Clinical Profile of HIV-related Aneurysms

AbstractObjectives: to describe the clinical features, management, outcome and laboratory features of human immunodeficiency virus (HIV)-related aneurysms. Materials: twenty-eight HIV positive patients with arterial aneurysms treated at a single university teaching hospital in a 6-year period. Methods case review of clinical records and laboratory findings. Specimens from patients surgically treated submitted for microbiological and histological examination.Results: ninety-two aneurysms were seen (range 1–10 per patient) in a young patient population (median age 30 years). Nineteen patients had evidence of advanced HIV infection. Aneurysms were atypically located and most frequently involved the carotid (24), superficial femoral (21) and popliteal (nine) arteries. Twenty-five of the 31 symptomatic aneurysms were treated surgically. Surgical intervention comprised arterial reconstruction for 19 and aneurysm resection and ligation for the remainder. Histological examination revealed distinctive arteritic features. There were two treatment-related deaths, with short-term post-operative outcome being otherwise favourable. Conclusions: HIV related aneurysms are characterised by their predilection for young patients, multiplicity, atypical location and their distinct histological features. Their increasing frequency reflects the unchecked advance of the HIV epidemic

Combined arteriovenous fistula and venous aneurysm following knee arthrodesis

We study a case of a 65-year-old woman who developed popliteal arteriovenous fistula (AVF) and venous aneurysm following left knee arthrodesis. Presenting features included left popliteal and calf pain, a tender pulsatile mass posterior to her left knee, popliteal bruit and a thrill at the popliteal fossa and ankle. Left femoral angiography showed an AVF arising from the right tibioperoneal trunk and an aneurysm at the level of the AVF. Findings at open investigation included AVF between the tibioperoneal trunk and the popliteal vein, and a venous aneurysm arising from the popliteal vein opposite the neck of the arteriovenous communication. The aneurysm and fistula were repaired using prolene suture

Occlusive Arterial Disease in HIV-infected Patients: a Preliminary Report

AbstractObjectives: to preliminarily describe the clinical features and management of arterial occlusive disease in human immunodeficiency virus (HIV) infected patients. Materials: twenty HIV positive patients with symptomatic large-vessel arterial occlusion treated by a tertiary vascular unit in a 3-year period. Methods: retrospective review of clinical case records. Results: patients were noted to be young (median age 37 years), with preponderance of males. Twelve patients had evidence of advanced HIV infection. All patients had critical ischaemia, involving the upper limbs in four and the lower limbs in 16. Coagulation abnormalities were noted in two cases. Operative intervention in 18 patients included revascularisation in seven. Thrombotic occlusion of normal-looking arteries was noted. Arterial biopsy revealed leucoÍcytoclastic vasculitis indicative of HIV arteritis in three of five cases examined. Conclusions: initial experience with large-vessel occlusive disease in HIV positive patients suggests an underlying arteritic aetiology, with clinical and pathological features distinct from atherosclerosis. Further in-depth study is necessary to clarify the pathophysiological basis thereof