scholarly journals Spontaneous Retroperitoneal Hematoma: a Case Report, Review of Literature, and Proposal of Diagnostic and Management Algorithm

2021 ◽  
Author(s):  
Takuma Kurotaki ◽  
Naoya Okada ◽  
Yasuo Sakurai ◽  
Takumi Yamabuki ◽  
Minoru Takada ◽  
...  
Keyword(s):  
Conservative Management ◽  
Arterial Embolization ◽  
Retroperitoneal Hematoma ◽  
Close Monitoring ◽  
Treatment Timing ◽  
Management Algorithm ◽  
Abdominal Aortic ◽  
Contrast Enhanced ◽  
Severe Hypotension ◽  
Enhanced Computed Tomography

Abstract Background: Spontaneous retroperitoneal hematoma (SRH) is defined as bleeding in the retroperitoneal space without any triggers such as trauma, invasive procedures, and abdominal aortic aneurysm. Case presentation: A 48-year-old man who experienced sudden abdominal pain, severe hypotension, and decreased hemoglobin (Hb) was diagnosed with SRH. Contrast-enhanced computed tomography (CT) revealed massive left retroperitoneal hematoma; however, neither extravasation nor causative aneurysm was noted. Through conservative management with close monitoring, he was treated and discharged on the 10th hospital day without any morbidity. Conclusions: SRH treatment comprises conservative management, transcatheter arterial embolization, and surgical intervention. The mortality rate of SRH is so high that the optimal treatment timing needs to be carefully judged based on detailed evaluation and management algorithm with clear criteria.

Successful Embolization of Persistent Endoleak from a Patent Inferior Mesenteric Artery

1997 ◽  
Vol 4 (3) ◽  
pp. 312-315 ◽  
Author(s):  
Greg van Schie ◽  
Kishore Sieunarine ◽  
Mike Holt ◽  
Michael Lawrence-Brown ◽  
David Hartley ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Aortic Aneurysm ◽  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Abdominal Aortic ◽  
Contrast Enhanced ◽  
Retrograde Filling ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Purpose: To report the successful endovascular occlusion of a persistent endoleak owing to collateral perfusion in a 1-year-old bifurcated aortic endograft. Methods and Results: An 81-year-old man underwent endovascular repair of a 5.5-cm abdominal aortic aneurysm (AAA) with a bifurcated stent-graft in 1995; collateral perfusion of the excluded aneurysm by retrograde filling of the patent inferior mesenteric artery (IMA) was noted postoperatively. At his 1-year follow-up, the mid-sac endoleak persisted on contrast-enhanced computed tomography. Using the superior mesenteric artery for access, the stump of the IMA was successfully embolized with glue. Conclusions: This case, which highlights the importance of documenting a patent IMA prior to AAA endografting, illustrates one option for the management of persistent collateral perfusion of endovascularly excluded aneurysms.

Endoleak as a Complication of Endoluminal Grafting of Abdominal Aortic Aneurysms: Classification, Incidence, Diagnosis, and Management

1997 ◽  
Vol 4 (2) ◽  
pp. 152-168 ◽  
Author(s):  
Geoffrey H. White ◽  
Weiyun Yu ◽  
James May ◽  
Xavier Chaufour ◽  
Michael S. Stephen
Keyword(s):  
Management Strategies ◽  
Clinical Trial Data ◽  
Diagnostic Techniques ◽  
Aneurysm Rupture ◽  
Aortic Aneurysms ◽  
Collateral Arteries ◽  
Abdominal Aortic ◽  
Contrast Enhanced ◽  
Imaging Surveillance ◽  
Enhanced Computed Tomography

The inability to obtain or maintain a secure seal between a vessel wall and a transluminally implanted intra-aneurysmal graft is a complication unique to the evolving technique of endovascular aneurysm exclusion. Because the term “leak” has long been associated with aneurysm rupture, the term “endoleak” is proposed as a more definitive description of this phenomenon. Embracing both persistent blood flow into the aneurysmal sac from within or around the graft (graft related) and from patent collateral arteries (nongraft related), endoleak can be classified as primary or secondary depending on the time of occurrence (within 30 days of implantation or following apparent initial seal, respectively). Diagnostic techniques to detect endoleak include arteriography, intraprocedural pressure monitoring, contrast-enhanced computed tomography, abdominal X ray, and duplex scanning. Management strategies for endoleak range from observation with periodic imaging surveillance to correction by additional endoluminal or surgical procedures. Standardization of the terminology describing this important sequela to endovascular aneurysm exclusion should facilitate uniform reporting of clinical trial data vital to the evaluation of this emerging technique.

