1
|
Gravos A, Katsifa K, Tselioti P, Grammatikopoulou V, Sakellaridis K, Kanakaki S, Tsapas C, Destounis A, Moschouris H, Athanasiadou I, Chatzivasiloglou F, Ivanova E, Prekates A. Ruptured arterial aneurysm in Wegener's granulomatosis: a case report. J Med Case Rep 2021; 15:343. [PMID: 34247654 PMCID: PMC8274053 DOI: 10.1186/s13256-021-02955-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/14/2021] [Indexed: 12/24/2022] Open
Abstract
Background Aneurysm formation is a possible, but rare, complication of granulomatosis with polyangiitis, known as Wegener’s granulomatosis. Urgent diagnosis and therapy is very important because a ruptured aneurysm could be life threatening. Case presentation We, therefore, present the case of a 63-year-old Greek man who was diagnosed with granulomatosis with polyangiitis and retroperitoneal hematoma due to ruptured aneurysm in renal artery and upper pancreaticoduodenal artery. His clinical course was complicated by acute renal failure and acute respiratory failure due to alveolar hemorrhage. Emergency coil embolization was performed. Postembolization recovery was uneventful; no bleeding occurred. The patient underwent mechanical ventilation and continuous veno-venous hemofiltration and received combined immunosuppression and supportive therapy, but eventually died 30 days after admission to hospital from severe septic shock and multiple organ failure. Conclusion Endovascular treatment is the therapy of choice, especially for patients with ruptured aneurysms that are hemodynamically stable. Early diagnosis is very important, as urgent embolization and early initiation of immunosuppression therapy are the treatment of choice.
Collapse
Affiliation(s)
- A Gravos
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece.
| | - K Katsifa
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
| | - P Tselioti
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
| | - V Grammatikopoulou
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
| | - K Sakellaridis
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
| | - S Kanakaki
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
| | - C Tsapas
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
| | - A Destounis
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
| | - H Moschouris
- Radiology Department, Tzaneio General Hospital of Piraeus, Kamatero, Greece
| | - I Athanasiadou
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
| | - F Chatzivasiloglou
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
| | - E Ivanova
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
| | - A Prekates
- Intensive Care Unit (ICU), Tzaneio General Hospital of Piraeus, Dodonis 26, Kamatero, PC: 13451, Greece
| |
Collapse
|
2
|
Bacalbasa N, Brezean I, Anghel C, Barbu I, Pautov M, Balescu I, Brasoveanu V. Successful Resection and Vascular Ligation of a Large Hepatic Artery Aneurysm - A Case Report and Literature Review. ACTA ACUST UNITED AC 2018; 31:979-982. [PMID: 28882969 DOI: 10.21873/invivo.11157] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/02/2017] [Accepted: 08/08/2017] [Indexed: 02/06/2023]
Abstract
The occurrence of hepatic artery aneurysms is rare and might be incidentally diagnosed, as the patient remains asymptomatic for a long period of time. However, due to the fact that these lesions are associated with a high risk of developing life threatening complications, such as intraperitoneal rupture, it has been stated that all cases should be submitted to treatment by endovascular or surgical approach. We present the case of a 68-year-old patient, who presented with recurrent upper digestive tract bleedings and was diagnosed with a large aneurysm of the common and the proper hepatic artery, and the gastroduodenal artery. The preoperative angiography revealed an anatomic variation consisting of the common hepatic artery originating from the celiac trunk, and the left hepatic artery originating from the left gastric artery. A percutaneous right portal vein embolization was performed in order to induce hypertrophy of the left lobe and prepare the patient for a right hepatectomy and aneurysmal resection. However, at the time of surgery, after performing the aneurysmal resection and arterial ligation, the vascular supply of the entire liver was efficiently provided by the left hepatic artery and its collaterals. Concluding, hepatic resection was no longer necessary.
Collapse
Affiliation(s)
- Nicolae Bacalbasa
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Iulian Brezean
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania .,"Ion Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - Claudiu Anghel
- "Dan Setlacec" Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Ion Barbu
- "Dan Setlacec" Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Mihai Pautov
- "Dan Setlacec" Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | | | - Vladislav Brasoveanu
- "Dan Setlacec" Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| |
Collapse
|
3
|
Abstract
BACKGROUND AND OBJECTIVES A new technology involving indocyanine green (ICG) fluorescence angiography has been introduced to assess tissue perfusion and perform vascular mapping during laparoscopic surgery. The purpose of this study was to describe the use of this technology to identify the variable blood supply patterns to the stomach and gastroesophageal (GE) junction during laparoscopic sleeve gastrectomy (LSG), which may help in preserving the blood supply and preventing ischemia-related leaks. METHODS Eighty-six patients underwent LSG and were examined intraoperatively with fluorescence angiography at an academic bariatric center from January 2016 to September 2017. Before the construction of the SG, 1 mL ICG was injected intravenously, and near infrared fluorescence imaging technology was used to identify the blood supply of the stomach. Afterward, the LSG was created with attention to preserving the identified blood supply to the GE junction and gastric tube. Finally, 3 mL ICG was injected to ensure that all the pertinent blood vessels were preserved. RESULTS Eighty-six patients successfully underwent the laparoscopic procedure with no complications. The following patterns of blood supply to the GE junction were found: (1) a right-side-dominant pattern (20%), arising from the left gastric artery; (2) a right-side-accessory pattern (36%), running in the gastrohepatic ligament and comprising either an accessory hepatic artery or an accessory gastric artery; and (3) a left-side accessory pattern arising from tributaries from the left inferior phrenic artery significantly contributing to the right-side blood supply. In addition, in 10% of the cases both right and left accessory patterns were present simultaneously. CONCLUSION ICG fluorescence angiography allows determination of the major blood supply to the proximal stomach before any dissection during sleeve gastrectomy, so that an effort can be made to avoid unnecessary injury to these vessels during the procedure.
Collapse
Affiliation(s)
- Camila B Ortega
- Department of Surgery, Duke University Health System, Durham, North Carolina, USA
| | - Alfredo D Guerron
- Department of Surgery, Duke University Health System, Durham, North Carolina, USA
| | - Jin S Yoo
- Department of Surgery, Duke University Health System, Durham, North Carolina, USA
| |
Collapse
|