Young athletes with unknown moderate enlargement of the ascending aorta are prone to aortic dissection during exertion. This dissection is linked to transient, severe hypertension during intense athletic effort. Promising young athletes are dying from this phenomenon. For this reason, the author suggests routine echocardiographic examination of young athletes.

A 49-year-old lady, known to have Eisenmenger PDA, careful transthoracic echocardiogram, showed clear evidence for pulmonary trunk dissection with a flap across the pulmonary trunk and this finding was confirmed by a CT scan.

Hemodynamically significant left main coronary artery stenosis (LMCA) is found in around 4% of diagnostic coronary angiograms and is known as unprotected LMCA stenosis if the left coronary artery and left circumflex artery has no previous patent grafts. Previous randomized studies have demonstrated a significant reduction in mortality when revascularization ...

Aortic dissection occurs in Turner syndrome with substantially higher frequency in comparison to the general population, and its prevention is one of the main aims of cardiologic follow-up. Findings of cystic medial necrosis in the aortic wall and a high prevalence of aortic dilation suggest that a form of aortopathy ...

Transesophageal echocardiography (TEE) is the fastest method for diagnosing aortic dissection type A and allows 3D TEE, even in hemodynamically instable patients. 3D TEE may provide additional information on aortic morphology, the involvement of coronary arteries by the dissection and aortic valve function. In this regard 2D and 3D TEE ...

A 77-year-old female suddenly became comatose. Examination at the emergency room revealed stable vital signs and bilateral positive plantar reflexes but absent brainstem reflexes. Basilar artery occlusion was initially diagnosed and recombinant tissue plasminogen activator was administered. However, her blood pressure dropped after thrombolysis. A chest CT scan showed aortic ...

AIM: Management of Vertebral Artery (VA) dissections remains controversial. The clinical and angiographic variables of VA dissections were evaluated to demonstrate the safety and efficacy of endovascular intervention in treatment of VA dissecting aneurysms. MATERIAL and METHODS: 25 patients with 27 VAdissecting aneurysms were treated with endovascular intervention during the ...

Deep vein thrombosis is a common and serious medical condition, which frequently complicates the postoperative recovery of surgical patients with recognised/unrecognised risk factors. The pathophysiology of formation of blood clots in veins of lower extremities has now come in light after development of newer investigations. Newer imaging techniques allow the ...

Carotid artery stenosis (CAS) is one of the major complications of external irradiation (radiotherapy, RT) for laryngeal carcinoma. Considering amaurosis fugax is often one of the first signs of significant CAS our focus was to determine weather patients with post-irradiation CAS also develop ocular microangiopathy as a result of insufficient ...

Aortic dissection is a rare, potentially catastrophic vascular emergency. Early recognition of the clinical manifestations, rapid confirmation using imaging modalities, urgent administration of appropriate medication and expedient selection of definitive long-term therapy are key to preserving life and reducing morbidity. In recent years it has become increasingly clear that there ...

Endovascular intervention has emerged as a less traumatic alternative treatment for several diseases of the thoracic aorta.(1,2) However, depending on the different aortic pathologies, procedure related complications have become increasingly evident: severe complications include type I endoleaks, migration, and endograft (EG) collapse, as well as those observed during conventional surgery ...

We describe an unusual case of Lactobacillus casei bacteraemia in a heavy dairy consumer woman, with a one month history of low grade fever and admitted to our hospital for sudden onset of severe thoracic pain due to dissection of the aortic arch and ascending aorta. The patient underwent four ...

We report a case of brain stem infarction. The case is interesting for simultaneous occurrence of basilar artery (BA) occlusion caused by BA dissection and left internal carotid artery (ICA) dissection after a minor cervical trauma. Stents were implanted at the ICA dissection, and BA occlusion was treated conservatively.

Aortic dissection represents the most common aortic emergency, affecting 3 to 4 per 100,000 people per year and is still associated with a high mortality. Twenty percent of the patients with aortic dissection die before reaching hospital and 30% die during hospital admission. Aortic dissections may be classified in 3 ...

We reviewed our experience of intraoperative type A aortic dissection during cardiovascular surgery. From January 1998 to May 2009, intraoperative aortic dissection occurred in 10 of 3421 cardiac surgical patients (M:F=4:6, 62.4+/-8.0 years). Preoperative diagnoses were valvular heart disease (n=6), ischemic heart disease (n=2), combined disease (n=1) and aortic aneurysm ...

A 49-year-old female presented with recurrent intolerable right retro-orbital pain, ptosis and diplopia for 4 months. Neurological evaluation revealed right oculomotor nerve and abducent nerve injuries. Neuroimaging found enlarged right cavernous sinus, right intracavernous carotid dissection aneurysm and a stenosis proximal to it. Tolosa-Hunt syndrome (THS) was suggested and treated with ...