Late Nonanastomotic Pseudoaneurysm From the Prosthetic Graft: A Successful Transcatheter Arterial Embolization Using Coils

2020 ◽  
pp. 153857442097558
Author(s):  
Atsushi Saiga ◽  
Jun Hashiba ◽  
Jun Koizumi ◽  
Hideki Ueda ◽  
Yoshihiro Kubota ◽  
...  
Keyword(s):  
Transcatheter Arterial Embolization ◽  
Arterial Embolization ◽  
Prosthetic Graft ◽  
Careful Consideration ◽  
Anastomotic Site ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Function Impairment ◽  
Enhanced Computed Tomography

A 71-year-old man who received a total arch replacement with a knitted Dacron® graft presented aneurysmal sac re-expansion due to leakage at the distal anastomotic site of the graft. He did not tolerate the stress of general anesthesia due to severe pulmonary function impairment. Therefore, thoracic endovascular aortic repair (TEVAR) in zone 3 was performed under epidural anesthesia. Contrast-enhanced computed tomography (CT) revealed another leakage into the aneurysmal sac in zone 1 after performing TEVAR. Because open surgical repair and debranching TEVAR were contraindicated, transcatheter arterial embolization was performed with careful consideration of his comorbidities. Follow-up contrast-enhanced CT performed 2 weeks after embolization indicated no opacification of the aneurysmal sac, and noncontrast-enhanced CT a year after embolization showed no dilatation of the aneurysmal sac.

Intravascular Ultrasound—Guided Stenting for Chronic Abdominal Aortic Dissection

2002 ◽  
Vol 9 (6) ◽  
pp. 926-931 ◽  
Author(s):  
Rocco Giudice ◽  
Antonio Frezzotti ◽  
Marco Scoccianti
Keyword(s):  
Aortic Dissection ◽  
Intravascular Ultrasound ◽  
Duplex Ultrasound ◽  
Satisfactory Outcome ◽  
Abdominal Aortic ◽  
Contrast Enhanced ◽  
Combined Use ◽  
Contrast Angiography ◽  
Abdominal Aortic Dissection ◽  
Enhanced Computed Tomography

Purpose: To describe how the combined use of duplex and intravascular ultrasound (IVUS) can assist in the evaluation and treatment of isolated abdominal aortic dissection without need for contrast angiography. Case Report: A 78-year-old man presented with intermittent bilateral buttock and thigh claudication. Duplex ultrasound and contrast-enhanced computed tomography (CT) confirmed a chronic dissection along 3 to 4 cm of the infrarenal abdominal aorta. During Extra Large Palmaz stent implantation, the procedure was based on IVUS images and fluoroscopy without angiography. Both duplex and IVUS images were critical in assessing the type and extent of the lesion to be treated, in guiding the procedure, and in assessing its satisfactory outcome. Conclusions: In selected cases, ultrasound-based imaging modalities can provide most of the information required to accomplish complex aortic procedures.

Endoluminal Repair of Abdominal Aortic Aneurysms: Strengths and Weaknesses of Various Prostheses Observed in a 4.5-Year Experience

1997 ◽  
Vol 4 (2) ◽  
pp. 147-151 ◽  
Author(s):  
James May ◽  
Geoffrey H. White ◽  
Weiyun Yu ◽  
Richard Waugh ◽  
Michael S. Stephen ◽  
...  
Keyword(s):  
Vascular Complications ◽  
Aortic Aneurysms ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Endoluminal Repair ◽  
Abdominal Aortic ◽  
Contrast Enhanced ◽  
Fluoroscopic Control ◽  
Enhanced Computed Tomography

