True brachial artery aneurysm after arteriovenous fistula closure following renal transplantation: a case report and literature review.
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SUBMITTER: Toyota S
PROVIDER: S-EPMC6892993 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Introduction:A true brachial artery aneurysm is a rare pathology with an incidence of 0.17% of all peripheral artery aneurysms. This pathology can manifest devastating complications if overlooked, however, a high index of suspicion coupled with a thorough history and physical allows easy diagnosis. We present a rare case of the oldest documented patient with a true brachial artery aneurysm with idiopathic etiology. Presentation of case:An 83-year-old gentleman presented with left upper extremity pain, erythema, and swelling for 1 week. He denied trauma to the area. Examination revealed a pulsatile mass of the antecubital fossa and decreased distal pulses. Imaging illustrated a 9mm aneurysm of the brachial artery with stenosis of the radial artery and non-enhancement of the origin of the ulnar artery. The patient underwent a brachial aneurysm excision, radial and ulnar embolectomy, and brachial to ulnar and radial artery bypass. Postoperatively, palpable pulses were appreciated in the radial and ulnar arteries. Pathology demonstrated a true aneurysm. The patient's postoperative course was uneventful and follow-up 6 months later revealed normal perfusion. Discussion:This case highlights the importance of maintaining a high index of suspicion coupled with a thorough history and physical examination when encountering neurovascular complaints of the upper extremities. Operative intervention even in asymptomatic patients is warranted due to a high complication rate of 33%. Conclusion:More research into the pathophysiology of this rare pathology is needed to further understand, prevent, or mitigate its complications.
| S-EPMC7300230 | biostudies-literature
Project description:Coronary Arteriovenous Fistula (CAF) is a rare defect that occurs in 0.1-0.2% of patients undergoing coronary angiography; Coronary Artery Aneurism (CAA) also occurs in approximately 15-19% of patients with CAF. It is usually congenital, but in rare occasions it occurs after chest trauma, cardiac surgery, or coronary interventions. The case described is that of a 72-year-old woman, without previous history of cardiovascular disease, who presented a huge cardiac mass. A multimodal approach was necessary to diagnose a giant CAA with CAF responsible for compression and displacement of cardiac structures. Due to likely congenitally origin of the lesion and the absence of symptoms correlated to the CAA and to the CAF we decided to avoid invasive interventions and to treat the patient with medical therapy.
| S-EPMC3845733 | biostudies-literature
Project description:PurposeTo report the effectiveness of left renal artery (LRA) occlusion using Amplatzer Vascular Plug (AVP) II as treatment for a high-flow renal arteriovenous fistula (RAVF) with multiple renal vein aneurysms (RVA) to prevent aneurysm rupture and cardiac decompensation.Case reportA 59-year-old female suffering from a post-traumatic RAVF presented with tachycardia and increased cardiac output (CO). Doppler ultrasonography and computed tomography (CT) scan revealed a high-flow RAVF with multiple RVAs and unilateral critically reduced kidney function. Appreciating recent interventional therapeutic advances, the patient was treated with endovascular placement of AVP II into the left renal artery (LRA) resulting in complete occlusion of the RAVF to effectively reduce the risk of RVA rupture and cardiac decompensation. No anti-platelet medication was administrated after the occlusion of the LRA. The patient's physical capacity improved since right heart volume strain was normalized, and CO was reduced.ConclusionTransbrachial AVP II occlusion of the LRA is effective to occlude high-flow RAVFs to prevent risk of life-threatening RVA rupture. Additional follow-up is warranted to verify long-term effectiveness of this approach.
| S-EPMC6930724 | biostudies-literature
Project description:BackgroundA coronary artery aneurysm (CAA) is an abnormal dilation of a coronary artery segment often accompanied by coronary artery fistula (CAF), leading to communication between a coronary artery and a cardiac chamber or a part of the coronary venous system. Both CAAs and CAFs can present with symptoms and signs of myocardial ischemia and infarction.Case presentationWe describe the case of a 46-year-old woman with non-ST-elevation myocardial infarction (NSTEMI) caused by a "giant" CAA. Various imaging modalities revealed a thrombus-containing aneurysm located at the right-posterior cardiac border, with established arteriovenous communication with the distal part of left circumflex artery (LCx). After initial treatment with dual antiplatelet therapy, a relapse of pain was reported along with a new increase in troponin levels, electrocardiographic abnormalities, reduced left ventricular ejection fraction (LVEF) and thrombus enlargement. Surgical excision of the aneurysm was favored, revealing its true size of 6 cm in diameter. Τhe aneurysm was excised without complications. The patient remained asymptomatic during follow-up.ConclusionsManagement of rare entities such as "giant" CAAs and CAFs can be challenging. Cases such as this can serve as precedents to facilitate treatment plans and develop consistent recommendations, emphasizing the importance of personalized strategies for future patients.
