Medicine and Health Sciences Commons^™

Splenic Artery Aneurysm Masquerading As Chest Pain: A Case Report Of A Rare Clinical Presentation, Emily Forester, Anjeanette Brown Md

Rowan-Virtua Research Day

Background: Splenic artery aneurysms most commonly present with vague epigastric or left upper quadrant abdominal pain that may radiate to the left shoulder. Chest pain associated with splenic artery aneurysm is an unusual phenomena. This case presents a rare occurrence of a splenic artery aneurysm originally presenting as atypical chest pain. Case Presentation: A 46 year old G3P2 AAF patient with family history of hypertension presented to the ER with pleuritic left chest pain, episodes of shortness of breath, and new onset hypertension. Chest x-ray and ECG were unremarkable. Pertinent labs included a hemoglobin of 10.6 and D-dimer of 4.10. …

Risk Factors For In-Hospital Seizure And New-Onset Epilepsy In Coiling And Clipping Treatment Of Aneurysmal Subarachnoid Hemorrhage, Viet-Thang Le, Anh Minh Nguyen, Phuc Long Nguyen

Journal Articles

OBJECTIVE: To identify risk factors associated with in-hospital seizures and new-onset epilepsy in patients with aneurysmal subarachnoid hemorrhage (SAH) who underwent coiling embolization or clipping surgery.

METHODS: This retrospective descriptive study included 195 patients diagnosed with aneurysmal SAH and treated with coiling embolization or clipping surgery between January 2018 and June 2022.

RESULTS: Among the 195 patients meeting inclusion criteria, 9 experienced an onset seizure at the time of SAH. In-hospital seizures were observed in 33 patients, of which 24 were electrographic seizures detected in 24 patients with suspected subclinical seizures. After 12 months of follow-up, 11 patients met criteria …

Horner’S Syndrome, A Rare Complication Of Transcarotid Artery Revascularization, Mollie Ahn, April Miller, Shonda Banegas, Edic Stephanian

North Texas GME Research Forum 2024

Extracranial carotid artery aneurysm is a rare sequela of atherosclerosis, trauma, and conditions of chronic inflammation. Standard treatments include antiplatelet medications, open resection, or endovascular stenting. Transcarotid artery revascularization (TCAR) has become a well-recognized alternative treatment in the past few decades. This case study documents the first reported case of Horner’s syndrome post-TCAR for an internal carotid artery (ICA) aneurysm. A 68 year-old male with intermittent double vision was referred to vascular surgery clinic with brain CT angiography showing a 9mm saccular aneurysm with dissection flap of the right cervical ICA. Prior attempts by neuro-interventional radiology were unsuccessful due to …

Delayed Giant Pseudoaneurysm With Left-To-Right Shunt Following Postinfarct Ventricular Septal Perforation Repair, Yojiro Machii, Makoto Taoka, Yuki Hayashi, Atsushi Harada, Keita Kamata, Masashi Tanaka

The Texas Heart Institute Journal

Left ventricular pseudoaneurysm with a left-to-right shunt is extremely rare, requiring surgery if symptomatic; however, surgery has a high risk. Here, the case of a 77-year-old man with heart failure symptoms is reported, in which he develops a giant left ventricular pseudoaneurysm 16 months after ventricular septal perforation repair as a result of acute myocardial infarction, with mild shunt blood flow from the pseudoaneurysm to the right ventricle. Intraoperative findings showed a free wall rupture along the area where the patch was secured during the initial surgery. The patient was discharged on postoperative day 13, and postoperative examination revealed no …

Global Outcomes For Microsurgical Clipping Of Unruptured Intracranial Aneurysms: A Benchmark Analysis Of 2245 Cases, Richard Drexler, Thomas Sauvigny, Tobias F. Pantel, Franz L. Ricklefs, Joshua S. Catapano, John E. Wanebo, Michael T. Lawton, Aminaa Sanchin, Nils Hecht, Peter Vajkoczy, Kunal Raygor, Daniel Tonetti, Adib Abla, Kareem El Naamani, Stavropoula I. Tjoumakaris, Pascal Jabbour, Brian T. Jankowitz, Mohamed M. Salem, Jan-Karl Burkhardt, Arthur Wagner, Maria Wostrack, Jens Gempt, Bernhard Meyer, Michael Gaub, Justin R. Mascitelli, Philippe Dodier, Gerhard Bavinzski, Karl Roessler, Nico Stroh, Matthias Gmeiner, Andreas Gruber, Eberval G. Figueiredo, Antonio Carlos Samaia Da Silva Coelho, Anatoliy V. Bervitskiy, Egor D. Anisimov, Jamil A. Rzaev, Harald Krenzlin, Naureen Keric, Florian Ringel, Dougho Park, Mun-Chul Kim, Eleonora Marcati, Marco Cenzato, Manfred Westphal, Lasse Dührsen

