Hemoptysis as a warning sign of thoracic aorta pseudoaneurysm: A case report

Pseudoaneurysm is defined as a reperfused pulsatile hematoma, encapsulated and communicated with the damaged vessel's lumen. It originates when there is a disruption of the arterial wall. Hemoptysis is a very rare sign/symptom of a thoracic aortic aneurysm or pseudoaneurysm. There is little information on hemoptysis associated with aortic aneurysm rupture, whose mechanisms are not explained by the presence of an aortopulmonary fistula. Among the hypotheses to explain this phenomenon, is the ability of the bronchial arteries to become hyperplasic and tortuous in the presence of a lesion that modifies the pulmonary architecture, being more susceptible to rupture. There are also descriptions of direct lung parenchymal injury from ruptured aneurysm. The present case illustrates that we must consider the hemoptysis as a warning sign in differential diagnosis of aortic aneurysms and pseudo aneurysms, among other causes, that it can be fatal in a short time due to massive hemorrhage.

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A case of successful surgical treatment of a ruptured giant aneurysm of the infrarenal aorta in an elderly patient

Atherothrombosis Journal ◽

10.21518/2307-1109-2021-11-1-157-163 ◽

2021 ◽

pp. 157-163

Author(s):

A. E. Zotikov ◽

M. R. Khokonov ◽

K. Kh. Eminov ◽

A. M. Solovieva ◽

A. V. Kozhanova ◽

...

Keyword(s):

Elderly Patient ◽

Abdominal Aortic Aneurysm ◽

Surgical Treatment ◽

Aortic Aneurysm ◽

Giant Aneurysm ◽

Aneurysm Rupture ◽

Aortic Aneurysms ◽

Infrarenal Aorta ◽

Giant Aneurysms ◽

Abdominal Aortic

Today, abdominal aortic aneurysm surgery is a fairly well-studied area of medicine. Nevertheless, some questions remain rather debatable. No clear criteria for giant aneurysms have been developed so far. The available foreign and domestic literature reports about 40 cases of surgical treatment of giant abdominal aortic aneurysms, 16 of which are cases of aneurysm rupture. Open surgery remains the method of choice in the treatment of giant aneurysms due to the pronounced technical difficulties of endovascular intervention. The authors present a case of successful surgical treatment of a giant aneurysm rupture in an elderly patient. The peculiarity of this patient's condition is the occurrence of aneurysm rupture after hospital admission. The patient refused surgical treatment for two years after aneurysm detection. On examination after admission, multispiral computed tomography revealed an aneurysm size of 101 mm. On the eve of surgery, pain syndrome in the left abdomen and tachycardia appeared. Aneurysm rupture was suspected and the patient was urgently admitted to the operating room. The surgery was performed under the conditions of machine reinfusion of autoblood. The patient underwent abdominal aortic aneurysm resection with linear prosthesis and retroperitoneal hematoma removal. The postoperative period had no peculiarities. On the 10th day after the operation the patient was discharged in satisfactory condition to the outpatient treatment. This clinical case demonstrates the possibility of successful surgical treatment of giant aneurysm rupture in elderly patients.

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ASSESSMENT OF CLINICAL PRESENTATION OF ABDOMINAL AORTIC ANEURISM

Inter Collegas ◽

10.35339/ic.5.4.161-164 ◽

2018 ◽

Vol 5 (4) ◽

pp. 161-164

Author(s):