Lateral ligament of the rectum has suffered many diverse descriptions in its existence and composition. This study was undertaken to define the anatomy, nature, content of the lateral ligament of the rectum, and its role in total mesorectal excision. Cadaver dissections were performed on 32 formalin-preserved cadavers. Bilateral lateral ligament ...

A 65-year-old man presenting with visceral malperfusion complicating acute type A aortic dissection underwent emergent surgery. Bypass grafting from the right common iliac artery to the superior mesenteric artery was performed prior to central aortic repair because intestinal ischemia caused hemodynamic instability. Subsequently, the ascending aorta was replaced with a ...

Retrograde Type A aortic dissection following successful endovascular treatment of thoracic aortic disease is not uncommon. We report a case where the primary pathology was distal aortic arch aneurysm without dissection, and the retrograde type A dissection occurred four months after successful hybrid endovascular management with right to left carotid ...

The diagnosis and treatment of traumatic vascular injuries continues to improve as new tools and techniques are developed. In addition to locoregional hemorrhagic complications, injuries to blood vessels in the neck and face can result in ischemic injuries to the brain and cervical spinal cord. Surgical access to these lesions ...

Aortic dissection is the most common acute emergency condition of the aorta and often has a fatal outcome. Outcome is determined by the type and extent of dissection and the presence of associated complications (eg, cerebral sequelae, aortic branch involvement, pericardial involvement, and visceral involvement), with early diagnosis and treatment ...

INTRODUCTION: Aortic dissection is frequently associated with ischemic stroke; however, a high clinical suspicion is necessary when the presentation is atypical. CASE REPORT: We present the atypical clinical picture of De Bakey type I (Stanford A) aortic dissection which presented as crossed hemiparesis in a 52-year-old previously healthy woman. CONCLUSION: ...

We show magnetic resonance imaging, computed tomography-angiography, and ultrasound images of internal carotid artery dissection in a patient with acute ischemic stroke. Arterial changes occurring during the first few days were detected by serial ultrasound examinations. Neurologic and functional outcome are provided and therapeutic options discussed.

Dissection of the carotid artery can occur intracranially or extracranially, although dissections tend to affect extracranial segments of the arteries much more commonly than intracranial segments. Carotid artery dissection (CAD) is most common in middle-aged women. Although not completely known, the main risk factors related to carotid artery dissection are ...

BACKGROUND AND PURPOSE: Dissecting aneurysms of the distal segment of the PICA are rare. The purpose of this study was to evaluate the clinical presentations, imaging features, treatment options, and clinical outcomes of dissecting PICA aneurysms. MATERIALS AND METHODS: Six patients with dissecting aneurysms in the distal segments of PICA ...

Emergency repair has been successfully performed in acute type A aortic dissection complicated by cerebral malperfusion. Despite the lack of criteria to define irreversible brain damage, immediate surgery is often denied in case of stroke or coma. We report two patients presenting with coma and altered brainstem reflexes shortly after ...

Acute Type A dissection is a surgical emergency. The presence of visceral and extremity malperfusion syndromes increases perioperative mortality twofold. On occasion, significant malperfusion may best be addressed in a staged fashion with preliminary attention to specific vascular beds with delayed repair of the dissection itself. We present a subacute ...

A 64-year-old woman was complicated with acute type A dissection arising from the left main trunk during percutaneous coronary angiography. As the extent of dissection was localized in the ascending aorta, a bare-metal stent was inserted into the left main trunk to cover the entry of dissection. Two days after ...

Without emergency surgical management, acute type A aortic dissection carries a high risk of death. Controversy exists as to whether extreme age remains a contraindication to surgery. We describe successful repair of type A aortic dissection with ascending aortic graft replacement, aortic valve repair, hemiarch reconstruction, and ablation of atrial ...

Aortic aneurysm and dissection cause significant morbidity and mortality. There are several known single gene disorders that predispose to isolated aortic disease and eventually aneurysm and dissection. FBN1 mutations are associated with multiple clinical phenotypes, including Marfan syndrome (MFS), MASS phenotype, and familial ectopia lentis, but rarely with isolated aortic ...

Although patho-physiology of spontaneous internal carotid artery dissection (sICAD) is largely unknown, an association with migraine has been suggested but not proven. Migraine is a condition which is worth considering while one is hunting a possible cause for internal carotid artery dissection (ICAD) and it may be found more often ...

BACKGROUND/PURPOSE: To describe the clinical characteristics and imaging findings of craniocervical dissection in childhood ischemic stroke, in a tertiary medical center. METHODS: In this retrospective study, we investigated children (aged 1 month to 18 years) with symptoms and radiographic confirmation of ischemic stroke from January 1996 to January 2007. Stroke ...

Aortic dissection is a life-threatening condition with a 50% mortality rate in the first 48 hours and a 3-month mortality rate of 90% in untreated patients. Aortic dissection is a rare complication of pregnancy, but there is significant morbidity and mortality for the mother and infant. A 43-year-old woman with ...

