Peripheral arterial intervention (lower and upper extremity)
Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead in Cardiovascular Catheterization and Intervention, 2017
Aneurysms are primarily due to atherosclerosis; however, they can be familial or due to hypertension or connective tissue diseases. They are usually asymptomatic and often found bilaterally at the same level. Complications include rupture, embolization, and infection. Iliac artery aneurysms are also associated with obstructive uropathies and iliac vein obstruction. Traditionally, surgical resection is indicated in symptomatic patients or a size of >3 cm in diameter. Endovascular procedures with coiling and stent grafts have been employed with encouraging safety results, but long-term patency data compared to surgery are lacking.118 Endovascular data for femoral artery aneurysms are limited to case reports only. Popliteal artery aneurysms are bilateral in 50% of the cases and can be diagnosed by ultrasound; however, contrast angiography is usually required before surgical excision or planned endovascular procedure. Endovascular covered stents are a viable option for popliteal aneurysms with encouraging early results. Ultrasound should be performed to appropriately size the neck and distal part of aneurysm (Figure 49.9).
Three People, Three Aortas
Michael Fine, James W. Peters, Robert S. Lawrence in The Nature of Health, 2018
There is surgery to repair aneurysms. Done as an emergency procedure, after the aneurysm has ruptured, the surgery is rarely successful, and 90 out of 100 people who survive long enough to get into an operating room end up dying from the aneurysm despite the surgery. Done electively, on the other hand, surgery to repair aneurysms is more successful, and 80 to 90 out of 100 people who have the surgery survive it. It is very major surgery, however, and involves four to eight hours in the operating room for a process called cross clamping the aorta (during which the surgeon ties off the aorta for a few minutes – as few as possible – but usually at least 15 or 20 minutes). This compromises the blood supply to the kidneys, which can cause them to fail as a result of the surgery, and places a massive strain on the heart, which can produce heart attacks during the surgery. Most people who have the surgery spend five to ten days in the intensive care unit afterwards, and many need an extensive period of rehabilitation (four to six weeks is common) to recover from the whole body assault that the surgery represents. Big, involved, and pricey, the procedure and all the related care costs about $30,000 without complications and perhaps $100,000–$300,000 if complications set in.
Aortic disease
Paul Schoenhagen, Carl J. Schultz, Sandra S. Halliburton in Cardiac CT Made Easy, 2014
CT is routinely performed for the identification and characterization of thoracic and abdominal aortic aneurysmal (AAA) disease.336 CT is used for screening of aortic aneurysms,359–361 and for surveillance of aneurysms deemed too small to warrant surgical repair. CT protocols with 1–3 mm slice reconstruction allow precise assessment of the aorta and arch branch, visceral branch vessels, and iliac arteries. Modern workstations allow semi-automated centerline reconstructions (Figure 2.20). In contrast to conventional angiographic techniques, CTA shows luminal dimensions and the vessel wall. In aortic aneurysm, luminal dimensions and adherent wall thrombus and calcification of the aneurysm sac can be assessed. Dimensions of the aneurysm are described by measuring the outer dimensions of the aneurysm sac. The size of the aneurysm (including the aneurysm sac) has prognostic and therapeutic implications.
Gelatinase inhibitors: a patent review (2011-2017)
Published in Expert Opinion on Therapeutic Patents, 2018
Xun Li
Aneurysm, a frequently occurred degenerative disorder and more common in older men, is characterized by the loss of smooth-muscle cells in the aortic media and the destruction of ECM. Aneurysms can occur in any blood vessel, commonly found in abdominal, thoracic, and intracranial parts of the body. As a result of a hereditary condition or an acquired disease, aneurysms are usually manifested as a localized, blood-filled balloon-like bulge in the weakened wall of a blood vessel. Formation of an aneurysm is a complex but progressive process, which includes the aortic wall degradation and aneurysmal dilatation. As an aneurysm increases in size (typical ≥25 mm in diameter), the risk of rupture increases, too [38]. Of course, a ruptured aneurysm will cause continuous bleeding or other severe complications with high mortality, e.g. sudden heart attack and unexpected death. Current treatments mainly involve surgical intervention via preventive excision or endovascular rehabilitation to block rupture. However, surgical treatment has almost no effect on the inhibition of growth or rupture of aneurysm, while pharmacotherapies are limited.
Improved visual acuity after microsurgical clipping of a symptomatic anterior cerebral artery aneurysm: case report
Published in British Journal of Neurosurgery, 2019
Fatih Arcan, Andreas W. Unterberg, Klaus Zweckberger
Intracranial aneurysms occur in most cases (about 85%) within the anterior circulation. Despite the proximity to nervous structures (optic nerve, chiasm, oculomotor nerve), visual symptoms are rare. According to the anatomical configuration, visual deterioration might occur due to direct pressure caused by the aneurysm dome or by adhesions following hemorrhages or mechanical irritation of the nerve. In most cases, visual symptoms, such as blindness or unilateral scotoma, are slowly progressing with increasing size of aneurysm. Furthermore, the variable nature of visual symptoms which is underlying spontaneous fluctuation is not fully understood but presumably due to factors like arterial micro-vasospasm or shifting of nervous structures.1 While posterior communicating artery aneurysms cause oculomotor deficits, aneurysms compressing the optic nerve, and thus causing blindness, are exceptional and preponderantly lacking in the literature. Furthermore, it is under debate, whether operative clipping or endovascular coiling might be the best treatment of choice for symptomatic aneurysms.
Don’t Miss This! Red Flags in the Pediatric Eye Examination: Ophthalmoplegia in Childhood
Published in Journal of Binocular Vision and Ocular Motility, 2019
Michael X. Repka
In a series of 41 children at a tertiary care facility, the deficit was congenital in 39%, trauma in 37%, neoplasm in 17%, ophthalmoplegic migraine in 2%, and CNS inflammation in 2%, with an average at onset of 25 months.3 Another group found trauma in 40%, congenital in 30%, infection in 20%, and the remainder divided among migraine, neoplasm, and unknown.4 Many of the idiopathic cases in both series were likely caused by schwannomas of the cranial nerve that could not be imaged. Recently, some clinicians have questioned whether the cases of ophthalmoplegic migraine could be due to a schwannoma thickening the nerve rather than a migraine. However, other authors have found inflammatory thickening of the nerve that is steroid responsive with functional improvement. Given this uncertainty, a new descriptive term has been suggested, “recurrent painful ophthalmoplegic neuropathy”.5 In children, a cerebral aneurysm producing an oculomotor nerve paresis is rare. When aneurysms occur, they are typically associated with subarachnoid hemorrhage and thus not isolated in terms of symptoms.
Related Knowledge Centers
- Abdominal Aortic Aneurysm
- Aorta
- Aortic Aneurysm
- Circle of Willis
- Embolism
- Myocardial Infarction
- Atrial Septal Defect
- Blood Vessel
- Thrombosis
- Circle of Willis
- Ventricular Aneurysm