[Show abstract][Hide abstract] ABSTRACT: Mycotic subclavian artery pseudoaneurysms are rare. There are controversies over the surgical or endovascular approach as the treatment of choice for these lesions. The standard surgical debridement might not be a choice for poorly surgically reachable lesions or for patients with multiple comorbidities. Endovascular aneurysm repair may be an effective alternative in selected cases. This treatment was rarely reported previously. Herein, we present a high-surgical-risk case with a highly suspected left subclavian arterial mycotic pseudoaneurysm, which, although difficult to approach surgically, was successfully managed with stent grafting and a complete antibiotic treatment course. An 89-year-old male was admitted due to intermittent fever and hemoptysis for 2 months. Salmonella group B was cultured from his sputum, and a 3.5 cm pseudoaneurysm was identified by chest multidetector-row computed tomography (MDCT) angiogram. Endovascular treatment with a graft stent was chosen due to high surgical risk and difficult surgical access to the lesion. The intervention was well planned ad hoc, based on MDCT images and meticulously performed by dual endovascular approaches. Antibiotics were continued after the procedure, and the patient was discharged from the hospital. As MDCT disclosed near-complete regression of the pseudoaneurysms 2 months later and the patient was in healthy status, antibiotics were continued for 6 months. He was readmitted 11 months later due to lacunar infarction with minor pneumonia over the left lower lung in which Salmonella enteritis was also diagnosed. After this acute event, he was again hospitalized 14 days later due to sepsis with adult respiratory distress syndrome and shortly expired despite all emergent treatment measures. No evidence of local subclavian infection recurrence was noted throughout or related to subsequent events. In conclusion, endovascular treatment of an infected subclavian artery pseudoaneurysm could be a choice in selected patients, but treatment of underlying infection determines the clinical outcome.
Full-text · Article · Sep 2012 · Journal of the Chinese Medical Association
[Show abstract][Hide abstract] ABSTRACT: Diagnosis of spontaneous coronary artery dissection (SCAD) is challenging because of its rarity and uncertain etiology. It frequently occurs in young women during pregnancy and in the postpartum period, and rarely found in elder women with no history of cardiovascular disease or coronary risk factors. In this article we report a case of SCAD in a 75-year-old woman without traditional cardiovascular risk factors who presented with syncope and mild chest discomfort. There were no abnormal electrocardiographic changes and no elevated cardiac enzymes were detected. Computed tomography of brain revealed nothing abnormal. Coronary artery disease was suspected. Coronary angiogram revealed dissection in the middle left circumflex artery. The patient underwent percutaneous transluminal coronary angioplasty and was free of symptoms at 6-month follow-up. Our report suggests that emergency coronary angiography is indicated if syncope caused by coronary artery disease is suspected.
Preview · Article · Dec 2011 · Chinese medical journal
[Show abstract][Hide abstract] ABSTRACT: Direct percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) is now the standard first-line therapy for all patients. However, few studies on PCI in young patients with AMI and Kawasaki disease have been published. Herein, we report a case of AMI in a 26-year-old man with a history of Kawasaki disease. Emergency coronary angiography showed a thrombotic occlusion of the ectatic left circumflex artery. PCI with aspirationthrombectomyalonewasperformedsuccessfully.Restenosiswasnotobservedoncoronaryarteriography at6-monthfollow-up.OurreportsuggeststhatPCIwiththrombosuctionforyoungpatientswithAMIandKawasaki disease can be safe and effective.