Department of Neurosurgery Faculty Papers

BACKGROUND AND OBJECTIVES: Benchmarks represent the best possible outcome and help to improve outcomes for surgical procedures. However, global thresholds mirroring an optimal and reachable outcome for microsurgical clipping of unruptured intracranial aneurysms (UIA) are not available. This study aimed to define standardized outcome benchmarks in patients who underwent clipping of UIA.

METHODS: A total of 2245 microsurgically treated UIA from 15 centers were analyzed. Patients were categorized into low- ("benchmark") and high-risk ("nonbenchmark") patients based on known factors affecting outcome. The benchmark was defined as the 75th percentile of all centers' median scores for a given outcome. Benchmark outcomes …

Early Feasibility Of Endovascular Repair Of Distal Aortic Arch Aneurysms Using Patient-Specific Single Retrograde Left Subclavian Artery Branch Stent Graft, Joshua Wong, Emanuel R Tenorio, Guilherme Lima, Marina Dias-Neto, Aidin Baghbani-Oskouei, Bernardo Mendes, Jarin Kratzberg, Laura Ocasio, Thanila A Macedo, Gustavo S Oderich

Journal Articles

OBJECTIVE: To describe the feasibility and outcomes of endovascular repair of distal aortic arch aneurysms using a patient-specific stent graft with a pre-loaded single retrograde left subclavian artery (LSA) branch stent graft.

METHODS: We reviewed the clinical data and outcomes of consecutive patients enrolled in an ongoing prospective, non-randomized physician-sponsored investigational device exemption study to evaluate the outcomes of endovascular aortic arch repair using patient-specific arch branch stent grafts (William Cook Europe, Bjaeverskov, Denmark) between 2019 and 2022. All patients received a design with triple-wide scallop and a single retrograde LSA branch with a pre-loaded catheter.

RESULTS: There were five …

Persistent Fdg Uptake At Apical Aneurysm In A Patient With Cardiac Sarcoidosis, Chaitanya Rojulpote, Shivaraj Patil, Mahesh K. Vidula, Robert Kotloff, Stuart Prenner, Paco E. Bravo

Einstein Health Papers

We present a case of cardiac sarcoidosis with persistent, focal fluorodeoxyglucose uptake at the left ventricular apical aneurysm concerning for ongoing active inflammatory injury, prompting aggressive immunosuppressive therapy. This case highlights the importance of understanding the various clinical entities that may resemble disease activity on fluorodeoxyglucose positron emission tomography/computed tomography imaging. (Level of Difficulty: Intermediate.)

Association Of Atrial Septal Aneurysm And Shunt Size With Stroke Recurrence And Benefit From Patent Foramen Ovale Closure, Jean-Louis Mas, Jeffrey L Saver, Scott E Kasner, Jason Nelson, John D Carroll, Gilles Chatellier, Geneviève Derumeaux, Anthony J Furlan, Howard C Herrmann, Peter Jüni, Jong S Kim, Benjamin Koethe, Pil Hyung Lee, Benedicte Lefebvre, Heinrich P Mattle, Bernhard Meier, Mark Reisman, Richard W Smalling, Lars Sondergaard, Jae-Kwan Song, David E Thaler, David M Kent

Journal Articles

IMPORTANCE: The Patent Foramen Ovale (PFO)-Associated Stroke Causal Likelihood classification system combines information regarding noncardiac patient features (vascular risk factors, infarct topography) and PFO features (shunt size and presence of atrial septal aneurysm [ASA]) to classify patients into 3 validated categories of responsiveness to treatment with PFO closure. However, the distinctive associations of shunt size and ASA, alone and in combination, have not been completely delineated.

