Saccular True Aneurysm of the Ascending Aorta 19 Years After Aortic Cannulation: Report of a Case

Tochii, Masato; Ando, Motomi; Takagi, Yasushi; Yamashita, M; Hattori, Koji; Hoshino, Ryo; Akita, Kiyotoshi

doi:10.1007/s00595-007-3487-7

Cited by 4 publications

(3 citation statements)

References 4 publications

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“…Shang et al [8] reported that saccular aortic aneurysms account for 1.5% of all aortic aneurysms. The causes of saccular aneurysm are trauma, infection, autoimmune disorders (e.g., Behcet's disease or other collagen vascular diseases), or previous cardiovascular surgery [9].…”

Section: Discussionmentioning

confidence: 99%

Significant thrombus in saccular aneurysm in a patient with polycythemia: a case report

Mitsuishi,

Nakamura,

Miura

et al. 2024

J Cardiothorac Surg

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Background Morphologically, the risk of aortic aneurysm rupture is mainly evaluated based on its type (e.g., fusiform or saccular) and diameter. Based on the finite element analysis, peak wall stress has been identified as a more sensitive and specific predictor of rupture in recent years. Moreover, in finite analysis, the neck of aneurysm is the highest peak wall stress and is associated with the rupture point. Case presentation A saccular aortic aneurysm (84 mm) was incidentally detected during preoperative examination for chronic empyema in a 74-year-old male patient with a history of polycythemia. Aortic arch graft replacement using an open stent was performed. Conclusions Morphologically, this case was associated with a very high risk of rupture; nevertheless, it did not rupture. In this case, a mural thrombus (likely formed due to polycythemia) covered the neck of aneurysm that is experiencing the highest peak wall stress and is associated with the rupture point. The mural thrombus decreased peak wall stress and could reduce the risk of rupture even for huge saccular aneurysms. Furthermore, the mural thrombus was fully occupied in aneurysms, such as during coil embolization. Thus, polycythemia could decrease the risk of rupture of huge saccular aneurysms.

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Section: Discussionmentioning

confidence: 99%

Significant thrombus in saccular aneurysm in a patient with polycythemia: a case report

Mitsuishi,

Nakamura,

Miura

et al. 2024

J Cardiothorac Surg

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show abstract

“…Shang et al [2] reported that saccular aortic aneurysms account for 1.5% of all aortic aneurysms. The causes of saccular aneurysm are trauma, infection, autoimmune disorders (e.g., Behcet's disease or other collagen vascular diseases), or previous cardiovascular surgery [3].…”

Section: Discussionmentioning

confidence: 99%

Reasons why huge saccular aneurysms do not rupture in patient with polycythemia: a case report

Mitsuishi,

Nakamura,

Miura

et al. 2023

Preprint

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Background Morphologically, the risk of aortic aneurysm rupture is mainly evaluated based on the diameter and type (e.g., fusiform or saccular). Recently, based on finite element analysis, a sac depth/neck width > 0.8 and aspect ratio (vertical diameter/horizontal diameter) < 1.0 indicate a high risk of rupture. However, some aneurysms do not rupture despite a high risk according to the morphology. Therefore, the influence of other risk factors of aortic aneurysm rupture should be considered. Case presentation: A saccular aortic aneurysm (84 mm) was incidentally detected during preoperative examination for chronic empyema in a 74-year-old male patient with a history of polycythemia. Aortic arch graft replacement using an open stent was performed. Conclusions Morphologically, this case was associated with a very high risk of rupture; nevertheless, it did not rupture. It has been reported that the wall stress based on finite element reflects the risk of rupture more accurately than the rupture risk based on the diameter of aneurysm. The neck of saccular aneurysm is the highest peak wall stress and is linked to the rupture point. Additionally, it has been reported that the disappearance of endothelial cells is associated with a high risk of rupture. Although a mural thrombus leads to vascular necrosis and aneurysm formation by blocking blood supply from vasa vasorum, in this case, a mural thrombus (likely formed due to polycythemia) covered the neck of aneurysm and embolized within saccular aneurysm preserving intima like coil embolization, and a decrease in peak wall stress could be attributed to reduction in the risk of rupture even for huge saccular aneurysms.

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“…Histopathological examination of the aortic wall showed inflammatory changes of the aneurysm and continuity of the medial elastic fibrous tissue inside the aneurysm. We have already reported 2) this rare case in Surgery Today in 2007. The patient was closely monitored by our department every 2 months, and computed tomography taken every year revealed recurrence of the ascending aortic aneurysm at the previous site that had been repaired with a polyester patch.…”

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confidence: 91%

Recurrence of Aneurysm of the Ascending Aorta after Patch Repair: The Fate of an Aortic Patch

Tochii

Amano

Sakurai

et al. 2016

Annals of Vascular Diseases

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Pseudoaneurysm of the ascending aorta is a rare but lifethreatening complication after aortic cannulation and cardiovascular surgery, and it has the potential to rupture. We experienced a rare case of recurrence of aneurysm of the ascending aorta 7 years after patch repair of a small aneurysm at an aortic cannulation site. The repaired aorta had been wrapped with a Teflon felt strip during the previous surgery, and the wrapped aorta had become thin with deterioration of the normal structure of the aortic wall.Keywords: aortic aneurysm, pseudoaneurysm, patch repair ventricular myxoma when the patient was 42 years old under cardiac arrest with ascending aortic cannulation and aortic cross clamping. The second surgery was performed for a 30 mm saccular aneurysm of the ascending aorta at the previous aortic cannulation site when the patient was 61 years old. In the second surgery, the aneurysm was resected and the defect of the ascending aorta was closed with a 20 × 20 mm round polyester patch. The aortic wall was covered with three pieces of Teflon felt strip reinforcement, which was 10 mm width and was placed with 5 mm gap each (Fig.

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Saccular True Aneurysm of the Ascending Aorta 19 Years After Aortic Cannulation: Report of a Case

Cited by 4 publications

References 4 publications

Significant thrombus in saccular aneurysm in a patient with polycythemia: a case report

Significant thrombus in saccular aneurysm in a patient with polycythemia: a case report

Reasons why huge saccular aneurysms do not rupture in patient with polycythemia: a case report

Recurrence of Aneurysm of the Ascending Aorta after Patch Repair: The Fate of an Aortic Patch

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