Evaluating aetiologies, treatment strategies and optimizing outcomes in pseudoaneurysms

INTRODUCTION: A pseudoaneurysm (false aneurysm) by definition results from a leakage of blood from an artery after trauma or after dehiscence of a surgical anastomosis. There are various etiologies for pseudoaneurysms like post anastomotic, post traumatic, infective, iatrogenic and idiopathic. We would like to discuss the various spectrums of pseudoaneurysms that had presented to our department, their clinical presentation and management strategies. PATIENTS AND METHODS: This study was conducted in the Department of Vascular surgery from August 2009 to January 2012. This was a descriptive study about patients presenting with pseudoaneurysms to the Vascular surgery Out Patient Department and Surgical emergency. Both elective and emergency cases were enrolled. The elective patients were evaluated with clinical examination, Duplex USG and 64 slice CT angiography in selected patients. Routine blood investigations with blood culture and clot or wall culture were performed. All the emergency cases were evaluated with clinical examination and if hemodynamically stable were subjected to Duplex examination. Once the diagnosis was confirmed, the patients were subjected to surgical intervention or duplex guided compression. RESULTS: There were totally 50 patients. Among the 50 patients, 15(30%) had anastomotic and 12 (24%) had posttraumatic pseudoaneurysms. The rest were infective 4 (8%), iatrogenic 6 (12%), idiopathic 2 (4%) and AV access related 11 (22%) pseudoaneurysms. Anastomotic and post traumatic comprised of more than half (54%) of patients. Skin breach was found in 22 (44%), active bleeding in 15 (30%), impending rupture in 15 (30%) and distal ischemia in 4 (8%). 36 (72%) patients presented as an emergency. Rest 14 (28%) patients presented in an elective manner. 4%) patients were subjected to Duplex guided compression. 23 (46%) underwent reconstruction and 25 (50%) underwent ligation with explantation of the graft. There were 3 (6%) deaths among the 50 patients. 6 (14%) patients underwent amputation and the rest 37 (86%) patients limbs were salvaged. There was a higher risk of limb loss in patients presenting with anastomotic aneurysms especially operated for occlusive arterial disease.(P=0.048) Out of the 11 patients with AV access related pseudoaneurysms, AVF salvage was achieved only in two patients (18%). CONCLUSION: Overall, Anastomotic pseudoaneurysms had a poorer prognosis in terms of increased amputation rates and lower limb salvage rates. This was because of distal occlusive disease and poor collateralisation

Flow-diverting stents in the management of extracranial carotid artery aneurysms

PURPOSE: This study aims to investigate the indications and therapeutic efficacy of flow-diverting stents (FDSs) in the management of extracranial carotid artery aneurysms (ECAAs) and dissections. METHODS: A retrospective analysis was conducted on 18 patients treated for ECAAs with an FDS between 2010 and 2024. Patient demographics, aneurysm characteristics, procedural details, and clinical and radiologic follow-up outcomes were extracted from medical records. Procedures were performed under general anesthesia using standard endovascular techniques. Patients received preoperative and postoperative antiplatelet therapy and were fully anticoagulated during the procedure. Follow-up assessments included digital subtraction angiography or computed tomography angiography at 6–12 months and clinical evaluations to monitor symptom resolution and complications. RESULTS: Eighteen patients, with an average age of 46.44 ± 17.54 years, underwent 19 endovascular interventions. Technical success was achieved in all cases. Single stent deployment was used in 15 aneurysms, and telescopic stent deployment in 7. Total occlusion of the aneurysm was achieved in 94.4% of cases. One patient required retreatment due to the separation of two overlapped telescopic stents. All patients were discharged within 2 days post-procedure, with symptomatic patients experiencing the complete resolution of symptoms. No complications or adverse events were reported during the follow-up period. CONCLUSION: The endovascular treatment of ECAAs with FDSs appears to be a safe and effective alternative, achieving high technical success and positive clinical outcomes. CLINICAL SIGNIFICANCE: The use of FDSs for treating ECAAs significantly improves patient outcomes with minimal complications

Takayasu arteritis with an initial presentation of chronic monoarthritis mimicking oligoarticular juvenile idiopathic arthritis

Patients with Takayasu arteritis (TA) generally present with non-specific symptoms that, if unrecognized and untreated, may develop vessel stenosis and/or aneurysm. There is limited data regarding chronic monoarthritis as the initial presentation in children with TA. We report a 6-yearold girl diagnosed and treated as oligoarticular juvenile idiopathic arthritis (JIA). She later developed stroke with malignant hypertension and was definitively diagnosed with TA. She additionally developed proteinuria secondary to focal segmental glomerulosclerosis. This is the report of a patient with chronic monoarthritis mimicking oligoarticular JIA which chronic monoarthritis was the presentation of TA. Since JIA is a diagnosis of exclusion, any atypical features of oligoarticular JIA should illuminate the possibility of an alternative diagnosis. Our literature review focused on musculoskeletal presentations of children with TA

Standard of Practice for the Endovascular Treatment of Thoracic Aortic Aneurysms and Type B Dissections

Thoracic endovascular aortic repair (TEVAR) represents a minimally invasive technique alternative to conventional open surgical reconstruction for the treatment of thoracic aortic pathologies. Rapid advances in endovascular technology and procedural breakthroughs have contributed to a dramatic transformation of the entire field of thoracic aortic surgery. TEVAR procedures can be challenging and, at times, extraordinarily difficult. They require seasoned endovascular experience and refined skills. Of all endovascular procedures, meticulous assessment of anatomy and preoperative procedure planning are absolutely paramount to produce optimal outcomes. These guidelines are intended for use in quality-improvement programs that assess the standard of care expected from all physicians who perform TEVAR procedures

Acute aortic dissection

Detailed formal protocol with illustrations and extensive bibliography.UT Southwestern--Internal Medicin

Vascular Malformations of the Central Nervous System

Vascular malformations of the central nervous system are important pathologies that could present with abrupt onset hemorrhage resulting in devastating neurological deficits. Current knowledge of their biology and natural history is increasing. Diagnostic modalities help clinicians to better evaluate the individual cases, and to decide the best treatment options. Treatment alternatives are various and all treatment options should be evaluated before choosing the final therapeutic modality. The purpose of this book is to review the current knowledge about vascular malformations of the central nervous system and to evaluate the treatment alternatives

Lecture notes by internal diseases

ВНУТРЕННИЕ БОЛЕЗНИУЧЕБНЫЕ ПОСОБИЯКурс лекций по внутренним болезням на английском языке предназначен для студентов факультетов подготовки иностранных граждан по специальности "Лечебное дело"