OBJECTIVE: To evaluate the association of PFO closure with stroke recurrence according to shunt size and/or the presence of an ASA.

DESIGN, SETTING, AND PARTICIPANTS: Pooled individual patient data from 6 randomized clinical trials …

External Iliac Vein Aneurysm Treated Via Balloon-Assisted Aneurysmorrhaphy With A Contemporary Review Of The Literature, Kyle W. Prochno, Michael Qaqish, Dawn M. Salvatore, Babak Abai, Paul J. Dimuzio, Michael J. Nooromid

Department of Surgery Faculty Papers

Isolated external iliac vein aneurysm is exceedingly rare, not well-described in the literature, and presents several potential surgical approaches. Herein, we describe the case of a 72-year-old woman who presented with incidentally found 4.3 cm x 3.4 cm x 5.6 cm right external iliac vein aneurysm after undergoing magnetic resonance imaging for orthopedic work-up. She was treated via parallel supra- and infra-inguinal incisions and novel combination of primary aneurysmorrhaphy with intraluminal balloon mandrel-assisted closure. The patient was discharged on postoperative day two, and 6-month follow-up ultrasound showed a normal caliber vessel with normal compressibility, suggesting this technique is safe and …

Transcatheter Aortic Valve Implantation For Severe Aortic Stenosis And Large Membranous Interventricular Septal Aneurysm, Maheedhar Gedela, Tomasz Stys, Terezia Petraskova, Adam Stys

The Texas Heart Institute Journal

No abstract provided.

Celiac Artery Aneurysm: A Rare Cause Of Abdominal Pain, Duwayne Campbell, Wayne Tamaska, Kevin Dwyer

Rowan-Virtua Research Day

Celiac artery aneurysm is a very rare vascular lesion accounting for only 5.1% of all splanchnic artery aneurysms. Etiology for celiac artery aneurysm includes, but not limited to, infectious diseases, atherosclerosis, trauma, congenital conditions such as median arcuate ligament syndrome and iatrogenic causes.

Etiology for abdominal pain is extensive. Patients should be evaluated for both intra-abdominal and extra-abdominal causes for pain, as presentations of a different pathophysiology vary widely. CT scan has become a mainstay part of the work for abdominal pain in the Emergency department, and often elicit pathologies that would otherwise be missed on blood work and other …

Case Report: Abdominal Aortic Aneurysm, Aishwarya Reddy, Jeffry Rima, Nick Morey, Jalisa Jones, Connor Lambert, Shiv Dhiman, S Arya

Research Day

Many research studies have demonstrated that age is a primary risk factor for the prevalence of diseases within developed countries, most notably concerning cardiovascular disease, which has been found to be the leading cause of death globally. Among the diseases that fall beneath this umbrella term of cardiovascular disease, aortic aneurysms (AA) and cerebrovascular accident (CVA; i.e. stroke) are two of the more prevalent and well-known diseases that are identified among the elderly population. However, despite the increasing prevalence of both AAs and CVAs within the elderly in tandem with their shared risk factors - hypertension, smoking, hyperlipidemia, etc. - …

Jnk And Nf-Κb Cell Signaling Pathways In Cardiovascular Disease Present Potential Targets For Curcumin Therapy, Mary Richfield

Senior Honors Theses

Curcumin (diferuloylmethane) is a compound derived from the rhizomes of Curcumin longa that has been long used for medicinal purposes. Curcumin alleviates the pathology of cardiovascular diseases, including atherosclerosis, aneurysm, and cardiomyopathy. The mechanism of curcumin therapy is under active research. The NF-κB and JNK pathways are two that curcumin interacts with to block inflammatory processes, apoptosis, and fibrotic tissue remodeling to prevent the pathologies of cardiovascular disease. While curcumin has demonstrated powerful mediation of cardiovascular disease, its bioavailability in body tissues is limited due to the instability and hydrophobicity of its structure. Further work is underway to stabilize …

Imaging Aortic Pathologies In Computed Tomography (Ct), Hailey Clark

Medical Imaging Senior Posters

Computed tomography (CT) is an increasingly important imaging modality to visualization of aortic pathologies. The aorta is the largest vessel in the body and gives rise to several important arteries that supply surrounding organs, so pathologies of this vessel can prove dangerous. The two main pathologies that affect the aorta are aneurysms and dissections, each of which can rupture and quickly become fatal. Symptoms for these pathologies can vary widely but primarily include pain localized to the area of the aorta that is affected, with risk factors encompassing several heart conditions as well as genetic factors. The prognosis for aortic …

Petrous Internal Carotid Artery Aneurysm: A Rare Vascular Abnormality, Neal Hall, David Kupshik, Nicholas Fuerstenau, Peter Britt

South Atlantic Division GME Research Day 2022

No abstract provided.

