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1

Visceral artery aneurysms – classification, diagnosis and treatment

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Piasek E., Sojka M., Kuczyńska M., Światłowski Ł., Drelich-Zbroja A., Furmaga O., Jargiełło T.

Journal of Ultrasonography

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2018

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vol. 18

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issue 73

148-151

EN

Although visceral artery aneurysms are rare, mortality due to their rupture is high, estimated at even 25–75%. That is why it is significant to detect each such lesion. Visceral artery aneurysms are usually asymptomatic and found incidentally during examinations performed for other indications. Autopsy results suggest that most asymptomatic aneurysms remain undiagnosed during lifetime. Their prevalence in the population is therefore higher. The manifestation of a ruptured aneurysm depends on its location and may involve intraperitoneal hemorrhage, gastrointestinal and portal system bleeding with concomitant portal hypertension and bleeding from esophageal varices. Wide access to diagnostic tests, for example ultrasound, computed tomography or magnetic resonance imaging, helps establish the correct diagnosis and a therapeutic plan as well as select appropriate treatment. After a procedure, the same diagnostic tools enable assessment of treatment efficacy, or are used for the monitoring of aneurysm size and detection of potential complications in cases that are ineligible for treatment. The type of treatment depends on the size of an aneurysm, the course of the disease, risk of rupture and risk associated with surgery or endovascular procedure. Endovascular treatment is preferred in most cases. Aneurysms are excluded from the circulation using embolization coils, ethylene vinyl alcohol, stents, multilayer stents, stent grafts and histoacryl glue (or a combination of these methods).

PL

Tętniaki tętnic trzewnych należą do rzadkich patologii. Śmiertelność z powodu ich pęknięcia jest wysoka, szacowana nawet na 25–75%, dlatego też wykrywanie każdego przypadku odgrywa ważną rolę. Tętniaki tętnic trzewnych są zazwyczaj asymptomatyczne i znajdowane przypadkowo podczas badania wykonywanego z innych wskazań. Badania autopsyjne sugerują, że większość bezobjawowych zmian pozostaje niezdiagnozowana za życia, a tym samym częstość występowania tętniaków trzewnych w populacji jest wyższa. Manifestacja pękniętego tętniaka zależy od jego lokalizacji i może przebiegać jako krwotok wewnątrzotrzewnowy, krwotok do przewodu pokarmowego oraz układu wrotnego z towarzyszącym nadciśnieniem wrotnym i krwawieniem z żylaków przełyku.Szeroki dostęp do takich metod diagnostycznych jak ultrasonografia, tomografia komputerowa czy też obrazowanie metodą rezonansu magnetycznego pozwala na ustalenie właściwego rozpoznania oraz zaplanowanie i wybór odpowiedniego leczenia. Po zabiegu metody te umożliwiają ocenę skuteczności postępowania, a w przypadkach niekwalifikujących się do leczenia służą do monitorowania wielkości tętniaków i wykrycia ewentualnych powikłań. Rodzaj leczenia zależy od rozmiarów tętniaka, przebiegu choroby, ryzyka pęknięcia oraz ryzyka związanego z leczeniem operacyjnym lub wewnątrznaczyniowym. Metodą z wyboru w większości przypadków jest zabieg wewnątrznaczyniowy. W celu wyłączenia tętniaków z krwiobiegu wykorzystywane są spirale embolizacyjne, EVOH (ethylene vinyl alcohol), stenty, stenty „gęsto plecione”, stentgrafty, kleje histoakrylowe (lub połączenie tych metod).

2

Endovascular coil embolization of the left internal carotid artery aneurysm – case report

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Lipowski A., Aboul-Hassan S., Krasiński Z., Woronowicz K.

Polish Journal of Surgery

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2021

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vol. 93

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issue 5

1-5

EN

In the current case report we present a novel case of a successful coil embolization of the left internal carotid artery aneurysm. The patient presented with neck pain and a palpable pulsating tumor and was admitted to the vascular surgery clinic where an angio-CT scan of the neck was performed. Angio-CT revealed a left internal carotid artery aneurysm with a narrow neck. The patient was admitted to the department of vascular surgery where she was enrolled into endovascular coil embolization. After the procedure, control angiography showed complete embolization of the aneurysm. Three months following the procedure, doppler ultrasonography of the carotid arteries showed no demonstrable flow into the aneurysm. Six months following the procedure, angio-CT confirmed complete aneurysm thrombosis. Based on this case, endovascular coil embolization of the carotid artery aneurysms is a safe and effective method of treatment.

3

Rare case of hepatic artery pseudoaneurysm

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Wyżgowski P., Grzela T., Przybył M., Nowakowska U., Leksowski K.

Polish Journal of Surgery

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2016

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vol. 88(3)

163-165

EN

Hepatic artery aneurysms are rare, but potentially life-threatening vascular pathologies. They are usually discovered incidentally during imaging diagnostics of different pathologies. The study presented a rare case of hepatic artery pseudoaneurym with a fistula to the left branch of the portal vein.

