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Popliteal artery aneurysm (PAA) has been increasingly treated with endovascular intervention in recent years. However, whether transpedal access can be utilized to treat PAA has not been widely reported. We report a case of successful treatment of a PAA with a covered stent via retrograde transpedal approach in an 80-year male with prohibitive surgical risk who initially failed antegrade approach. This case demonstrates the feasibility of treating PAA via a retrograde transpedal access in selected patients.

Objective To evaluate the clinicoradiologic characteristics of hemorrhagic meningiomas (HMs) that are missed or misdiagnosed on radiologic imaging studies. Methods Clinical and radiologic data from 6 patients with HM who were initially misdiagnosed were collected and recorded respectively. In addition, we performed a literature review for misdiagnosed HM and summarized the results. Results Five of the 6 patients with misdiagnosed HM were female, and 1 was male. Both computed tomography (CT) and magnetic resonance imaging were performed in 4 patients, and CT alone was performed in 2. On CT, the HM was heterogeneously hyperdense in 5 patients and isodense in 1 patient. In all 4 patients who underwent magnetic resonance imaging, the HM was mixed iso- and hypointense on T1-weighted imaging and heterogeneously hyperintense on T2-weighted imaging. Marked heterogeneous contrast enhancement was observed in 2 patients, strong rim enhancement in 1, and peripheral enhancement in 1. The dural tail sign was seen in only 1 patient. The initial radiologic misdiagnoses were subdural hematoma (n = 1), malignant glioma (n = 1), ruptured arterial aneurysm (n = 1), metastasis (n = 2), and uncertain (n = 1). In the literature review, 22 cases of HM diagnostic error were collected. The main misdiagnoses were subdural hematoma (27.3%), traumatic hematoma (13.6%), vascular anomaly (13.6%), malignant glioma (4.5%), and metastasis (4.5%). Conclusions Our study showed that in patients with HM with inadequate imaging evaluation, a small tumor associated with massive hematoma and atypical imaging features was more likely to be misdiagnosed.

Introduction: The most common lesions of jugular vein dilatation are aneurysms and ectasia. A jugular vein aneurysm is less common compare to an arterial aneurysm in adults. Because of the rare incidence, treatment guidelines primarily associated with the timing of surgery are not clearly established. Proper treatment can reduce patient complaints without excessive intervention. Case report: A 54 years old woman complained of swelling in the right neck that started three years ago and cephalgia for two years. From CT angiography, we obtained a jugular vein dilatation of 2.3 cm. During periodic evaluation from ultrasonography doppler, there is no increase in the size of the jugular vein. Conclusion: Jugular vein aneurysm presenting in adults is an infrequent phenomenon. It is a benign condition, and conservative observation is advised. It should be operated only if symptomatic or progressive enlarging. A periodic examination must be done to evaluate the size of the jugular vein before a surgical decision

Vascular Ehlers–Danlos syndrome (vEDS) causes fatal vascular complications due to vascular fragility. However, invasive therapeutic procedures are generally avoided except in emergencies. We report a case of vEDS presenting with rapid expansion of a hepatic arterial aneurysm successfully treated using prophylactic endovascular therapy. A 43-year-old woman with vEDS confirmed by genetic testing was hospitalized for a symptomatic hepatic arterial aneurysm that expanded rapidly within a week. Prophylactic coil embolization was then successfully performed. Although the general applicability of this approach cannot be determined, prophylactic endovascular therapy can clearly be an option for arterial aneurysms at high risk of rupture.

Objectives Segmental arterial mediolysis is a rare disease that most commonly affects the superior mesenteric artery among abdominal arteries. However, aneurysms involving the ileocolic arterial branch of the superior mesenteric artery are extremely rare. Here, we describe the treatment of a patient with an ileocolic arterial aneurysm suspected to have occurred secondary to segmental arterial mediolysis. Methods We confirmed the diagnosis of ileocolic arterial aneurysm, which showed the characteristic “string-of-beads” appearance of the distal main trunk of the superior mesenteric artery on angiography. We performed endovascular coil embolization for the aneurysm, and for both the inflow and outflow vessels. After confirming that the aneurysm was no longer visible, the treatment was completed. Results There were no clinical findings suspicious of ischemic enteritis or intestinal necrosis after embolization. We confirmed that the ileocolic arterial aneurysm was not observed on computed tomography angiography one month after treatment. Conclusions While development of an ileocolic arterial aneurysm associated with segmental arterial mediolysis is very rare, it is at a high risk of sudden rupture. Therefore, coil embolization is a useful intervention in such patients and can be implemented based on the size and morphology of the aneurysm.

