Endovascular management of dissecting posterior cerebral artery aneurysm associated with persistent hypoglossal artery: A case report

Persistent embryological connections between the anterior and posterior circulations are rare entities. Persistent hypoglossal artery is the second most common persistent carotid-basilar anastomosis. As it is often associated with hypoplasia of vertebral arteries, it poses a challenge during endovascular interventions. We present a case of a 32-year-old woman who presented with occipital headache of four weeks’ duration. Magnetic Resonance Angiography showed hypoplastic vertebral arteries with a persistent hypoglossal artery arising from the cervical segment of the left internal carotid artery and supplying the entire posterior circulation, associated with a dissecting aneurysm of the right posterior cerebral artery. Endovascular parent vessel occlusion was performed for the dissecting posterior cerebral artery aneurysm by navigating the guide catheter, microwire, and microcatheter through the persistent hypoglossal artery because the vertebral arteries were hypoplastic. Post-intervention, the patient did not develop any neurological deficit and was discharged in a stable condition.

Unusual presentation of moyamoya disease with popliteal involvement: case report and review of the literature

Moyamoya disease is a rare disorder that involves the cerebrovascular system. Usually, it leads to occlusion of the arteries of the cerebral system and causes cerebral circulatory complaints. A 48-year-old female patient was admitted to our clinic with intermittent claudication in both legs. Biphasic and monophasic waveform patterns were detected bilaterally in distal (trifurcation arteries) lower extremities with Doppler sonography. The patient therefore underwent systemic vascular examination. Computed tomography angiography revealed bilateral carotid occlusion at the level of supraclinoid segments, and opacifications were detected at the distal segments of the bilateral anterior cerebellar and middle cerebellar arteries. The patient was diagnosed with moyamoya disease, and anticoagulant treatment was started. In conclusion, most previous reports have presented the cerebrovascular involvement of moyamoya disease. However, this disease can involve different peripheral vascular systems and careful and systemic vascular examination is necessary for an exact diagnosis.

Upper limb arterial pattern: clinical correlation and embryological perspective

Background Variations in the upper limb arterial pattern are commonplace and necessitate complete familiarity for successful surgical and interventional procedures. Variance in the vascular tree may involve any part of the axis artery of the upper limb, including the axillary artery and brachial artery or its branches, in the form of radial and ulnar arteries, which eventually supply the hand via anastomosing arches. Objectives To study the peculiarities of the arterial pattern of the upper limb and to correlate them with embryological development. Methods The entire arterial branching of forty-two upper limbs of formalin fixed adult human cadavers was examined during routine dissection for educational purposes, conducted over a 3-year period in the Department of Anatomy, Lady Hardinge Medical College, New Delhi. Results The study found: 1) One case in which a common trunk arose from the third part of the axillary artery, which immediately splayed into four branches (2.4%); 2) High division of the brachial artery into ulnar and radial arteries, in 3 cases (7.1%); 3) Pentafurcation of the brachial artery into ulnar, interosseus, radial, and radial recurrent arteries and a muscular twig to the brachioradialis in 1/42 cases (2.4%); 4) Incomplete Superficial Palmar arch in 3/42 cases (7.1%); and 5) Presence of a median artery in 2/42 case(4.8%) Conclusions This study observed and described the varied arterial patterns of the upper limb and identified the various anomalous patterns, supplementing the surgeon’s armamentarium in various surgical procedures, thereby helping to prevent complications or failures of reconstructive surgeries, bypass angiography, and many similar procedures.

Oclusão arterial aguda consequente a embolia paradoxal – relato de caso e revisão de literatura

Resumo A embolia paradoxal é a transposição de um trombo originário da circulação sistêmica venosa para a arterial através de um defeito cardíaco, mais comumente o forame oval pérvio (FOP). A manifestação mais comum é o acidente cerebrovascular. A oclusão arterial aguda (OAA) é rara, requer alta suspeição diagnóstica e corresponde a menos de 2% de todos casos de embolia arterial. O tromboembolismo pulmonar (TEP) é a causa mais comum de elevação temporária do shunt direita-esquerda em pacientes com FOP e ocorre em pelo menos 60% dos casos de embolia paradoxal. Em 2019, um homem de 27 anos, sem fator para hipercoagulabilidade, deu entrada no Hospital Universitário do ABC, com quadro de OAA grau I Rutherford em membros inferiores secundária a tromboembolismo através de FOP prévio não diagnosticado, associado a trombose venosa profunda de membro inferior direito e TEP bilateral. O manejo incluiu anticoagulação plena e encaminhamento para cirurgia cardíaca.

