가성동맥류의 수술적 가료

김재홍,임만빈,이창영,김일만,Kim, Jae Hong,Yim, Man Bin,Lee, Chang Young,Kim, Ill Man 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.3

Objective : Surgical experiences of pseudoaneurysms such as traumatic, mycotic and ill-defined unknown causes of aneurysms are rare. The authors have studied the results of surgical management from such cases in our series. Patients and Method : In the last 17 years, 1320 patients with cerebrovascular aneurysms were managed surgically. Among these, 16 patients showed the pseudoaneurysms. The authors analyzed retrospectively the clinical characteristics, treatment methods, management outcomes and problems in the managements. Results : There were 6 patients with traumatic aneurysm, 4 mycotic aneurysms and 6 ill-defined unknown causes of aneurysm. The sites of traumatic aneurysms were cavernous portion of the internal carotid artery(n=3), distal portion of the anterior cerebral artery (n=2) and vertebral artery(VA : n=1). Good outcomes in 5 cases could be obtained by extracranial - intracranial bypass followed by parent vessel occlusion or resection of aneurysm followed by re-anastomosis of parent vessel. The sites of mycotic aneurysm were peripheral portions of middle cerebral artery(MCA : n=3) and posterior cerebral artery(PCA : n=1). The outcomes of the patients with a mycotic aneurysm were relatively poor. It was partially due to the development of new aneurysm after treatment in one. The sites of ill-defined unknown causes of aneurysm were extracranial carotid artery(n=3), V2 portion of the VA(n=1), peripheral portion of the PCA (n=1) and MCA(n=1). Good outcome in all cases could be obtained by resection of aneurysm with or without saphenous vein graft. Conclusion : For the treatments of cerebrovascular pseudoaneurysm, combinations of aggressive medical, endovascular and surgical managements seem mandatory. Insertion of stent for a extracranial carotid artery aneurysm and coiling for a peripheral mycotic aneurysm can be option in future.

종격동 농양을 동반한 좌쇄골하 동맥의 진균성 동맥류: 증례 보고

조재굉,정해웅,구용운 대한영상의학회 2002 대한영상의학회지 Vol.47 No.5

Mycotic aneurysms most commonly occur in femoral arteries or the abdominal aorta. Mycotic aneurysm arising from the left subclavian artery is very rare. The morbidity and mortality of ruptured mycotic aneurysms, regardless of their location, remain high despite the current practice of administering an intensive antibiotic regimen. We encountered a case of mycotic aneurysm presenting as mediastinal abscess and arising from in the left subclavian artery. Therefore, we report this case with radiologic findings to remind readers of the possibility of this unusual location of mycotic aneurysm. 진균성 동맥류는 대부분 대퇴 동맥이나 복부동맥에 주로 발생하고 좌쇄골하 동맥에서 발생하는 경우는 드물다. 진균성 동맥류는 발생위치에 관계없이 파열되면 강력한 항생제 치료에도 불구하고 높은 이환률과 사망률을 나타내므로 조기진단이 매우 중요하다. 저자들은 77세 여자환자에서 상종격동에 농양을 동반한 좌쇄골하동맥에서 발생한 진균성 동맥류를 경험하였기에 방사선학적 소견과 함께 보고하고자 한다.

