cardiovascular-agents and Aneurysm--False

Blunt abdominal aortic injury (BAAI) is a rare injury with less than 200 cases in the current reported world literature, mostly in case report format. We sought to describe the experience of a high-volume trauma center and to provide a contemporary review of the literature to better understand the natural history and management of this injury.. This was a retrospective review of patients with BAAI between 1996 and 2010. Data collected included demographics, mechanism of injury, associated injuries, type of intervention, subsequent imaging, and follow-up. BAAI was classified by the presence of external aortic contour abnormality noted as an intimal tear, large intimal flap, pseudoaneurysm, or free rupture. Abdominal aorta zones of injury were classified by possible surgical approaches as zone I (diaphragmatic hiatus to superior mesenteric artery [SMA]), zone II (includes SMA and renal arteries), and zone III (from the inferior aspect of the renal arteries to the aortic bifurcation).. We identified 28 individuals (68% male) with BAAI (median age, 28.5; range, 6-61 years). The median injury severity score was 45 (range, 16-75), and 39% were hypotensive at presentation. BAAI presented as intimal tear (21%), large intimal flap (39%), pseudoaneurysm (11%), and free rupture (29%). Zone III was the most common location of injury. Management depended on the location and type of injury: nonoperative (32%), open aortic repair (36%), endovascular repair (21%), and multimodality (10%). Overall mortality was 32%. Most deaths occurred during the initial operative exploration. The mortality rate of free aortic rupture was 100%. Intimal tears resolved or remained stable. Median follow-up was 15.5 months (range, 8 days-7.5 years). Vascular complications due to repair included a thrombosed access femoral artery during an endovascular repair and death of a patient who underwent a hybrid repair.. This is the largest BAAI series described in the English literature at one institution. BAAIs range from intimal tears to free rupture, with outcomes and management correlating with type and location of injury. Nonoperative management with blood pressure control using β-blockers coupled with antiplatelet therapy and close follow-up is successful in individuals with intimal tears with minimal thrombus formation because they remain stable or resolve on follow-up. Free rupture remains a devastating injury, with 100% mortality. For all other categories of aortic injury, successful repair correlates with a favorable prognosis.

Topics: Adolescent; Adult; Aneurysm, False; Aorta, Abdominal; Aortic Aneurysm; Aortic Diseases; Aortic Rupture; Aortography; Cardiovascular Agents; Child; Endovascular Procedures; Female; Humans; Incidence; Male; Middle Aged; Predictive Value of Tests; Retrospective Studies; Severity of Illness Index; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Vascular Surgical Procedures; Vascular System Injuries; Washington; Wounds, Nonpenetrating; Young Adult

Left ventricular pseudoaneurysm is a very rare complication following acute myocardial infarction, which results from a free wall rupture. Hemopericardium and cardiac tamponade caused by rupture of the free wall after acute myocardial infarction are often fatal. It is difficult to fully document the evolution of left ventricular pseudoaneurysm resulted from acute myocardial infarction with conservative treatment.. Herein, we followed a 75-year-old female patient for 3 years. Recorded the evolution of the disease: acute lateral myocardial infarction - emergency reperfusion therapy - cardiac rupture - positive successful rescue - the pseudoaneurysm formation - maintaining conservative treatment - gradual enlargement of the pseudoaneurysm - thrombosis in pseudoaneurysm - thrombus filling with pseudoaneurysm - finally stabilized condition - the treatment of coronary revascularization.. This case is reported here because of its scarcity, which provides provides us with a complete record of the entire evolution and an astonishing indication of the long-term prognosis of non-surgical treatment for pseudoventricular.

Topics: Aged; Aneurysm, False; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Conservative Treatment; Disease Progression; Female; Heart Aneurysm; Heart Rupture, Post-Infarction; Humans; ST Elevation Myocardial Infarction; Stents; Thrombectomy; Time Factors; Treatment Outcome

Topics: Aneurysm, False; Bisoprolol; Cardiovascular Agents; Catheter Ablation; Female; Heart Ventricles; Humans; Middle Aged; Tachycardia, Ventricular; Ventricular Dysfunction, Left

Endovascular aortic repair has revolutionized the management of traumatic blunt aortic injury (BAI). However, debate continues about the extent of injury requiring endovascular repair, particularly with regard to minimal aortic injury. Therefore, we conducted a retrospective observational analysis of our experience with these patients.. We retrospectively reviewed all BAI presenting to an academic level I trauma center over a 10-year period (2000-2010). Images were reviewed by a radiologist and graded according to Society for Vascular Surgery guidelines (grade I-IV). Demographics, injury severity, and outcomes were recorded.. We identified 204 patients with BAI of the thoracic or abdominal aorta. Of these, 155 were deemed operative injuries at presentation, had grade III-IV injuries or aortic dissection, and were excluded from this analysis. The remaining 49 patients had 50 grade I-II injuries. We managed 46 grade I injuries (intimal tear or flap, 95%), and four grade II injuries (intramural hematoma, 5%) nonoperatively. Of these, 41 patients had follow-up imaging at a mean of 86 days postinjury and constitute our study cohort. Mean age was 41 years, and mean length of stay was 14 days. The majority (48 of 50, 96%) were thoracic aortic injuries and the remaining two (4%) were abdominal. On follow-up imaging, 23 of 43 (55%) had complete resolution of injury, 17 (40%) had no change in aortic injury, and two (5%) had progression of injury. Of the two patients with progression, one progressed from grade I to grade II and the other progressed from grade I to grade III (pseudoaneurysm). Mean time to progression was 16 days. Neither of the patients with injury progression required operative intervention or died during follow-up.. Injury progression in grade I-II BAI is rare (~5%) and did not cause death in our study cohort. Given that progression to grade III injury is possible, follow-up with repeat aortic imaging is reasonable.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aneurysm, False; Aorta, Abdominal; Aorta, Thoracic; Aortic Aneurysm; Aortography; Cardiovascular Agents; Disease Progression; Endovascular Procedures; Female; Humans; Injury Severity Score; Length of Stay; Male; Middle Aged; Retrospective Studies; Risk Factors; Time Factors; Tomography, Spiral Computed; Trauma Centers; Treatment Outcome; Vascular System Injuries; Wounds, Nonpenetrating; Young Adult