SUMMARY: We present a unique case of multiple sCADs occurring after a ruptured intracranial aneurysm embolization. We discuss the impact of head extension during embolization as the prevailing factor in multiple artery dissections in this case and point out another cause of new-onset neurologic deficit in patients with aneurysmal SAH.

Three patients had severe abdominal pain of sudden onset. Computed tomography showed localized dissection in the superior mesenteric artery in two patients and in the celiac artery in one. With conservative therapy abdominal symptoms were self-remitted. All patients were successfully treated with medication and have been doing well during follow-up.

We present our experience with an acute Stanford type B aortic dissection in a 25-year-old, 26-week gravid patient without a known connective tissue disorder and discuss a literature-based treatment strategy. After failed conservative treatment manifest by aneurysm rupture, emergency cesarean section delivery and immediate repair of her thoracic aorta was ...

A 48-year-old man presented with a rare dissection of the anterior cerebral artery (ACA) causing simultaneous subarachnoid hemorrhage (SAH) and cerebral infarction manifesting as sudden onset of headache and left hemiparesis. Computed tomography and magnetic resonance imaging showed SAH localized in the interhemispheric fissure and cerebral infarction in the territory ...

The technical factors and surgical methods employed in carotid endarterectomy are controversial. In particular, whether or not to use an indwelling arterial shunt during carotid endarterectomy remains a source of conflict. We describe a rare case in which uncomplicated carotid endarterectomy was followed by distal internal carotid artery dissection and ...

Bleeding related to inadvertent femoral catheter insertion is an infrequent but morbid complication. We report two cases of acute life-threatening bleeding after attempts at femoral vein catheterization. Both patients were morbidly obese, had multiple comorbidities, and were at high risk for surgical intervention. Aggressive resuscitation failed to stabilize the patients. ...

The arterial cannulation site for optimal tissue perfusion and cerebral protection during cardiopulmonary bypass (CPB) for surgical treatment of acute type A aortic dissection remains controversial. Right axillary artery cannulation confers significant advantages, because it provides antegrade arterial perfusion during cardiopulmonary bypass, and allows continuous antegrade cerebral perfusion during hypothermic ...

The objective of our study was to estimate the incidence of posttraumatic dissections of cervical arteries in patients with whiplash injury acquired in a car accident. We performed a retrospective analysis of medical records of 500 patients with whiplash injury acquired in car accidents between 1996 and 2005 and searched ...

Coronary artery stents mechanically buttress the arterial wall and prevent negative remodeling, leading to increased lumen gain and less angiographic and clinical restenosis as compared with balloon angioplasty alone. Although stents prevent negative remodeling, they do not eliminate restenosis, as they cause complex arterial injury triggering responses that culminate in ...

Brain-supplying arterial dissection is considered one of the most common vascular causes of stroke in younger patients. Dissections are usually preceded by trauma or mechanical stress; the vascular stressor may be trivial as this condition has been described in association with manipulation and stretching the neck. Here we describe a ...

Acute thoracic aortic pathology is a relatively new term. The experience gained in treatment of thoracic aorta pathology has shown the importance of early diagnosis of the disease of this localization. Improved resolution of modern diagnostic medical equipment has made it possible to recognize early forms of aortic lesions and ...

The management and follow-up of chronic type B aortic dissections continues being a clinical challenge. Patients with chronic type B dissection have high mid/long term mortality mainly due to progressive aortic dilatation and subsequent rupture.

Spontaneous cervicocephalic arterial dissection (SCAD) has been recognized as an uncommon cause of cerebral stroke. Although it has been viewed as an important cause of stroke, especially in juvenile cases, its natural course and pathophysiology have yet to be fully clarified, and no treatment criteria have been established. Recent studies ...

Purpose: Headache is recognized as one of the specific signs of intracranial arterial dissection (ICrAD). We clarified the incidence of ICrAD in non-emergency outpatients complaining of headache and the nature of headache observed in case of ICrAD. Patient population and methods: Consecutive non-emergency outpatients coming to the neurological and neurosurgical ...

The most common treatment of acute type A aortic dissection is immediate surgical repair. However, early surgery for acute dissections with peripheral vascular compromise carries a high mortality rate. Herein, we report a case in which we placed percutaneous endovascular stents in a type A dissection patient before proceeding with ...

Isolated spontaneous dissection of celiac trunk is a rare entity. The spontaneous dissection of the visceral artery occurs without aortic dissection. The most consistent presenting symptom is acute onset abdominal pain. Complications consist of ischemia, aneurysm formation, and rupture. We report an exceptional case of an isolated spontaneous dissection of ...

A 51-year-old man presented with an extremely rare case of intracranial subarachnoid hemorrhage caused by rupture of an anterior spinal artery aneurysm manifesting as disturbance of consciousness following sudden onset of neck pain and numbness of the extremities. Cranial computed tomography revealed subarachnoid hemorrhage, mainly in the posterior fossa. Cerebral ...