| S-EPMC10986014 | biostudies-literature
Project description:BackgroundCoronary artery aneurysms (CAAs) are uncommon, and giant aneurysms (>2 cm) are even more unusual. Coronary atherosclerosis and Kawasaki disease are the leading causes for this pathology. The treatment for this condition is controversial because the evidence is based on case report series.Case summaryWe describe the case of a 77-year-old female patient who presented with heart failure symptoms. She was diagnosed with a giant saccular aneurysm arising from the right coronary artery (RCA) ostium and a fistula between the RC and the left anterior descending artery (LAD) to the coronary sinus. And an atrial septal defect (ASD) and severe tricuspid regurgitation were also found. The patient underwent surgery through a medium sternotomy, the aneurysm was opened and resected under cardiopulmonary bypass. The RCA was ligated at the distal end of the aneurysm, and a saphenous vein graft bypass was performed. A coronary arteriovenous fistula from the distal portion of RC and LAD artery to a severely enlarged coronary sinus was found and corrected with an autologous pericardial patch. Closure of the ASD was performed with a pericardial patch and a tricuspid ring annuloplasty was done. Post-operative course was uneventful.DiscussionThere are few cases of giant coronary aneurysms associated with fistulas reported in the literature. Despite the endovascular percutaneous techniques available to treat these patients, we believe that surgical treatment was the best option for this particular case. We consider that surgical treatment is a very good option for giant CAAs associated with AV fistulas that are not susceptible for current endovascular available devices. The literature lacks evidence regarding the best approach for these cases, and we think that invasive treatment should be tailored according to the heart's anatomy and patient risk.
| S-EPMC7649478 | biostudies-literature
Project description:Teaching point: A ruptured aorto-iliac aneurysm, complicated by an iliac arteriovenous fistula, is rare but has a possibly fatal outcome and requires prompt diagnosis and appropriate treatment.
| S-EPMC11342842 | biostudies-literature
Project description:IntroductionTrue non-traumatic radial artery aneurysms (RAAs) are extremely rare, and few cases have been described. The majority of RAAs are post-traumatic or iatrogenic pseudo-aneurysms following arterial cannulation. However, RAAs due to other causes have also been described. Here a rare case of true idiopathic distal RAA, which was managed by surgical resection and repair with interposition vein graft, is described.ReportA 62 year old female with a known medical history of hypertension and hyperlipidaemia presented with left wrist swelling of one year duration, associated with a pulsatile lump that was increasing in size. Duplex ultrasound and computed tomography angiography revealed a distal RAA. She underwent open surgical resection and repair with interposition vein graft using the distal left cephalic vein. Histopathology of the specimen revealed an aneurysm with atherosclerosis. She recovered well post-operatively with no complications.DiscussionTrue idiopathic RAAs are rare. Surgical treatment is almost always recommended in view of the risk of complications. A case of true idiopathic distal RAA is presented here, which was managed successfully by surgical resection and repair with interposition vein graft.
| S-EPMC8077031 | biostudies-literature
Project description:This is a case report of a 59 years old male who had a commercial non-related living renal transplantation for his end stage renal insufficiency secondary to adult polycystic kidney disease. He suffered an immediate and early post-operative bleeding, which was managed conservatively. He was presented at Sultan Qaboos University Hospital four months after his transplant with abdominal pain, nausea, loss of appetite and a rise in serum creatinine levels. Ultrasonography and angiography have shown a 4 cm false aneurysm of the transplant renal artery at the anastomotic site with the external iliac artery. Surgical exploration with resection of the false aneurysm and reanastomosis of the donor renal artery to the external iliac artery was carried out successfully with preservation of the renal allograft. This is a rare case of an extra-renal false aneurysm at the anastomotic site of the transplant renal artery to the external iliac artery four months after renal allotransplantation. Literature review on the management and outcome of false aneurysms after renal transplant was carried out.
| S-EPMC3191650 | biostudies-other
Project description:IntroductionAcquired renal arteriovenous fistulas (AVFs) include those that occur as a complication of renal biopsy.Case reportThe authors report the case of a woman with recent-onset grade I hypertension, who was referred to our staff for sonographic studies of the kidneys and urinary tract. Laboratory data revealed microhematuria and proteinuria <0.5 g/24 h, and renal function was borderline (MDRD GFR 58 mL/min). Renal sonography of the left kidney revealed an anechoic, arboriform area at the level of the pelvis, which was suggestive of hydronephrosis. The color Doppler examination showed turbulent flow within the anechoic area, with high-velocity arterial flow and arterialization of the venous waveform at spectral analysis. Selective renal angiography later confirmed the presence of a middle renal AVF with pseudoaneurysm, which had been provoked by a renal biopsy performed over 10 years earlier in another center. Since the patient was currently in good health, the prescribed management consisted solely of close clinical and US follow-up.DiscussionAV fistulas are among the most commonly diagnosed renovascular malformations. The case reported here underlines the importance of using color Doppler ultrasound when obstructive uropathy is suspected, especially in patients who have undergone renal biopsy.
| S-EPMC3558108 | biostudies-literature
Project description:A 27-year-old man developed an unruptured anterior-inferior cerebellar artery (AICA) feeding aneurysm from a transverse-sigmoid dural arteriovenous malformation. The patient, with a known history of left transverse and sigmoid sinus thrombosis, presented with pulse-synchronous tinnitus. Angiography revealed an extensive dural arteriovenous fistula (AVF), with feeders from both the extracranial and intracranial circulations, involving the right transverse sinus, the torcula, and the left transverse/sigmoid sinuses. Multimodal endovascular and open surgical therapy was used to manage the lesion. Before a planned second-stage treatment for the left sigmoid sinus component, the dural AVF improved significantly. During this interval, however, a small flow-related aneurysm developed on the left AICA feeding the petrous dural region. The aneurysm resolved after resection of the involved sigmoid sinus. This is the first reported case of an unruptured feeding-artery aneurysm in an intracranial dural AVF that resolved spontaneously with treatment of the dural AVF. Until more is known about the natural history, the decisions of when and whether to treat an unruptured dural AVF feeding-artery aneurysm must be made on an individual basis.
| S-EPMC1888736 | biostudies-other