ZusammenfassungGefäßchirurgische Zentren in Österreich (n = 15) wurden Mitte April 2020 mit erklärendem Begleitschreiben des Vorstands der Österreichischen Gesellschaft für Gefäßchirurgie (ÖGG) eingeladen, an einer Onlineumfrage über die Implikationen der COVID-19-Pandemie teilzunehmen. Insgesamt 12 Zentren (80 %) haben den Fragebogen ausgefüllt.Alle Zentren waren mit positiv getesteten Patienten und 75 % auch mit positiv getesteten Mitarbeitern konfrontiert. Deutlich seltener war dies jedoch an den gefäßchirurgischen Abteilungen (positiv getestete Patienten in 25 %/Mitarbeiter in 33 %). Elektive Eingriffe wurden an allen Abteilungen entweder gestoppt (abgesagt oder verschoben) oder selektiv eingeschränkt. Dies betraf u. a. auch symptomfreie Patienten mit Karotisstenose, Aortenaneurysma kleiner 7 cm, peripherem Aneurysma, PAVK im Stadium II nach Fontaine oder Varikose. In allen Zentren wurden weiterhin uneingeschränkt gefäßchirurgische Notfälle behandelt. Uneinheitlich war das Vorgehen bei chronischen Ulzera, chronischer Mesenterialinsuffizienz, symptomfreiem Aortenaneurysma größer 7 cm und in der Shuntchirurgie.Insgesamt war v. a. die zum Zeitpunkt der OP-Verschiebungen unklare Befristung der Maßnahmen problematisch, somit war auch das Risiko der abgesagten bzw. hinausgezögerten Behandlung nicht leicht abschätzbar. Für die Indikationen mit uneinheitlichem Vorgehen sollte unizentrisch und multizentrisch das Ergebnis der Patienten analysiert werden, auch hinsichtlich der mit der Verschiebung assoziierten psychologischen Belastung. Zudem bedürfen auch die aufgrund der COVID-19-Pandemie erfolgten Veränderungen im Alltag einer kritischen Auswertung, auch hinsichtlich demografischer und geografischer Unterschiede. Es ist anzunehmen, dass die Auswirkungen der COVID-19-Pandemie langfristig bedeutsam sind.

Background: Failure of the primary management at controlling the post-partum hemorrhage (PPH) is occasionally encountered. A catastrophic cause of PPH as vagina arterial aneurysms with AVF is rare and not reported in English literature.Case presentations: We present a 34-year-old woman of arterial aneurysms with arteriovenous fistulas (AVF) at bilateral lower vagina causing intractable PPH with aggressive bleeding. By trans-arterial embolization (TAE) the bleeding is successfully controlled, and patient then could recover smoothly.Conclusion: These vascular anomalies being fierce culprit of the PPH would result in primary management failure. Knowledge of the possible etiology of post-partum hemorrhage is crucial for treatment management. This case report aims to point out a pivotal role of TAE at detecting and treating this unusual cause of PPH.

Objective – according to the separate clinical observation to evaluate the strategy and tactics of an individualized treatment planning after the rupture of posterior inferior cerebellar artery (PICA) aneurysm in acute period of hemorrhagic stroke. Materials and methods. A retrospective analysis of the case of microsurgical treatment of PICA aneurysm in the acute period after hemorrhage was performed. The patient’s diagnosis and treatment was held at the State Institution «Romodanov Neurosurgery Institute, NAMS of Ukraine» in 2019. The patients age at the time of diagnosis was 50 years. The complex of diagnostic workout included clinical neurological examination, instrumental (neuroimaging and functional tests) and laboratory investigation. Results. According to the results of comprehensive clinical and instrumental examination, patient underwent emergency combined one-stage surgical procedure that include aneurysms clipping with external ventriculostomy of the posterior horn of the right lateral ventricle for surgical correction of the consequences after aneurysms rupture (expansion of the blood into the ventricular system, with hemotamponade of III and IV ventricle, internal obstructive hydrocephalus), which caused the emergency of surgical procedure. The intervention (external drainage of the posterior horn of the right lateral ventricle, clipping of left PICA aneurysm) was performed on the 5th day after rapture. Operation and postoperative period have passed without complications with positive neurological and neuroimaging follow-up. Conclusions. The applied diagnostic and therapeutic options can be utilized as a method of choice for individualized surgical planning after rapture of PICA aneurysm.

Key Clinical Message The natural history of idiopathic peripheral pulmonary arterial aneurysms (PAAs) is unclear; however, they can cause sudden death by rupture. Our case illustrates the utility and low invasiveness of transcatheter embolization using an AMPLATZER™ Vascular Plug 4 and hydrogel‐coated metallic coils in patients with idiopathic peripheral PAAs.

International audience; We describe the fourth cases of arterial aneurysm consecutive to Capnocytophaga canimorsus infection in a 77-year-old man. The infection occurred after a dog bite. He presented fever. The thoracic-abdominal computed tomography angiography revealed aneurysms on the abdominal aorta, left common femoral artery, and left popliteal artery. The diagnosis was performed by a blood culture positive for Capnocytophaga canimorsus. The outcome was favorable with surgery and antibiotic therapy.