Single-Cell Analysis Of Aneurysmal Aortic Tissue In Patients With Marfan Syndrome Reveals Dysfunctional Tgf-Β Signaling, Ashley Dawson, Yanming Li, Yang Li, Pingping Ren, Hernan G. Vasquez, Chen Zhang, Kimberly R. Rebello, Waleed Ageedi, Alon R. Azares, Aladdein Burchett Mattar, Mary Burchett Sheppard, Hong S. Lu, Joseph S. Coselli, Lisa A. Cassis, Alan Daugherty, Ying H. Shen, Scott A. Lemaire

Saha Cardiovascular Research Center Faculty Publications

The molecular and cellular processes leading to aortic aneurysm development in Marfan syndrome (MFS) remain poorly understood. In this study, we examined the changes of aortic cell populations and gene expression in MFS by performing single-cell RNA sequencing (scRNA seq) on ascending aortic aneurysm tissues from patients with MFS (n = 3) and age-matched non-aneurysmal control tissues from cardiac donors and recipients (n = 4). The expression of key molecules was confirmed by immunostaining. We detected diverse populations of smooth muscle cells (SMCs), fibroblasts, and endothelial cells (ECs) in the aortic wall. Aortic tissues from MFS showed alterations …

Aortic Fistulas: Pathophysiologic Features, Imaging Findings, And Diagnostic Pitfalls, Aishwarya Gulati, Md, Harit Kapoor, Md, Achala Donuru, Mbbs, Frcr, Kunal Gala, Mbbs, Dnb, Maansi Parekh, Mbbs, Dnb

Department of Radiology Faculty Papers

Fistulas between the aorta and surrounding organs are extremely rare but can be fatal if they are not identified and treated promptly. Most of these fistulas are associated with a history of trauma or vascular intervention. However, spontaneous aortic fistulas (AoFs) can develop in patients with weakened vasculature, which can be due to advanced atherosclerotic disease, collagen-vascular disease, vasculitides, and/or hematogenous infections. The clinical features of AoFs are often nonspecific, with patients presenting with bleeding manifestations, back or abdominal pain, fever, and shock. Confirmation with invasive endoscopy is often impractical in the acute setting. Imaging plays an important role in …

Utilization Of The Ballast Long Guiding Sheath For Neuroendovascular Procedures: Institutional Experience In 68 Cases, Ameer E. Hassan, Elizabeth M. Burke, Marlon Monayao, Wondwossen G. Tekle

School of Medicine Publications and Presentations

Background: The rise of neurointerventional devices has created a demand for guide systems capable of navigating to the carotid artery consistently regardless of tortuosity. The shift toward large distal access catheters (DACs) and desire for greater trackability have inspired the creation of flexible, supportive, large-lumen long guiding sheaths. Recently, the Ballast long guiding sheath was introduced to provide stability and flexibility while navigating neurointerventional devices through tortuous intracranial anatomy.

Objective: To report our experience using the Ballast long guiding sheath in a series of patients undergoing a variety of neuroendovascular procedures.

Methods: We retrospectively identified all patients who underwent neuroendovascular …

Brachial Artery Aneurysm After Arteriovenous Fistula Ligation Status Post-Kidney Transplant, Alyssa Imperatore, Justin Adibi, Rahul Sharma, Yury Bak

Rowan-Virtua Research Day

Arteriovenous fistulas (AVF) are the most common and effective method of receiving hemodialysis; However, these access techniques do not come without consequence. Aneurysmal degeneration after creation and even years after ligation of such AVF can occur. This is still considered a rare complication. A true brachial artery aneurysm has an overall incidence of 0.17% among peripheral artery aneurysms. Factors that increase incidence of this complication include trauma, age and immunosuppression. Research on this topic is becoming more prevalent, but more answers are still needed. Below is a case of brachial artery aneurysm presenting years after AVF ligation in a patient …