4

Cide-AGene Expression in Patients with Obesity Qualified for Endovascular Treatment of Abdominal Aorta Aneurysm

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Feldo M., Kocki J., Feldo J., Łukasik S., Bogucki J., Skwarzyński A., Wroński J., Kęsik J., Zubilewicz T.

Polish Journal of Surgery

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2015

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vol. 86

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issue 10

473-478

EN

CIDE-A gene and the genes of LRP group play a key role in the regulation of the body weight and lipid metabolism in mammals. CIDE-A is defined as a potential human obesity gene and the LRP1 gene is associated with the development of abdominal aortic aneurysm (AAA). The aim of the study was to define the role of CIDE-A gene in patients with dyslipidemia and asymptomatic AAA. Material and methods. The study group consisted of 38 subjects, including 27 men and 11 women qualified for endovascular aneurysm repair (EVAR). The subjects with abdominal aortic aneurysm were enrolled in the study group, depending on the body mass index (BMI); in obese patients (BMI > 30). The control group (n = 16) included subjects without lipid disorders. One-step isolation of RNA from lymphocytes and adipose tissue cells was performed using the modified TRI method by Chomc-zynski and Sacchi, and then the gene expression was tested by real-time PCR. Results. The highest mean relative of the gene expression for CIDE-A was reported in subjects with the normal body weight. The lowest mean relative of the gene expression for CIDE-A was observed in the group of obese patients with aortic aneurysm and lipid disorders. A high negative correlation (r = -0.7101) in the gene expression for CIDE-A was observed in the group of obese patients with aortic aneurysm, depending on the BMI. Conclusions. Due to the important role of the CIDE-A gene and Cide-A protein in the development of metabolic syndrome, obesity and the accompanying vascular lesions such as abdominal aortic an-eurysm, seen in this context, the tested gene and protein Cide-A represent a potential therapeutic target in these diseases.

5

Percutaneous Endovascular Abdominal Aortic Aneurysm Repair Within the Infrarenal Region. Preliminary Report

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Iłżecki M., Zubilewicz T., Terlecki P., Przywara S.

Polish Journal of Surgery

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2013

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vol. 85

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issue 10

563-568

EN

The aim of the study was to thoroughly evaluate the closure device ProStar XL in terms of its efficiency and safety in the percutaneous endovascular treatment of abdominal aortic aneurysms in the infrarenal section of the body. Additionally, it was crucial to assess if there were any occurrences of regional complications at any step of the procedure. It was also important to stipulate the estimated hospitalization period as well as the overall cost of the PEVAR treatment with the use of ProStar XL. Material and methods. The analysis included 21 cases with PEVAR performed in the infrarenal region. The final success was achieved in 98.2% of the cases. One PEVAR case (that constituted 0.2% of this group) was unsuccessful because of the bleeding while the placement of the sutures with the use of ProStar XL was being performed. Results. This resulted in the emergency treatment of the CFA with the continuous stitch (Prolene 5-0). During the postoperative period the above described patient was given 2 units of the Packed Red Blood Cells (PRBC). However, this complication (unexpected bleeding) did not influence the length of the hospitalization period in any significant way. Conclusions. Percutaneous vascular closure device ProStar XL used in the treatment of the common femoral artery (CFA) constitutes a necessary and safe supplement for Endovascular Aortic Aneurysm Repair (EVAR). The implementation of ProStar XL closure device proves to significantly shorten the hospitalization period after the EVAR treatment. Additionally, the safety of the entire procedure is exponentially linked to the experience of the operating surgeon.

6

Vascular complications in patients with Autosomal Dominant Polycystic Kidney Disease. A review of the literature and current clinical recommendations

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Koska-Ścigała A., Zdrojewski Ł., Jankowska M., Dębska-Ślizień A.

European Journal of Translational and Clinical Medicine

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2020

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vol. 3

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issue 2

64-71

EN

Autosomal dominant polycystic kidney disease is the most common genetic cause of renal failure. Apart from kidney involvement, patients are at risk of extra-renal manifestations, including vascular lesions. The etiology of vascular changes is diverse and depends, among other factors, on polycystin gene mutation, increased activity of the renin-angiotensin-aldosterone system and the occurrence of hypertension. The observed vascular system complications include cerebral artery aneurysms, cervico-encephalic arteries' dissection, aortic aneurysm and dissection and intracranial arterial dolichoectasia. This article discusses the etiopathogenesis, symptomatology, principles of prevention and treatment of the aforementioned diseases of the vascular system accompanying polycystic kidney disease.

7

Doppler ultrasound appearance of neck tumors

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Szymańska A., Szymański M., Gołąbek W., Drelich-Zbroja A., Jargiełło T.