BACKGROUND: The aim of the present study is to develop relevant quality indicators (QI) to monitor and improve quality of care in vascular surgery. METHODS: The Delphi method was used to incorporate expert opinion to reach consensus on a set of QI. A national expert panel consisting of 52 vascular surgeons was installed on a voluntary basis and endorsed by the Belgian Society of Vascular Surgery and the Flemish Hospital Network KU Leuven. A task force team consisting of 12 surgeons was created to serve as a delegation of the expert panel to discuss and filter the obtained data from the different Delphi rounds. RESULTS: A total of 3 Delphi rounds were needed to reach consensus on a set of 20 QI. Each QI had a content validity index (using a 7-point Likert scale), a feasibility index, and a target level. Twelve outcome indicators and 8 process indicators on several vascular topics were selected: overall for all vascular treatments (n = 1), arterial occlusive disease in general (n = 3), arterial occlusive disease of the lower limbs (n = 4), arterial occlusive disease of the carotid arteries (n = 5), arterial aneurysm disease in general (n = 2), arterial aneurysm disease with endovascular treatment (n = 1), and venous disease (n = 4). CONCLUSIONS: This resulted in the successful identification of 20 validated and relevant vascular QI, focusing on arterial occlusive disease, arterial aneurysm disease, and venous disease. The next step in this project will be the performance of an implementation study. ispartof: ANNALS OF VASCULAR SURGERY vol:71 pages:237-248 ispartof: location:Netherlands status: published

Highlights • Aneurysms of the proximal occipital artery may cause symptoms by compressing adjacent structures. • Resection may require intubation by the nose. • Resection if usually followed by regeression of symptoms., Introduction True aneurysms of the proximal occipital artery are rare, may cause neurological symptoms due to compression of the hypoglossal nerve and their resection may be technically demanding. Presentation of case The case of an aneurysm of the proximal occipital artery causing discomfort and tongue deviation by compression on the hypoglossal nerve is reported. Postoperative course after resection was followed by complete regression of symptoms. Conclusion Surgical resection, as standard treatment of aneurysms of the occipital artery, with the eventual technical adjunct of intubation by the nose is effective in durably relieving symptoms and preventing aneurysm-related complication.

An axillary arterial aneurysm is a rare disorder, with few surgical cases reported to date. Here we report the case of a left axillary arterial aneurysm associated with Marfan syndrome. A 44-year-old female with Marfan syndrome presented with numbness of the left upper limb and a pulsatile mass on the left chest. A computed tomography scan revealed a highly enlarged and tortuous left axillary arterial aneurysm. We performed a graft replacement and resection of the aneurysm with two skin incisions. After the surgery, the blood flow to the patient's left upper limb was confirmed, and the neurological symptoms improved significantly.

Introduction In patients with popliteal artery aneurysm lacking a suitable vein for bypass, prosthetic graft, or endovascular stent graft are alternative treatment options. However, durability is limited. Construction of an autologous spiral vein graft has previously been used to replace infected aortic grafts and arteriovenous fistulas. Technical summary Five patients underwent surgery for popliteal arterial aneurysm with the spiral vein graft technique. Technical success was 100%. Operative technique and results are reported. Conclusion The spiral vein graft technique can be used for popliteal artery aneurysm with good short term results, avoiding use of prosthetic grafts.

The aim of this study was to evaluate the safety and clinical effectiveness of endovascular stent repair of celiac arterial aneurysm (CAA). From January 2015 to December 2018, 11 patients (7 males, 4 females with a mean age of 52.2 ± 7.9 years) underwent endovascular stent repair of CAA in our center. A covered stent was used to occlude the CAA neck. Follow-up was performed 2 weeks and 1, 3, 6, and 12 months following surgery and yearly thereafter. Rates of technical success, treatment-related complications, and long-term outcome were analyzed. Each patient was placed with 1 stent for repair of CAA. Stent was placed in the celiac and common hepatic arteries for 10 patients and was placed in the celiac artery for 1 patient. The duration of the procedure ranged from 50 to 75 minutes (mean 63.2 ± 7.2 minutes). The rate of technical success of the endovascular stent repair was 100%. No patient experienced CAA rupture or instant endoleak during or after stent insertion. Abdominal pain was relieved progressively after stent insertion. All patients were followed-up for 6 to 48 months (mean 22.4 ± 10.8 months). All patients were alive during the follow-up. No endoleaks were experienced during follow-up with 100% stent patency rate. No patient suffered splenic, hepatic, or bowel infarction during follow-up. Endovascular stent repair is a safe, simple, and effective treatment for patients with CAA.

The GORE EXCLUDER Iliac Branch Endoprosthesis (IBE; W. L. Gore and Associates, Flagstaff, AZ, USA) applicability is limited by the aorto-iliac length (AOL). The shortage may be a major exclusion criterion. An 85-year-old male presented with an abdominal aortic and left common iliac arterial aneurysm. The left-side AOL was 146-mm, which was deemed 19-mm too short for IBE usage. To increase implantation length, the contra-lateral connection stent graft was deployed along the implantation line, wound half-circumferentially around the ipsilateral limb. Any form of endoleak, limb occlusion, and device migration has not been observed for twelve months.

