1
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Affiliation(s)
- J. Testart
- Clinique Chirurgicale, Service Pr. Watelet, CHU de Rouen, 1 rue de Germont, 76031 Rouen Cedex 01
| | - L. Boyet
- Clinique Chirurgicale, Service Pr. Watelet, CHU de Rouen, 1 rue de Germont, 76031 Rouen Cedex 01
| | - G. Perrier
- Clinique Chirurgicale, Service Pr. Watelet, CHU de Rouen, 1 rue de Germont, 76031 Rouen Cedex 01
| | - E. Clavier
- Département d’imagerie médicale, Service Pr. Thiebot, CHU de Rouen, 1 rue de Germont, 76031 Rouen Cedex 01
| | - C. Peillon
- Clinique Chirurgicale, Service Pr. Watelet, CHU de Rouen, 1 rue de Germont, 76031 Rouen Cedex 01
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2
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Kuruma S, Kikuyama M, Kamisawa T, Chiba K. Hyper-dense fluid on plain computed tomography may reveal a ruptured aneurysm in patients with median arcuate ligament syndrome. Clin J Gastroenterol 2019; 12:473-478. [PMID: 30997671 DOI: 10.1007/s12328-019-00968-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 03/16/2019] [Indexed: 11/26/2022]
Abstract
Rupture of abdominal aneurysms associated with median arcuate ligament syndrome (MALS) is a serious condition and requires accurate diagnosis in a clinical setting. We examined three patients with this condition: two women aged 45 and 71 years, and a 61-year-old man. They complained of abdominal pain and had fluid collection around the duodenum. Plain computed tomography (CT) of the fluid collection revealed hyper density, which suggests the presence of blood. Moreover, contrast-enhanced CT revealed aneurysms in the pancreatic head area. Angiography revealed aneurysms of the branches of the gastroepiploic artery, which were treated by endovascular embolization in all patients. Thus, patients with abdominal pain and high-density fluid collection around the duodenum on plain CT may suffer from hemorrhage following rupture of MALS-associated aneurysms.
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Affiliation(s)
- Sawako Kuruma
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
| | - Masataka Kikuyama
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Terumi Kamisawa
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Kazuro Chiba
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
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3
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Borazan E, Yılmaz L, Aytekin A, Gökaslan G, Kervancıoğlu S. A rare case of non-traumatic acute intraabdominal hemorrhage: ruptured superior mesenteric artery aneurysm. Acta Chir Belg 2018; 118:64-67. [PMID: 28679320 DOI: 10.1080/00015458.2017.1302702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Rupture of superior mesenteric artery aneurysm (SMAA) is a very rare and life-threatening condition, presenting with acute intraabdominal hemorrhage. CASE The patient was hospitalized upon complaint of nonspecific severe abdominal pain. Diagnosis of SMAA was established by abdominal Doppler ultrasound that showed a pseudo-aneurysmal lesion with size of 76 × 47 mm at the superior mesenteric main branch. Endovascular stenting was not performed because of the wide neck in the segment of the jejunal branches from SMA and the risk of branch loss during treatment. On the second day of hospitalization, the patient developed an acute abdomen. At explorative laparotomy for intraabdominal bleeding, the root of superior mesenteric artery was immediately and temporarily clamped to provide bleeding control. Aneurysmal tissue was resected and affected part was repaired by Dacron prosthetic graft to maintain proximal and distal vascular continuum. Intestinal viability was preserved. The patient survived disease-free as verified by his 18-month postoperative physical examination. CONCLUSIONS The patient presents a very rare case showing ability to perform emergent intestine-sparing vascular surgery in ruptured SMAA. Surgery or endovascular treatment options should not be delayed especially in pseudo-aneurysms. It is critical to include ruptured SMAA in differential diagnosis of intraabdominal bleeding.
