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Tsuchida K, Kokaguchi K, Hasegawa T, Akamatsu D, Namiki K. Endovascular treatment for a ruptured lumbar artery aneurysm in a patient with neurofibromatosis type 1. J Vasc Surg Cases Innov Tech 2023; 9:101208. [PMID: 37799844 PMCID: PMC10547740 DOI: 10.1016/j.jvscit.2023.101208] [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: 03/27/2023] [Accepted: 04/24/2023] [Indexed: 10/07/2023] Open
Abstract
The present medical case report describes successful endovascular treatment via stent graft and coil packing for a ruptured lumbar artery aneurysm in a 55-year-old woman with neurofibromatosis type 1. Although less common, vasculopathy, such as an aneurysm, stenosis, rupture, and arteriovenous fistula, have been reported and can be a cause of death for patients with this disorder. However, only a few cases of a ruptured lumbar aneurysm have been reported.
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Affiliation(s)
- Ken Tsuchida
- Division of Vascular Surgery, Osaki Citizen Hospital, Osaki, Japan
| | | | - Tetsuya Hasegawa
- Division of Diagnostic Radiology, Osaki Citizen Hospital, Osaki, Japan
| | - Daijirou Akamatsu
- Division of Vascular Surgery, Department of Surgery, Tohoku University Hospital, Sendai City, Japan
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Nakai S, Uchida T, Kuroda Y, Yamashita A, Ohba E, Mizumoto M, Hayashi J, Kobayashi K, Ochiai T. Endovascular Repair for Abdominal Aortic Aneurysm Rupture With Neurofibromatosis Type 1. Ann Vasc Surg 2022; 79:439.e1-439.e4. [PMID: 34648864 DOI: 10.1016/j.avsg.2021.07.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/11/2021] [Accepted: 07/18/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1), also known as von Recklinghausen disease, is a rare congenital disorder with an autosomal dominant inheritance. Severe perioperative complications owing to the congenital fragility of the vascular wall in NF1 patients have been reported. The optimal vascular surgical approach remains controversial. We describe endovascular aortic repair of an abdominal aortic aneurysm rupture in a patient with NF1. CASE PRESENTATION A 78-year-old woman with NF1 was transferred to our institution with a diagnosis of ruptured abdominal aortic aneurysm. The patient showed multiple café-au-lait spots, numerous neurofibromatosis, and severe scoliosis. Emergency endovascular aortic repair was performed, without technical difficulty. Despite an uneventful postoperative course, she developed an idiopathic left cervical hematoma caused by hemorrhage, and required tracheostomy due to severe airway obstruction. In addition, postoperative CT showed a newly developed saccular aneurysm at the proximal end of the stent graft. On postoperative day 40, she was transferred to a rehabilitation hospital, without recurrent bleeding and saccular aneurysm enlargement. CONCLUSION In patients with NF1 who require a vascular surgical procedure, surgeons should consider the vascular wall fragility in selecting the optimal treatment strategy and the possible complications.
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Affiliation(s)
- Shingo Nakai
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.
| | - Tetsuro Uchida
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yoshinori Kuroda
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Atsushi Yamashita
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Eiichi Ohba
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Masahiro Mizumoto
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Jun Hayashi
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Kimihiro Kobayashi
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tomonori Ochiai
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
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Morita R, Abo D, Soyama T, Yoshino Y, Yoshikawa T, Kimura T, Kudo K. Spontaneous rupture of the pancreatic arcade artery caused by neurofibromatosis type 1 successfully treated using emergency transcatheter arterial embolization, partial intra-aortic balloon occlusion, and stent graft placement: a case report and review of the literature. CVIR Endovasc 2020; 3:37. [PMID: 32715394 PMCID: PMC7383047 DOI: 10.1186/s42155-020-00129-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 05/27/2020] [Indexed: 11/30/2022] Open
Abstract
Background Vascular abnormalities in neurofibromatosis type 1 (NF1) are rare, but are the second leading cause of death in persons with NF1. In NF1 vasculopathy (NF-V), fatal bleeding due to a spontaneous arterial rupture sometimes occurs. Ruptured extracranial arteries in patients with NF1 often involve thoracic vessels, such as the intercostal and subclavian arteries; very few reports exist regarding the abdominal region. Herein, we present the first case of intraperitoneal bleeding due to spontaneous pancreatic arcade artery (PAA) rupture associated with NF1, successfully treated by transcatheter arterial embolization (TAE) combined with stent-graft placement and partial intra-aortic balloon occlusion (IABO). Case presentation A 40-year-old woman complained of back and abdominal pain. Upon admission, her blood pressure was 85/41 mmHg and heart rate was 129 beats/min. Computed tomography (CT) showed large intraperitoneal bleeding due to PAA rupture. After CT scanning, her systolic blood pressure decreased to 50 mmHg. Therefore, we performed emergency TAE with partial IABO. She was treated by TAE of the anterior superior pancreaticoduodenal artery, anterior inferior pancreaticoduodenal artery, and inferior pancreaticoduodenal artery. However, even after TAE, minor extravasation around the superior mesenteric artery continued, and her vital signs remained unstable. Stent-graft placement was selected to stop the haemorrhage, preserving normal blood flow of the superior mesenteric artery trunk. Excellent patency of the stent graft was confirmed on follow-up CT, and she was discharged on postoperative day 56. Conclusion PAA rupture associated with NF1 can be successfully treated by TAE combined with partial intra-aortic balloon occlusion, and stent-graft placement.
