1/12. Successful treatment of a pseudoaneurysm of the cystic artery with microcoil embolization.Pseudoaneurysms of visceral arteries are uncommon but well-characterized vascular abnormalities, usually provoked by intraabdominal inflammatory processes such as pancreatitis or cholecystitis, or by surgical trauma. However, pseudoaneurysms of the cystic artery are rare. They complicate cholecystitis or cholecystectomy, and manifest as hemobilia as they rupture into the biliary tree. The advent of transcatheter embolization techniques has begun to allow minimally invasive treatment of these life-threatening complications. Transcatheter embolization can be performed using several types of material, such as synthetic occlusive emulsions, gelatin sponges or other particles, or metallic microcoils. Microcoils are small metallic helical particles, made of stainless-steel, platinum, or tungsten. Super-selective catheterization of an artery and release of microcoils causes the vessel to thrombose and allows control of bleeding.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/12. Unusual origin and fistulization of an aortic pseudoaneurysm: "off-pump" surgical repair.Aortic pseudoaneurysm is an unusual complication of cardiac operations. The origin depends on the site of arterial wall disruption. rupture into the right side of the bronchial tree is an exceedingly rare evolution. Repair is commonly performed using cardiopulmonary bypass. In our report a male patient underwent two procedures for aortic dissection, and 6 months after the second operation massive hemoptysis appeared abruptly. A false aneurysm rose from a graft-to-graft anastomotic site and ruptured into a segmental bronchus of the right upper lobe. Repair was performed without cardiopulmonary bypass.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
3/12. Late development of aortic pseudoaneurysm after coarctation repair with fistulization to the bronchial tree. A case report.BACKGROUND: Fistulous communication between the aorta and the tracheobronchial tree is an uncommon and serious cause of hemoptysis secondary to complications of a previous operation performed on the aorta. In cases in which an appropriate surgical intervention is carried out, the survival rate approaches 76%. This surgery is considered one of the most risky operations on the aorta, challenging the surgeon's ability to resolve the problem. methods: We present the case report of a 43-year-old female with massive hemoptysis. Her medical history disclosed repair of coarctation of the aorta (15 years before). She underwent emergency left thoracotomy; surgical exploration revealed a false aneurysm from the previous aortic patch repair which communicated to a subsegmental bronchus of the left upper lobe. RESULTS: The thoracic aorta was isolated and clamped, and the previous patch was removed. The bronchial side of the fistula was managed with left superior lobectomy and the aorta was repaired with the placement of a coated woven dacron graft onto healthy aortic tissue. CONCLUSIONS: The patient had an uneventful recovery and remains asymptomatic six months after discharge.- - - - - - - - - - ranking = 5keywords = tree (Clic here for more details about this article) |
4/12. False aneurysm of the pancreaticoduodenal artery complicating therapeutic endoscopic retrograde cholangiopancreatography.A 76-year-old woman underwent two endoscopic retrograde cholangiopancreatography (ERCP) procedures for palliation of a carcinoma of the pancreas. At the first procedure a pre-cut sphincterotomy was performed because deep cannulation of the biliary tree was impossible. An endoscopic plastic biliary stent was inserted at the second ERCP. The patient developed abdominal pain and a post-procedure CT demonstrated a pseudoaneurysm. This was not present on the pre-procedure CT and was thought to arise from the pancreaticoduodenal artery as a complication of the pre-cut sphincterotomy. Visceral angiography confirmed the origin of the aneurysm from a branch of the inferior pancreaticoduodenal artery. The aneurysm was successfully embolised. To our knowledge, this is the first time that this complication has been reported.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
5/12. Pseudoaneurysm of the gastroduodenal artery as a cause of obstructive jaundice.A 35-year-old man presented to our emergency room with asymptomatic jaundice. A physical exam revealed a palpable mass with audible bruit in the epigastrium. Total serum bilirubin was 21.7 mg%. A real time sonography/Doppler examination showed widening of the biliary tree (common bile duct diameter of 13 mm) and a mass in the pancreatic head with turbulent flow. Arteriography of the celiac axis revealed a pseudoaneurysm of the gastroduodenal artery. A ligation of the gastroduodenal artery was performed surgically, and the aneurysmal cavity was explored and emptied. An intraoperative cholangiography showed slight stenosis of the common bile duct distally, and so a choledochojejunostomy was performed. The patient's recovery was uneventful. A follow-up angiogram revealed the short stump of the gastroduodenal artery and no aneurysm or extravasation of dye. A follow-up ultrasound showed the common bile duct measuring 5.5 mm. The bilirubin level dropped to normal values. The patient was discharged on 12 days after surgery. Ten months following surgery he was doing well. The pathology, diagnosis, and treatment of such cases are briefly discussed.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
