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Minaya-Bravo AM, Vera-Mansilla C, Ruiz-Grande F. Presentation of a large jejunal artery aneurysm: Management and review of the literature. Int J Surg Case Rep 2018; 48:50-53. [PMID: 29803195 PMCID: PMC6026721 DOI: 10.1016/j.ijscr.2018.04.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/23/2018] [Accepted: 04/30/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Jejunal artery aneurysms (JAAs) constitute less than 1% of all visceral artery aneurysms. They affect mostly men in their fifth decade. In the last years, the widespread of fine cut fine image techniques has increased the number of JAAs diagnosed incidentally. The first case was reported by Levine in 1944. Since then, only a half of hundred cases have been reported. There is a lack of consensus of management of intact JAAs because of the low number of cases published. We present the largest JAA reported in the English literature up to our knowledge. PRESENTATION We report a 49 year-old woman with a 4 × 5 cm. intact jejunal artery aneurysm found incidentally in a CT. It rose from the first jejunal branch of superior mesenteric artery without signs of rupture. She underwent elective surgery and the aneurysm was completely excised. DISCUSSION Causes of JAAs include congenital, atherosclerosis or degenerative process. Their rate of rupture depends on location, size and underlying disease and it reaches 10-20% for all visceral artery aneurysms. Risk factors of rupture include pregnancy, hyper-flow situations and connective diseases. Most of cases in the literature presented rupture at the time of diagnosis. JAAs are usually treated following the recommendations for visceral artery aneurysms, so intact JAAs greater than 2 cm. and those causing symptoms should be treated. Treatment includes surgery, embolisation or stent. Surgery is the preferred management for emergency settings. CONCLUSION JAAs are extremely rare and constitute only 1% of all visceral aneurysms. They are a life-threatening condition.
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Affiliation(s)
- Ana María Minaya-Bravo
- General and Digestive Surgery Department, Henares Teaching Hospital, Coslada, 28822, Madrid, Spain.
| | - Cristina Vera-Mansilla
- General and Digestive Surgery Department, Don Benito-Villanueva de la Serena Hospital, 06400, Badajoz, Spain.
| | - Fernando Ruiz-Grande
- Vascular Surgery Department, Principe de Asturias Teaching Hospital, Alcalá de Henares, 28805, Madrid, Spain.
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Brizzi V, Déglise S, Dubuisson V, Midy D, Ducasse E, Berard X. Laparoscopic Resection of a Middle Colic Artery Aneurysm. Ann Vasc Surg 2018; 48:253.e1-253.e3. [PMID: 29421421 DOI: 10.1016/j.avsg.2017.10.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/15/2017] [Accepted: 10/24/2017] [Indexed: 12/30/2022]
Abstract
We report herein the successful laparoscopic resection of an asymptomatic 3-cm middle colic artery aneurysm in a young woman. Endovascular treatment represents nowadays the first-line option facing visceral artery aneurysm, but in this case, embolization was excluded because of hostile anatomy. Advantages of laparoscopic approach were the safe resection of the aneurysm with immediate evaluation of the bowel tolerance and the possibility of a histological examination of the arterial wall, without the disadvantages of laparotomy.
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Affiliation(s)
- Vincenzo Brizzi
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France.