Purpose: To summarize the results of endovascular abdominal aortic aneurysm (AAA) treatment using several endograft designs over a 4.5-year experience and offer comparisons on the various devices. Methods: From May 1992 to August 1996, 121 AAA patients meeting the criteria for an endoluminal repair were treated with 1 of 5 endograft designs in three configurations. The endografts were implanted in the operating room under fluoroscopic control. Follow-up included contrast-enhanced computed tomography within 10 days of operation, 6 months postoperatively, and annually thereafter. Results: Endografts were successfully deployed in 106 patients (88%). Fifteen cases were converted to open repair. Six procedure-related deaths occurred within 30 days owing to myocardial infarction (3), combined renal failure and septicemia (2), and multisystem failure (1). There were 36 local/vascular complications (30%) and 18 systemic/remote complications (15%). Of the 121 patients undergoing endoluminal AAA repair, 93 (77%) are currently alive and well with their AAAs excluded from the circulation. Conclusions: Trends in endoluminal AAA repair and prosthetic design point toward simpler devices and earlier treatment of smaller aneurysms once the long-term outcome of aortic endografting has been determined.

scholarly journals Successful endovascular therapy in an elderly patient with severe hemorrhage caused by traumatic injury

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 203-207
Author(s):  
Masato Murata ◽  
Makoto Aoki ◽  
Shuichi Hagiwara ◽  
Masao Sekihara ◽  
Takayuki Kohri ◽  
...  
Keyword(s):  
Traumatic Injury ◽  
Arterial Embolization ◽  
Severe Trauma ◽  
Aortic Injury ◽  
Multiple Rib Fractures ◽  
Intestinal Necrosis ◽  
Abdominal Aortic ◽  
Severe Hemorrhage ◽  
Internal Iliac ◽  
Enhanced Computed Tomography

AbstractAn 85-year-old female suffered pelvic fracture, multiple rib fractures, right hemopneumothorax, and blunt abdominal aortic injury in a traffic accident. After transfer to our hospital, transcatheter arterial embolization (TAE) was performed immediately for hemorrhage from the bilateral internal iliac arteries. Enhanced computed tomography (CT) after TAE showed an increase of hematoma and extravasation at the bifurcation of the abdominal aorta. Therefore, emergency abdominal endovascular aortic repair was performed on the same day. On the 3rd day after transfer, metabolic acidosis worsened suddenly, and enhanced CT revealed intestinal necrosis. Emergency surgery for the intestinal necrosis was performed. The patient was transferred to the previous hospital on the 31st day after transfer. Endovascular treatment is useful for elderly patients with severe trauma. However, the preservation and/or reconstruction of the blood flow to important organs should be monitored.

scholarly journals A study of surgical outcome of necrotizing pancreatitis

2017 ◽  
Vol 5 (1) ◽  
pp. 305
Author(s):  
Bhondave Suraj Tukaram ◽  
Niranjan Dash ◽  
V. J. Thipse ◽  
J. M. Gadekar
Keyword(s):  
Conservative Management ◽  
Death Rate ◽  
Necrotizing Pancreatitis ◽  
Timing Of Surgery ◽  
The Other ◽  
Conservative Approach ◽  
Medical College ◽  
Contrast Enhanced ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Background: Increasing understanding and literature regarding the management of Necrotizing Pancreatitis has laid paths for surgical and conservative management. Although a conservative approach is increasingly used, this study depicts the importance of surgical management in today’s era. The objective was to evaluate the surgical role in patients of documented Necrotizing Pancreatitis, with or without organ failure and debilitating symptoms by putting conservative management on a complementary part.Methods: Sixteen consecutive patients were reviewed with Necrotizing Pancreatitis managed at DVVPF’s Medical college and hospital, Ahmednagar between January 1, 2014, and July 1, 2017 documented by contrast-enhanced computed tomography (CECT).Results: Out of sixteen patients of Necrotizing Pancreatitis recruited for the study, 13 (81%) patients were surgically managed; among which death rate was 7%. Of the other 3(19%) patients which were conservatively managed, there was 1 (33%) death. Patient who died while conservative management would have been candidate for earlier surgical intervention.Conclusions: The results suggest that surgical approach can be applied successfully to manage most patients with Necrotizing Pancreatitis, still further evaluation being required for indication and timing of surgery.

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