Embolism arterial aneurysms

Atherothromboembolism ntracranial small vessel disease Leukoaraiosis Dissection (Table 6.4) Fibromuscular dysplasia Congenital arterial anomalies Moyamoya syndrome Embolism from arterial aneurysms Inflammatory vascular diseases Irradiation... 

Embolism from intra- and extracranial arterial aneurysms... 

Embolism from thrombus within the cavity of an aneurysm is rare and is difficult to prove in cases where there maybe other potential sources of embolization. Intracranial aneurysms more commonly present with rupture and subarachnoid hemorrhage, whereas internal carotid artery aneurysms tend to cause pressure symptoms including a pulsatile and sometimes painful mass in the neck or pharynx, ipsilateral Horner s syndrome or compression of the lower cranial nerves. Extracranial vertebral artery aneurysms may cause pain in the neck and arm, a mass, spinal cord compression and upper limb ischemia (Catala et al. 1993). 

M.J. Bratby, E.D. Lehmann, J. Bottomley, et al. Endovascular embolization of visceral artery aneurysms with ethylene-vinyl alcohol (Onyx) a case series. Cardiovascular and Interventional Radiology. 2006 29 1125-1128. 

Araoz PA, Andrews JC (2000) Direct percutaneous embolization of visceral artery aneurysms techniques and pit-falls. JVIR 11 1195-1200... 

Cynamon J, Lerer D, Veith F et al. (2000) Hypogastric artery coil embolization prior to endoluminal repair of aneurysms and fistulas buttock claudication, a recognized but possibly preventable complication. J Vase Interv radiol 11 543-545... 

Stainless steel or platinum coils and detachable balloons are rarely used as aprimaryembolicagentinbron-chial artery embolization. Although these can be used to occlude a pathologic bronchial artery efficiently, use of coils predudes repeat embolization, which is often needed as patients are prone to distal collateralization (Fig. 16.21) [43,44]. The primary indication for use of coils is in patients with a bronchial artery aneurysm. Secondly, in cases where a superselective position of a (micro) catheter cannot be reached, coils can be used to protect a normal distal vascular territory against inadvertent embolization [25]. 

Partially targeted treatment (embolization) to eliminate risk factors of hleeding/rehleeding (feeding artery aneurysms, intranidal aneurysms, false aneurysms)... 

Levy D1 (1997) Embolization of wide-necked anterior communicating artery aneurysm technical note. Neurosurgery 41 979-982... 

Chan RP, David E (2004) Reperfusion of splanchnic artery aneurysm following transcatheter embolization treatment with percutaneous thrombin injection. Cardiovasc Intervent Radiol 27 264-267... 

Renal artery aneurysms can also be seen in patients with angiomyolipomas (AMLs) (Fig. 8.2). Classically, AMLs occur in elderly females and patients with tuberous sclerosis. The entire lesion can often be embolized in addition to coiling the aneurysms. A combination of coils and PVA or simply ethanol infusion with a balloon occlusion catheter can be performed as definitive treatment or if surgical resection is anticipated. 

Complications of the embolization procedure include those of diagnostic angiography with the addition of aneurysm rupture, nontarget embolization, splenic infarction, abscess formation, and rarely sepsis (Fig. 8.5). Total splenic infarction can occur, which puts the patient at an increased risk of infection with encapsulated bacteria such as pneumococcus. Older literature suggests that bland splenic artery aneurysms rupture at a rate of approximately 2% [30]. However, in pregnant patients, rupture occurs in nearly every case with mortality rates for mother and fetus 70% and 95% respectively [31]. Obviously, any aneurysm in the pregnant female should be addressed since over 95% will rupture if left untreated [30, 32]. 

Results of transcatheter embolization of mesenteric aneurysms appear favorable in the literature, and technical success has been reported to range from 75% to 100% [1,3,15,18,19,24-27,33,35-42]. However, many of these studies are not only retrospective and small, but the mesenteric VAAs are often lumped in with splenic and hepatic artery aneurysms, making it difficult to isolate effective treatment rates for SMA, IMA, and GDA aneurysms independently. The anatomy and location of the lesion will often dictate the success of embolization. Furthermore, some case series report the use of different methods, such as percutaneous thrombin or coil injection versus transcatheter embolization. 

Despite the fact that minimally invasive embolization procedures have been performed for over twenty years, very few long-term data on VAA occlusion are available. Further investigation and development of newer techniques such as stent graft placement are needed. Coil, glue, thrombin, and particle embolization will continue to be effective methods for treatment of visceral artery aneurysms in both the elective and emergent settings. Good... 

Metcalfe et al. (2003) tested cold hibernated elastic memory (CHEM) polyurethane for the treatment of lateral wall aneurysms on the carotid arteries of dogs. The SMP polyurethane was made in open cellular (foamy) structures with the glass transition temperature of 60 C. After 3 weeks, in vivo experiments showed that the CHEM foam led to improved aneurysm embolization, and a thick neoin-tima formation by favoring the ingrowth of cells. However, residual necks and recurrences were observed in some cases due to the incomplete filling of the vascular lumen. 

Lacombe P, Frija G, Parlier H, et al. Transcatheter embolization of multiple pulmonary artery aneurysms in Behqet s syndrome. Report of a case. Acta Radiol Diagn (Stockh) 1985 26(3) 251-253. 

Haematologic Intravenous administration of recombinant tissue plasminogen activator (rtPA), also known as alteplase, is a common component of ischaemic stroke management, but its use is associated with intracranial haemorrhage in 6.4% of patients. A 51-year-old woman who had received IV rtPA for acute left middle cerebral artery thromboembolism later presented with subarachnoid haemorrhage from an acutely ruptured anterior communicating artery aneurysm. The patient xmderwent mechanical thromboembolectomy of the left middle cerebral artery occlusion with recanalization followed by coil embolization of the aneurysm, but she did not improve neurologjcally and ultimately died (32). ... 

CHD = myocardial infarction (Ml), significant myocardial ischemia (angina), history of coronary artery bypass graft (CABG), history of coronary angioplasty, angiographic evidence of lesions, carotid endarterectomy, abdominal aortic aneurysm, peripharal vascular disease (claudication), thrombotic/embolic stroke, transient ischemic attack (TIA)... 

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