| | - Sebastien Déglise
- Vascular Surgery Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Vincent Dubuisson
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France
| | - Dominique Midy
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France; Faculty of Medicine, University of Bordeaux, Bordeaux, France
| | - Eric Ducasse
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France; Faculty of Medicine, University of Bordeaux, Bordeaux, France
| | - Xavier Berard
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France; Faculty of Medicine, University of Bordeaux, Bordeaux, France
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Landry GJ, Yarmosh A, Liem TK, Jung E, Azarbal AF, Abraham CZ, Mitchell EL, Moneta GL. Nonatherosclerotic vascular causes of acute abdominal pain. Am J Surg 2018; 215:838-841. [PMID: 29361271 DOI: 10.1016/j.amjsurg.2017.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND To examine the epidemiology, treatments, and outcomes of acute symptomatic non-atherosclerotic mesenteric vascular disease. METHODS Subjects were reviewed over a six year period. Categories included embolism (EM), dissection (DI), and aneurysm (AN). Presentation, demographics, treatment and outcomes were compared. RESULTS 46 patients were identified (EM:20, AN:15, DI:11). Age at presentation differed (EM: 66.3, AN 62.4, DI 54.6, p < .05). EM more likely affected the superior mesenteric artery (EM80%, AN20%, DI45%, p = .002), DI hepatic artery (EM20%, AN13%, DI55%, p < .05), and AN mesenteric branches (EM5%, AN47%, DI0%; p = .001). EM more likely had history of arrhythmia (EM40%, AN7%, DI0%, p,0.05) and diarrhea (EM30%, AN7%, DI0%, p < .05). Treatment was most often surgical in EM (EM85%, AN33%, DI9%, p < .001), endovascular in AN (EM5%, AN40%, DI 9%, p < .02), and conservative in DI (EM15%, AN 33%, DI82%, p < .05). In hospital mortality was infrequent (EM10%, AN7%, DI0%, p = ns). Mean hospital length of stay differed by mechanism (EM13.6days, AN9.2, DI2.3, p = .005). Median follow up was 61 months. Survival at 1, 3 and 5 years for emboli was 75%, 70% and 59%, for aneurysms 93%, 86%, and 77%, and for dissections 100% at all time points (p = .043 log rank). CONCLUSIONS Patients with EM, AN, and DI differ in age, anatomic distribution and method of treatment. The etiology significantly affects long term survival.
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Affiliation(s)
- Gregory J Landry
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, OP11, Portland, OR 97239-3098, USA.
| | - Alla Yarmosh
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, OP11, Portland, OR 97239-3098, USA
| | - Timothy K Liem
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, OP11, Portland, OR 97239-3098, USA
| | - Enjae Jung
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, OP11, Portland, OR 97239-3098, USA
| | - Amir F Azarbal
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, OP11, Portland, OR 97239-3098, USA
| | - Cherrie Z Abraham
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, OP11, Portland, OR 97239-3098, USA
| | - Erica L Mitchell
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, OP11, Portland, OR 97239-3098, USA
| | - Gregory L Moneta
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, OP11, Portland, OR 97239-3098, USA
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Storace M, Martin JG, Shah J, Bercu Z. CTA As an Adjuvant Tool for Acute Intra-abdominal or Gastrointestinal Bleeding. Tech Vasc Interv Radiol 2017; 20:248-257. [DOI: 10.1053/j.tvir.2017.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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55
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Venturini M, Marra P, Colombo M, Panzeri M, Gusmini S, Sallemi C, Salvioni M, Lanza C, Agostini G, Balzano G, Tshomba Y, Melissano G, Falconi M, Chiesa R, De Cobelli F, Del Maschio A. Endovascular Repair of 40 Visceral Artery Aneurysms and Pseudoaneurysms with the Viabahn Stent-Graft: Technical Aspects, Clinical Outcome and Mid-Term Patency. Cardiovasc Intervent Radiol 2017; 41:385-397. [PMID: 29164308 DOI: 10.1007/s00270-017-1844-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/13/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE Endovascular repair of true visceral artery aneurysms (VAAs) and pseudoaneurysms (VAPAs) with stent-grafting (SG) can simultaneously allow aneurysm exclusion and vessel preservation, minimizing the risk of ischemic complications. Our aim was to report a single-center experience on SG of visceral aneurysms, focusing on technical aspects, clinical outcome and mid-term patency. MATERIALS AND METHODS Consecutive patients affected by VAAs-VAPAs and submitted to endovascular treatment were retrospectively reviewed, and SG cases with the self-expandable peripheral Viabahn stent-graft were analyzed (2003-2017). Aneurysm type, patient number, SG clinical setting, procedural data, peri-procedural complications, technical success, 30-day clinical success, 30-day mortality and follow-up period (aneurysm exclusion, stent-graft patency, ischemic complications) were analyzed. RESULTS SG was performed in 40 patients (24 VAPAs/16 VAAs) and in 44 procedures (25 in emergency, 19 in elective treatments), via transfemoral in 37 cases (transaxillary in 7 cases). One peri-procedural complication was recorded (a splenic artery dissection successfully converted to transcatheter embolization). The overall technical and clinical success rates were, respectively, 96 and 84%, with excellent trend in elective treatments (both 100%). Overall 30-day mortality was 12.5% (septic shock after pancreatic surgery). Stent-graft thrombosis occurred in 2 patients within 3 months, with aneurysm exclusion and without ischemic complications. Stent-graft patency and aneurysm exclusion were confirmed at 6, 12 and 36 months in 18, 12 and 7 patients, respectively. CONCLUSION SG of VAAs and VAPAs was safe and effective, particularly in elective treatments. The Viabahn stent-graft, flexible and without shape memory, is suitable for endovascular repair of tortuous visceral arteries.