Journal of Ultrasonography

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2018

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vol. 18

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issue 73

96-102

EN

Aim: The purpose of this study was the evaluation of the sonographic appearance of neck tumors and determining the features useful in differential diagnosis. Material and method: The studied group consisted of 57 patients: 16 patients with carotid body tumors, 9 patients with neurogenic tumors, 8 patients with venous anomalies, 12 patients with neck cysts, 6 patients with lipomas, 5 patients with extracranial carotid artery aneurysms and 1 with a laryngocele. Results: All carotid paragangliomas were located within the carotid bifurcation and demonstrated rich low-resistance vascular flow, with higher maximum velocity and lower flow resistance parameters registered in the ipsilateral external carotid artery. In 7 out of 9 cases, neurogenic tumors were homogeneous, and in the remaining 2 cases – heterogeneous. Four schwannomas were hypervascular or showed moderate vascularity, and the rest of neurogenic tumors were hypovascular or avascular, with symmetrical maximum velocity and resistance values of carotid blood flow. Apart from one branchial cleft cyst with multiple fine internal acoustic reflexes, all other neck cysts were anechoic and avascular, and presented with posterior acoustic enhancement. The laryngocele presented as a well-demarcated, hypoechoic, homogeneous lesion located in the immediate proximity of the larynx, without signs of internal vascular flow. Lipomas were well-demarcated, homogeneous, hypoechoic tumors with regular margins, without signs of internal vascular flow. Venous malformations presented as irregular, hypoechoic spaces with venous blood flow, easily compressed by the probe. Extracranial carotid artery aneurysms were hypoechoic, well-defined spaces, which presented with slow internal, turbulent flow on Doppler study, and showed continuity with the carotid artery. Conclusions: Doppler ultrasound allows to visualize features characteristic for certain neck tumors. Solid or cystic structure, echogenicity, localization, as well as internal flow signals and vascularity pattern create a combination of ultrasound findings helpful in the differential diagnosis of lesions such as paragangliomas, venous malformations, neurogenic tumors, aneurysms, cysts and laryngoceles.

PL

Cel pracy:Celem pracy była analiza obrazu ultrasonograficznego guzów szyi oraz ustalenie charakterystycznych cech umożliwiających różnicowanie poszczególnych patologii. Materiał i metody: W badanej grupie było 57 chorych: 16 z przyzwojakiem tętnicy szyjnej wspólnej, 9 z guzem neurogennym, 8 z malformacją żylną, 12 z torbielą szyi, 6 z tłuszczakiem, 5 z tętniakiem tętnicy szyjnej oraz 1 z laryngocele. Wyniki: Wszystkie przyzwojaki były położone w podziale tętnicy szyjnej wspólnej; prezentowały liczne naczynia o niskooporowym przepływie krwi oraz większe prędkości i niższe wartości oporu naczyniowego w tętnicy szyjnej zewnętrznej po stronie guza. Guzy neurogenne miały utkanie homogenne (7/9) lub niejednorodne (2/9). W czterech guzach schwannoma unaczynienie było bogate lub umiarkowane, u pozostałych chorych skąpe; wartości prędkości oraz współczynników oporu przepływu krwi w tętnicach szyjnych zewnętrznych były obustronnie porównywalne. Jedna torbiel boczna szyi zawierała drobne, rozproszone wewnętrzne odbicia, pozostałe zmiany były bezechowe, wszystkie ze wzmocnieniem akustycznym, bez sygnałów przepływu krwi. Laryngocele miało postać hipoechogenicznej, nieunaczynionej zmiany położonej w bezpośrednim sąsiedztwie krtani. Tłuszczaki były dobrze odgraniczonymi, hipoechogenicznymi guzami o regularnych obrysach i jednorodnej echostrukturze, bez cech przepływu krwi. Malformacje żylne miały postać hipoechogenicznych, nieregularnych przestrzeni, podatnych na ucisk, o żylnym spektrum przepływu krwi. Tętniaki tętnic szyjnych miały postać dobrze odgraniczonych, hipoechogenicznych przestrzeni w łączności z tętnicą szyjną, ze zwolnionym, turbulentnym przepływem krwi. Wnioski: Dopplerowskie badanie ultrasonograficzne wykazuje cechy charakterystyczne dla poszczególnych guzów szyi. Odróżnienie zmian litych od płynowych, echostruktura i lokalizacja, cechy przepływu krwi i typ unaczynienia tworzą kompozycje objawów pomocne w różnicowaniu zmian ogniskowych.

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Coexistence of posterior cerebral circulation anatomical variations and basilar artery aneurysms: Case-control study

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Czuba M. E., Frączek M. J., Ciuk K., Polak J., Gabryś P., Brzegowy P., Urbanik A., Czuba M. E., Frączek M. J., Ciuk K., Polak J., Gabryś P., Brzegowy P., Urbanik A.

Folia Medica Cracoviensia

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2020

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vol. 60

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issue 3

Refine search results

Visceral artery aneurysms – classification, diagnosis and treatment

Endovascular coil embolization of the left internal carotid artery aneurysm – case report

Rare case of hepatic artery pseudoaneurysm

Cide-AGene Expression in Patients with Obesity Qualified for Endovascular Treatment of Abdominal Aorta Aneurysm

Percutaneous Endovascular Abdominal Aortic Aneurysm Repair Within the Infrarenal Region. Preliminary Report

Vascular complications in patients with Autosomal Dominant Polycystic Kidney Disease. A review of the literature and current clinical recommendations

Doppler ultrasound appearance of neck tumors

Coexistence of posterior cerebral circulation anatomical variations and basilar artery aneurysms: Case-control study