Background: Arterial aneurysmatic lesions are one of the unique features of Behcet’s disease (BD). However, it is difficult to determine which BD patients will develop an aneurysm. Objectives: In this study, we aimed to determine the differences between BD patients with and without an arterial aneurysm. Methods: Data of the 23 BD patients with an arterial aneurysm was published as an abstract in 2013 (1). We retrospectively reviewed the medical records of 441 patients with BD according to International Study Group (ISG) criteria between January 2013 and June 2018. Totally, we determined 45 BD patients with an arterial aneurysm. Six patients with isolated carotid and/or cranial arterial aneurysms who were followed by other clinics excluded from the analysis. Overall, 39 BD patients with an extracranial and extra carotidal aneurysm included in the study. Data regarding demographic features, clinical, laboratory and vascular imaging findings were collected. Results: A total of 39 BD patients (Male: 76.9%) with an arterial aneurysm were analyzed in this study. Mean age, mean age of diagnosis and a median follow-up of patients were 40.9±11.0 years, 29.7±7.7 and 71.8 (2-186) months, respectively. The mean age at the onset of the arterial aneurysm was 36.1±11.5 years. The median time lag between the onset of BD and detection of an aneurysm was 63.6 (0-482) months. The prevalence of male patients in BD with aneurysms, without aneurysms and only mucocutaneous were 76.9%, 52.3%, and 34.3%, respectively. Comparison of BD patients with and without an aneurysm shown in table 1. In multivariate analysis, having a venous thrombosis was the sole risk factor for the development of arterial aneurysm (OR 10.53, 95% CI 1.53-72.71) (Table). Distribution of aneurysms was shown in the figure. At the first diagnosis, a median number of the aneurysm was 1 (1-4), the median diameter of an aneurysm was 39 mm (10-80) and 16 (41%) patients had more than one aneurysm. Type of the firstly detected aneurysm was as follows; 38.5% saccular, 17.9% fusiform, 15.4% pseudoaneurysm and 2.6% dissecting aneurysms. Aneurysm type was not known in 25.6% of patients. The first diagnostic finding was an aneurysmal symptom in the 25% of BD patients. Conclusion: Aneurysm was the diagnostic symptom in 25% of BD patients with an aneurysms. The median time lag between the onset of BD and detection of an aneurysm was almost 5 years. In aneurysmal BD, there is male sex dominance and having venous thrombosis is the most important risk factor. Although pulmonary arteries have an important role in the BD course, the involvement of the aorta and iliac arteries can be seen frequently. References [1] Kalyoncu U, et al. Ann Rheum Dis 2013;72 (abs) Disclosure of Interests: Berkan Armagan: None declared, Ertugrul Cagri Bolek: None declared, Alper Sari: None declared, Gozde Kubra Yardimci: None declared, Bayram Farisogullari: None declared, Emre Bilgin: None declared, Fatma Gonca Eldem: None declared, Levent Kilic: None declared, Omer Karadag: None declared, Bora Peynircioglu: None declared, Barbaros Erhan Cil: None declared, Metin Demircin: None declared, Ali Akdogan: None declared, Sule Apras Bilgen: None declared, Ali Ihsan Ertenli: None declared, Sedat Kiraz: None declared, Umut Kalyoncu Grant/research support from: MSD, Roche, UCB, Novartis and Pfizer, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim, Speakers bureau: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim

Objective Vascular Ehlers-Danlos syndrome (vEDS) is a rare connective tissue disorder owing to pathogenic variants in COL3A1 that lead to impaired type III collagen production. We aim to describe the contemporary multi-institutional experience of aortic and arterial pathology in individuals with vEDS, to evaluate disease patterns and refine management recommendations. Methods This cross-sectional, retrospective study of individuals with genetically confirmed vEDS was conducted between 2000 and 2015 at multiple institutions participating in the Vascular Low Frequency Disease Consortium. Aortic and arterial events including aneurysms, pseudoaneurysms, dissections, fistulae, or ruptures were studied. Demographics, COL3A1 variants, management, and outcomes data were collected and analyzed. Individuals with and without arterial events were compared. Results Eleven institutions identified 86 individuals with pathogenic variants in COL3A1 (47.7% male, 86% Caucasian; median age, 41 years; interquartile range [IQR], 31.0-49.5 years; 65.1% missense COL3A1 variants). The median follow-up from the time of vEDS diagnosis was 7.5 years (IQR, 3.5-12.0 years). A total of 139 aortic/arterial pathologies were diagnosed in 53 individuals (61.6%; 50.9% male; 88.5% Caucasian; median age, 33 years; IQR, 25.0-42.3 years). The aortic/arterial events presented as an emergency in 52 cases (37.4%). The most commonly affected arteries were the mesenteric arteries (31.7%), followed by cerebrovascular (16.5%), iliac (16.5%), and renal arteries (12.2%). The most common management was medical management. When undertaken, the predominant endovascular interventions were arterial embolization of medium sized arteries (13.4%), followed by stenting (2.5%). Aortic pathology was noted in 17 individuals (32%; 58.8% male; 94.1% Caucasian; median age, 38.5 years; IQR, 30.8-44.7 years). Most notably, four individuals underwent successful abdominal aortic aneurysm repair with excellent results on follow-up. Individuals with missense mutations, in which glycine was substituted with a large amino acid, had an earlier onset of aortic/arterial pathology (median age, 30 years; IQR, 23.5-37 years) compared with the other pathogenic COL3A1 variants (median age, 36 years; IQR, 29.5-44.8 years; P = .065). There were 12 deaths (22.6%) at a median age of 36 years (IQR, 28-51 years). Conclusions Most of the vEDS arterial manifestations were managed medically in this cohort. When intervention is required for an enlarging aneurysm or rupture, embolization, and less frequently stenting, seem to be well-tolerated. Open repair of abdominal aortic aneurysm seems to be as well-tolerated as in those without vEDS; vEDS should not be a deterrent to offering an operation. Future work to elucidate the role of surgical interventions and refine management recommendations in the context of patient centered outcomes is warranted.