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Affiliation(s)
- Massimo Venturini
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy.
| | - Paolo Marra
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Michele Colombo
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Marta Panzeri
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Simone Gusmini
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Claudio Sallemi
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Marco Salvioni
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Carolina Lanza
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Giulia Agostini
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Gianpaolo Balzano
- Department of Vascular Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Yamume Tshomba
- Department of Pancreatic Surgery, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Germano Melissano
- Department of Pancreatic Surgery, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Falconi
- Department of Vascular Surgery, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Chiesa
- Department of Pancreatic Surgery, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Del Maschio
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Rubio Montaña M, Blázquez Sánchez J, Ocaña Guaita J, Gandarias Zúñiga C. Disección aislada de la arteria mesentérica superior: tratamiento endovascular mediante stent y embolización. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2016.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tkalčić L, Budiselić B, Kovačević M, Knežević S, Kovačić S, Miletić D, Tomulić V, Kuhelj D. Endovascular Management of Superior Mesenteric Artery (SMA) Aneurysm - Adequate Access is Essential for Success - Case Report. Pol J Radiol 2017; 82:379-383. [PMID: 28794812 PMCID: PMC5521092 DOI: 10.12659/pjr.901935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/07/2016] [Indexed: 01/17/2023] Open
Abstract
Background An aneurysm of the superior mesenteric artery (SMA) with a diameter of 2.2 cm was found incidentally on an ultrasound (US) examination in a 26-year-old woman. The only known risk factor was an intracranial aneurysm that was found on her grandmother’s autopsy. Based on pregnancy planning and the current literature, endovascular management with a covered stent was proposed. Case Report Self-expandable, covered stent (Bard, Fluency®) was implanted using a single transfemoral approach. A stiff guidewire and a large sheath distorted the anatomy, which resulted in an incomplete aneurysmal neck covering. In the absence of additional covered stents, the procedure was terminated. Two weeks later, computed tomographic angiography (CTA) confirmed persistent aneurysmal perfusion due to the incomplete neck coverage. A multidisciplinary board opted for a second endovascular attempt, this time with a longer covered stent via the transaxillary approach in order to reduce anatomical distortion. Balloon, expandable, cobalt-chrome covered stent (Jotec, E-ventus BX®) was implanted in the SMA, covering the aneurysmal neck and overlapping the previously implanted covered stent. Angiography confirmed a complete exclusion of the aneurysm. A control US performed three weeks later confirmed a patent covered stent and complete aneurysmal exclusion. There was a mild median nerve damage periprocedurally that resolved in three months. The most recent US control examination, performed eleven months after the procedure, showed an excluded aneurysm and a patent covered stent. There were no clinical signs of bowel ischaemia during the follow-up period. Conclusions Endovascular management of SMAA proved to be safe and efficient. The “access from above” is probably safer and should be considered in the majority of cases with acceptable sizes of access vessels. Mid-term results in our patient are good and life-long follow-up is planned to prevent late complications.
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Affiliation(s)
- Lovro Tkalčić
- Department of Radiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Berislav Budiselić
- Department of Radiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Miljenko Kovačević
- Department of Vascular Surgery, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Siniša Knežević
- Department of Radiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Slavica Kovačić
- Department of Radiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Damir Miletić
- Department of Radiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Vjekoslav Tomulić
- Department of Cardiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Dimitrij Kuhelj
- Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Venturini M, Marra P, Colombo M, Alparone M, Agostini G, Bertoglio L, Sallemi C, Salvioni M, Gusmini S, Balzano G, Castellano R, Aldrighetti L, Tshomba Y, Falconi M, Melissano G, De Cobelli F, Chiesa R, Del Maschio A. Endovascular Treatment of Visceral Artery Aneurysms and Pseudoaneurysms in 100 Patients: Covered Stenting vs Transcatheter Embolization. J Endovasc Ther 2017; 24:709-717. [DOI: 10.1177/1526602817717715] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To retrospectively report a large single-center experience of visceral artery aneurysms (VAAs) and pseudoaneurysms (VAPAs) treated with covered stenting (CS) as the first therapeutic option vs transcatheter embolization (TE). Methods: One hundred patients (mean age 59±14 years; 58 men) underwent 59 elective and 41 emergent endovascular procedures to treat 51 VAAs and 49 VAPAs. Seventy patients had TE and 30 received CS (27 Viabahn and 3 coronary stent grafts). Both TE and CS were performed in 10 cases. Results: Technical success was 96% (97% CS, 96% TE), and 30-day clinical success was 83% (87% CS, 81.4% TE). Four major complications occurred; 30-day mortality was 7%, mainly due to septic shock following pancreatic surgery. The midterm follow-up was 20.8 months in the total population and 32.8 months in the CS group. More than 6 months after CS all aneurysms remained excluded; stent patency was achieved in 88%. Twelve CS patients with >3 years’ follow-up had maintained stent patency. Conclusion: In endovascular treatment of visceral aneurysms, covered stenting was feasible in 30%. CS showed a slightly better efficacy than TE and good midterm patency. The Viabahn covered stent seems to be suitable for endovascular repair of tortuous visceral arteries affected by true or false aneurysms.
