European Journal of Molecular & Clinical Medicine

Background:  Previous studies detected large number of variations in circle of Willis in normal populations. There is limited data for the effect and correlation of normal varieties and pathologic vascular anomalies
Purpose:  Prevalence of normal variants and impact of its presence in decision making process.
Patients and methods: Ninety patients' records underwent therapeutic angiography were retrospectively reviewed and reallocated into two equal groups according to pathology (group 1=vascular malformation group, group 2= ischemic insults). Age, sex, type of pathology, site of normal variants and finally their impact on decision making process were calculated.    
Results: The mean and standard deviation of age in our study was found to be (40.18 years ± 15.6), most of patients were between 30-40 years old. The total number of normal variants that were detected in our study either at extra- or intracranial vascular tree was 46 variants. Forty-nine cases were "ignored" or added no impact on the proposed plan during neurointervention. The sensitivity of normal variants in changing decision making process was seen in 15% of cases while the specificity was 100%.
DSA, normal variations, variants, aneurysm, COW

Purpose: Visceral artery pseudo-aneurysms were infrequently encountered in clinical practice. With the advent of higher resolution imaging, VAPA has been diagnosed more frequently and promptly. Though the natural history of this pathology is not fully elucidated, they can present with devastating complications. This study is one of the few large case series exclusively describing visceral artery pseudo-aneurysm offering a glimpse in to various etiologies, presentations, and treatment approaches for visceral artery pseudo-aneurysms in a specialized care center.
Material and Methods: Medical records of patients with visceral artery pseudo-aneurysms between January 2015 to May 2020 were retrieved, and data pertaining to etiology, clinical presentation, imaging, and management were compiled and analyzed.
Results: During the study period 29 visceral artery pseudo-aneurysms were identified in 27 patients (2 patients had more than one VAPA). They had diverse etiology, location, and presentation. The splenic artery was the most common site of VAPA (n=10). The commonest etiology was pancreatitis (41%). Only 7 patients were asymptomatic while the majority had symptoms (n=20). Abdominal pain was the most frequent symptom (66%) followed by gastrointestinal bleeding (30%). 16 patients were successfully treated by endovascular intervention, while 2 patients required surgical intervention. No morbidity or mortality was noted during the period of hospitalization.
Conclusion: Visceral artery pseudo-aneurysms can be secondary to plethora of pathologies. A high degree of suspicion with prompt imaging helps in timely diagnosis. Endovascular interventions are highly effective treatment modalities for visceral artery pseudo-aneurysms. It should be considered as the preferred modality of treatment in anatomically suited VAPA.

Cerebralaneurysmscoexist with arteriovenousmalformations. In tandem arteriovenousmalformation and aneurysm, in the case of haemorrhage, itisoftendifficult to indicatewhichis the source ofbleeding.Thiscancausediagnosticdifficulties.We present a case of a 40-year-old patient with subarachnoid hemorrhage, occipital malformation and concomitantaneurysm of the ipsilateral posterior cerebral artery. After clinical and neuroimaging analysis, anddiagnostic deliberations, the source of bleeding turned out to be an aneurysm. This case is significant because the aneurysm was treated by surgical clipping, which is rare today. Intravascularcoilingis the treatment of choice for vertebrobasilaraneurysms. Due to the development of endovasculartechniques, clipping of suchaneurysmshasbecomehistoricmethod.We present a procedure of clippingthroughanextendedpterionalcraniotomy. We detail the nuanses, limitations, and potentialcomplications.We also pay attention to maintaining the diagnostic vigilance of indicating the source of bleeding in the event of coexisting aneurysm and malformation.