We describe a treatment strategy for an aberrant arterial aneurysm associated with pulmonary sequestration. A 58-year-old man with impending aberrant arterial aneurysm rupture underwent a 2-stage surgery that included an emergency thoracic endovascular aortic repair (TEVAR) of the descending aorta to occlude the origin of the aberrant artery, followed by lobectomy. TEVAR can lead to faster occlusion of the aneurysm and can avoid operative risk of aneurysm rupture during lobectomy. The aberrant artery was broad where it branched off the aorta and had a short neck, rendering primary ligation or stump-forming unsuitable. Pathological findings revealed the fragility of the aberrant artery; thus, its root was prone to breakdown of the stump after simple aneurysmectomy. Furthermore, TEVAR may reduce graft infection during lobectomy in the second surgery. The 2-stage surgery may be useful for aberrant aneurysms complicated by pulmonary sequestration.

Pulmonary arterial aneurysm is a rare condition involving a focal dilation of the pulmonary artery and all three layers of the vessel wall. Few reports have described managing this anomaly using video-assisted thoracoscopic surgery. We report a 60-year-old woman with a pulmonary artery aneurysm in the truncus superior of the right pulmonary artery. The patient underwent a two-port video-assisted thoracoscopic surgery with a right upper lobectomy. The postoperative course was uneventful. She maintained a good prognosis for 4 months after surgery, and we continue to take great care throughout her follow-up.

OBJECTIVES: Ninety-five per cent of those operated on for popliteal artery aneurysm (PA) are men. Thus, PAs in women are difficult to investigate. The aim was to study the disease in women.METHODS: Women treated for PA in 1987-2012, prospectively registered in the Swedish vascular registry, Swedvasc, supplemented by case records, were compared with the larger male cohort. Survival was determined through cross linkage with the National Population Registry.RESULTS: 1509 patients (men and women), 1872 legs, were identified; of these 74 patients (4.9%) were women, 81 legs (4.3%). The median age was 70 years in women versus 69 in men. Twenty-nine centres operated on women (range 1-7 women/centre). There were no time trends in the proportion of women operated on (p=.5). Bilateral PA occurred in 9.5% of women and 27.0% of men (p=.002). For symptomatic aneurysms, there was a larger proportion of small aneurysms (CONCLUSIONS: PA is similar in women and men, but bilateral disease was less common in women and symptomatic PA were more often

Ruptured abdominal aortic aneurysm (AAA) is associated with nearly 100% mortality when left untreated. If a patient presents with an AAA rupture, emergent surgery is required. Patients with symptoms from an unruptured AAA require urgent surgery. Patients with an AAA > 5.5 cm, peripheral artery disease, peripheral arterial aneurysm, or rapid expansion of AAA should undergo elective repair. Surgical options include open repair and endovascular repair. Patients who do not meet criteria for repair should receive counseling on risk factor modification, including tobacco cessation, exercise, blood pressure and cholesterol management, and antiplatelet therapy.

Pediatric arterial aneurysm is rare disease. Among them, idiopathic-congenital arterial aneurysm is extremely rare. This is a case report of right common iliac artery idiopathic aneurysm with absence of right external iliac artery. A 4-year-old girl who had been complaining of intermittent abdominal pain since 2 years prior presented with a right lower abdominal mass that had been palpable since 6 months prior. Abdominal CT revealed a 5.2 cm × 4.5 cm × 5.1 cm, right-sided, partially thrombosed, saccular, iliac artery aneurysm. She underwent to operation, aneurismal resection. A pathological examination confirmed that it was a true aneurysm, considering that all layers of the vascular wall were stretched with no deficit. The patient was discharged 3 days after the surgery without any complication. Five months passed since the surgery, and the patient is doing well without any abdominal or leg pain.

Aneurysmal disease affecting the aorta and visceral vessels in young patients is uncommon and typically associated with connective tissue disorders. We describe the case of a 17-year-old girl who presented with acute onset of abdominal pain; computed tomography scan revealed aortic and bilateral renal artery aneurysms and a perirenal hematoma. She was taken to the angiography suite; rupture of the right renal artery aneurysm was identified and immediately treated successfully with coil embolization. The left renal artery aneurysm was repaired with ex-vivo renal autotransplantation; 2 years later, the aorta and right renal artery underwent surgical reconstruction.

