Petar Popov

Jugular vein aneurysm.

Jugular vein aneurysm is a rare morphologic entity. This report describes a case of an asymptomatic internal jugular vein aneurysm that presented as an enlarging mass in the neck. Diagnosis was established with duplex ultrasonography and venography. No thrombus was diagnosed in the aneurysm, but since the patient was uncomfortable with having a tumor in his neck, surgery was performed with resection of the aneurysm and lateral venorrhaphy of the jugular vein.

Distribution of Risk Factors in Patients with Premature Coronary, Supra-Aortic Branches and Peripheral Atherosclerotic Disease

Objective: The aim of this study was to determine the distribution of major risk factors among patients with atherosclerotic disease aged ≤50 years. Subjects and Methods: The study population comprised 944 patients aged ≤50 years with clinically significant manifestations of atherosclerotic disease compared with 350 consecutive (control) older patients (age >50 years). Results: The most significant risk factors for atherosclerotic disease of the supra-aortic branches were: smoking (87.5%, p < 0.001), family history of atherosclerosis (52.3%, p < 0.001), diabetes mellitus (28.5%) and being male (56.9%) (p < 0.05 for both). In patients with coronary artery disease, there was considerable disparity in the prevalence of smoking (85.4%), hyperlipoproteinemia (67.4%), and family history of atherosclerosis (68%) (p < 0.001). For peripheral artery disease, the most significant risk factors were smoking (97%, p < 0.001), hyperlipidemia (p < 0.01), and family history of atherosclerotic disease (p < 0.01). When compared to controls, patients with premature atherosclerosis smoked more frequently, had hyperlipidemia, had a family history of atherosclerosis, and were more frequently of male sex. Conclusion: Premature atherosclerosis was most frequently associated with smoking, hyperlipidemia, family history of atherosclerotic disease, and male sex.

Pancreaticoduodenal artery pseudoaneurysm embolization.

We report a case of successful transcatheter arterial embolization of a pancreaticoduodenal artery pseudoaneurysm (PSA) caused by erosion of the pancreatic pseudocyst content near pancreaticoduodenal arteries. A 55-year-old man was admitted to a local hospital for investigation of severe, stabbing epigastric pain confined to the upper abdomen. He had a history of previous alcohol abuse, chronic pancreatitis, and a duodenal ulcer. Upper gastrointestinal endoscopy revealed narrowing in the pyloric channel along with an ulcer located at the first and second portions of the duodenum with oozing beneath an adherent cloth and duodenal distortion. Computed tomography additionally revealed an enlarged head of the pancreas with numerous spot calcifications and round cystic formation inside, with a diameter of 30 × 25 mm. Following two surgical procedures for duodenal ulcers, selective angiography revealed a PSA located inside the pancreas head and high-grade stenosis > 90% of the celiac trunk and hepatic artery that rose separately from the aorta. Fiber coil embolization was used to occlude the PSA sac successfully. There was no complication after completion of the last embolic procedure. The patient was doing well after 26 months.

Technical strategy in a patient with symptomatic thoracic aneurysm near the origin of the left subclavian artery and left internal thoracic artery coronary graft.

Abstract  Thoracic endovascular aortic repair (TEVAR) is a safe and reliable technique utilized in the treatment for aortic aneurysms. However, in up to 40% of patients, devices are typically placed over the left subclavian artery (LSA) origin. In this report, we present a case of a successful TEVAR procedure following the transposition of the LSA with protective carotico‐axillary/carotid bypass in a patient with a patent left internal thoracic artery (LITA)‐left anterior descending (LAD) coronary artery bypass graft and right internal carotid artery (ICA) occlusion. (J Card Surg 2012;27:725‐727)

Images in vascular medicine: Giant aneurysm of the aberrant right subclavian artery (arteria lusoria)

A 68-year-old man presented with a history of progressively worsening dysphagia, excessive weight loss of more than 30 kg during the preceding 6 months, and retrosternal discomfort. During the previous 2 weeks, any attempt at food or liquid intake provoked vomiting. After gastroenterological evaluation and endoscopy identified pulsating extraluminal compression on the esophagus, he was referred to a vascular surgeon for further evaluation. The patient was hypertensive without any history of ischemic heart disease. A contrast-enhanced CT scan of the mediastinum (Panel A) revealed a giant fusiform aneurysm measuring approximately 10 cm in diameter which contained extensive mural thrombus. The aneurysm compressed the trachea (Panel B; arrow 1), and almost completely obliterated the esophagus (Panel B; arrow 2). CT angiography (Panel C) revealed the aneurysm of an Panel A

Vocal Cord Paralysis as the First Sign of Spontaneous Carotid Dissection in a Patient With Extracranial Internal Carotid Artery Aneurysm