V. Boiko ◽

O. Buchneva ◽

Ya. Shafer ◽

Yu. Pisklova ◽

A. Krylova

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Clinical Manifestations ◽

Aneurysm Rupture ◽

Aortic Aneurysms ◽

Vascular Involvement ◽

Urgent Surgery ◽

Abdominal Aortic ◽

Abdominal Aortic Aneurism ◽

Causes Of Mortality

Boyko V., Buchneva O. Shafer Ya., Pisklova Yu., Krylova O.To date, vascular disease rank first (more than 50%) among the causes of mortality in Ukraine. Atherosclerotic vascular involvement, being the most frequent etiological factor of abdominal aortic aneurysm, in the absence of timely diagnosis and treatment, causes severe complications, early disability and death. Clinical and functional diversity of abdominal aortic aneurysm causes difficulties in diagnosing, defining different therapeutic approaches, methods of operation and protection of visceral organs and spinal cord. The article analyzes various clinical manifestations of abdominal aortic aneurysms in 264 patients who underwent surgical treatment at the State Facility V.T Zaytsev Institute of General and Urgent Surgery from 2010 to 2018.Key words:a bdominal aortic aneurysm, rupture of abdominal aortic aneurysm РезюмеАНАЛІЗ КЛІНІЧНОГО ПЕРЕБІГУ АНЕВРИЗМ ЧЕРЕВНОГО ВІДДІЛУ АОРТИБойко В., Бучнєва О., Шафер Я., Пісклова Ю., Крилова О.На сьогоднішній деньзахворювання судин займають перше місце (більше 50%) серед причин смертності в Україні. Атеросклеротичнеураженнясудин, будучи найбільш частим етіологічним фактороманевризм черевного відділу аорти, за відсутності своєчасної діагностики і лікування викликає важкі ускладнення, ранню інвалідизацію і смерть. Клінічне і функціональне різноманіття аневризм черевної аорти викликає труднощі в діагностиці, визначає різну тактику лікування, способи операції тазахисту внутрішніх органів і спинного мозку. У статті проаналізовані різноманітні клінічні презентації аневризм черевного відділу аорти у 264 пацієнтів, яким було проведено хірургічне лікування на базі ДУ "ІЗНХ ім.В. Т.Зайцева" з 2010 по 2018 рік. Ключові слова: аневризма черевної аорти, розрив аневризми черевної аорти РезюмеАНАЛИЗ КЛИНИЧЕСКОГО ТЕЧЕНИЯ АНЕВРИЗМ БРЮШНОГО ОТДЕЛА АОРТЫБойко В., Бучнева О., Шафер Я., Писклова Ю., Крылова А.На сегодняшний день заболевания сосудов занимают первое место (более 50%) среди причин смертности в Украине. Атеросклеротическом поражении сосудов, являясь наиболее частым этиологическим фактором аневризм брюшного отдела аорты, при отсутствии своевременной диагностики и лечения вызывает тяжелые осложнения, раннюю инвалидизацию и смерть. Клиническое и функциональное многообразие аневризм брюшной аорты вызывает трудности в диагностике, определяет разную тактику лечения, способы операции и защиты внутренних органов и спинного мозга. В статье проанализированы разнообразные клинические презентации аневризм брюшного отдела аорты у 264 пациентов, которым было проведено хирургическое лечение на базе ДУ "ІЗНХ ім.В. Т.Зайцева" с 2010 по 2018 год.Ключевые слова: аневризма брюшной аорты, разрыв аневризмы брюшной аорты

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Late Rupture of an Abdominal Aortic Aneurysm after Parodi's Endoprosthesis Replacement

Swiss Surgery ◽

10.1024/1023-9332.7.4.190 ◽

2001 ◽

Vol 7 (4) ◽

pp. 190-193 ◽

Cited By ~ 4

Author(s):

De Monti ◽

Ghilardi ◽

Gobatti ◽

Labagnara ◽

Scorza

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Surgical Procedures ◽

Aneurysm Rupture ◽

Endovascular Surgery ◽

Aortic Aneurysms ◽

Retroperitoneal Haematoma ◽

Abdominal Aortic ◽

Prosthesis Replacement

Endovascular surgery as a whole, and specifically in the context of aortic aneurysms, is a very interesting methodology the potential of which is increasingly being recognized. Follow up information on patients who underwent these procedures will be critical to validate the different techniques which have been developed and to identify the most appropriate situations for this type of surgical procedures. The authors present a case of aortic aneurysm rupture who had undergone Parodi's endoprosthesis placement two years before. CT angiographic evaluation showed a wide endoleak due to distal stent detachment, a complete dislodging of the endoprosthesis itself and retroperitoneal haematoma. Prosthesis replacement through a laparotomic approach was carried out and the patient was discharged 10 days postoperatively, surgically cured.

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Abstract WP94: Emphysema: A Potential Risk Factor for Ruptured Cerebral and Aortic Aneurysms

Stroke ◽

10.1161/str.48.suppl_1.wp94 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Ali Mahta ◽

Alexander E Merkler ◽

Michael E Reznik ◽

Hooman Kamel

Keyword(s):

Risk Factors ◽

Aortic Aneurysm ◽

Cox Regression ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Predictor Variable ◽