Context: Concurrent arterial aneurysms (AAs) occurring in 2.7-16.7% patients harboring an arteriovenous malformation (AVM) aggravate the risk of intracranial hemorrhage. Aim: We evaluate the variations of aneurysms simultaneously coexisting with AVMs. A classification-based management strategy and an abbreviated nomenclature that describes their radiological features is also proposed. Setting: Tertiary care academic institute. Statistics: Test of significance applied to determine the factors causing rebleeding in the groups of patients with concurrent AVM and aneurysm and those with only AVMs. Subjects and Methods: Sixteen patients (5 with subarachnoid hemorrhage and 11 with intracerebral/intraventricular hemorrhage; 10 with low flow [LF] and 6 with high flow [HF] AVMs) underwent radiological assessment of Spetzler Martin (SM) grading and flow status of AA + AVM. Their modified Rankin's score (mRS) at admission was compared with their follow-up (F/U) score. Results: Pre-operative mRS was 0 in 5, 2 in 6, 3 in 1, 4 in 3 and 5 in 1; and, SM grade I in 5, II in 3, III in 3, IV in 4 and V in 1 patients, respectively. AA associated AVMs were classified as: (I) Flow-related proximal (n = 2); (II) flow-related distal (n = 3); (III) intranidal (n = 5); (IV) extra-intranidal (n = 2); (V) remote major ipsilateral (n = 1); (VI) remote major contralateral (n = 1); (VII) deep perforator related (n = 1); (VIII) superficial (n = 1); and (IX) distal (n = 0). Their treatment strategy included: Flow related AA, SM I-III LF AVM: aneurysm clipping with AVM excision; nidal-extranidal AA, SM I-III LF AVM: Excision or embolization of both AA + AVM; nidal-extranidal and perforator-related AA, SM IV-V HF AVM: Only endovascular embolization or radiosurgery. Surgical decision-making for remote AA took into account their ipsilateral/contralateral filling status and vessel dominance; and, for AA associated with SM III HF AVM, it varied in each patient based on diffuseness of AVM nidus, flow across arteriovenous fistula and eloquence of cortex. Follow up (F/U) (23.29 months; range: 1.5-69 months) mRS scores were 0 in 12, 2 in 2, 3 in 1 and 6 in 1 patients, respectively. Conclusions: Patients with intracranial AVMs should be screened for concurrent AAs. Further grading, management protocols and prognostication should particularly “focus on the aneurysm.”

An aberrant arterial aneurysm with pulmonary sequestration is rare. Here, we report about a 35-year-old man who had no symptoms related to pulmonary sequestration. Computed tomography revealed an aberrant arterial aneurysm with an 18 mm in diameter with intralobar pulmonary sequestration, which gradually increased in size to 27 mm over 5 years. The patient underwent thoracic endovascular aortic repair with coil embolization for the aneurysmal distal branches to prevent aneurysm rupture. The postoperative course was unremarkable without a need for lobectomy. During a 1-month follow-up period, the aneurysm shrunk with no endoleaks. Stent-graft placement and coil embolization represent an effective and less invasive treatment option to completely block systemic arterial flow and unexpected retrograde backflow and control the expansion of the aneurysm.

Background Extracranial carotid artery aneurysm is an extremely rare peripheral arterial aneurysm. The treatments of extracranial CAAs include open surgical, endovascular, and conservative options. Main surgical indications are transient ischemia attacks, strokes, or progressive growth. But both open surgery and endovascular repair have disadvantages and complications. Methods We report a case of true internal carotid artery aneurysm (ICAA) with hostile anatomic conditions for both open surgery and endovascular approach in a 53-year-old man who presented with new cerebral infarctions. According to the features of this case, the patient was treated with a new hybrid procedure with extra-luminal aneurysm repair. A sheath was inserted through the common carotid artery, maneuvered out of the lumen through the proximal landing zone of the ICAA, and then returned into the distal normal vessel of the internal carotid artery. A stent graft was delivered through the sheath and was deployed while retrieving the sheath. Results The aneurysm was repaired successfully with an uneventful postoperative course and no postprocedural complications. The patient has been followed up for 2 years with no symptom, and the stent was patent without restenosis. Conclusions The procedure is feasible and provides a new solution for difficult cases like this.

Background The association between a dural arteriovenous fistula (dAVF) and perimedullary arteriovenous fistula (AVF) is rarely observed at the craniocervical junction (CCJ). We present a case of subarachnoid hemorrhage (SAH) with concurrent dAVF and perimedullary AVF at the CCJ. Here, we describe the cause of bleeding and the process of determining whether it was a varix or an arterial aneurysm. Case Description A 69-year-old man with SAH visited the emergency department. A dAVF at the CCJ was detected on digital subtraction angiography (DSA). However, after 3 weeks, when the DSA was repeated, a perimedullary AVF and varix were identified. We performed an endovascular treatment, but because the perimedullary AVF remained, we performed a direct surgery. The patient was discharged without weakness, but this left abducens nerve palsy remained. Conclusions In recent reports, SAH caused by concurrent dAVF and perimedullary AVF raised the possibility of an arterial aneurysm. However, in this case, the possibility of venous bleeding was high and a varix rather than an aneurysm was observed. On the basis of the reported cases, concurrent dAVF and perimedullary AVF at the CCJ is a "middle-flow arteriovenous shunt" that may induce a varix or an arterial aneurysm.