감염성 심내막염 환자에서 증상 없이 발견된 뇌동맥류 1예

김희만,임세중,이주용,이꽃실,김준명,홍유선,이규창 대한내과학회 2003 대한내과학회지 Vol.64 No.4

30세 남자 환자로 심내막염 진단 후 발견된 무증상의 감염성 뇌동맥류로 항생제 치료 후 단계적인 수술로 심장판막 대치술과 뇌동맥류 결찰술을 시행하여 심각한 뇌신경학적 후유증이나 합병증이 발생하기 전에 성공적으로 치료한 경험을 하였기에 문헌 고찰과 함께 보고하는 바이다. Cerebral mycotic aneurysm is an uncommon complication of infective endocarditis. In spite of low incidence, mycotic aneurysm is a serious complication because of the high risk of its rupture. Therefore, early diagnosis and management of cerebral mycotic aneurysm are imperative before the rupture. We experienced a case of asymptomatic cerebral mycotic aneurysm in a 30-year old man with infective endocarditis. He was admitted for splenic and renal infarction due to systemic embolization. The echocardiography showed severe mitral regurgitation, mitral valve prolapse and vegetation on the mitral valve. Streptococcus mitis was identified from blood cultures. In the course of antibiotics therapy, brain magnetic resonance image and 4-vessel cerebral angiography were performed, which revealed multiple unruptured cerebral mycotic aneurysms. Considering the high risk of rupture we performed mitral valve replacement with bioprosthesis. On follow-up cerebral angiography after the valve replacement surgery, one of aneurysms was enlarged, and successfully treated by surgical intervention without complication. We report one case of mycotic aneurysm without neurologic symptom in an infective endocarditis patient, who was treated without serious sequelae of the aneurysm. (Korean J Med 64:477-481, 2003)

부비동염에서 기원한 진균성 동맥류의 치료과정 중 발생한 코일의 이동

장혁(Hyeok Chang),김도희(Do Hee Kim),김정희(Jung Hee Kim),이호진(Ho Jin Lee),홍상덕(Sang Duk Hong),홍창기(Chang Ki Hong) 대한두개저학회 2020 대한두개저학회지 Vol.15 No.1

Invasive sphenoid fungal sinusitis sometimes invades the adjacent structures such as the optic nerve or cavernous sinus. Here, we present the treatment for a primarily embolized mycotic aneurysm that ruptured during endoscopic sinus surgery. This report describes the case of a 72-year-old man with a mycotic aneurysm. Although the patient’s mycotic aneurysm was controlled by coil embolization, the subsequent endoscopic surgery resulted in massive bleeding and dislocation of the embolic coil. The ruptured vessel was stably controlled by internal carotid artery occlusion. This case emphasizes the need for careful consideration when performing endoscopic surgery for sphenoid sinusitis in patients especially with a mycotic aneurysm.

Treatment of an Acute Mycotic Aneurysm of the Common Carotid Artery with a Covered Stent-Graft

이석훈,조영권,박종무,정규리,김현숙,우정주 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.1

We report herein a case successful endovascular treatment with a stent-graft of a rare case of rapidly growing mycotic aneurysm of the left common carotid artery due to acute bacterial endocarditis after eradication of the infection. Infected mycotic aneurysms of the peripheral vasculature have been considered as a contraindication for stent-graft implantation because of the possibility of microorganism spreading to the stent-graft; however, if there is evidence of complete eradication of microorganism and surgery is not an option, stent-graft implantation can be an effective and safe treatment modality for exclusion of the mycotic aneurysm.

Extra-anatomic Bypass Grafting after Endovascular Embolization for the Treatment of Mycotic Aneurysm − 2 case reports −

Kwan-wook Kim,Jung Hwan Kim,윤영남 대한흉부외과학회 2011 Journal of Chest Surgery (J Chest Surg) Vol.44 No.2

Mycotic aneurysm is a disease requiring immediate treatment because of the high risk of rupture. A difficult surgical approach, especially in the case of occurrence on the iliac artery, involving endovascular embolization and extra-anatomic bypass grafting, is known to be a suitable treatment. We performed extra-anatomic bypass grafting after endovascular embolization successfully in two patients. The postoperative computed tomography of both patients showed complete exclusion of the mycotic aneurysm.

A Case of Intracranial Mycotic Aneurysm due to Aspergillus species.