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Affiliation(s)
- Ersin Borazan
- Department of General Surgery, Gaziantep University Medical Faculty, Universite Bulvarı, Gaziantep Universitesi Tıp Fakültesi, Gaziantep, Turkey
| | - Latif Yılmaz
- Department of General Surgery, Gaziantep Universitesi Tip Fakultesi, Gaziantep, Turkey
| | - Alper Aytekin
- Department of General Surgery, Gaziantep Universitesi Tip Fakultesi, Gaziantep, Turkey
| | - Gökhan Gökaslan
- Department of Cardiovascular Surgery, Gaziantep Universitesi Tip Fakultesi, Gaziantep, Turkey
| | - Selim Kervancıoğlu
- Department of Radiology, Gaziantep Universitesi Tip Fakultesi, Gaziantep, Turkey
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4
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Pancreaticoduodenal Artery Aneurysm Associated with Celiac Trunk Stenosis: Case Illustration and Literature Review. Case Rep Radiol 2017; 2017:6989673. [PMID: 28815097 PMCID: PMC5549485 DOI: 10.1155/2017/6989673] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/19/2017] [Indexed: 11/17/2022] Open
Abstract
Pancreaticoduodenal artery aneurysms (PDA) are rare visceral aneurysms. Celiac trunk stenosis represents a common attributable aetiology for those aneurysms. Therefore, an alternative treatment approach, which differs from those isolated aneurysms, is recommended. We hereby present a 77-year-old male patient who was admitted with sudden onset of severe abdominal pain and significant drop in haemoglobin, occurring within a 24-hour interval. Contrast-enhanced computed tomography revealed a ruptured visceral aneurysm arising from the anterior branch of the inferior pancreaticoduodenal artery. A severe stenosis was also noted at the take-off of the celiac trunk. Selective catheterization of the supplying branch of the superior mesenteric artery, followed by coil embolization of the aneurysm, was performed, resulting in cessation of flow within the aneurysm, with preservation of the posterior branch, supplying the celiac territory. PDAs are usually asymptomatic and discovered incidentally at rupture. The risk of rupture is independent of the aneurysmal size and is associated with a 50% mortality rate. The consensus on coping with aneurysms is to treat them whenever they are discovered. Selective angiography followed by coil embolization represents a less invasive, and frequently definitive, approach than surgery. The risk for ischemia mandates that the celiac territory must not be compromised after embolization.
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5
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Atkins BZ, Ryan JM, Gray JL. Treatment of a Celiac Artery Aneurysm with Endovascular Stent Grafting. Vasc Endovascular Surg 2016; 37:367-73. [PMID: 14528384 DOI: 10.1177/153857440303700510] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As a result of more sophisticated and more commonly performed investigative procedures, aneurysms of the visceral abdominal vasculature, including celiac artery aneurysms, are increasingly recognized. Traditional therapy for visceral artery aneurysms has been limited to open aneurysmectomy or aneurysmorrhaphy to prevent catastrophic aneurysmal rupture. However, these procedures are associated with significant postoperative morbidity and mortality despite technical successes. High complication rates are likely related to poor preoperative conditions among the patient population typically presenting with these visceral artery aneurysms. This report introduces an alternative therapy for visceral artery aneurysms and highlights the potential for catheter-based interventions. This case report depicts a 61-yearold morbidly obese woman diagnosed with a 10-centimeter celiac artery aneurysm during investigation of upper abdominal pain. Given the patient's poor medical condition, punctuated by hemodynamic instability, open operation was avoided, and percutaneous embolization was not feasible owing to a large aneurysm neck. Therefore, inflow to the celiac artery aneurysm was excluded by placing a modular stent graft component within the abdominal aorta at the celiac artery orifice. During the intervening 12 months since stent graft deployment, the aneurysm sac diameter has steadily decreased, as determined by serial computed tomography scans. This report underscores the potential for catheter-based techniques to offer new therapeutic options for patients with visceral artery aneurysms. Careful individualization is required given the highly variable size, location, and character of such lesions.
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Affiliation(s)
- B Zane Atkins
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
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6
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Kandasamy D, Gamanagatti S, Gupta AK. Pediatric Interventional Radiology: Vascular Interventions. Indian J Pediatr 2016; 83:702-10. [PMID: 26964551 DOI: 10.1007/s12098-016-2055-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
Abstract
Pediatric interventional radiology (PIR) comprises a range of minimally invasive diagnostic and therapeutic procedures that are performed using image guidance. PIR has emerged as an essential adjunct to various surgical and medical conditions. Over the years, technology has undergone dramatic and continuous evolution, making this speciality grow. In this review, the authors will discuss various vascular interventional procedures undertaken in pediatric patients. It is challenging for the interventional radiologist to accomplish a successful interventional procedure. There are many vascular interventional radiology procedures which are being performed and have changed the way the diseases are managed. Some of the procedures are life saving and have become the treatment of choice in those patients. The future is indeed bright for the practice and practitioners of pediatric vascular and non-vascular interventions. As more and more of the procedures that are currently being performed in adults get gradually adapted for use in the pediatric population, it may be possible to perform safe and successful interventions in many of the pediatric vascular lesions that are otherwise being referred for surgery.
