Endovascular treatment of visceral artery aneurysms

[Interventional and vascular surgical management for inflammatory arrosion hemorrhage from visceral arteries following pancreatic surgery]

Spontaneous or postoperative hemorrhage into the abdominal cavity due to inflammatory vessel arrosion represents an uncommon but menacing situation. According to the literature, such hemorrhage is associated with a lethality of nearly 2%. Therapeutical options include reoperation and interventional radiological techniques such as endovascular catheter techniques with stent graft implantation or the embolization of vessels. We report on the management of seven cases with hemorrhage either from the gastroduodenal artery ( n=5) following pancreatic surgery for pancreatic carcinoma, liposarcoma, and chronic pancreatitis or from the common hepatic artery ( n=1) and the superior mesenteric artery ( n=1) following chronic pancreatitis. The present article describes our experiences with stent graft implantation (hemobahn prosthesis) in four cases. Based on these experiences, we see the advantages of stent grafts in primary hemostasis without any contact to infected tissue and the preservation of regular perfusion. However, further clinical data are required focussing on indication, technical success rates, stent-related complications, and long-term outcome.

Visceral Artery Aneurysms

Visceral artery aneurysms (VAA) frequently present as life-threatening emergencies. The purpose of this study was to review our experience with VAA treatment. Between 1988 and April 2002, 31 VAA were treated in 28 patients (14 males, 14 females) with average age of 55 +/- 15 years. The most common locations were the splenic artery (16) and the hepatic artery (7). Three patients underwent emergency surgery, 22 patients had elective open surgery, and 7 patients underwent endovascular treatment. In the surgical group the perioperative mortality rate was 3.6%. The perioperative morbidity rate was 7.1% (one case of respiratory distress manifested in the immediate postoperative period and one urgent case of bilious fistula). In the endovascular group none of the patients died; the perioperative morbidity rate was of 14.3% (one case of hepatic artery thrombosis after failure of gastroduodenal artery aneurysm embolization). Failure of the procedure was 42.9% (3 cases of aneurysm recanalization). In conclusion, we believe that an aggressive surgical approach is justified, even in the case of asymptomatic VAA, because of the low morbidity and mortality rates. Endovascular treatment should be reserved for selected cases.

Celiac Artery Aneurysm Embolization by Coil Occlusion

We present here an extremely rare case of celiac artery aneurysm treated by embolization coil occlusion and review the literature on celiac artery aneurysm and its treatment. This case documents how celiac artery aneurysms can be successfully treated in a single setting with a good long-term outcome. In this unique case the technical and clinical details specific to this very complex and unusual aneurysm embolization are highlighted.

Treatment of multiple visceral aneurysms in a 20-year-old patient

A 20-year-old man with a history of cerebral aneurysm and a contained rupture of an intrasplenic aneurysm had a fusiform celiac and splenic artery aneurysm at presentation. This was repaired with excision of the celiac artery, aortohepatic bypass grafting, splenic artery ligation, and splenectomy.

Endoluminal stent-graft repair of a renal artery aneurysm

PURPOSE

To present a renal artery aneurysm that was treated successfully by endoluminal grafting.

CASE REPORT

A 48-year-old woman presented with a 2.5-cm saccular left renal artery aneurysm. A Jostent coronary stent-graft was placed transluminally into the left renal artery via a femoral artery cutdown. After 12 months, renal function remained normal, and computed tomography revealed normal kidney perfusion with complete resolution of the renal artery aneurysm. CONCLUSIONS; The advances in endovascular stent-grafts will allow more visceral artery aneurysms to be treated with a minimally invasive approach.

Hemorrhage from a right hepatic artery pseudoaneurysm: endovascular treatment with a coronary stent-graft

PURPOSE

To report a novel case demonstrating the successful endovascular treatment of a right hepatic artery pseudoaneurysm using a balloon-expandable coronary stent-graft.

CASE REPORT

A 60-year-old woman underwent surgical treatment for a Klatskin tumor, but her postoperative course was complicated by serious blood loss. An emergent celiac angiogram through a right transfemoral approach demonstrated a small iatrogenic pseudoaneurysm in the proximal right hepatic artery. A 7-F guiding catheter was positioned at the origin of the celiac trunk, and a Jostent coronary stent-graft mounted on a 2.7-F, 4-mm x 30-mm balloon catheter was successfully placed across the aneurysm neck. The final angiogram demonstrated total exclusion of the pseudoaneurysm with preservation of the arterial lumen. The hemodynamic condition of the patient became stable. At 12-month follow-up, duplex scanning confirmed regular right hepatic artery patency and absence of thrombotic tissue or signs of infection around the stent-graft.

CONCLUSION

For hepatic artery pseudoaneurysms, endovascular repair using small covered stents may be a viable alternative to transcatheter embolization. The use of coronary instruments facilitates treatment of vascular lesions in small caliber visceral vessels.