Abstract 16257: Giant Left Circumflex (LCx) Coronary Artery Aneurysm (CAA) Presenting as a Cardiac Mass

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ahmad O Aljamal ◽  
Mohamad Raad ◽  
Sachin Parikh
Keyword(s):  
Artery Aneurysm ◽  
Coronary Intervention ◽  
Covered Stent ◽  
Aneurysm Rupture ◽  
Fistula Formation ◽  
Cardiovascular Risk Reduction ◽  
Drug Induced ◽  
Stent Occlusion ◽  
Threatening Condition ◽  
Life Threatening

Introduction: CAAs are a rare but potentially life-threatening condition. Commonly defined as localized dilations greater than 1.5 times the adjacent artery, “giant” CAA (GCAA) is a term used to describe CAAs that have progressed to greater than four times the adjacent artery. Case: A 73-year-old male who presented with acute dyspnea was found to have a 4.5cm epicardial mass on computed tomography angiography (CTA) of the chest. Coronary angiography revealed a large partially thrombosed saccular aneurysm of the proximal LCx with diffuse ectasia of the remaining coronary arteries. He underwent percutaneous coronary intervention (PCI) with the placement of a covered stent from the left anterior descending to the left main artery, traversing and effectively occluding the LCx. He tolerated the procedure and was discharged on clopidogrel and apixaban. Discussion: Due to their insidious nature, CAAs are underdiagnosed and progress undetected. Serious complications include aneurysm rupture and fistula formation. CAAs are most commonly caused by atherosclerosis but have been associated with infectious, rheumatologic, and genetic etiologies. Drug-eluting stents are increasingly implicated in CAAs by the mechanism of direct vessel trauma and drug-induced inhibition of smooth muscle proliferation. The optimal management of CAAs remains unclear. Cardiovascular risk reduction and monitoring are recommended. Invasive management is usually reserved for giant or unstable aneurysms. Surgical resection or repair is conventional but percutaneous methods such as coiling and stent occlusion are increasingly utilized. Our patient underwent a successful vessel and aneurysm occlusion with favorable post-PCI outcomes. Conclusion: GCAAs are extremely rare and understudied. Percutaneous management appears effective in the management of GCAAs, but the study of long-term safety and outcomes is required.

Treatment of Malignant Esophageal Fistulas: Fluoroscopic Placement of Esophageal SEMS, Endoscopically-assisted through Surgical Gastrostomy. A Case Report

2016 ◽  
Vol 25 (2) ◽  
pp. 249-252 ◽  
Author(s):  
Gabriel Constantinescu ◽  
Vasile Şandru ◽  
Mădălina Ilie ◽  
Cristian Nedelcu ◽  
Radu Tincu ◽  
...  
Keyword(s):  
Esophageal Carcinoma ◽  
Guide Wire ◽  
Subsequent Development ◽  
Covered Stent ◽  
Metallic Stents ◽  
Fistula Formation ◽  
Life Threatening ◽  
Endoscopic Placement ◽  
Surgical Gastrostomy ◽  
Methods Of Treatment

Progressive esophageal carcinoma can infiltrate the surrounding tissues with subsequent development of a fistula, most commonly between the esophagus and the respiratory tract. The endoscopic placement of covered self-expanding metallic stents (SEMS) is the treatment of choice for malignant esophageal fistulas and should be performed immediately, as a fistula formation represents a potential life-threatening complication. We report the case of a 64-year-old male diagnosed with esophageal carcinoma, who had a 20Fr surgical gastrostomy tube inserted before chemo- and radiotherapy and was referred to our department for complete dysphagia, cough after swallowing and fever. The attempt to insert a SEMS using the classic endoscopic procedure failed. Then, a fully covered stent was inserted, as the 0.035” guide wire was passed through stenosis retrogradely by using an Olympus Exera II GIF-N180 (4.9 mm in diameter endoscope) via surgical gastrostomy, with a good outcome for the patient. The retrograde approach via gastrostomy under endoscopic/fluoroscopic guidance with the placement of a fully covered SEMS proved to be the technique of choice, in a patient with malignant esophageal fistula in whom other methods of treatment were not feasible. Abbreviations: ERCP: endoscopic retrograde cholangio-pancreatography; GI: gastrointestinal; SEMS: self-expandable metallic stents.