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Affiliation(s)
- Devasenathipathy Kandasamy
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Shivanand Gamanagatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Arun Kumar Gupta
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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7
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Marion-Audibert AM, Mesnil A, Guillet M, Rode A, Mabrut JY, Garbit V, Lepoutre-Dujardin E, Pere-Verge D, Baulieux J, Souquet JC. [Pseudoaneurysm of the hepatic artery: rare complication of chronic pancreatitis]. ACTA ACUST UNITED AC 2008; 32:74-8. [PMID: 18405652 DOI: 10.1016/j.gcb.2007.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Bleeding from a pseudoaneurysm is a rare complication of chronic pancreatitis. We present two cases of ruptured pseudoaneurysms of the hepatic arteries. The first case involved a pancreatic pseudocyst that ruptured in the duodenum and the second resulted in an intrahepatic hematoma that compressed the bile tract causing secondary hemobilia. Angiographic embolization was the primary treatment in both cases, with surgery for the first patient and later radiological drainage in the second. The hemorrhage was controlled in both cases despite the severe prognosis and high mortality in these cases.
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Affiliation(s)
- A-M Marion-Audibert
- Service d'hepatogastroenterologie, hôpital de la Croix-Rousse, 103, Grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
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8
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Raad E, Demaria R, Rouvière P, Prudhomme M, Frapier JM, Dauzat M, Albat B. Les anévrismes des artères digestives. À propos d'un cas clinique de localisation anévrismale multiple et revue de la littérature. ACTA ACUST UNITED AC 2007; 32:216-20. [PMID: 17658233 DOI: 10.1016/j.jmv.2007.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 06/13/2007] [Indexed: 11/29/2022]
Abstract
Visceral artery aneurysms constitute a rare vascular disease, with a risk of rupture associated to a high mortality. Often asymptomatic, they are discovered following a routine radiological examination. We present the case of a 71-year-old patient with multiple aneurysms involving the celiac trunk, the splenic artery, and the common hepatic artery. The surgical treatment consisted of an aortohepatic bypass using polytetrafluoroethylene prosthesis, after exclusion of all the aneurysms. The angiography and postoperative angioscan demonstrated the perfect patency of the prosthesis, totally excluding the aneurysms. Given the variety of presentations and the absence of precise predictive factors, there is no therapeutic consensus so far. Surgery is the first therapeutic choice. Endovascular treatment by angioembolization must be reserved for particular conditions. The purpose of this article is to propose the best therapeutic approach on the basis of evidence in the literature.
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Affiliation(s)
- E Raad
- Service de chirurgie cardiovasculaire, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 371, avenue du Doyen-G.-Giraud, 34295 Montpellier, France
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9
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Hepatic artery aneurysm involving the proper hepatic and gastroduodenal artery treated using a gastroepiploic artery in situ bypass. J Vasc Surg 2007; 45:1069-71. [DOI: 10.1016/j.jvs.2006.12.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Accepted: 12/13/2006] [Indexed: 11/24/2022]
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10
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Vasquez JC, Montesinos E. Surgical management of giant superior mesenteric artery aneurysm. Ann Vasc Surg 2007; 21:219-21. [PMID: 17349367 DOI: 10.1016/j.avsg.2006.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2005] [Revised: 05/28/2006] [Accepted: 06/09/2006] [Indexed: 11/20/2022]
Abstract
The superior mesenteric artery (SMA) is an uncommon location of aneurysm formation. This entity is potentially lethal and should be treated once a diagnosis is made. When the aneurysm reaches a large size, there is a high risk of rupture and surgical treatment should not be delayed, although it can be technically demanding because there is a significant portion of bowel at risk for ischemia. Here, we describe our approach for the management of a giant SMA aneurysm.
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Affiliation(s)
- Julio C Vasquez
- Thoracic and Cardiovascular Surgery Program, Dos de Mayo Nacional Hospital, Lima, Peru.
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11
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Miller MT, Comerota AJ, Disalle R, Kaufman A, Pigott JP. Endoluminal embolization and revascularization for complicated mesenteric pseudoaneurysms: A report of two cases and a literature review. J Vasc Surg 2007; 45:381-6. [PMID: 17264020 DOI: 10.1016/j.jvs.2006.09.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Accepted: 09/04/2006] [Indexed: 11/16/2022]
Abstract
Mesenteric artery pseudoaneurysms are a rare and complex complication after abdominal trauma, surgery, or inflammatory disease. These lesions can be associated with compression or erosion into adjacent structures and may result in life-threatening hemorrhage. Traditional management has been open surgical ligation, aneurysm resection with interposition grafts, or resection or partial resection of the end organ involved. We present two cases of endovascular repair of complex mesenteric pseudoaneurysms. One patient presented with a recurrent pseudoaneurysm of the superior mesenteric artery and the second presented as recurrent gastrointestinal bleeding secondary to a traumatic celiac artery pseudoaneurysm-to-pancreatic duct fistula. A systematic review of the literature on endovascular management of mesenteric vascular disease and mesenteric pseudoaneurysms is included in this report to allow these cases to be put into proper perspective.