Objective To evaluate the parameters related to the high risk of preoperative seizures in infants (1 year or younger) with ruptured intracranial aneurysms. Methods Infants with ruptured intracranial aneurysms treated at our institution from January 2012 to January 2018 were retrospectively analyzed. Seventeen similar cases of infant patients with seizures reported in published studies were reviewed. Results The mean age of the 7 infant patients treated at our institution was 4.1 ± 3.3 months (range, 28 days to 11 months), with 2 male and 5 female subjects. One patient (14.3%) had an internal carotid artery aneurysm with subarachnoid hemorrhage, and the remaining 6 patients (85.7%) had middle cerebral artery (MCA) aneurysms in the distal arterial region with lobe hemorrhage. Five of the 7 infants (71.4%) had seizures, 4 of whom (4/5, 80.0%) had MCA distal arterial aneurysms with lobe hemorrhage. Management was successful for all patients with aneurysm clipping or resection surgery, and one patient experienced postoperative seizures. Of the 17 reviewed cases of infant patients with seizures, 10 patients (58.8%) exhibited the typical distal arterial aneurysm with lobe hemorrhaging, and 6 (60%) of them had aneurysms in MCA. Conclusions Infant patients with ruptured intracranial aneurysms have a high risk of preoperative seizures. The typical radiologic finding of distal arterial aneurysm with lobe hemorrhage was frequently observed in the MCA, and it might be related to the high risk of preoperative seizures in this population. Microsurgical techniques effectively control postoperative seizures in infants with ruptured intracranial aneurysms.

An 84-year-old man with chronic obstructive pulmonary disease (COPD) was referred to our institution for further treatment of severe swelling of the left lower extremity. The left iliac vein was compressed by the abdominal aortic aneurysm and a right common iliac arterial aneurysm measuring 62 mm and 45 mm in diameter and was partially thrombosed. Multiple pulmonary artery embolisms were also noted. Endovascular repair of the abdominal aortic aneurysm and the right common iliac arterial aneurysm was performed because of his respiratory dysfunction. The left leg edema gradually resolved after endovascular treatment. Six months after the treatment, computed tomography (CT) demonstrated resolution of the venous thrombus of the left lower extremity. Although open surgery is reliable treatment for iliac compression syndrome, endovascular treatment might be a feasible and an adequate therapeutic option for patients who have severe comorbidities, complications, or high frailties.

Introduction: The decision for active intervention for unruptured intracranial aneurysm patients are challenging due to most unruptured intracranial aneurysm patients are asymptomatic and they are reasonably healthy, but the procedure related risks such as stroke and mortality cannot be ignored. Selected high volume centers’ outcomes can potentially mislead the decision making process. Thus we aim to review the real-world clinical outcome of unruptured intracranial aneurysm treatment through a large national database. Methods: Unruptured intracranial aneurysm patients (18 to 86 years) from the 2007 to 2013 National Inpatient Sample Data were analyzed. Clinical outcomes evaluated include mortality, stroke, combined mortality and stroke, discharge home rate and complications except for mortality and stroke (M&S). Comparison of clinical outcomes between coiling and clipping were made through multivariate logistic regression and propensity-score matching. Also, hospital volume effects and over time trend of clinical outcomes per each intervention were analyzed. Results: Among 54,202 unruptured intracranial aneurysm patients, 37,050 (68.3%) were not treated, and either clipping or coiling was performed in 17,077 (31.5%). 6,120 (35.8%) patients had clipping and coiling was performed in 10,957 (64.16%). Unadjusted overall mortality, stroke, discharge home rate and complications except M&S were 0.5%, 3.27%, 2.2%, 84.24% and 11.05%, respectively. Coiling was favored for stroke and discharge home rate (p0.05). Complications except M&S favored clipping and was statistically significant (p Conclusion: Active interventions on unruptured intracranial aneurysm showed very low overall mortality. However, coiling showed lower stroke rate and higher home discharge rate than clipping. There was no significant difference in mortality between coiling and clipping.

Introduction: Comparison of real world clinical outcomes between clipping and coiling for ruptured aneurysm is challenging, mainly due to confounding case severity and variation in physician expertise. We sought to compare outcomes and costs of coiling and clipping by utilizing a large national database. Methods: Ruptured intracranial aneurysm patients age 18 to 86 years were identified from the National Inpatient Sample (NIS) from 2007 to 2013. The clinical outcomes evaluated were in-hospital mortality, in-hospital stroke, discharge destination and other complications. Also, the total hospitalization cost was compared. Multivariate logistic regression and propensity-score matching were used. Confounding factors such as specific neurovascular comorbidities (e.g. hypertension, diabetes), Charleson comorbidity index (CCI), all patient refined diagnosis related group (APR-DRG) risk of mortality, APR-DRG severity index, and NIS-SAH severity score were also controlled for. Results: 14379 patients with ruptured intracranial arterial aneurysms were identified (5966 clipping, 8413 coiling). Univariate analysis showed that coiling patients had higher preprocedural risks by CCI (p < 0.001) and APR-DRG mortality (p Conclusions: After adjusting for severity, there was no significant difference in mortality between coiling and clipping in ruptured aneurysm treatment. However, coiling patients had a lower chance of an in-hospital stroke and a higher chance of being discharged home. A limitation of the study is the possibility of unmeasured confounders.

