Clarke Jonathan, Choong Andrew, Raja Shahzad, Amrani Mohamed, Hellawell Giles, Hussain Tahir
Outer North West London Regional Vascular Unit, North West London Hospitals National Health Service Trust, Northwick Park Hospital, Watford Road, Harrow, UK.
Outer North West London Regional Vascular Unit, North West London Hospitals National Health Service Trust, Northwick Park Hospital, Watford Road, Harrow, UK; Department of Surgery, University of Queensland, Brisbane, Australia.
Ann Vasc Surg. 2014 May;28(4):1033.e11-5. doi: 10.1016/j.avsg.2013.07.027. Epub 2013 Nov 5.
We present the rare case of a 66-year-old Caucasian male patient presenting with intermittent left-side abdominal pain. He underwent a kidneys, ureters, and bladder computed tomography scan on which an incidental 45-mm giant aneurysm of the left anterior descending coronary artery was discovered along with 55-mm right-sided and 62-mm left-sided common iliac artery aneurysms and a 100-mm benign renal oncocytoma. He underwent on-pump coronary artery bypass grafting of the left anterior descending, left circumflex and right coronary arteries using internal mammary artery and saphenous vein grafts. He subsequently underwent simultaneous open left nephrectomy and bilateral common iliac aneurysm repair using a bifurcated tube graft. He made a full recovery postoperatively. Giant coronary artery aneurysms are rare. In the pediatric population, they are predominantly secondary to Kawasaki disease. In adults, atheromatous disease is the leading cause. The coexistence of giant coronary artery aneurysms with extracoronary artery aneurysms is extremely unusual. We propose that the identification of giant coronary artery aneurysms necessitates further imaging investigations to identify the presence of extracoronary aneurysms. To our knowledge, this is the first description of such a case in the literature.
我们报告了一例罕见病例，一名66岁的白种男性患者，表现为间歇性左侧腹痛。他接受了肾脏、输尿管和膀胱计算机断层扫描，结果发现左前降支冠状动脉有一个45毫米的巨大动脉瘤，同时还有右侧55毫米和左侧62毫米的髂总动脉瘤以及一个100毫米的良性肾嗜酸细胞瘤。他接受了使用乳内动脉和大隐静脉移植进行的左前降支、左旋支和右冠状动脉的体外循环冠状动脉搭桥术。随后，他同时接受了开放性左肾切除术和使用分叉管状移植物进行的双侧髂总动脉瘤修复术。他术后完全康复。巨大冠状动脉动脉瘤很罕见。在儿童人群中，它们主要继发于川崎病。在成人中，动脉粥样硬化疾病是主要原因。巨大冠状动脉动脉瘤与冠状动脉外动脉瘤并存极为罕见。我们认为，识别巨大冠状动脉动脉瘤需要进一步进行影像学检查，以确定是否存在冠状动脉外动脉瘤。据我们所知，这是文献中对该病例的首次描述。