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12
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Ashley RA, Patterson DE, Bower TC, Stanson AW. Large congenital pelvic arteriovenous malformation and management options. Urology 2006; 68:203.e11-3. [PMID: 16850535 DOI: 10.1016/j.urology.2006.01.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The congenital pelvic arteriovenous malformation (AVM) arises from dysplastic arteries and veins. These rare conditions might present to the urologist by producing massive hematuria. Most AVMs can be controlled by surgical resection, usually in conjunction with preoperative angiographic embolization. Here, we present a case of a large pelvic AVM that caused significant patient morbidity and required treatment by novel methods after the usual means had failed. In this report, we will detail those unique interventions required to control a tenuous clinical situation.
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Affiliation(s)
- Richard A Ashley
- Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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13
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Matsumoto S, Kiyosue H, Yotsumoto S, Sagara Y, Hori Y, Sakamoto I, Hirao K, Mori H. Transarterial embolization of common hepatic artery pseudoaneurysm secondary to aortic dissection. Cardiovasc Intervent Radiol 2005; 29:713-6. [PMID: 15959695 DOI: 10.1007/s00270-004-0063-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Gandini R, Pipitone V, Konda D, Pendenza G, Spinelli A, Stefanini M, Simonetti G. Endovascular treatment of a giant superior mesenteric artery pseudoaneurysm using a nitinol stent-graft. Cardiovasc Intervent Radiol 2005; 28:102-6. [PMID: 15772727 DOI: 10.1007/s00270-004-0007-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
A 68-year-old woman presenting with gastrointestinal bleeding (hematocrit 19.3%) and in a critical clinical condition (American Society of Anesthesiologists grade 4) from a giant superior mesenteric artery pseudoaneurysm (196.0 x 131.4 mm) underwent emergency endovascular treatment. The arterial tear supplying the pseudoaneurysm was excluded using a 5.0 mm diameter and 31 mm long monorail expanded polytetrafluoroethylene (ePTFE)-covered self-expanding nitinol stent. Within 6 days of the procedure, a gradual increase in hemoglobin levels and a prompt improvement in the clinical condition were observed. Multislice CT angiograms performed immediately, 5 days, 30 days and 3 months after the procedure confirmed the complete exclusion of the pseudoaneurysm.
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Affiliation(s)
- Roberto Gandini
- Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Rome, Italy
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15
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Basile A, Saluzzo CM, Lupattelli T, Carbonatto P, Bottari A, Mundo E, Certo A. Nonoperative management of iatrogenic lesions of celiac branches by using transcatheter arterial embolization. Surg Laparosc Endosc Percutan Tech 2005; 14:268-75. [PMID: 15492656 DOI: 10.1097/00129689-200410000-00008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We present our experience in the nonoperative management of iatrogenic lesions of celiac branches by using transcatheter arterial embolization. We treated 6 pseudoaneurysms (5 intrahepatic and 1 of the gastroduodenal artery), 6 vessel lacerations (1 common hepatic artery, 1 right hepatic artery, 1 gastroduodenal artery, 2 pancreatoduodenal, 1 polar intrasplenic artery), 1 arterioportal fistula, and 1 arteriobiliary fistula; all the bleeding lesions were secondary to surgical, endoscopic, or interventional radiologic procedures.
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Affiliation(s)
- Antonio Basile
- Department of Radiology, Ospedale Ferrarotto, Catania, Italy.