Incidence Rates ◽

Aneurysm Rupture ◽

Aortic Aneurysms ◽

Ruptured Aortic Aneurysm ◽

Increased Risk

Background: Whether emphysema is associated with the development and rupture of cerebral and abdominal aortic aneurysms is unclear. Methods and Materials: We performed a retrospective cohort study using outpatient and impatient claims data from a nationally representative 5% sample of Medicare beneficiaries > 66 years of age. Our predictor variable was emphysema and our outcome was a hospitalization for aneurysmal subarachnoid hemorrhage (SAH) or ruptured aortic aneurysm. All predictors and outcomes were defined using previously reported International Classification of Diseases, 9 th Revision, Clinical Modification ( ICD-9-CM ) diagnosis code algorithms. Survival statistics were used to calculate incidence rates and Cox regression was used to measure the association between emphysema and outcomes while adjusting for demographics and previously reported risk factors for aneurysm rupture: hypertension, diabetes, and tobacco and alcohol use. Results: We identified 133,337 patients with emphysema and 1,484,760 patients without emphysema. Over a mean follow-up period of 4.3 (+/-1.9) years, we identified 5,396 cases of aneurysm rupture, 477 of which occurred in patients with emphysema. The annual incidence of aneurysm rupture was 159 (95% confidence interval [CI], 146-174) per 100,000 in patients with emphysema and 74 (95% CI, 72-76) per 100,000 in patients without emphysema. After adjusting for demographics and other risk factors, emphysema was independently associated with aneurysm rupture (hazard ratio [HR], 1.6; 95% CI, 1.4-1.8). In secondary analyses, emphysema was associated with both aneurysmal SAH (HR, 1.4; 95% CI, 1.2-1.6) and ruptured aortic aneurysm (HR, 2.1; 95% CI, 1.7-2.5). Conclusion: Patients with emphysema faced an increased risk of developing SAH and aortic aneurysm rupture. This finding is consistent with the hypothesis that protease/anti-protease imbalance, which is seen in emphysema, may play a role in vessel wall weakening and the development and rupture of aneurysms.

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Multidetector Computed Tomography Angiography Findings of Chronic-Contained Thoracoabdominal Aortic Aneurysm Rupture with Severe Thoracal Vertebral Body Erosion

Case Reports in Radiology ◽

10.1155/2013/596517 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Ruken Yuksekkaya ◽

Ali Ekrem Koner ◽

Fatih Celikyay ◽

Murat Beyhan ◽

Ferdag Almus ◽

...

Keyword(s):

Computed Tomography ◽

Aortic Aneurysm ◽

Multidetector Computed Tomography ◽

Ct Angiography ◽

Vertebral Body ◽

Multidetector Ct ◽

Thoracoabdominal Aortic Aneurysm ◽

Aneurysm Rupture ◽

Aortic Aneurysms ◽

Adjacent Structures

Chronic-contained aortic aneurysm rupture with vertebral erosion is a rare entity with fatal complications. Multidetector computed tomography (CT) angiography is an important diagnostic method for the evaluation of the aortic aneurysms, their complications, and also the relationship between aneurysm and branching vessels and adjacent structures. We present the multidetector CT angiography findings of a 62-year-old patient with chronic-contained thoracoabdominal aortic aneurysm rupture causing severe vertebral body erosion.

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3D Modeling of Blood Flow in Simulated Abdominal Aortic Aneurysm

Vascular and Endovascular Surgery ◽

10.1177/15385744211012926 ◽

2021 ◽

pp. 153857442110129

Author(s):

Mauricio Gonzalez-Urquijo ◽

Raul Garza de Zamacona ◽

Ana Karen Martinez Mendoza ◽

Miranda Zamora Iribarren ◽

Erika Garza Ibarra ◽

...

Keyword(s):

Fluid Dynamics ◽

Computational Fluid Dynamics ◽

Shear Stress ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Abdominal Aortic Aneurysms ◽