6/12. Potentially fatal haemobilia due to inappropriate use of an expanding biliary stent.AIM: To highlight the fatal complication caused by expanding biliary stents and the importance of avoiding use of expanding stent in potentially curable diseases. methods: Arteriobiliary fistula is an uncommon cause of haemobilia. We describe a case of right hepatic artery pseudoaneurysm causing arteriobiliary fistula and presenting as severe malena and cholangitis, in a patient with a mesh metal biliary stent. The patient had lymphoma causing bile duct obstruction. RESULTS: Gastroduodenoscopy failed to establish the exact source of bleeding and hepatic artery angiography and selective embolisation of the pseudo aneurysm successfully controlled the bleeding. CONCLUSION: Bleeding from the pseudo aneurysm of the hepatic artery can be fatal. Mesh metal stents in biliary tree can cause this complication as demonstrated in this case. So mesh metal stent insertion should be avoided in potentially benign or in curable conditions. Difficulty in diagnosis and management is discussed along with the review of the literature.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
7/12. life-threatening hemobilia caused by hepatic artery pseudoaneurysm: a rare complication of chronic cholangitis.hemobilia is one of the causes of obscure gastrointestinal haemorrhage. Most cases of hemobilia are of iatrogenic or traumatic origin. hemobilia caused by a hepatic artery pseudoaneurysm due to ascending cholangitis is very rare and its mechanism is unclear. We report a 74-year-old woman with a history of surgery for choledocholithiasis 30 years ago, suffering from a protracted course of life-threatening gastrointestinal bleeding. A small intestines series and endoscopic retrograde cholangiopancreatography revealed a chronic cholangitis with marked contrast reflux into the biliary tree. Angiography confirmed the bleeding from a pseudoaneurysm of the middle hepatic artery. Coil embolization achieved successful hemostasis. We discussed the mechanism and reviewed the literature.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
8/12. Percutaneous management of a hepatic artery aneurysm: bleeding after liver transplantation.In this article we present an unusual case of hepatic artery aneurysm bleeding due to a hepatic artery thrombosis after liver transplantation. The patient developed a recurrent hepatic artery thrombosis leading to severe graft failure in four consecutive liver transplantations. While being evaluated for a fifth transplant, stabilization of the clinical situation was attempted by interventional therapy. The first intervention was to place a stent into the hepatic artery to prevent further ischemic damage. This failed to improve graft function, but unfortunately led to the development of a pseudoaneurysm at the distal end with a subsequent rupture into the biliary tree. Bleeding was treated successfully by direct puncture and coil embolization of the aneurysm. In addition, the patient demonstrated a hemodynamically relevant portal vein stenosis on the CT scan. Stenting of the portal vein markedly improved graft function. After extensive investigations, a paroxysmal nocturnal hemoglobinuria was found to be the underlying cause of the recurrent hepatic artery thrombosis. Here we suggest that hepatic artery aneurysm bleeding is a rare but potentially fatal complication that can be successfully treated by percutaneous coil embolization. Additionally, we propose that stenting of the portal vein can lead to a significant improvement of the graft perfusion even though the hepatic artery remained occluded.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
9/12. liver abscess associated with hepatic artery pseudoaneurysm with arteriovenous fistula: imaging and interventional management.hepatic artery pseudoaneurysm is an infrequently encountered entity that is usually seen secondary to trauma or surgical procedures. The clinical presentation is often due to complications such as massive intrahepatic or intraperitoneal bleeding as a result of rupture of the pseudoaneurysm into the biliary tree or peritoneal cavity, respectively. hepatic artery pseudoaneurysm, associated with a liver abscess, has very rarely been described in the literature. We present the imaging features of a case of liver abscess associated with a hepatic artery pseudoaneurysm and complicated by rupture and formation of an arteriovenous fistula. The case was successfully managed by percutaneous endovascular embolization. The association between a hepatic artery pseudoaneurysm and a liver abscess must not be overlooked, bearing in mind the potentially fatal associated complications which can be averted or treated by timely intervention.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
10/12. Multiple mycotic pseudoaneurysms due to yersinia enterocolitica: report of a case and review of the literature.The etiology of mycotic aneurysms is variable but most often includes streptococci, staphylococci, salmonella, and pseudomonas infections. yersinia enterocolitica is an organism that has been infrequently associated with vascular infections. We report a case of two ruptured mycotic pseudoaneurysms occurring in the same patient in the superficial femoral artery and the infrarenal abdominal aorta only 10 days apart. The literature is reviewed, and the clinical findings and pathology are discussed. The unique problem of multiple mycotic aneurysms developing at different times as a result of Yersinia bacteremia suggests the need to monitor these patients longitudinally and evaluate multiple sites on the arterial tree to detect occult pseudoaneurysms and prevent late death from rupture.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
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