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Diseases of the Aorta
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Aneurysms can be defined as external bulges of a blood-containing structure which expand in systole. All aneurysms have the risk of external rupture with fatal consequences. In true aortic aneurysms, the wall is made up of all the constituents of the aortic wall, i.e. intima, media and adventitia. In what are called false aneurysms, the external bulge has a wall consisting of adventitia or periaortic tissue only (Fig. 8.20). If the aneurysm sac bulges out to one side and communicates with the lumen via a narrow defect in the media, it is called a saccular aneurysm. Diffuse aneurysms involve the whole circumference of the aorta and often extend over a long distance. Diffuse aneurysms of the ascending aorta are almost always associated with aortic regurgitation, due to dilatation of the aortic root at the level of the supra-aortic ridge.
Neurosurgery: Cerebrovascular diseases
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Paolo Gritti, Luigi Andrea Lanterna, Francesco Ferri, Carlo Brembilla, Ferdinando Luca Lorini
Subarachnoid hemorrhage (SAH) is a severe subtype of stroke with a third of patients involved who do not survive, and at least one of five of those who survive are unable to regain functional independence (44). Rupture of arterial aneurysms is the major cause of SAH and the fourth most frequent and devastating cerebrovascular disorder, with an estimated incidence of approximately 7–9 cases per 100,000 inhabitants per year (5,45). Saccular aneurysm takes the form of small, thin-walled blisters protruding from arteries of the circle of Willis or its major branches, and its rupture releases blood directly into the cerebrospinal fluid under arterial pressure (Figure 7.5) (2,45). The bleeding usually lasts only for a few seconds, but it can cause an increase of intracranial pressure (ICP), which can be followed by severe headache, seizure, nausea, vomiting, focal neurologic deficit, or stiff neck. If the bleeding is violent and continuous, the increase of ICP and the dropping of the cerebral perfusion pressure explains the transient or persisting decreased consciousness, deep coma, or death (2,45). Etiology and risk factors of SAH aneurysm rupture could also include familial predisposition and heritable connective tissue diseases as polycystic kidney disease, Ehlers–Danlos syndrome type IV, neurofibromatosis type 1, and Marfan syndrome, but cigarette smoking may also predispose to aneurysmal SAH, whereas moderate- to high-level alcohol consumption is an independent risk factor (2,46).
Thoracic and vascular surgery
Published in Harold Ellis, Sala Abdalla, A History of Surgery, 2018
It was Rudolph Matas who took the first steps in reconstructive arterial surgery. In 1888, he performed the first cure of an aneurysm by opening the sac and obliterating it with sutures without obstructing the lumen of the artery (Figure 14.20). In 1903, in an extensive article in the Annals of Surgery, he showed that this technique could be applied with success to saccular aneurysm. When the sac was fusiform, the orifices of the feeding vessels were sutured from within the lumen of the aneurysm and the sac was then obliterated (Figure 14.21). This remained the only method of conservative treatment of aneurysm until the 1950s when, as we shall see, graft replacement of aneurysm was introduced.
Pulsed radiofrequency energy device (PEAK plasmablade™) and CustomBone® Cranioplasty: an appealing surgical rendez-vous
Published in British Journal of Neurosurgery, 2023
F. Graziano, R. Maugeri, G. R. Giammalva, E. Lo Bue, G. Zabbia, D. G. Iacopino
Case n.8: A 49 yo female had a subarachnoid haemorrhage due to a saccular aneurysm rupture; this aneurysm was located onthe right anterolateral wall in the left anterior cerebral artery (ACA). She underwent a combined neurosurgical and endovascular treatment. Firstly, he had hemicraniectomy and heamatoma evacuation, than the aneurysm was endovascularlyembolized. In the post op time, she experienced a common complication: an obstructive hydrocephalus, that was treated with a ventriculoperitoneal (VP) shunt. Then, after a complete recover, she was admitted for the prosthesis implant. ACustomBone®HA prosthesis was chosen. There were no complications during surgery. The dissection was performed with PEAK plasmablade and this manoeuvre reduced surgical time to 100 minutes only. Furthermore, the result of subgaleal haematoma was satisfying; the post op brain CT revealed a minimal haematoma of 4 mm. Subcutaneous drainage was removed after 24 hours.
Influence of neurovascular embolic coil primary wind diameter on aneurysm packing density and case costs
Published in Journal of Medical Economics, 2021
Ramesh Grandhi, Emilie Kottenmeier, Heather L. Cameron, Sarah T. Kane, Philipp Taussky
A 35-year-old female patient was transferred to our institution with a Hunt & Hess Grade 4 subarachnoid hemorrhage. After appropriate resuscitation and stabilization in the neurocritical care unit, she was brought to the neurointerventional suite where angiography demonstrated a 2.1 × 2.5 × 2.8 mm ruptured saccular aneurysm with an ovoid shape located at the junction of the A1 and A2 divisions of the right anterior cerebral artery (Figure 2). She underwent treatment using a single 2.5 mm × 3.5 cm 0.012″ PWD embolic coil (ORBIT GALAXY, Cerenovus, SARL, Switzerland) (Figure 4). Aneurysm volume was estimated to be 7.69 mm3, and the total volume of the inserted coil was 2.55 mm3. The packing density achieved was calculated to be 33.16% (Table 2). Had a 0.010″ PWD coil of the same length been used instead of the 0.012″ PWD coil, the resulting coil volume and packing density would have been 1.77 mm3 and 23.02%, respectively. Absolute and relative packing density differences of 10.14% and 44.04%, respectively, were obtained in favor of the 0.012″ PWD coil. Because the number of coils inserted was assumed to be the same in the actual case and theoretical analysis, the total cost of coils was equivalent. Therefore, for the same cost, using a single 0.012″ PWD coil was estimated to achieve greater packing density compared with using a single 0.010″ PWD coil.
Braided stents and their impact in intracranial aneurysm treatment for distal locations: from flow diverters to low profile stents
Published in Expert Review of Medical Devices, 2019
Christina Iosif, Alessandra Biondi
Indeed, in pre-clinical research now scientists tend to create junctions between different scientific fields, in order to investigate the interactions of local hemodynamics with platelet, thrombus and endothelial behavior. In this spirit, Ou C et al. [118] reported a computational model based on fibrin accumulation for the prediction of stasis thrombosis following flow-diverting treatment in cerebral aneurysms. They created an experimental model by ligating rat’s right common carotid artery (RCCA) to create flow-stasis environment. Thrombus formed in RCCA as a result of flow stasis. The fibrin distributions in different sections along the axial length of RCCA were measured. The fibrin distribution predicted by their computational model displayed a trend of increase from the proximal neck to the distal tip, consistent with the experimental results on rats. Then, the model was applied on a saccular aneurysm treated with flow diverter to investigate thrombus development following flow diversion. Thrombus was predicted to form inside the sac, and the aneurysm was occluded with only a small remnant neck remained. They concluded that their model can serve as a tool to evaluate flow-diversion treatment outcome and optimize the design of flow diverters.