The Pipeline Endovascular Device Versus The Flow Re-Direction Endoluminal Device For Cerebral Aneurysm. A One-Year Follow-Up In A Single-Center Experience, Omar Pichardo, Alan Picazo, Omar Castillon, Jonathan Zuniga, Gustavo Alan Juarez Jimenez

Archives of Neurosurgery

Background: The Flow Diverters are devices derived from brain stents, made up of a network of microfilaments of various materials that allow the vessel remodeling. The Pipeline Embolization Device and The Flow Re-Direction Endoluminal Device are the two devices with more global clinical experience. Our objective is to compare the 1-year results using these devices in a cohort of patients assessing their occlusion rate and their clinical outcome as by the modified Rankin Score (mRS).

Methods: In this retrospective nested case-control cohort study, we reviewed the medical records of patients undergoing treatment with a Flow Diverter stent for brain aneurysms …

Comparison Of Endovascular Therapy Versus Medical Therapy In The Management Of Descending Thoracic Aortic Dissection, Eli Cehelyk, Babak Abai, Md

Phase 1

Introduction: This retrospective review aimed to compare clinical outcomes between patients with descending aortic dissections, with and without organ malperfusion, who were managed with thoracic endovascular aortic repair (TEVAR) or best medical therapy (BMT).

Methods: Thirty-eight patients diagnosed with descending aortic dissections between 2013 and 2020 were identified for analysis. Patients with dissection secondary to trauma and death unrelated to cardiothoracic pathology were excluded. Participants were divided into three groups based on their management: TEVAR (without side branch stenting), TEVAR+ (with additional branch stenting) and BMT. The primary outcome measure was length of hospital stay (LOS) and statistics were analyzed …

Endovascular Treatment Modalities For Basilar Artery Fenestration Aneurysms: Experienceof Two Centers And Literature Review, Mehmet Korkmaz, Celal Çi̇nar, Ömer Fati̇h Nas, Bahatti̇n Hakyemez, İsmai̇l Oran

Turkish Journal of Medical Sciences

Background/aim: The aim of this study is to present our experience on various endovascular treatment modalities of basilar fenestration aneurysms and reviewing our findings together with literature data. Materials and methods: A total of 26 basilar artery fenestration (BAF) aneurysms in 24 patients were endovascularly treated in two different neurointerventional radiology clinics. All patients had been evaluated with computed tomography (CT), CT angiography, and digital subtraction angiography before the procedure. Results: Aneurysms of all patients were successfully occluded (technical success rate 100%). Procedure-related complications were seen in two patients. Our comprehensive literature research revealed that studies related with the topic …

Points To Consider When Evaluating Three-Dimensional Digital Subtraction Angiography Ofintracranial Aneurysms And Their Effects On Treatment, İsmai̇l Yardimcioğlu, Yilmaz Önal, Murat Veli̇oğlu, Hakki Muammer Karakaş

Turkish Journal of Medical Sciences

Background/aim: In this study, we aimed to investigate what should be regarded as potential determinants of treatment strategies when evaluating 3D digital subtraction angiography (DSA) images. Material and methods: Our inclusion criteria were as follows: (1) presence of at least one intracranial aneurysm demonstrated by conventional angiography, (2) having both 2D and 3D images, and (3) being over 18 years old. First, two-dimensional (2D) and then 3D angiography images of 226 aneurysms of 150 patients were scanned. Morphological characteristics such as size, configurations, relationship with parent artery, baby counts, and other incidental findings were determined. Results: Of the 226 aneurysms, …

Popliteal Artery Aneurysms Treatments: Early Midterm Results Of The Use Of Endovascularstent Grafts, Kaptaniderya Tayfur, Mehmet Şenel Bademci̇

Turkish Journal of Medical Sciences

Background/aim: Popliteal artery aneurysms (PAAs) are abnormal bulgings, which account for 70% of all peripheral artery aneurysms. They are usually asymptomatic. In this study, we present our long-term results of endovascular stent grafts in the treatment of PAA in the light of literature data. Material and methods: A total of 63 legs of 63 patients with PAA, who were treated with endovascular techniques in our clinic between July 2010 and July 2019, were retrospectively analyzed. All patients underwent color Doppler ultrasound (DUS), magnetic resonance angiography (MRA), or computed tomography angiography (CTA) to identify the diameter and length of PAAs, vessel …

Gunshot-Related Pediatric Left Ventricular Apical Aneurysm, Achala Donuru, David Saul, Maansi Parekh, Maruti Kumaran, Vinay Kandula, Rami Kharouf

Department of Radiology Faculty Papers

Penetrating injuries of the thorax and abdomen, such as gunshot and stabbing, are rare in children. We present the case of a pediatric patient with a history of remote gunshot injury presenting with a late aneurysm in the left ventricle.