최현용,임용철,강재규 대한뇌혈관외과학회 2010 Journal of Cerebrovascular and Endovascular Neuros Vol.12 No.3

Intracranial mycotic aneurysms due to Aspergillus species are extremely uncommon but fatal. A medium-sized ruptured intracranial aneurysm at the middle cerebral artery bifurcation was identified in a 50-year-old female patient. Proper microsurgical clipping was not feasible due to the aneurysm? friable nature. Microsuture and wrapping were done instead. Histological findings confirmed a mycotic aneurysm caused by Aspergillus. Herein, we report on the clinical course and histopathological findings with a relevant literature review. (Kor J Cerebrovascular Surgery 12(3):123-125, 2010)

폐렴구균 감염에 의한 복부 대동맥류 1예

최소연,백경란,기현균,문치숙,오원섭,송재훈,신동현,위유미,고영혜 대한감염학회 2005 감염과 화학요법 Vol.37 No.2

폐렴구균은 폐렴, 수막염, 중이염 등의 감염증을 일으키나 감염성 대동맥류를 유발하는 경우는 매우 드물다. 저자들은 고혈압, 당뇨병 등을 가지고 있으며 대동맥류가 확인되지 않았던 78세 남자 환자에서 감염증의 증상없이 대동맥류 파열로 내원하여 폐렴구균에 의한 대동맥류로 진단되었던 증례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Streptococcus pneumoniae has been an important etiologic agent of community-acquired pneumonia, meningitis, and otitis media. S. pneumoniae is also an important cause of bacteremia, especially in a community setting and it may cause intravascular infection. S. pneumoniae has been rarely been reparted to cause mycotic aneurysm and three is no case report on abdominal aneurysm caused by S. pneumoniae in Korea, yet. We experienced a case of abdominal aneurysm caused by S. pneumoniae infection. A 78-year old male with hypertension and diabetes mellitus was transferred to our hospital due to ruptured abdominal aortic aneurysm. Surgical intervention was done for removal of hematoma and vascular anastomosis. Ascending aorta showed atheromatous plaque with dystrophic calcification and thrombus. S. pneumoniae was isolated from the culture of the surgical specimen. After successful treatment with antibiotics for 7 weeks, he has been followed up uneventfully in outpatient clinic for 1 year.

Candida albicans 에 의한 칸디다 안구내염에 병발한 감염성 흉부 대동맥류 1예

권현희 대한의진균학회 2017 대한의진균학회지 Vol.22 No.4

Candida species cause various invasive fungal diseases, including candidemia, endocarditis, endophthalmitis, peritonitis, osteomyelitis and arthritis, but infected (mycotic) aortic aneurysms caused by Candida species are very rare. So, we report a case of infected thoracic aortic aneurysm concurrent with endophthalmitis by Candida albicans in a 42-year-old man. The patient initially was diagnosed with candidial endophthalmitis and hospitalized for vitrectomy. On admission, he had chest CT taken and infected thoracic aortic aneurysm was detected. He treated with antifungal agent and resection and patch repair of aortic aneurysm. Two months later, a new aneurysm on the patch repair site was detected and thoracic endovascular aortic repair (TEVAR) was performed. After TEVAR and long-term antifungal therapy, his infected aortic aneurysm has been successfully treated.

Case Report : Complete Visual Recovery after Mycotic Aneurysm Embolization Complicated by Cavernous Sinus Thrombophlebitis

( Ungsoo Samuel Kim ),( Ji Soo Kim ),( O Ki Kwon ),( Jeong Min Hwang ) 대한안과학회 2010 Korean Journal of Ophthalmology Vol.24 No.5

A 62-year-old woman has been suffered from cavernous sinus thrombophlebitis which was confirmed by four-vessel angiography, orbit magnetic resonance imaging, and blood culture. Three weeks after recovery of cavernous sinus thrombophlebitis, right eye proptosis and complete third, fourth, and sixth cranial nerve palsies developed. Best-corrected visual acuity decreased to 20/70 in the right eye. Repeat magnetic resonance imaging demonstrated a 1.5-cm-sized mass in the right cavernous sinus, suspicious for mycotic aneurysm. Amphotericin B supplementation was begun and was followed by successful transarterial Guglielmi detachable coil embolization. Four months later, extraocular movement was normalized, and visual acuity improved to 20/25 in the right eye.