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Affiliation(s)
- Massimo Venturini
- Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Marra
- Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Michele Colombo
- Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Marco Alparone
- Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Agostini
- Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Bertoglio
- Department of Vascular Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Sallemi
- Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Marco Salvioni
- Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Simone Gusmini
- Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Gianpaolo Balzano
- Department of Pancreatic Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Renata Castellano
- Department of Vascular Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Aldrighetti
- Department of Hepatobiliary Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Yamume Tshomba
- Department of Vascular Surgery, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Falconi
- Department of Pancreatic Surgery, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Germano Melissano
- Department of Vascular Surgery, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Chiesa
- Department of Vascular Surgery, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Del Maschio
- Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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Feng W, Yue D, ZaiMing L, ZhaoYu L, XiangXuan Z, Wei L, QiYong G. Iatrogenic hemobilia: imaging features and management with transcatheter arterial embolization in 30 patients. Diagn Interv Radiol 2017; 22:371-7. [PMID: 27328719 DOI: 10.5152/dir.2016.15295] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE We aimed to evaluate the imaging features of computed tomography (CT) and angiography and the efficacy of transcatheter arterial embolization (TAE) in patients with hemobilia of different iatrogenic causes. METHODS Thirty patients with hemobilia were divided into two groups according to their iatrogenic causes, i.e., group 1, 11 patients (36.7%) with transhepatic intervention and group 2, 19 patients (63.3%) with surgical procedures in the hilar area. Seventeen patients (56.7%) underwent abdominal contrast-enhanced CT before selective angiography. Polyvinyl alcohol particles, gelatin sponges, and coils were used for TAE. Data from the two groups were compared using Fisher's exact test and the Mann-Whitney U test. RESULTS Contrast-enhanced CT showed a hematoma, extravasation of contrast material, and pseudoaneurysm. The bleeding source was determined by angiographic features in all patients, which were not significantly different between the two groups (P = 0.127), and pseudoaneurysm was the most common. The embolic material and number of coils used for TAE were significantly different between the two groups (P < 0.001), but the embolization was technically successful in all patients. The clinical success rate of the first embolization was 100% in group 1 vs. 84.2% in group 2. The overall clinical success rate of TAE was 100% in all patients. The complication rate was 63.6% in group 1 vs. 68.4% in group 2 (P = 1.000). CONCLUSION CT was useful in diagnosing hemobilia, and angiograms enabled determination of the bleeding source. Pseudoaneurysm was one of the most common angiographic features. TAE was successfully performed with different embolic materials on the basis of the iatrogenic cause and bleeding location.
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Affiliation(s)
- Wen Feng
- Department of Radiology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China.