Adverse reactions to medication

2019 ◽  
pp. 103-114
Author(s):  
Tomasz Bajorek ◽  
Jonathan Hafferty
Keyword(s):  
Adverse Effect ◽  
Adverse Effects ◽  
Adverse Reactions ◽  
Bleeding Risk ◽  
Inpatient Setting ◽  
Extrapyramidal Side Effects ◽  
Inpatient Psychiatry ◽  
Drug Induced ◽  
Threatening Condition ◽  
Life Threatening

Adverse reactions to medication represent a major issue in inpatient psychiatry. This chapter systematically explores the most relevant, concerning, and problematic adverse effects routinely encountered in an inpatient setting. It describes the typical presentation, pathophysiology, incidence, and practical management of these problems. Extrapyramidal side effects including acute dystonia, drug-induced parkinsonism, akathisia, and tardive dyskinesia are considered before the chapter explores the rare but potentially life-threatening condition of neuroleptic malignant syndrome. Other adverse effects common to antipsychotics that are described include hyperprolactinaemia and psychotropic-induced arrhythmias including QTc prolongation. Sexual dysfunction is an under-recognized and undertreated adverse effect common to several classes of psychotropic medication and is also considered. Focusing on antidepressants, the chapter reviews the frequently encountered issue of hyponatraemia as well as serotonin syndrome and selective serotonin reuptake inhibitor-induced bleeding risk. Finally, the chapter addresses perinatal considerations for psychotropic drugs.

scholarly journals A nasty surprise: cardiogenic shock induced by extensive dissection of the left internal mammary artery graft occurring 3 months after coronary angiography—a case report

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Henning Ebelt ◽  
Peter Röhl ◽  
Andreas Schwenzky ◽  
Matthias Hoyme ◽  
Matthias Wiora
Keyword(s):  
Acute Coronary Syndrome ◽  
Bypass Surgery ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Threatening Condition ◽  
Internal Mammary ◽  
Life Threatening ◽  
Acute Dissection

Abstract Background Acute dissection of the left internal mammary artery (LIMA) graft in patients with previous cardiac bypass surgery is a rare but potentially life-threatening condition. Case summary A 58-year-old man with history of coronary artery disease and bypass surgery 15 years ago presented with acute coronary syndrome (non-ST-elevation myocardial infarction, NSTEMI). Angiography showed severe three-vessel disease with occlusion of a saphenous vein graft (SVG) to the first diagonal branch but patents grafts to left artery descendent (LIMA) and SVG to the right coronary artery. No coronary intervention was performed and the patient was treated medically (aspirin and ticagrelor) and discharged home after 6 days. Three months later, the patient again was admitted to the hospital with acute coronary syndrome (NSTEMI) and developing cardiogenic shock. Angiography now showed an extensive flow limiting dissection of his LIMA graft with the dissection starting at the ostium of the LIMA. After implantation of an Impella 2.5, percutaneous coronary intervention (PCI) of the graft was performed under guidance by optical coherence tomography (OCT) leading to implantation of a drug-eluting stent into the ostium of the LIMA and repeated balloon dilatations of the medial and distal parts of the graft. Antegrade flow was established and the patient’s condition improved so that the Impella was removed in the cath lab. After an uneventful course, the patient was discharged home after 6 days. Elective repeat angiography after 8 weeks showed an excellent functional result without persisting signs of LIMA dissection or stenosis. Discussion Acute dissection of a LIMA graft is a rare event that may lead to a life-threatening condition. According to the literature, LIMA dissection happens during coronary interventions in approximately half of the cases but it also may evolve spontaneously. However, as seen from our case, there might be a substantial delay between LIMA angiography and the clinical onset of dissection. In the vast majority of cases, dissection of LIMA can be treated by PCI. The use of Impella as reported for the first time in this case may improve the safety of the procedure. In accordance to PCI of the native coronary arteries, it seems possible to leave non-flow limiting dissections in cases of extensive disease in order to avoid the late complications of complete stenting of the graft.

scholarly journals Supraclavicular area swelling in neurofibromatosis patient

2018 ◽  
Vol 25 (5) ◽  
pp. 298-300
Author(s):  
Duk Hee Lee ◽  
Jae Hee Lee ◽  
Keon Kim ◽  
Ji Yeon Lim ◽  
Yoon Hee Choi
Keyword(s):  
Vertebral Artery ◽  
Vascular Complications ◽  
Artery Aneurysm ◽  
Neurofibromatosis 1 ◽  
Vascular Lesions ◽  
Left Vertebral Artery ◽  
Left Shoulder ◽  
Vascular Abnormality ◽  
Threatening Condition ◽  
Life Threatening

Neurofibromatosis 1 is an autosomal dominant disorder characterized by cafe-au-lait spots, cutaneous neurofibroma, and bony deformities. Vascular abnormality such as stenosis, aneurysm, or rupture associated with neurofibromatosis 1 is rare. Rupture of vertebral artery aneurysm into the thoracic cavity is extremely rare. The outcomes of patients with aneurysmal ruptures are very poor when spontaneous hemothorax occur. A 31-year-old woman presented to the emergency department with left shoulder pain and with both lower chest wall pain and left supraclavicular area swelling. The chest computed tomography scan revealed about 4-cm pseudo-aneurysm probable arising from the left vertebral artery with large hematoma at left supraclavicular area. Neurofibromatosis 1 is generally being regarded as a benign disease but has the potential for serious vascular complications. When aneurysms were ruptured, cervical hematoma, hemothorax, or hypotension was developed. It is potentially a life-threatening condition, so it must require emergent management. Emergency physicians must remember the relation of neurofibromatosis 1 and serious vascular complications and ensure rapid access to rule out vascular lesions, so as to prevent the life-threatening condition.

