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Subarachnoid haemorrhage and cerebrovascular traumatic pathology
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
Daniel du Plessis, Paul Johnson
Histological examination can be identical to saccular aneurysms, particularly in the case of true aneurysms following scarring of the vessel wall. A false aneurysm is most usually traumatic in origin. Histological features suggestive of trauma include dissection of the arterial wall and foci of medial and intimal fibrosis away from the site of the aneurysm (Paul et al. 1980). A history of trauma, which, as commented above, may be years previously, should be sought. Aneurysms in childhood, particularly if peripheral, are commonly traumatic or inflammatory in origin. Aneurysms secondary to penetrating trauma occur most commonly in teenage boys suffering gunshot wounds. Those secondary to non-penetrating trauma occur at the skull base or in the periphery with motor vehicle accidents or falls being the most common cause of injury. Peripheral traumatic aneurysms can further be divided into distal anterior cerebral artery aneurysms secondary to trauma against the falcine edge and distal cortical artery aneurysms associated with an overlying skull fracture (Paul et al. 1980, Buckingham et al. 1988). Traumatic paediatric anterior cerebral artery aneurysms may commonly have a delayed presentation and may not necessarily involve major trauma with predisposition to this form of injury likely explained by anatomical consideration such as the edge of the anterior falx or sphenoidal ridge (Laurent et al. 1981).
The cardiovascular system
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
A true aneurysm is a localised dilatation of an artery resulting from a degenerative process in its wall. The combination of the degenerative process and the pressure of blood pulsating within the artery means that dilatation is progressive and the affected artery may ultimately rupture, with life- or limb-threatening consequences. A false aneurysm is effectively a hole in the wall of an artery communicating with a cavity whose wall is made up of connective tissue surrounding the artery and thrombus. Nowadays, most false aneurysms are iatrogenic in origin, resulting from arterial punctures made by radiologists, cardiologists, surgeons or anaesthetists for diagnostic or therapeutic purposes; they may also result from penetrating injuries (stabbings, shootings, shrapnel injuries, etc.). The term ‘dissecting aneurysm’ (of the aorta) is sometimes encountered, but this is a misnomer. An aortic dissection is a split that develops in the media of the vessel. Although dilatation may result, the pathology, natural history and treatment of aortic dissection are different from those of true aneurysm formation.
Vascular
Published in Michael Gaunt, Tjun Tang, Stewart Walsh, General Surgery Outpatient Decisions, 2018
Try to identify an underlying cause from those listed above. Determine whether the aneurysm is asymptomatic or symptomatic. False aneurysm will usually have been preceded by some trauma or puncture of the artery, most commonly by the performance of an angiogram. Symptoms may consist of pain due to expansion or pressure on adjacent structures, distal embolisation or ischaemia.
Craniocerebral nail gun injuries: a definitive review of the literature
Published in Brain Injury, 2021
Aneurysms post-traumatic penetrating intracranial injury in this review was found to occur in 5% of all reported cases. This is similar to the reported rates for high velocity missile injuries (3.6%) (64,66) and less frequent than stab wound(s) related aneurysms (14.9%) (66,67). In one case, care was withdrawn, and the patient subsequently died (14). Another case failed to report the management strategy used (27). The final case reported conservative management of a right internal carotid (ICA) aneurysm. This developed post-operatively and was reported as a false aneurysm. It was managed conservatively and resolved within 1 month (26). All three aneurysms developed in arteries that were in close proximity to the penetrating nail(s). This is consistent with literature suggesting increased risk of aneurysmal formation in tissues nearest to penetrating objects (14, 26, 27). Aneurysms should be monitored because rupture of traumatic intracranial aneurysms typically occurs within 3 weeks of the initial injury and carries with it a 50% mortality (68).
External iliac artery injury following total hip arthroplasty via the direct anterior approach—a case report
Published in Acta Orthopaedica, 2020
Ellen Burlage, Jasper G Gerbers, Bob R H Geelkerken, Wiebe C Verra
Rue et al. (2004) described 2 main groups of vascular injuries during THA surgery: direct and indirect injuries. Direct damage may occur by arterial transection due to a misplaced retractor or by excessive reaming and by arterial penetration of a screw during cup fixation. Longitudinal vascular laceration may cause intraoperative bleeding and a decline in blood pressure. Because the bleeding of puncture injuries results in a slow and small amount of bleeding, it is likely this will not be observed during surgery. The bleeding will form a false aneurysm presenting as a hematoma or pulsatile mass. The patient can complain of hip pain due to pressure or ischemic symptoms caused by impaired blood flow (Proschek et al. 2006). Indirect damage can be caused by compression, stretching, or tearing of a vessel or by excessive heating by the bone cement. Secondary formation of a thrombus or presence of an intimal flap can lead to hypoperfusion and ischemia of the distal leg. Immediately after surgery, the dorsalis pedis arterial pulse can be absent. It is also possible that ischemic pain due to hypoperfusion and the absence of pulsations will not appear until a few hours postoperatively (Mortazavi et al. 2019).
Pseudoaneurysm of the superior lateral genicular artery following anterior cruciate ligament repair
Published in Acta Chirurgica Belgica, 2018
L. M. R. Oversier, B. J. G. A. Corten, D. G. Barten, J. W. M. Elshof
Pseudoaneurysm is a rare complication of surgery of the knee [1]. The pathogenesis of false aneurysm involves partial arterial laceration, which allows hemorrhage into surrounding soft tissues that confine it [2]. An encapsulated hematoma is formed, which undergoes organization with invasion of fibrin and connective tissue, and endothelialization of its central cavity, which communicates with the arterial defect [2]. A false aneurysm should be suspected clinically if a hard, painful or pulsatile mass is present in the region of the affected joint. Definitive confirmation of the diagnosis can be obtained by duplex ultrasonography or computed tomography angiography (CTA). The condition can be treated with ultrasound guided percutaneous thrombin injection.