Aneurysm Rupture ◽

Aortic Aneurysms ◽

Abdominal Aortic ◽

Computer Aided

Background: Besides biological factors, abdominal aortic aneurysm rupture is also caused by mechanical parameters, which are constantly affecting the wall’s tissue due to their abnormal values. The ability to evaluate these parameters could vastly improve the clinical treatment of patients with abdominal aortic aneurysms. The objective of this study was to develop and demonstrate a methodology to analyze the fluid dynamics that cause the wall stress distribution in abdominal aortic aneurysms, using accurate 3D geometry and a realistic, nonlinear, elastic biomechanical model using a computer-aided software. Methods: The geometry of the abdominal aortic aneurysm; was constructed on a 3D scale using computer-aided software SolidWorks (Dassault Systems SolidWorksCorp., Waltham MA). Due to the complex nature of the abdominal aortic aneurysm geometry, the physiological forces and constraints acting on the abdominal aortic aneurysm wall were measured by using a simulation setup using boundary conditions and initial conditions for different studies such as finite element analysis or computational fluid dynamics. Results: The flow pattern showed an increase velocity at the angular neck, followed by a stagnated flow inside the aneurysm sack. Furthermore, the wall shear stress analysis showed to focalized points of higher stress, the top and bottom of the aneurysm sack, where the flow collides against the wall. An increase of the viscosity showed no significant velocity changed but results in a slight increase in overall pressure and wall shear stress. Conclusions: Conducting computational fluid dynamics modeling of the abdominal aortic aneurysm using computer-aided software SolidWorks (Dassault Systems SolidWorksCorp., Waltham MA) proves to be an insightful approach for the clinical setting. The careful consideration of the biomechanics of the abdominal aortic aneurysm may lead to an improved, case-specific prediction of the abdominal aortic aneurysm rupture potential, which could significantly improve the clinical management of these patients.

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Abstract 149: Regulator of G-Protein Signaling-1 Modulates Leukocyte Trafficking in Atherosclerosis and Aortic Aneurysm Formation Through Chemokine Receptor Desensitization

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.34.suppl_1.149 ◽

2014 ◽

Vol 34 (suppl_1) ◽

Author(s):

Jyoti Patel ◽

Eileen McNeill ◽

Gillian Douglas ◽

Ashley Hale ◽

Joseph de Bono ◽

...

Keyword(s):

Bone Marrow ◽

Aortic Aneurysm ◽

G Protein ◽

Aneurysm Rupture ◽

Aortic Aneurysms ◽

G Protein Signaling ◽

Protein Signaling ◽

Aneurysm Formation ◽

Inflammatory Monocytes

The regulation of macrophage recruitment and retention into the vascular wall is critical in the progression of atherosclerosis and aortic aneurysm formation. This can be mediated by chemokine activation of multiple G-protein coupled receptors. The Regulator of G-Protein Signaling-1 (RGS1) acts to deactivate the intracellular response to sustained chemokine stimulation. We have found that RGS1 is upregulated with atherosclerotic plaque progression and with monocyte-macrophage activation but its role is unknown. Rgs1-/- macrophages have significantly enhanced migratory responses to atherogenic chemokines and have impaired desensitization to chemokine re-stimulation (p<0.001). In vivo, RGS1 has a role in the accumulation of macrophages in atherosclerotic lesions and during Angiotensin II (AngII) aortic aneurysm rupture. In the absence of RGS1, atherosclerosis and macrophage accumulation is attenuated in early lesions in the aortic root and aortas of ApoE-/- mice (p<0.001). Rgs1-/- mice are protected from AngII induced aneurysm rupture compared to ApoE-/- mice with 94% survival vs. 56%. Rgs1-/- mice have significantly fewer CD11b+ myeloid cells and CD14+ macrophages in aortas than ApoE-/- mice (p<0.05) after 5 days of AngII infusion. Following bone marrow transplantation, recipient mice receiving ApoE-/- bone marrow were more susceptible to aortic aneurysm rupture (p=0.0124), indicating bone marrow-derived RGS1 is required for aneurysm rupture. Furthermore, AngII treatment increased systolic blood pressure to a greater extent in Rgs1-/- mice than ApoE-/- mice suggesting aneurysm formation in these mice is independent of AngII induced hypertension and this is mediated by vascular-derived RGS1. To gain insight into the mechanism by which RGS1 regulates trafficking, we selectively labelled inflammatory monocytes in vivo to track their movement into aortas following AngII infusion. We found an accumulation of labelled CD45+ cells in the aortas of ApoE-/- mice from day 3 to day 5 but not in Rgs1-/- mice indicating RGS1 as a regulator of macrophage retention in aortic aneurysms. These findings identify a novel role for RGS1 in leukocyte retention in vascular inflammation, highlighting RGS1 as a potential target in cardiovascular disease.

