Aortic dissection originating from an aberrant right subclavian artery.
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A 47-year-old male patient presented with aortic dissection originating from an aberrant right subclavian artery. Intraoperative arteriography showed an anomaly of the aortic arch including a common carotid trunk and an aberrant right subclavian artery. An intimal tear was located in the aberrant right subclavian artery. Dissection retrogradely involved the aortic arch and then anterogradely involved the distal aorta. We treated the patient endovascularly with a Wallgraft endoprosthesis deployed in the aberrant right subclavian artery to seal the entry site. Follow-up computed tomography showed a satisfactory healing process with complete thrombosis in the proximal part of the false lumen. (+info)
Risk of vascular anomalies with Down syndrome.
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High-pressure pulmonary artery aneurysm and unilateral pulmonary artery agenesis in an adult.
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The presence of a pulmonary artery aneurysm, major aortopulmonary and coronary-pulmonary collateral vessels, and severe pulmonary hypertension in an adult with unilateral pulmonary artery agenesis and previous patent ductus arteriosus ligation is very rare. A 34-year-old man experienced these conditions. When he was 10 years old, catheterization and angiography revealed right pulmonary artery agenesis, dilation of the main pulmonary artery, multiple collateral vessels extending from the aorta to the right pulmonary system, and a patent ductus arteriosus (shunt ratio, 3.57) that was then ligated; the other conditions were not corrected. This adult patient was in New York Heart Association functional class II; mild central cyanosis was detected only during exercise. The right pulmonary arterial system was seen only at the right hilar area via collateral vessels from the subclavian, bronchial, internal mammary, and intercostal arteries. Angiography revealed collateral vessels from the right and circumflex coronary arteries to the right pulmonary system. The right intraparenchymal pulmonary arterial systems were patent but of small diameter (pulmonary artery pressure, 85 mmHg; ratio of peak right-to-left ventricular pressure, 0.94; peak pulmonary pressure unresponsive to 100% oxygen). Pulmonary vascular resistance was not estimated because of the risk of aneurysmal rupture. We concluded that irreversible pulmonary hypertension had developed (delayed by the patent ductus arteriosus ligation in childhood) and that the patient's only chance for survival was heart-lung transplantation. To sustain the patient until surgery, we administered sildenafil. Herein, we describe the vascular conditions that accompany unilateral absence of the pulmonary artery, and therapeutic methods. (+info)
Prospective randomized efficacy of ultrasound-guided foam sclerotherapy compared with ultrasound-guided liquid sclerotherapy in the treatment of symptomatic venous malformations.
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A systematic classification of the congenital bronchopulmonary vascular malformations: dysmorphogeneses of the primitive foregut system and the primitive aortic arch system.
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Forty-one cervicofacial vascular anomalies and their surgical treatment--retrospection and review.
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INTRODUCTION: Haemangiomas in children usually involute spontaneously and surgical treatment is exceptional. Vascular malformations do not regress spontaneously and resection may become necessary. We present a series of surgically treated face and neck vascular anomalies during a 9-year period, assessing the epidemiology, presenting signs and symptoms, diagnostic modalities, indications for surgery, treatment methods and clinical outcome post-treatment. MATERIALS AND METHODS: The medical and pathological records of all patients with cervicofacial vascular anomalies treated surgically at our department from 1997 to 2005 were retrospectively reviewed in relation to current evidence. RESULTS: Forty-one patients were identified. Of these, 9 patients had haemangiomas and the remaining 32 had a variety of vascular malformations. Cervicofacial vascular anomalies were most commonly located at the lip. Atypical looking vascular anomalies like masseteric intramuscular haemangiomas and parotid malformations were diagnostic problems. All 41 had surgical excision of their vascular anomalies for troubling symptoms, cosmesis or diagnostic purpose. For cervicofacial arteriovenous malformations, 28% were classified as Schobinger stage I, 50% stage II, and the remainder stage III. Combined embolisation-resection was used to treat 6 arteriovenous malformations (stage II to III) and of these, 3 required flap reconstruction. CONCLUSIONS: Accurate diagnosis distinguishing between cervicofacial haemangiomas and vascular malformations is key to best treatment. The diagnosis can usually be made by history and physical examination aided by early magnetic resonance imaging (MRI). Although cervicofacial haemangiomas can be managed conservatively or with medical therapy, surgery is indicated for preventing psychological distress and in cases of chronic aesthetic alteration resulting from partial regression. Aesthetic concerns and prevention of psychosocial distress point to early excision of venous malformation as the treatment of choice. Lymphatic malformations are best treated by excision. Outcome after excision of localised cervicofacial haemangiomas and low-flow vascular malformations is excellent. Large extensive low-flow malformations as well as those located at the lips may require multiple procedures including reconstruction; patients should be informed that the outcome is generally not as good. Combined embolisation-resection is definitive treatment for arteriovenous malformations and flap reconstruction may prevent their recurrence. Tissue expansion is a useful reconstructive tool after the excision of large vascular anomalies. (+info)
Tie2-R849W mutant in venous malformations chronically activates a functional STAT1 to modulate gene expression.
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