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Abdelgabar A, d'Archambeau O, Maes J, Van den Brande F, Cools P, Rutsaert RR. Visceral artery pseudoaneurysms: two case reports and a review of the literature. J Med Case Rep 2017; 11:126. [PMID: 28472975 PMCID: PMC5418714 DOI: 10.1186/s13256-017-1291-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/05/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Visceral artery pseudoaneurysms are relatively rare but have a high mortality rate in case of rupture. Their detection in the last decades is rising due to an increased use of computed tomography and angiography. However, due to the nonspecific nature of the clinical symptoms and signs, diagnosis is often delayed or missed. We describe two cases of patients presenting with nonspecific abdominal complaints and anemia leading to a diagnosis of visceral pseudoaneurysm. Both cases are successfully treated with a different endovascular intervention. CASE PRESENTATION The first case is a 67-year-old Caucasian man presenting with diffuse abdominal pain, vomiting, diarrhea, and weight loss. Digital angiography showed a complex pseudoaneurysm of the superior mesenteric artery. The patient was treated with stent placement and selective embolization of the afferent branches. The second patient is a 78-year-old Caucasian man with a history of chronic pancreatitis admitted with epigastric pain, rectal bleeding and melena. Angiography showed a pseudoaneurysm of the gastroduodenal artery. The patient was successfully treated with coil embolization. CONCLUSIONS We report two cases of visceral pseudoaneurysms and review the literature concerning etiology, presentation, diagnosis, and treatment. Visceral artery pseudoaneurysms should be considered in the differential diagnosis of a patient with nonspecific abdominal symptoms. Diagnosis is often made with computed tomography or computed tomography angiography but digital angiography remains the gold standard. Treatment options include surgical, endovascular or percutaneous interventions. The choice of treatment is case specific.
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Affiliation(s)
- Amna Abdelgabar
- Department of Vascular and Thoracic Surgery, Sint Vincentius Hospital, Antwerp, Belgium.
| | | | - Joachim Maes
- Department of Radiology, Sint Augustinus Hospital, Antwerp, Belgium
| | - Filip Van den Brande
- Department of Vascular and Thoracic Surgery, Sint Vincentius Hospital, Antwerp, Belgium
| | - Peter Cools
- Department of General Surgery, Sint Vincentius Hospital, Antwerp, Belgium
| | - Roger R Rutsaert
- Department of Vascular and Thoracic Surgery, Sint Vincentius Hospital, Antwerp, Belgium
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Hansraj N, Hamdi A, Wise ES, DiChiacchio L, Sarkar R, Toursavadkohi S. Open and Endovascular Management of Inferior Mesenteric Artery Aneurysms: A Report of Two Cases. Ann Vasc Surg 2017; 43:316.e9-316.e14. [PMID: 28479424 DOI: 10.1016/j.avsg.2017.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 04/12/2017] [Accepted: 04/12/2017] [Indexed: 11/28/2022]
Abstract
Inferior mesenteric artery (IMA) aneurysms are a rare entity, attributing to 1% of Splanchnic aneurysms (Edogawa S, Shibuya T, Kurose K et al. Inferior mesenteric artery aneurysm: case report and literature review. Ann Vasc Dis 2013;6:98-101), often found incidentally on evaluation for other intra-abdominal pathologies. Similar to other visceral arterial aneurysms, there is an estimated 20-50% risk of potentially fatal rupture and repair is generally recommended. We report 2 patients with IMA aneurysms, using them as cases to illustrate feasibility of both open and endovascular management options. Patient 1 is a 69-year-old male with bilateral claudication found to have an asymptomatic 20-mm IMA aneurysm. This patient underwent aortobifemoral bypass with branch polytetrafluoroethylene graft to distal IMA after excision of IMA aneurysm. Patient 2 is a 32-year-old male who underwent an ex vivo renal artery aneurysm repair and was noted on routine follow-up to have an incidental saccular 1.5-cm IMA aneurysm for which he underwent endovascular coil embolization. Both patients had an unremarkable postoperative course with a notable absence of stigmata of bowel ischemia.
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Affiliation(s)
- Natasha Hansraj
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
| | - Abdulrahman Hamdi
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Eric S Wise
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Laura DiChiacchio
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Rajabrata Sarkar
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Shahab Toursavadkohi
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
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Visceral aneurysms: Old paradigms, new insights? Best Pract Res Clin Gastroenterol 2017; 31:97-104. [PMID: 28395793 DOI: 10.1016/j.bpg.2016.10.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 09/22/2016] [Accepted: 10/02/2016] [Indexed: 02/07/2023]
Abstract
True visceral artery aneurysms (VAAs) are a rare entity with an incidence of 0.01-2%. The risk of rupture varies amongst the different types of VAAs and is higher for pseudo aneurysms compared with true aneurysms. Size, growth, symptoms, underlying disease, pregnancy and liver transplantation have all been associated with increased risk of rupture. Mortality rates after rupture are around 25%. The splenic artery is most commonly affected and the etiology is predominantly atherosclerosis. Open repair can be done by simple ligation or reconstruction of the artery, while endovascular options include embolization or using a stent graft. Location, collateral circulation and medical condition of the patient should all be taken into account when an intervention is planned. We compared types of treatment and searched for risk factors for rupture but unfortunately, the level of evidence found in the literature is low. Therefore, deciding when and how to treat a patient with a VAA based on the current literature, remains challenging for clinicians.