Preclinical studies are important in helping practitioners and device developers improve techniques and tools for endovascular treatment of intracranial aneurysms. Thus an understanding of the major animal models used in such studies is important. The New Zealand rabbit elastase induced arterial aneurysm of the common carotid artery is one of the most commonly used models in testing the safety and efficacy of new endovascular devices. In this review we discuss: (1) the various techniques used to create the aneurysm, (2) complications of aneurysm creation, (3) natural history of the arterial aneurysm, (4) histopathologic and hemodynamic features of the aneurysm, (5) devices tested using this model, and (6) weaknesses of the model. We demonstrate how preclinical studies using this model are applied in the treatment of intracranial aneurysms in humans. The model has similar hemodynamic, morphological, and histologic characteristics to human aneurysms, and demonstrates similar healing responses to coiling as human aneurysms. Despite these strengths, however, the model does have many weaknesses, including the fact that the model does not emulate the complex inflammatory processes affecting growing and ruptured aneurysms. Furthermore, the extracranial location of the model affects its ability to be used in preclinical safety assessments of new devices. We conclude that the rabbit elastase model has characteristics that make it a simple and effective model for preclinical studies on the endovascular treatment of intracranial aneurysms, but further work is needed to develop aneurysm models that simulate the histopathologic and morphologic characteristics of growing and ruptured aneurysms.

A case report of a ruptured dissecting aneurysm of the renal artery into the perinephric region. The patient presented at hospital with symptoms of severe acute colicky right flank pain with rapid deterioration. CT image demonstrates definite diagnosis and she recovers well after nephrectomy. The histology of the renal artery shows a dissecting renal arterial aneurysm due to cystic medial degeneration of the arterial wall.

The aim of this paper was to report an unusual case of a 30-year-old woman admitted to the emergency department for a subarachnoid spinal haemorrhage. Clinical presentation was typical and the initial CT-scan did not show any intracranial lesions. Diagnosis was then confirmed by a full-spinal MRI that revealed a cervical radiculomedullary artery aneurysm. The diagnosis was also confirmed by an arteriography that showed a left C6 radiculomedullary artery aneurysm. Surgical management was performed and included a direct approach of the vascular lesion using an anterolateral cervicotomy and occlusion of the parent vessel. Histological examination confirmed the typical aspect of the aneurysm. The postoperative course was uneventful and the patient was discharged from hospital at day 15. This type of vascular lesion is very uncommon and requires a prompt diagnosis. Initial MRI can confirm the presence of a subarachnoid haemorrhage related to the aneurysm, which can be also visualized by an arteriography. Management of these vascular disorders requires a multidisciplinary specialized spine-team and is commonly performed using a direct surgical approach.

Rupture of a chronic thrombosed or excluded popliteal arterial aneurysm is rare, but has been previously reported in the literature. The management of a ruptured thrombosed popliteal aneurysm, in a context of chronic limb ischemia, raises the problem of latent ischemia and its outcome. In this case report, we present the first case of a ruptured thrombosed popliteal aneurysm in a patient presenting chronic ischemia.

Isiyel E, Bakkaloglu S, Oguz D, Yenicesu I, Boyunaga O, Ozdemir Y, Damar C, Kandur Y, Akcaboy M, Aslan AT, Sismanlar T, Hasanoglan E, Buyan N. An adolescent case of extensive Behcet`s disease successfully treated with Infliximab. Turk J Pediatr 2019; 61: 585-588. Cardiac involvement is an uncommon and life-threatening complication of Behcet`s Disease. We present a 14-year-old boy, admitted to our hospital for recurrent hemoptysis. In his radiologic evaluation, a right ventricular thrombus and pulmonary arterial aneurysm were identified. He was diagnosed with Behcet`s Disease, and then he received prednisone and cyclophosphamide. However, his cardiac thrombus enlargened. After his treatment was replaced with infliximab, the pulmonary aneurysms regressed, and the cardiac thrombus disappeared. In conclusion, infliximab should be considered as a reliable option for vascular Behcet`s Disease resistant to conventional treatment.

Objective: Brachial arterial aneurysms are relatively uncommon in childhood. Development of the distal ischemic complications is the main risk in brachial arterial aneurysm and pseudoaneurysms. Nine infants who had surgery for brachial artery pseudoaneurysm in our clinic were reported and the results of the treatment are discussed. Material and Methods: Nine patients who were operated for pseudoaneurysms at our clinic between 2005 and 2010 were evaluated retrospectively from hospital records. Radiological diagnosis of pseudoaneurysms was considered as an indication for surgery. results: A total of 9 patients were evaluated, and six were girls. Pseudoaneurysms were located in the right arm in five patients. All the cases were referred from other pediatric centers. conclusion: Brachial arterial pseudoaneurysms in infants are a rare complication after multiple venous punctures. Early diagnosis and surgical reconstruction of these cases are very important for the prevention of ischemic complication. Brachial artery pseudoaneurysms with ultrasonographic diagnosis were repaired surgically at our clinic to prevent ischemic complications.

Intracranial pial arteriovenous fistulas (AVF) are rare vascular malformation especially in the first 2 years of life. The pathology in this age group is associated with greater morbidity and mortality. We report a rare case of 36-day-old male infant with a pial AVF associated with an arterial aneurysm, who presented with intraventricular hemorrhage and hydrocephalus. In addition, an online review of the literatures on pediatric pial AVF was performed using PubMed on published case reports and articles from 1980 to April 2013.