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Complications of stenting for occlusive disease of aortic arch branches
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Christopher A. Latz, Mark F. Conrad
Nerve palsy following percutaneous intervention is rare but occurs most commonly in association with brachial or axillary artery access. Impairment usually results from nerve compression from a hematoma or pseudoaneurysm. More rarely, injury due to direct needle injury or neuropraxic/cautery injury during dissection or via ischemic injury following thrombosis of the access vessel has been described. The most commonly injured nerve with brachial access is the median nerve, and symptoms can include difficulty with forearm pronation, finger flection, or opposition of the thumb. Management is based on the cause and a duplex ultrasound of the affected area can help make the diagnosis. For minor hematomas, compression to stop expansion can be enough, but once neuro compressive symptoms develop, open surgical decompression is usually necessary. If a pseudoaneurysm is identified, this should be repaired surgically as well. It is important not to delay diagnosis or intervention in these patients as decompression beyond 48 hours from symptom development is associated with improvement in only 50% of patients, while almost all who are treated early show improvement in symptoms.38
Paper 2
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Pseudoaneurysm is possible following trauma; however, these would be more common follow a laceration. Renal artery stenosis would be unlikely to acutely develop in this clinical setting. Renal vein thrombosis is more common in transplant kidneys than native kidneys and the forward flow in diastole on the arterial trace is reassuring. The lack of hydronephrosis and the clinical history makes ureteric obstruction unlikely.
Secondary Hemorrhage after Myomectomy
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Pseudoaneurysm is a complication of vascular injury secondary to trauma or inflammation. It is a blood-filled cavity that communicates with lumen of the artery because of a focal deficiency in all three layers of the arterial wall [10, 11]. Pseudoaneurysms have been reported after uterine curettage, abortion, normal vaginal delivery, and cesarean section [10, 12–14]. A uterine artery pseudoaneurysm is a rare complication of myomectomy. Removal of the myoma or postmyomectomy local site infection can very rarely lead to disruption of a small part of the three-layered wall of the uterine artery with extravasation of blood and formation of a pseudosac in the myometrium. As more blood dissects into the myometrium, the pseudosac enlarges and can communicate with the uterine cavity and its rupture can lead to torrential bleeding per vaginum [15]. The exact incidence of uterine artery aneurysm after myomectomy is unknown [15] and these may be largely under-reported as their presence may be realized only when they lead to hemorrhage.
Mixed lesion of traumatic pseudoaneurysm and pyogenic granuloma on a digit
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Toshifumi Yamashiro, Yusuke Hachisu, Ryuichi Azuma
In contrast, PG is one of the most common vascular abnormalities that occurs following trauma to the hands and fingers [4,9]. They are often observed as painful, easily hemorrhagic mass lesions with a propensity to increase in size, and are treated with topical therapy, cryotherapy, CO2 laser, and surgery [9]. Furthermore, the use of surgical treatment and subsequent histological studies for differential diagnosis is based on previous reports of malignancies that have a similar appearance to PG, such as amelanotic malignant melanoma and Kaposi’s sarcoma [10,11]. Despite being diagnosed by a previous physician as having treatment-resistant periungual PG, the physical and imaging findings for the patient described in this study were not consistent with pure PG. Several findings were indicative of a traumatic aneurysm while also presenting features of PG. Consequently, the histopathology showed a mixture of features of both traumatic pseudoaneurysm and PG, which were consistent with the physical, imaging and intraoperative findings. While it remains unclear how this lesion developed and expanded, but standard examination and treatment resulted in a positive outcome.
Pseudoaneurysm formation and rupture after stereotactic radiotherapy for cerebral arteriovenous malformation: a case report and review of literature
Published in British Journal of Neurosurgery, 2021
Anderson Chun On Tsang, Derek Ping Hong Wong, Wah Cheuk, Kam Fuk Fok
In the reported cases, the pseudoaneurysms occurred at a latency period of up to 15 years after initial radiotherapy. Although this is admittedly a rare complication, an extended long-term angiographic follow-up even after complete AVM obliteration may be justified to detect delayed vascular changes. Radiation-related aneurysms are prone to rupture, most frequently resulting in subarachnoid hemorrhage and associated with great morbidities. Including our patient, 3 out of 5 cases of post-radiotherapy pseudoaneurysm presented as rupture with symptomatic intracerebral and intraventricular hemorrhage. It is therefore prudent to obliterate the pseudoaneurysm once detected to prevent catastrophic complications. These pseudoaneurysms could be occluded with coils or embolic materials endovascularly, as was performed in 2 of the cases. Alternatively, when vascular access was difficult or when there were other concurrent indications for surgery, such as for clot evacuation and removal of remaining AVM in our case, open surgery for clipping or excision was feasible.
Hemorrhagic gastroduodenal artery pseudoaneurysm coil embolization
Published in Baylor University Medical Center Proceedings, 2019
Timothy N. Phelps, Taylor G. Maloney, Marco Cura
Visceral artery aneurysms and pseudoaneurysms are rare entities that occur most commonly in the hepatic and splenic arteries.1 Surgical intervention may be too high risk if the pseudoaneurysm is poorly located and could result in further morbidity and mortality in unstable patients or poor surgical candidates. The endovascular approach is limited in cases with multiple feeding arteries and complex arterial anatomy, which may necessitate a percutaneous technique. Percutaneous approaches risk damaging surrounding structures within the abdomen while accessing the pseudoaneurysm, particularly the adjacent bowel and vasculature. Because inherent risks are associated with traversing bowel or abutting bowel with a sharp-tip needle, an alternative approach is to perform a visceral dissection technique with a blunt-tip needle, as demonstrated in our case.