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The Future of Abdominal Aortic Aneurysm Treatment and the Role of Totally Percutaneous Endografting

Interventional Cardiology Review ◽

10.15420/icr.2010.5.1.86 ◽

2010 ◽

Vol 5 (1) ◽

pp. 86

Author(s):

Laura Capoccia ◽

Vincent Riambau ◽

◽

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Abdominal Aortic Aneurysm Repair ◽

Aneurysm Rupture ◽

Aortic Aneurysms ◽

Mortality And Morbidity ◽

Low Profile ◽

Abdominal Aortic ◽

Distal Migration ◽

Randomised Controlled

Endovascular abdominal aortic aneurysm repair (EVAR) has experienced a continuous spread worldwide as a result of the constant drive to develop innovative methods and devices that enable physicians to achieve therapeutic aims while reducing procedural risks and patient discomfort. Randomised controlled studies have demonstrated clear early benefits over open repair in terms of mortality and morbidity, but a high reintervention rate jeopardised the EVAR outcome. Complications in EVAR, such as endoleaks, separation of modular components, stent or hook fractures and distal migration of the endograft, can lead to aneurysm enlargement and thus to the native risk of aneurysm rupture. In order to prevent such complications and minimise potential re-interventions, new-generation stent grafts, low-profile delivery systems and new percutaneous closing devices have been developed and adopted, making a totally percutaneous approach possible and desirable. Nevertheless, operators must be aware and trained to face every complication that could possibly develop during and after the procedure. Given these circumstances, EVAR is under consideration as the first line of treatment for abdominal aortic aneurysms.

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Thoracic Saccular Aortic Aneurysm Presenting with Recurrent Laryngeal Nerve Palsy prior to Aneurysm Rupture: A Prodrome of Thoracic Aneurysm Rupture?

Case Reports in Otolaryngology ◽

10.1155/2012/367873 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Masafumi Ohki

Keyword(s):

Aortic Aneurysm ◽

Recurrent Laryngeal Nerve ◽

Nerve Palsy ◽

Recurrent Laryngeal Nerve Palsy ◽

Aneurysm Rupture ◽

Laryngeal Nerve ◽

Aortic Aneurysms ◽

Aortic Arch Replacement ◽

Laryngeal Nerve Palsy ◽

Left Recurrent Laryngeal Nerve

Left recurrent laryngeal nerve palsy rarely results from cardiac disease. We present 2 cases of left recurrent laryngeal nerve palsy caused by thoracic saccular aortic aneurysms. One patient suffered an aortic aneurysm rupture one month after the advent of hoarseness, necessitating emergency surgery with aortic arch replacement. The other patient underwent elective aortic arch replacement surgery. Both saccular aortic aneurysms protruded downward in the aortopulmonary window to compress the recurrent laryngeal nerves. This is only the 5th case report of the rare occurrence of acute recurrent laryngeal nerve palsy subsequent to saccular aneurysm rupture in the English literature. Recurrent laryngeal nerve palsy does not always indicate imminent aneurysm rupture, but should trigger awareness of a potential rupture in the near future. Left recurrent laryngeal nerve palsy might be a prodrome of aneurysm rupture.

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Endovascular Treatment of Aortic Aneurysms in Finland: The First Four Years' Experience

Scandinavian Journal of Surgery ◽

10.1177/145749690209100204 ◽

2002 ◽

Vol 91 (2) ◽

pp. 155-159 ◽

Cited By ~ 5

Author(s):

P. S. Aho ◽

G. Pimenoff ◽

J. P. Salenius ◽

S. Leinonen ◽

K. Ylönen ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Treatment ◽

Aortic Aneurysms ◽

Interventional Radiologist ◽

Secondary Interventions ◽

Abdominal Aortic ◽

Short Time ◽

Mid Term Results

Background and aims: In this study the results of endovascular treatment of aortic aneurysms in Finland are presented and compared to the results of the Eurostar registry. Material and methods: A total of 229 patients with aortic aneurysm were treated in five different Finnish centres during 1996–2000. The data of these patients were collected prospectively by surgeon or interventional radiologist involved. During the same period of time 2464 patients were registered in the Eurostar registry. Results: The procedure was performed successfully in 97 % of patients in Finland, and the 30-day mortality was 0,9 %. A graft limb thrombosis was detected in 9 % of the patients in Finland. A permanent primary endoleak at the first 30-day control was seen in 23 patients (10 %). During the follow-up 17 secondary endoleaks (7 %) were detected. A secondary intervention was necessary in 26 % of the patients. Three patients (1.3 %) had late rupture of the abdominal aortic aneurysm. Conclusions: According to the Finnish short-time results, endovascular treatment of aortic aneurysms is safe and associated with relatively low morbidity and mortality. The mid-term results are more disappointing with relatively many graft thromboses and endoleaks, and a frequent need of secondary interventions.

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