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Affiliation(s)
- Ryo Morita
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan. .,Department of Diagnostic Imaging, Hokkaido University Graduate School Medicine, Hokkaido University, Sapporo, Japan.
| | - Daisuke Abo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Takeshi Soyama
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Yuki Yoshino
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Toru Yoshikawa
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Tasuku Kimura
- Department of Diagnostic Radiology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Kohsuke Kudo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan.,Department of Diagnostic Imaging, Hokkaido University Graduate School Medicine, Hokkaido University, Sapporo, Japan
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Spontaneous ascending aortic rupture in a pregnant woman with neurofibromatosis type 1. Gen Thorac Cardiovasc Surg 2018; 67:979-981. [PMID: 30120674 DOI: 10.1007/s11748-018-0989-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
Abstract
Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder that affects 1 in 3000 individuals. Vascular involvement in NF-1 is a well-recognized, but rare, feature of this disease. In pregnant women, the risk of aortic dissection or rupture is elevated during pregnancy and the postpartum period. We report a pregnant woman who had a history of NF-1 with a spontaneous ascending aortic rupture. This rupture was successfully treated by emergent surgery. The mother and the 28-week-gestation newborn recovered uneventfully. During 7 years of follow-up, aorta of the patient shows no significant change. A review of the literature regarding the pathogenesis of this condition is also presented.
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Bargiela D, Verkerk MM, Wee I, Welman K, Ng E, Choong AMTL. The endovascular management of neurofibromatosis-associated aneurysms: A systematic review. Eur J Radiol 2017; 100:66-75. [PMID: 29496081 DOI: 10.1016/j.ejrad.2017.12.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 12/13/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Neurofibroblastoma (NF) or Von Recklinghausen disease, is an autosomal dominant disorder affecting one in 3000 individuals. Cardinal features of NF include multiple café-au-lait macules, benign neurofibromas, and iris hamartomas. Albeit less common, vascular lesions of medium and large-sized arteries and veins are a well-recognized complication, which can lead to fatal consequences such as rupture. METHOD A systematic review was conducted as per the Preferred Reporting Instructions for Systematic Reviews and Meta-analysis (PRISMA) guidelines utilizing PubMed, EMBASE, and Cochrane databases. RESULTS There were 59 articles identified involving 66 patients (mean age 44.3 ± 30 years), of which 89% had neurofibromatosis type 1. There were 63.6% of patients who presented with aneurysm rupture, 33.3% presented with intact symptomatic aneurysms, and 3.1% presented with intact asymptomatic aneurysms. Anatomically, 4.5% of patients suffered from intracranial aneurysms; 12.1% suffered from visceral artery aneurysms (including hepatic, superior mesenteric, gastroduodenal and renal arteries), and other patients suffered from aneurysms within the chest, abdomen, pelvis, upper limbs and neck. Amongst the various endovascular procedures, coiling was performed in 83.3% of cases. There were 12 covered stents employed in 10 patients (18.2%), of which 7 were balloon-expandable grafts; 2 were self-expandable graft; 3 were not mentioned. The rates of major and minor complications were 15% and 6% respectively, with 4 cases (6%) of perioperative death. On a mean follow-up of 15 months (range 1.5-72 months), two patients developed a distant vascular lesion from the treated lesion. CONCLUSION Endovascular management is safe and effective even in hemodynamically unstable neurofibroblastoma patients at all ages. Vascular tree screening should be conducted in clinically suspicious patients to prevent fatal aneurysmal complications. A formal meta-analysis could not be performed due to the lack of randomized controlled trials.
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Affiliation(s)
- David Bargiela
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Department of Physiology, Development and Neuroscience, University of Cambridge, UK
| | - Misha M Verkerk
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Ear, Nose and Throat Department, St George's Hospital, London, UK
| | - Ian Wee
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kiera Welman
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Hervey Bay Hospital, Pialba, Queensland, Australia
| | - Eugene Ng
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Department of Vascular Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Andrew M T L Choong
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Division of Vascular Surgery, National University Heart Centre, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Spontaneous Renal Artery Dissection in a Patient with Neurofibromatosis Type I. Case Rep Cardiol 2016; 2016:4593932. [PMID: 27867667 PMCID: PMC5102707 DOI: 10.1155/2016/4593932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 10/09/2016] [Indexed: 11/25/2022] Open
Abstract
We present a case of spontaneous renal artery dissection (SRAD) in a 28-year-old female with history of neurofibromatosis type I (NF-1) treated successfully with endovascular stenting. The clinical presentation, diagnostic testing, and treatment options are discussed. An endovascular approach with stenting was successfully performed after failure of medical treatment with subcutaneous low molecular weight heparin. Patient's blood pressure and symptoms improved significantly. This may be the first reported case of SRAD in a patient with NF-1 successfully treated with endovascular stenting.
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Martins P, Manuel V, Ferreira T, Tiago J, Ministro A, Martins C, Silva Nunes J, Fernandes JFE. Degenerescência aneurismática na doença de Von Recklinghausen. ANGIOLOGIA E CIRURGIA VASCULAR 2014. [DOI: 10.1016/j.ancv.2014.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Hongsakul K. Commentary. J Neurosci Rural Pract 2014; 5:272. [PMID: 25002769 PMCID: PMC4078614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Keerati Hongsakul
- Department of Radiology, Vascular and Interventional Unit, Prince of Songkla University, Hat Yai, Songkhla, Thailand,Address for correspondence: Dr. Keerati Hongsakul, Department of Radiology, Faculty of Medicine, Vascular and Interventional Unit, Prince of Songkla University, 15 Kanchanavanit Road, Hat Yai, Songkhla-90110, Thailand. E-mail:
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