Matters Of Heart - Spring 2012

In the Literature, cont.

Endovascular repair of an internal mammary artery aneurysm in a patient with Loeys-Dietz syndrome
By: JW Ohman, KM Charlton-Ouw and A Azizzadeh, Houston Texas
J Vas Surg 2012; 55:837-840

This report details a 34 year old woman with a history of multiple vascular anomalies associated with LDS. After undergoing repair of an aortic dissection, a growing aneurysm of the internal mammary artery artery was detected. The internal mammary arteries or internal thoracic arteries are arteries that supply the anterior chest wall and the breasts. The woman did not have any clinical symptoms of this aneurysm. Due to previous surgeries, she was not thought to be a good candidate for repair through opening the chest again. Because of other vascular findings including a tortuous aorta and small dissection of the subclavian artery, it was decided to access the aneurysm through an artery in the arm (branchial artery). A cannula (or tube) was placed in the artery, and a coil embolization was performed. This means that coils made of soft platinum material are placed within the aneurysm. The body responds by healing around the coil(s), which helps block the flow of blood into the aneurysm, preventing it from rupturing or leaking. There were no complications after surgery for the individual who has continued to do well 24 months after surgery. This type of repair is called an endovascular repair, meaning that the repair can be done through a catheter and not through opening the body, and may be an appropriate option for some peripheral (non-aortic) aneurysms.


Bilateral popliteal artery aneurysms in a young man with Loeys-Dietz syndrome
By: MA Stepheonson, I Vlachakis and D Valenti, London UK
J Vas Surg 2012, published online

This report details a 28 year old man who had undergone surgery for an aortic dissection. The man noticed a swelling behind his right knee and could feel a mass. CTA imaging and duplex arterial screening (high-frequency ultrasound test that can visualize the arteries in the legs and the velocity and direction of blood flow in those arteries) confirmed aneurysms in the popliteal (behind the knee) arteries. These are arteries that, through its branches, provide blood to the knee joint and muscles in the thigh and calf. In this case, open repair was selected. Surgery was first performed on the right side because this aneurysm was largest (approximately 7.8x6.3cm). The aneurysm was excised, or cut out, with a graft replacement sewn in. He experienced a hematoma (localized collection of blood) in his thigh that had to be removed, but otherwise did well with surgery, and underwent surgery on the left side two months later.


Clipping of a Cerebral Aneurysm in a patient with Loeys-Dietz syndrome: Case Report
By: BD Hughes, CJ Powers, AR Zomorodi, Durham, North Carolina
Neurosurgery 69:E752-E755, 2011

This report details a 31 year old woman who had undergone aortic root replacement years earlier and with a recent diagnosis of LDS, MRA imaging revealed an aneurysm of the right ophthalmic artery as it arises from the internal carotid artery. It was recommended that she undergo elective clipping of the aneurysm. In this procedure, a metal clip is placed at the base of the aneurysm as it balloons off from the artery. The skull was cut open (craniotomy) to allow access to the artery and there was eventual success with the placement of a metal clip at the base of the artery, effectively obliterating the aneurysm of the ophthalmic artery while preserving blood flow to that artery. The woman did not have any neurologic complications of the procedure and at one year follow-up is recovered completely and back to regular activities.



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