Arterial rupture

Coronary artery rupture has been associated with amfetamine abuse (21). 

Brennan K, Shurmur S, Elhendy A. Coronary artery rupture associated with amphetamine abuse. Cardiol Rev 2004 12 282-3. 

Arterial dissection is a common cause of ischemic stroke and TIA in young adults and may also occur in older people. Sometimes there is a predisposing cause (Schievink 2001 Rubinstein et al. 2005) (Table 6.4) but often there is no explanation. The artery may become occluded by the wall hematoma itself thrombosis and emboUsm may complicate occlusive or non-occlusive dissections, and aneurysmal bulging of the weakened wall may occur (O Connell et al. 1985). Arterial rupture is unusual. 

The clinical symptoms of classical Menkes disease can be traced back to developmentaUy important copper enzymes such as lysyl oxidase, tyrosinase (see Copper Hemocyanin/Tyrosinase Models), cytochrome c oxidase (see Cytochrome Oxidase), dopamine -hydroxylase, superoxide dismutase, and amine oxidase (see Superoxide Dismutase). Lysyl oxidase is needed for the cross-linking of connective tissue a deficiency in this enzyme causes weakened connective tissue and connective tissue disorder such as arterial ruptures as observed in these patients. Low levels of cytochrome c oxidase cause temperature instability and the absence of tyrosinase explains the hair depigmentation observed in affected individuals. ... 

The clinical features of the disease include hypothermia, arterial rupture, and bone changes. Patients are found to have extremely low levels of copper in the liver, brain, and serum as well as having very low ceruloplasmin levels. These all are due to the basic biochemical defect of severely reduced ability to absorb copper from the intestine and a disturbance in the intracellular transport of copper. ... 

Nose Blood Chronic ulceration Potential site of bleeding after thrombolysis. Osier Weber Rendu syndrome Occasionally secondary to dissecting carotid artery rupture Nasopharyngeal carcinoma, Wegener s, with cranial nerve involvement... 

Glue embolization of major arteries is very effective but contains a high risk of ischemic complications. Thus if, in major artery rupture, the bleeding point is beyond the range of catheterization, alert the gastroenterologist to get a control endoscopy or, even wiser, get a surgeon for a definitive salvage. 

In the treatment of vascular disease such as arteriosclerosis, intracoronary stent placement is a common adjimct to balloon angioplasty (74). Stents, however, can also cause imdesirable side effects. For example, the continued exposure of a stent to blood can lead to thrombus formation and the presence of a stent in a blood vessel can over time cause the blood vessel wall to weaken creating the potential for arterial rupture or formation of aneurisms. A stent can also become overgrown by tissue after its implantation such that its utility is diminished or eliminated while its continued presence may lead to a variety of complications such as the foregoing. To ameliorate the above situation, stents can be fabricated from materials that are biodegradable and, if desired, bioabsorbable (74). 

Fig. 25.5. Volume-rendered multi-detector row CT angiogram in a patient with blunt trauma to the left upper leg. Volume-rendered view shows an abrupt contrast material stop with irregular edge at the distal segment of the superficial femoral artery, which is laterally deviated, indicating arterial rupture (arrow). Image shows also a severely dislocated fracture of the femur shaft at the level of arterial interruption...

We advocate ultrasound as the first-choice imaging modality in these patients because it is easily performed and non-invasive. Immediate ultrasonography enables to determine the entity of hematoma and allows detection of the site and the length of the tear of the tunica albuginea (Bertolotto and Pozzi Mucelli 2004). Moreover, ultrasonography permits to exclude the concomitant presence of cav-ernosal artery rupture with formation of an arterial-lacunar fistula. 

Menkes disease children die from neural degeneration or arterial ruptures, which are secondary effects of copper deficiency. Since most cell types express the wild-type gene that is defective in Menkes syndrome, copper injections are usually not effective treatment for Menkes disease. Cultured Menkes fibroblasts are also defective they show increased copper accumulation and reduced efflux, which give a clue to the primary cause of the disease and allow for a specific radioactive Cu -retention diagnostic test. The excessive accumulation of copper by the Menkes cells, accompanied by the Cu " sequestration with intracellular metallothionein (which does not occur with wild-type cells), leads to a problem in intracellular copper movement. Consequently, cellular copper is high, while intracellular copper is unavailable for metabolic functions. 

Complications of angioplasty are generally related to the catheter size and location of the puncture site, severity of the patient s disease, and associated comorbid conditions such as hypertension or a need for anticoagulation or thrombolysis. The major complications are all in the order of 2 to 5% and include puncture site hematomas and/or subsequent pseudoaneurysms, intimal dissection (which may, depending upon its severity, be a normal sequela of balloon dilatation rather that a complication), arterial rupture, and distal embolization (13,14,15). 

Cooper SG, Sofocleous CT (1998) Percutaneous management of angioplasty-related iliac artery rupture with preservation of luminal patency by prolonged balloon tamponade. J Vase Interv Radiol 9 81-83... 

Joseph N, Levy E, Lipman S (1987) Angioplasty-related iliac artery rupture treatment by temporary balloon occlusion. Cardiovasc Intervent Radiol 10 276-279... 

Smith TP, Cragg AH (1989) Non-surgical treatment of iliac artery rupture following angioplasty. J Vase Interv Radiol 4 16-18... 

Kelly AJ (1995) Case report iliac artery rupture-percutaneous treatment by stent insertion. Clin Radiol 50 876-877... 

Allaire E, Melliere D, Poussier B, Kobeiter H, Desgranges P, Becquemin JP (2003 Iliac artery rupture during balloon dilatation what treatment Ann Vase Surg 17306-314... 

Citardi MJ, Chaloupka JC, Son YH, Sasaki CT (1995) Management of carotid artery rupture by monitored endovascular therapeutic occlusion (1988-1994). Laryngoscope 105 1086-1092... 

Swain RE, Biller HF, Ogura JH (1974) An experimental analysis of causative factors and protective methods in carotid artery rupture. Arch Otolaryngol 99 235-241... 

Porto DP, Adams GL,Foster C (1986) Emergency management of carotid artery rupture. Am J Otolaryng 7 213-217... 

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