Unilateral non-rotated left kidney with vascular and ureter variations in a cadaver: a unique case report with embryological and educational aspects

The kidneys and ureters are retroperitoneal structures in the upper part of the paravertebral gutters, tilted against the structures on the sides of the lowest two thoracic and upper three lumbar vertebrae, so that their anterior and posterior surfaces face antero-laterally and postero-medially, respectively. Congenital anomalies of the urinary tract are often the underlying cause of renal pathologies; 40% of these pathological conditions are due to variations in location, shape, and size of the kidney(s), calyces, ureter, or bladder. This case report describes the presence of a unilateral non-rotated left kidney with vascular and ureter variations found during routine cadaveric dissection for medical graduates. Alterations in rotation of the kidney and its relation to structures at the hilum have great clinical significance when conducting surgical procedures like partial nephrectomy, nephron sparing surgery, and renal transplantation.

Emergency endovascular repair of aortoiliac aneurysms in COVID-19 times

In this paper, we describe a case series of four patients who were admitted with emergencies related to aortic aneurysms over a 3-day period and were treated with endovascular repair. The first patient was an 81-year-old female with a history of abdominal pain and a ruptured aortic aneurysm diagnosed by AngioCT-scan. The second patient was a 63-year-old male with a history of oral digestive bleeding and an AngioCT-scan showing an aortoenteric fistula. The third patient was a 77-year-old female with sudden-onset abdominal pain and ruptured right common iliac aneurysm. The fourth patient presented with abdominal pain and an AngioCT-scan showed aortic rupture. All four patients were discharged with no major complications or surgical mortality. These case series show that despite the Covid-19 pandemic situation, since elective surgeries decreased, vascular emergencies have increased.

External iliac artery endofibrosis in an elite female endurance cyclist

External iliac artery endofibrosis is a rare pathology that affects high-level endurance athletes, especially cyclists. Classical symptoms include pain, loss of power, and/or cramp in the affected limb while training at maximal effort. The patient’s lack of atherosclerotic risk factors makes clinical suspicion of arteriopathy challenging. Moreover, the best management of such patients is still a subject of discussion. We report the case of a 36-year-old professional female endurance cyclist who presented with lower extremity pain during training. Right external iliac artery endofibrosis was diagnosed and the patient underwent surgical treatment. At two-months follow-up, she reported significant improvement in symptoms. This case highlights the importance of diagnosing peripheral vascular disease in young patients and athletes, who do not fit the ordinary profile of patients with atherosclerotic risk factors.

Resultados do tratamento do refluxo de veias safenas com endolaser 1.470 nm e correlação com o grau de insuficiência venosa

Resumo Contexto Pacientes com doença venosa crônica avançada são mais propensos a exigir outros procedimentos para recidiva de veias varicosas. Ainda não está estabelecido se a gravidade da insuficiência venosa é um fator que influencia a taxa de oclusão de veias safenas tratadas por endolaser. Objetivos Analisar a taxa de oclusão dos segmentos venosos tratados com endolaser e correlacionar com o Venous Clinical Severity Score (VCSS) e a classificação Clínica-Etiológica-Anatômica-Patológica (CEAP) dos pacientes. Métodos Análise retrospectiva de coorte de pacientes operados com endolaser 1.470 nm entre novembro/2012 a março/2020. Foram realizadas estatística descritiva e curva de sobrevida de Kaplan-Meier com regressão de Cox para grupos de VCSS e CEAP. Resultados Foram analisados 170 pacientes e 180 segmentos venosos; a idade média foi de 44,3 ± 9,2, sendo a maioria do sexo feminino (71%). A densidade de energia média utilizada na veia safena magna foi 49,2 ± 8,3 J/cm. As principais complicações foram dor no trajeto da safena (12,2%) e parestesias após 6 meses (17,2%). Não houve diferença na taxa de oclusão venosa entre grupos com VCSS ≤ 7 e VCSS > 7 (p = 0,067). O grupo de pacientes com CEAP agrupada C4-C5-C6 teve taxa de oclusão menor em relação ao grupo C2-C3 [hazard ratio (HR) = 3,22; intervalo de confiança (IC) 1,85, 5,61; p = 0,001]. Conclusões As taxas de oclusão de segmentos venosos tratados com endolaser foram menores na presença de classificações CEAP avançadas. Nesses pacientes, provavelmente deve-se despender mais energia para o tratamento eficaz das safenas.

Aneurisma idiopático de artéria ilíaca comum direita em criança de três anos - relato de caso

Resumo A incidência de aneurismas ilíacos em crianças não é conhecida, havendo apenas alguns relatos de casos na literatura sobre o tema. Neste estudo, é relatado o caso de um paciente masculino, 3 anos, com aneurisma sacular isolado na bifurcação da artéria ilíaca comum direita de origem idiopática, que foi submetido a ressecção, ligadura da artéria ilíaca interna e anastomose vascular término-terminal. Após 1 mês de seguimento, foi diagnosticada oclusão assintomática da anastomose. Devido à presença de circulação colateral, não houve repercussões clínicas da oclusão, e a criança apresentou evolução clínica favorável a médio prazo.