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Provost H, Drudi LM, Schwenter F, Elkouri S, Blair JF, Charbonneau P. A mycotic aneurysm of a jejunal branch treated by aneurysmectomy without bowel resection. J Vasc Surg Cases Innov Tech 2024; 10:101364. [PMID: 38130368 PMCID: PMC10731609 DOI: 10.1016/j.jvscit.2023.101364] [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] [Received: 08/23/2023] [Accepted: 10/21/2023] [Indexed: 12/23/2023] Open
Abstract
Jejunal artery pseudoaneurysms are extremely rare, accounting for <1% of all visceral artery pseudoaneurysms. Fewer than 50 cases were reported in literature during the previous century. This case report describes the case of a 72-year-old man who underwent aneurysmectomy to treat a 21-mm mycotic jejunal artery pseudoaneurysm found in the setting of endocarditis. This pseudoaneurysm was treated with laparotomy, and gentle dissection of the tissues surrounding the pseudoaneurysm was performed before ligation and resection. This allowed for vascular collateral branch preservation, which, thus, avoided concomitant bowel resection. This report highlights the feasibility of this technique.
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Affiliation(s)
- Hubert Provost
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Laura M. Drudi
- Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Frank Schwenter
- Department of General Surgery, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Stéphane Elkouri
- Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Aortic Centre, Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Jean-François Blair
- Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Aortic Centre, Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Philippe Charbonneau
- Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Aortic Centre, Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
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Lim MS, Steinbrecher K, Koefoed AW, Braverman AC. Familial visceral branch artery aneurysms in Loeys-Dietz syndrome. BMJ Case Rep 2024; 17:e256836. [PMID: 38199651 PMCID: PMC10806958 DOI: 10.1136/bcr-2023-256836] [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: 01/12/2024] Open
Abstract
Loeys-Dietz syndrome (LDS) is an autosomal dominant heritable disorder due to pathogenic variants in one of several genes involved in TGF-β (transforming growth factor-beta) signalling. LDS is associated with aortic aneurysm and dissection. LDS may also lead to extra-aortic aneurysms, the majority of which occur in the head and neck vasculature. Visceral aneurysms are uncommon, and no cases of distal superior mesenteric artery (SMA) branch aneurysms in patients with LDS have been reported. Three related females with TGFBR1-related LDS developed distal SMA branch artery aneurysms involving the ileocolic and jejunal arteries. Endovascular or surgical intervention was performed in each. The presence and severity of arterial, craniofacial, and cutaneous features of LDS in these patients are variable. TGFBR1-related LDS may rarely lead to SMA branch artery aneurysms that can develop later in life. Surgical and endovascular procedures can successfully treat these aneurysms, but data to guide size thresholds and optimal treatment strategies are lacking.
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Affiliation(s)
- Michelle S Lim
- Cardiovascular Division, Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | - Kacie Steinbrecher
- Washington University in St Louis School of Medicine Mallinckrodt Institute of Radiology, Saint Louis, Missouri, USA
| | - Andrew W Koefoed
- Washington University School in St Louis School of Medicine, St Louis, Missouri, USA
| | - Alan C Braverman
- Cardiovascular Division, Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA
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Saito N, Nakano R, Taguchi H, Haga M, Shimoda E, Inoue M, Morimoto K, Takahama J, Tanaka T. A Case of Jejunal Artery Aneurysm Successfully Treated with Endovascular Embolization. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:165-168. [PMID: 38020463 PMCID: PMC10681762 DOI: 10.22575/interventionalradiology.2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/31/2023] [Indexed: 12/01/2023]
Abstract
Jejunal artery aneurysms are extremely rare; only 58 cases have been reported up to 2022. The high rupture rate necessitates a curative treatment. Only four cases of true jejunal artery aneurysms treated with endovascular embolization were reported. We report a case of a 75-year-old man with a true jejunal artery aneurysm who was successfully treated with endovascular embolization. The aneurysm was located in the third jejunal branch. The proximal and distal distance to the superior mesenteric artery and the first bifurcation of the third jejunal branch, respectively, were too short to perform isolation. First, we performed packing in the aneurysm, followed by secondary parent artery embolization. Finally, we achieved total occlusion of the aneurysm and its parent artery with preserved distal intestinal blood flow.
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Affiliation(s)
- Natsuhiko Saito
- Department of Radiology, Higashiosaka City Medical Center, Japan
| | - Ryota Nakano
- Department of Radiology, Higashiosaka City Medical Center, Japan
| | - Hidehiko Taguchi
- Department of Radiology, Higashiosaka City Medical Center, Japan
| | - Masayo Haga
- Department of Radiology, Higashiosaka City Medical Center, Japan
| | - Emiko Shimoda
- Department of Radiology, Higashiosaka City Medical Center, Japan
| | - Masayoshi Inoue
- Department of Radiology, Higashiosaka City Medical Center, Japan
| | - Kengo Morimoto
- Department of Radiology, Higashiosaka City Medical Center, Japan
| | - Junko Takahama
- Department of Radiology, Higashiosaka City Medical Center, Japan
| | - Toshihiro Tanaka
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Japan
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Abu-Abaa M, Al-Qaysi G, Hassan A, Kananeh S. Subarachnoid Hemorrhage With Multifocal Cerebral Aneurysms in a Patient With Crohn’s Disease and Sjögren's Syndrome: A Case Report and Literature Review. Cureus 2023; 15:e35585. [PMID: 37007320 PMCID: PMC10063248 DOI: 10.7759/cureus.35585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/04/2023] Open
Abstract
Only a few reports of the association between Crohn's disease (CD) and Sjögren's syndrome (SS) have been documented in the medical literature. Herein, we are presenting a 61-year-old female patient who presented with subarachnoid hemorrhage (SAH). She has a past medical history of primary SS on no active treatment, and CD in remission while on maintenance immunotherapy. She also tested positive for COVID-19. Computed tomography angiography (CTA) brain as well as cerebral angiogram revealed multifocal cerebral aneurysms. Successful coiling was achieved with a cerebral angiogram. This case serves to add to a limited body of reported cases and remind clinicians of the association between SS/CD and cerebral aneurysms. Herein, we review the literature regarding this association and also the effect of immunotherapy and COVID-19 on the progression of cerebral aneurysms.
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