Topics: Acute Disease; Age Factors; Aneurysm, False; Aorta, Abdominal; Aorta, Thoracic; Aortic Diseases; Aortic Dissection; Aortic Valve; Atherosclerosis; Bicuspid Aortic Valve Disease; Cardiovascular Agents; Clinical Laboratory Techniques; Diagnostic Imaging; Early Diagnosis; Endovascular Procedures; Female; Genetic Diseases, Inborn; Heart Defects, Congenital; Heart Valve Diseases; Hematoma; Humans; Long-Term Care; Male; Neoplasms, Vascular Tissue; Physical Examination; Risk Factors; Vascular Calcification; Vascular Stiffness; Vascular Surgical Procedures

This report describes the case of previous type-A aortic dissection treated with the placement of a termino-terminal prosthesis, which developed a large peri-prosthetic pseudoaneurysmatic sac, detected by CT, performed 2 years after the surgery. This raised the suspicion of a communication between the pseudoaneurysmatic sac and the aortic lumen, but was not able to show it directly. Transthoracic echocardiography confirmed the presence of the fistula, showing a systo-diastolic color Doppler jet signal connecting these two structures.The complementary role of these two diagnostic techniques allowed a complete evaluation of this complex pathology.

Topics: Aged; Aneurysm, False; Aortic Aneurysm; Aortic Dissection; Aortography; Arterio-Arterial Fistula; Blood Vessel Prosthesis Implantation; Cardiovascular Agents; Echocardiography, Doppler, Color; Echocardiography, Doppler, Pulsed; Female; Humans; Predictive Value of Tests; Pulmonary Artery; Time Factors; Tomography, X-Ray Computed

Topics: Adult; Aneurysm, False; Angioplasty, Balloon, Coronary; Anterior Wall Myocardial Infarction; Aortic Dissection; Cardiovascular Agents; Coronary Aneurysm; Coronary Angiography; Echocardiography; Electrocardiography; Humans; Male; Stents; Treatment Outcome; Ultrasonography, Interventional

Coronary pseudoaneurysms following implantation of drug-eluting stents, although rare, are not unknown. Nearly all such cases have been reported in patients with sirolimus or paclitaxel polymer-based stents. We describe a case of coronary pseudoaneurysm developing with a non-polymer-based drug-eluting stent in a 50-year-old man who was successfully managed by coronary artery bypass grafting.

Topics: Aneurysm, False; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Aneurysm; Coronary Angiography; Coronary Artery Bypass; Coronary Artery Disease; Drug-Eluting Stents; Humans; Male; Middle Aged; Prosthesis Design; Sirolimus; Treatment Outcome

Left ventricular pseudoaneurysm is a nonfrequent complication of acute myocardial infarction. We describe a case of a patient with previous cardiac surgery and recent inferior myocardial infarction, who developed severe congestive heart failure due to a giant pseudoaneurysm of the inferoposterior wall.

Topics: Aged; Aneurysm, False; Angioplasty, Balloon, Coronary; Cardiac Surgical Procedures; Cardiovascular Agents; Echocardiography, Doppler; Electrocardiography; Fatal Outcome; Heart Aneurysm; Heart Failure; Heart Rupture, Post-Infarction; Heart Ventricles; Humans; Male; Myocardial Infarction; Reoperation; Severity of Illness Index; Stents

Coronary artery stent infection is a rare complication of percutaneous intervention. We report a case of fulminant coronary stent infection with Staphylococcus aureus presenting as a pseudoaneurysm of the left circumflex artery following repeated implantation of drug-eluting stents in the setting of multiple episodes of recurrent in-stent restenosis. We speculate that sirolimus- and paclitaxel-eluting stents may be more likely to predispose to infection than bare metal stents because of their immunomodulating and antiproliferative effects.

Topics: Aged; Aneurysm, False; Aneurysm, Infected; Blood Vessel Prosthesis Implantation; Cardiovascular Agents; Cell Proliferation; Coronary Restenosis; Fatal Outcome; Humans; Immunosuppressive Agents; Male; Paclitaxel; Prosthesis-Related Infections; Sirolimus; Staphylococcal Infections; Staphylococcus aureus; Stents

Pseudoaneurysms in the coronary circulation are an uncommon occurrence that can develop spontaneously in the setting of atherosclerosis or can develop after catheter-based coronary interventions. The natural history, clinical outcome, and optimal therapy for pseudoaneurysms in the coronary circulation are not clearly established. Recent advances in the techniques and technologies used for endovascular treatment of intracranial aneurysms may be applicable to the management of coronary aneurysms and pseudoaneurysms. We present a case of spontaneous coronary pseudoaneurysm formation after paclitaxel drug-eluting stent implantation and a case of pseudoaneurysm formation in a saphenous vein graft that were both successfully treated with stent-assisted detachable coil embolization.

Topics: Aged; Aneurysm, False; Blood Vessel Prosthesis Implantation; Cardiovascular Agents; Coronary Aneurysm; Coronary Circulation; Embolization, Therapeutic; Humans; Male; Middle Aged; Paclitaxel; Reoperation; Saphenous Vein; Stents