Treatment Of Headache In Aneurysmal Subarachnoid Hemorrhage: Multimodal Approach, Garrett B. Hile, Aaron M. Cook

Pharmacy Practice and Science Faculty Publications

Sudden severe headache is a cardinal symptom and the most common complaint amongst patients presenting with aneurysmal subarachnoid hemorrhage. The multifactorial etiology of these headaches makes pharmacotherapy problematic. Current aneurysmal subarachnoid hemorrhage guidelines have limited or no recommendations for headache treatment. Our institution utilizes a multimodal pharmacotherapy protocol in the management of aneurysmal subarachnoid hemorrhage headache. The purpose of this study was to evaluate the efficacy of the current aneurysmal subarachnoid hemorrhage headache treatment approach at our institution. This was a retrospective cohort study of patients presenting with aneurysmal subarachnoid hemorrhage. A multimodal aneurysmal subarachnoid hemorrhage headache treatment protocol was …

Giant 75mm Intracranial Aneurysm Masquerading As Primary Malignancy, Andrew W. Hwang, Satvir Dhillon Md, Remus Popa

Internal Medicine

No abstract provided.

Impact Of Race, Gender, And Clinical Risk Factors On Outcomes Following Treatment Of Unruptured Intracranial Aneurysms, Andrew Koo

Yale Medicine Thesis Digital Library

INTRODUCTION: In an unprecedented era of soaring healthcare costs, payers and providers alike have started to place increased importance on measuring the quality of surgical procedures as surrogate markers for operative success. Length of hospital stay (LOS) and discharge disposition during index admission are two metrics increasingly used. For the treatment of unruptured cerebral aneurysms, the determinants of extended length of stay and poor discharge disposition remain relatively unknown.

OBJECTIVES: 1) To investigate the influence that patient demographics, such as gender and race, have on post-procedural discharge disposition after treatment of unruptured aneurysms, and 2) To identify the nationwide impact …

Reducing Vascular Access Complications Through Precise Cannulation Plan Implementation, Rosemarie Quicho

Master's Projects and Capstones

Abstract

Aneurysm, which is the dilatation of the arteriovenous fistula (AVF), and pseudo-aneurysm, which is caused by leaking of blood outside the arteriovenous graft (AVG), pose a threat to the vascular access (VA) and the patient (Mudoni et al., 2015). Uneven vein penetration by dialysis needles and subsequent skin scarring lead to the development of inflammatory changes in the VA area. Scab formation masks the signs of ongoing inflammation. Damage to and tearing of the scab can then lead to lethal exsanguination from the VA (Handlos, Marecová, Smatanová, Dvořáček, & Dobiáš, 2018). Dialysis staff members are trained to use the …

Pediatric Moyamoya Presenting As A Subarachnoid Hemorrhage From A Ruptured Anterior Cerebral Artery Aneurysm., Mohammad Hassan A. Noureldine, Ibrahim Saikali, Anis Nassif, Rita Chahinian, Ahmad Sweid, Raghid Kikano, Michel Mawad

Department of Neurosurgery Faculty Papers

BACKGROUND: The incidence of Moyamoya disease (MMD)-associated intracranial aneurysms ranges from 3% to 14% in adult patients, whereas this complication has rarely been reported in children.

CASE DESCRIPTION: We herein report the first case, to our knowledge, of an extremely rare subarachnoid hemorrhage presentation of a child with a ruptured anterior cerebral artery dissecting aneurysm secondary to a newly discovered, unilateral Moyamoya-like pathology.

CONCLUSIONS: MMD-associated aneurysms are extremely rare in children, and hemorrhage may be the initial presentation of the disease. Prompt intervention is essential to exclude the ruptured aneurysm that is at risk of rebleeding because of persistent hemodynamic …