Recommendable Age for Mass Screening of Unruptured Intracranial Aneurysms Using MR Angiography (original) (raw)

Indications for A3-A3 Bypass in Patients with Anterior Cerebral Artery Territory Aneurysms

Surgery for Cerebral Stroke, 2019

A3-A3 side-to-side bypass (A3-A3 bypass) is commonly used for revascularization of the anterior cerebral artery territory; however, it is indicated in few patients. This study investigated the indications for A3-A3 bypass based on our clinical experience and a literature review. The study included 5 patients (3 men and 2 women) who underwent A3-A3 bypass between April 2012 and November 2017. The patients were in their 20s (n = 2), 40s (n = 1), and 50s (n = 2). The diagnoses included unruptured anterior communicating artery aneurysm treated with trapping (n = 1), recurrent enlargement of the anterior communicating artery after clipping (n = 1), anterior cerebral artery dissection (n = 1), anterior cerebral artery stenosis with cerebral infarction (n = 1), and traumatic distal anterior cerebral artery aneurysm (n = 1). A3-A3 bypass was completed and patency was confirmed in all patients. The requirements for A3-A3 bypass performance include suturing skills for anastomosis, appropriate selection of donor and recipient vessels, and comprehensive preoperative assessment. The indications for A3-A3 bypass are various. When performing a craniotomy for anterior communicating artery aneurysms and distal anterior cerebral artery aneurysms, the A3-A3 bypass can be used as a rescue technique. Therefore, stroke surgeons should master the essential skills. Training in suturing skills is an important part of preparation for the procedure.

A Conversion Case of Aortic Arch Aneurysm after TEVAR Utilizing a Collared Branched Graft

Japanese Journal of Cardiovascular Surgery, 2021

An 83-year-old female patient was referred to our hospital because of an aortic arch aneurysm. At the age of 78, she had undergone zone 1 TEVAR with bypass surgery from the right axillary artery to the left common carotid artery and left axillary artery in another hospital. After that, the proximal landing zone expanded, and the type 1 endoleak led to aneurysmal expansion. Therefore, open surgical repair was planned. In the operative findings, the proximal stent graft diameter was 40 mm, and the diameter of the aorta was 45 mm. We chose a Vascutek Siena TM Collared Branched Graft 26 mm Terumo, Japan and anastomosed the trimmed collar to the proximal stent graft covered with the aortic wall. We successfully reconstructed the aortic arch.