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Kriger AG, Smirnov AV, Akhtanin EA, Varava AB. [A true giant aneurysm of gastro-duodenal artery]. Khirurgiia (Mosk) 2017:98-100. [PMID: 28091464 DOI: 10.17116/hirurgia20161298-100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- A G Kriger
- Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation
| | - A V Smirnov
- Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation
| | - E A Akhtanin
- Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation
| | - A B Varava
- Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation
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Nasr LA, Faraj WG, Al-Kutoubi A, Hamady M, Khalifeh M, Hallal A, Halawani HM, Wazen J, Haydar AA. Median Arcuate Ligament Syndrome: A Single-Center Experience with 23 Patients. Cardiovasc Intervent Radiol 2017; 40:664-670. [DOI: 10.1007/s00270-016-1560-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 12/22/2016] [Indexed: 11/28/2022]
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Abstract
INTRODUCTION True visceral artery aneurysms (VAA) should be treated under elective conditions in dependency on maximum diameter. In this respect, the traditional accepted threshold is 2cm, whereas VAA sizing less than 2cm should conservatively be observed without invasive treatment. The aim of this study was to review differences in the treatment outcome over three decades. MATERIAL AND METHODS This was a retrospective review of all treated VAAs at one institution from 1985 to 2015. Patients demographics, aneurysm characteristics, management and outcome were recorded with special regard to differences in the course of time. RESULTS Thirty-one true VAA in 29 patients (74% female) were repaired (5 ruptured, 26 intact). Mean diameter was 30.27±11mm for intact and 38.0±8.5mm for ruptured VAA (rVAA) (P=NS). Most patients were asymptomatic (67.8% asymptomatic, 16.1% symptomatic without rupture and 16.1% with rupture). There was a vice-versa situation in chosen treatment techniques between the first (1985-2000) and the second (2001-2015) time period [first period: 75% open repair (OR) and 25% endovascular repair (ER); second period: 27% OR and 73% ER; P=0.009]. OR included aneurysm ligation and resection with (end-to-end-anastomosis, graft interposition or without blood flow reconstruction), while ER was exclusively coil embolization with sacrifice of all parent afferent and efferent arteries. Immediate technical success was 81% for all procedures. There was a trend toward higher technical success rate of VAA being treated in second time period, but we found no significant differences (69% in the first, 93% in the second; P=0.101). Conversion to OR due to technical failures was necessary after 3 endovascular repairs (20%). The overall 30-day-mortality rate decreases in the course of time (25% in the first and 0% in the second period; P=0.038). Furthermore, there was a lower 30-day mortaliy rate after ER of all VAA (elective and urgent repair) (20% after OR, 0% after ER; P=0.038). There was no decrease in 30-day mortality rate of rVAA (100% in the first and 20% in the second period; P=NS). CONCLUSION In the fact of medical progress and a growing number of endovascular procedures, this study presents a decrease in mortality rate after elective aneurysm repair over three decades. This might become an argument to reduce the 2-cm threshold in highly selected individuals.
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Chan DKH, Tan KK. Successful gelfoam angioembolisation in anastomotic pseudoaneurysm: A case report. Int J Surg Case Rep 2016; 23:128-30. [PMID: 27111875 PMCID: PMC4855737 DOI: 10.1016/j.ijscr.2016.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/05/2016] [Accepted: 04/07/2016] [Indexed: 12/12/2022] Open
Abstract
The modern use of selective angioembolisation involves microcoils, microparticles and gelfoams. This has not been evaluated in patients with lower gastrointestinal tract bleeding secondary to anastomotic pseudoaneurysms. Selective angioembolisation should be considered in such cases, especially when the surgical risks are high.