Introduction: Spontaneous dissection of supra-aortic arteries is an exceptionally rare cause of vocal cord dysfunction. We are reporting a case of spontaneous carotid dissection and internal carotid artery aneurysm presenting as vocal cord paralysis. Case Report: A 44-year-old female was admitted with hoarseness and swallowing disorders. Diagnostic imaging revealed dissection and obliteration of the right internal carotid artery (ICA) 23 mm from the carotid bifurcation. Electromyography revealed unilateral paralysis/paresis of the right vocal cord. Genetic analyses for thrombophilia, methylenetetrahydrofolate reductase, and plasminogen activator inhibitor 1 were found to be at high risk. The patient was discharged after 5 days without any neurological findings, and control angiography revealed complete restitution of the flow in the right ICA one month later. However, a fusiform aneurysm of the distal part of the extracranial right ICA was detected and excluded with endovascular procedure. Conclusion: Connective tissue systemic disorders and even mild trauma could initiate the dissection process of neck arteries. Precise diagnosis might be difficult even for an experienced neurologist, however, the final outcome is favorable.

Visceral Artery Aneurysms

In clinical practice relatively rare vascular entity, visceral artery aneurysms (VAA) can thrombose, embolise and rupture, causing high morbidity and mortality [1]. Splanchnic aneurysms pose a difficult therapeutic challenge especially in emergency cases. Almost 22% of VAA patientswith mortality as high as 8.5%,are diagnosed after rupture with variable clinical manifestations that raise the risk of misdiagnosis and unwarranted treatment [2]. Frequent use of imaging techniques and especially computed tomography scanning have significant impact on the overall increase in the number of new cases. Mostly, VAA are be‐ ing discovered incidentally during assessment for abdominal pain or other disorders. Re‐ gardless of how VAA are discovered, the choice of treatment depends on clinical presentation, underlying etiology, location, general health status, and comorbidity factors. For many years surgical treatment, involving either aneurysm resection with bypass or liga‐ tion, were the only therapeutic options, especially in emergency cases [3]. At the present time, however, endovascular techniques are considered the method of choice for first-line treatment and good results have been obtained in emergency cases [4,5].

Surgical treatment of internal carotid artery restenosis following eversion endarterectomy

INTRODUCTION Carotid angioplasty and internal carotid artery stenting is the therapeutic method of choice in the treatment of carotid restenosis, but when it is not technically feasible (expressed tortuosity of supraaortic branches, calcifications, presence of pathological elongation of very long lesions) a redo surgery is indicated. OBJECTIVE The aim of our study was to examine the benefits and risks of redo surgery in patients with symptomatic and asymptomatic significant internal carotid artery restenosis and its impact on early and late morbidity and mortality. METHODS The study included 45 patients who were surgically treated for a hemodynamically significant internal carotid artery restenosis from January 2000 to December 2009. Surgical techniques included redo endarterectomy with direct suture, redo anderectomy with a patch plastic and resection with Dacron tubular graft interposition. The patients were followed for postoperative neurological ischemic events (transient ischemic attack (TIA), stroke), local surgical complications and lethal outcome after one month, six months, one year and after two years). RESULTS In the early postoperative period (up to 30 days) there were no lethal outcomes. TIA was diagnosed in four patients (8.8%), minor stroke in one patient (2.2%) and one patient (2.2%) also had cranial nerve injury. After two years two patients died (4.4%) due to fatal myocardial infarction, three patients (6.5%) had ipsilateral stroke and one patient developed graft occlusion (2%). CONCLUSION In the case of symptomatic and asymptomatic carotid restenosis that cannot be treated by carotid percutaneous angioplasty, redo surgical treatment is therapeutic option with an acceptable rate of early and late postoperative complications.

Successful intestinal ischemia treatment by percutaneus transluminal angioplasty of visceral arteries in a patient with abdominal angina

INTRODUCTION Abdominal angina, also known as chronic mesenteric ischemia or intestinal angina, is a rare disease caused by intestinal flow reduction due to stenosis or occlusion of mesenteric arteries. A case of successful treatment of a patient with abdominal angina by percutaneous transuliminal angioplasty of high-grade superior mesenteric artery and coeliac trunk stenosis was presented. CASE OUTLINE A 77-year-old male patient was admitted at our Clinic for severe postprandial abdominal pains followed by frequent diarrhoeas. Extensive gastrointestinal investigations were performed and all results were normal. Multislice computerized (MSCT) arteriography was indicated which revealed ostial celiac trunk and superior mesenteric artery subocclusion. Percutaneous transluminal angioplasty of the superior mesenteric artery and coeliac trunk was done with two stents implantation. Just a few hours following the intervention, after food ingestion, there were no abdominal pains. Six months later, the patient described a significant feeling of relief after food ingestion and no arduousness at all. CONCLUSION High-grade visceral arteries stenoses in patients with intestinal ischemia symptoms can be treated by either surgical procedures or percutaneus transluminal angioplasty. In cases when a low operative risk is anticipated, surgical treatment is recommended due to a better anatomical outcome, while percutaneus angioplasty is advised to elderly patients in whom increased operative risks can be expected.