Off-label use of a reversed flared endurant iliac limb stengraft for the management of a life-threatening internal iliac artery aneurysm rupture

Vascular ◽  
2014 ◽  
Vol 22 (5) ◽  
pp. 381-384 ◽  
Author(s):  
Gino Gemayel ◽  
Nicolas Murith ◽  
Afksendiyos Kalangos
Keyword(s):  
Iliac Artery ◽  
Internal Iliac Artery ◽  
Artery Aneurysm ◽  
Emergency Situation ◽  
Aneurysm Rupture ◽  
Off Label Use ◽  
Iliac Artery Aneurysm ◽  
Internal Iliac Artery Aneurysm ◽  
Internal Iliac ◽  
Life Threatening

We report a case of a life-threatening internal iliac artery aneurysm rupture managed successfully with an on-table reversed flared iliac limb stentgraft and embolization. This easily off-the-shelf reproducible technique avoids using a more complex and expensive bifurcated aorto-iliac graft and could be a good solution in emergency situation where a custom graft is not available.

scholarly journals Giant Coronary Artery Aneurysms: Review and Update

2014 ◽  
Vol 41 (6) ◽  
pp. 603-608 ◽  
Author(s):  
Patricia D. Crawley ◽  
William Jeremy Mahlow ◽  
D. Russell Huntsinger ◽  
Swara Afiniwala ◽  
Dale C. Wortham
Keyword(s):  
Coronary Artery ◽  
Thrombus Formation ◽  
Artery Aneurysm ◽  
Coronary Intervention ◽  
Pericardial Tamponade ◽  
Fistula Formation ◽  
Illustrative Case ◽  
Coronary Artery Aneurysms ◽  
Causative Factors ◽  
Percutaneous Coronary

Giant coronary artery aneurysms are rare, with a reported prevalence of 0.02% to 0.2%. Causative factors include atherosclerosis, Takayasu arteritis, congenital disorders, Kawasaki disease, and percutaneous coronary intervention. Most giant coronary artery aneurysms are asymptomatic, but some patients present with angina pectoris, sudden death, fistula formation, pericardial tamponade, compression of surrounding structures, or congestive heart failure. Clinical sequelae include thrombus formation, embolization, fistula formation, and rupture. Surgical correction is generally accepted as the preferred treatment for giant coronary artery aneurysms. We present an illustrative case of a giant 70 × 40-mm coronary artery aneurysm in a 56-year-old man who declined surgery and died one month later. In addition, we provide a review of the medical literature on giant coronary artery aneurysms.

scholarly journals Limb ischemia after coil migration used for a hypogastric aneurysm embolization

2021 ◽  
Vol 5 (1) ◽  
pp. 004-006
Author(s):  
Olaria Miquel Gil ◽  
Wiesendanger Natalia Hernandez ◽  
Hernández Clàudia Riera ◽  
Gracia Carlos Esteban ◽  
Pujol Secundino Llagostera
Keyword(s):  
Iliac Artery ◽  
Therapeutic Option ◽  
Artery Aneurysm ◽  
Limb Ischemia ◽  
Covered Stent ◽  
Aneurysm Rupture ◽  
Hypogastric Artery ◽  
Iliac Artery Aneurysm ◽  
Aneurysm Embolization ◽  
Coil Migration

Hypogastric artery aneurysms are an uncommon entity. When the diameter achieves > 30-35 mm, they should be treated. Endovascular repair may be considered as first line therapy. One therapeutic option for internal iliac artery aneurysm exclusion is its embolization with or without covering the ostium with a covered stent. They may be some complications when it is not, as a distal coil migration that may produce ischemic symptoms. We are presenting a 73-years-old male admitted to hospital with an acute right lower limb ischemia caused by a coil migration. He recently underwent a right hypogastric artery aneurysm endovascular treatment by coil embolization without covering the hypogastric ostium with a covered stent. The patient underwent an emergency surgery to remove the coil by a transfemoral surgical approach with posterior thrombectomy of the secondary thrombus. Actually, he remains asymptomatic and with right posterior tibial pulse. Covered stent placement at the common iliac artery and external iliac artery could be the best option to avoid the risk of aneurysm rupture caused by endotension and the risk of distal coil migration.

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