Introduction The use of angioembolisation in patients with lower gastrointestinal tract haemorrhage has become well established, especially in cases of diverticular bleeding, or in bleeding from arterio-venous malformations. Pseudoaneurysms are rare and the evaluation of selective gelfoam angioembolisation amongst patients with lower gastrointestinal tract bleeding secondary to this etiology has not been extensively studied. The friable nature of pseudoaneurysms may lead to a greater risk of rupture during an attempted angioembolisation procedure. Presentation of case We describe the successful treatment and outcome of a lady who initially presented with perforation of the colon at the rectosigmoid junction, for which she underwent resection and anastomosis. A few days later, she was noted to have persistent hematochezia, which was secondary to bleeding pseudoaneurysms at the rectosigmoid branches of the inferior mesenteric artery. She successfully underwent selective angioembolisation of these pseudoaneurysms with gelfoam. She did not suffer any complications from the procedure. Discussion Although there have been significant advances in the armamentarium associated with percutaneous interventional radiology procedures for hemostasis in gastrointestinal bleeding, the use of selective angioembolisation for bleeding pseudoaneurysms have not been readily adopted due to the friable nature of the wall of the pseudoaneurysm, and its risk for rupture. Our case report illustrates that angioembolisation in such cases is feasible, and should be a consideration especially when the risk of surgical intervention is high. Conclusion Selective gelfoam angioembolisation should be considered in the management of patients with bleeding from the gastrointestinal tract secondary to pseudoaneurysms.
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Affiliation(s)
- Dedrick Kok-Hong Chan
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Ker-Kan Tan
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore.
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Affiliation(s)
- Abigail Fong
- The University of Chicago, Pritzker School of Medicine, Chicago, Illinois
| | - Rakesh Navuluri
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Chicago, Chicago, Illinois
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Regus S, Lang W. Rupture Risk and Etiology of Visceral Artery Aneurysms and Pseudoaneurysms. Vasc Endovascular Surg 2016; 50:10-5. [DOI: 10.1177/1538574415627868] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: The aim of this study was to analyze differences in rupture risk and etiology of visceral artery aneurysms (VAAs) and visceral artery pseudoaneurysms (VAPAs) in a single-center experience. Materials and Methods: We retrospectively reviewed all patients with a VAA or VAPA after treatment by open surgical or endovascular repair (ER) in our institution. Patient history, treatment details, and outcome were recorded and analyzed. Results: From January 1996 to April 2014, 29 (12 women) patients with 33 aneurysms (26 VAAs and 7 VAPAs) were treated in elective and urgent settings by open repair or ER. Etiology was quite different, most common was atherosclerosis (61.5%) in VAA and chronic pancreatitis (85.7%) in VAPA. Rupture rate was 19.2% in VAA and 42.9% in VAPA, whereas mean size of ruptured VAA was 4.4 cm and of ruptured VAPA was 2 cm. Open repair (suture, ligation, and aneurysmectomy with or without arterial reconstruction) and ER (coil embolization in the packing technique) were performed in half of all cases. After follow-up (72-month VAA and 82-month VAPA), aneurysm-free survival was reported to be 95% in VAA and 100% in VAPA. Conclusion: Chronic pancreatitis seems to be a prominent risk factor for the development of VAPA in this single-center experience. Modern endovascular techniques with promising short- and long-term results could broaden indications to treat asymptomatic VAA and VAPA.
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Affiliation(s)
- Susanne Regus
- Vascular Surgery, Department of Vascular Surgery, University Hospital, Erlangen, Germany
| | - Werner Lang
- Vascular Surgery, Department of Vascular Surgery, University Hospital, Erlangen, Germany
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Abstract
Hydrogel-coated coils are truly detachable coils with a platinum core covered with hydrogel. The coils are available in 0.018- and 0.035-in systems. These coils have the ability to expand up to four times their size ∼20 minutes after deployment, thus providing a very effective mechanical vascular occlusion effect. The vessel-occlusive effect of these coils is a volume, space-occupying effect, not a thrombotic effect, as seen in fibered coils. Hydrogel-coated coils were originally developed and designed to treat brain aneurysms; however, their use has expanded to peripheral applications. Hydrogel-coated coils have been used in the management of visceral aneurysms, high-flow vascular arteriovenous fistulae, and endoleaks after endovascular thoracic and abdominal aneurysm repair. The purpose of this article is to describe the hydrogel-coated coil system, the mechanism of action, technical details for optimal deployment, and clinical applications.
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Affiliation(s)
- Hector Ferral
- Department of Radiology, Section of Interventional Radiology, NorthShore University HealthSystem, Evanston, Illinois
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