 2135 Kariyasuka, Yamato-cho, Ichinomiya, Aichi, 491-0934, Japan
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Balachandra S, Siriwardena AK. Systematic appraisal of the management of the major vascular complications of pancreatitis. Am J Surg 2005; 190:489-95. [PMID: 16105542 DOI: 10.1016/j.amjsurg.2005.03.009] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2004] [Revised: 12/19/2004] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study is a systematic appraisal of the management of major vascular complications of pancreatitis conducted by collating individual patient-episode data from published literature. METHODS Searches identified 79 papers of which 62 provided detailed information on the clinical course of 214 patients. Principal outcomes were modes of presentation, results of diagnostic angiography, and embolization and overall outcome. RESULTS There were 160 "spontaneous" and 40 postoperative episodes of hemorrhage. Underlying pancreatic disease was chronic pancreatitis (40), pseudocyst (135), and acute pancreatitis in 39. Angiography was undertaken in 173 (81%) with embolization attempted in 115 and achieving hemostasis in 85 (75%). There were 40 (19%) deaths. Mortality was greater in patients undergoing surgery as first intervention compared with angiography first (P = .01, Fisher exact test). CONCLUSION This analysis of pooled data provides evidence of a central role for mesenteric angiography in the diagnosis of major vascular complications of pancreatitis and for angiographic embolization as a powerful tool for achieving hemostasis.
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Affiliation(s)
- Srinivasan Balachandra
- Hepatobiliary Unit, Department of Surgery, Manchester Royal Infirmary, Oxford Road, Manchester M13 9RN, United Kingdom
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