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16
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Sessa C, Tinelli G, Porcu P, Aubert A, Thony F, Magne JL. Treatment of visceral artery aneurysms: description of a retrospective series of 42 aneurysms in 34 patients. Ann Vasc Surg 2005; 18:695-703. [PMID: 15599627 DOI: 10.1007/s10016-004-0112-8] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Visceral artery aneurysms (VAA) can be treated by revascularization, ligation, or, most often, endovascular techniques depending on clinical presentation, hemodynamic status, and location. From 1975 to 2002 a total of 42 VAA in 34 patients were treated. The lesion involved the splenic artery (SA; 19), pancreaticoduodenal artery (PDA; 6), celiac trunk (CT; 5), superior mesenteric artery (SNA; 4), common hepatic artery (CHA; 3), gastroduodenal artery (GDA; 2), left hepatic artery (LHA; 1), a branch of the inferior mesenteric artery (BIMA; 1), and a branch of the SMA (BSMA; 1). Twenty-seven VAA in 21 patients (64%) were uncomplicated (group I) and 15 VAA in 13 patients (36%) had ruptured (group II) (PDA; 6; CT, 3; SA, 1; CHA, 1; LHA, 1; BSMA, 1; BIMA, 1). In group I VAA were treated by embolization (n = 11), splenectomy (n = 6), bypass (n = 7), ligation (n = 2), and aneurysmorraphy (n = 1). No deaths were observed. The morbidity rate associated with surgical treatment was 12% including hepatic bypass thrombosis without ischemic complications in two cases. The morbidity rate associated with endovascular treatment was 18% including cholecystitis in one case and bile duct stenosis in one case. The VAA recanalization rate following embolization was 9%. In group II, 12 VAA (80%) were treated by ligation in association with splenectomy in two cases and left hepatectomy in one case. Only one bypass procedure was performed and embolization was used to treat two VAA (1 SMA and 1 PDA). The mortality rate was 20% (3/15). The morbidity rate associated with surgical treatment was 46% (6/13) including bile duct stenosis in one case, ischemic cholecystitis in one case, duodenal fistula in one case, pancreatic fistula in one case, bile tract fistula in one case, and colonic ischemia in one case. No patient died after endovascular treatment and the morbidity rate was 50% (1/2) with duodenal stenosis occurring in one case. In sum, VAA can rupture. Emergency cases can be treated by ligation in most cases or by embolization if the hemodynamic status of the patient allows. Regardless of treatment technique, the morbidity and mortality rate remains high after rupture, especially in cases involving PDA. Embolization can be proposed as a first-line treatment for most VAA. Because of the risk of rupture, endovascular or open repair is warranted for VAA and has a favorable prognosis.
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Affiliation(s)
- Carmine Sessa
- Department of Vascular Surgery, Grenoble University Hospital, Grenoble, France.
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17
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Puri S, Nicholson AA, Breen DJ. Percutaneous thrombin injection for the treatment of a post-pancreatitis pseudoaneurysm. Eur Radiol 2004; 13 Suppl 4:L79-82. [PMID: 15018170 DOI: 10.1007/s00330-003-1836-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Visceral artery pseudoaneurysms are often treated surgically or by transcatheter embolisation. We report a case of a pseudoaneurysm in a patient with chronic pancreatitis, which was successfully occluded by percutaneous injection of thrombin into the pseudoaneurysmal sac as a first-line management.
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Affiliation(s)
- S Puri
- Department of Radiology, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
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18
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Tessier DJ, Stone WM, Fowl RJ, Abbas MA, Andrews JC, Bower TC, Gloviczki P. Clinical features and management of splenic artery pseudoaneurysm: case series and cumulative review of literature. J Vasc Surg 2003; 38:969-74. [PMID: 14603202 DOI: 10.1016/s0741-5214(03)00710-9] [Citation(s) in RCA: 214] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Splenic artery pseudoaneurysm is uncommon. We report our institution's recent 18-year experience with these aneurysms and review the literature. METHODS We reviewed the records for 37 patients with visceral artery pseudoaneurysm evaluated at our institution from 1980 to 1998. From this group we found only 10 patients (27%) with splenic artery pseudoaneurysm. We also reviewed 147 cases of splenic artery pseudoaneurysm reported in the English literature. RESULTS In this series of 10 patients, 5 were men. Mean age was 51.2 years (range, 35-78 years). Causes of aneurysm included chronic pancreatitis in 4 patients, trauma in 2 patients, iatrogenic cause in 1 patient, and unknown cause in 3. The most common symptom was bleeding in 7 patients and abdominal or flank pain in 5 patients; 2 patients had no symptoms. Aneurysm diameter was known for four pseudoaneurysms, and ranged from 0.3 to 3 cm (mean, 1.7 cm). Splenectomy and distal pancreatectomy were performed in 4 patients, splenectomy alone in 2 patients, endovascular transcatheter embolization in 2 patients, and simple ligation in 1 patient. One patient with a ruptured pseudoaneurysm died before any intervention could be performed; there were no postoperative deaths. Follow-up data were available for 7 patients, with a mean of 46.3 months (range, 4.5-120 months). CONCLUSIONS Splenic artery pseudoaneurysm is rare and usually is a complication of pancreatitis or trauma. Average aneurysm diameter in our series of 10 patients was smaller than previously reported (1.7 cm vs 5.0 cm). Although conservative management has produced excellent results in some reports, from our experience and the literature, we recommend repair of all splenic artery pseudoaneurysms.
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Affiliation(s)
- Deron J Tessier
- Department of Surgery, Division of Vascualr Surgery, Mayo Clinic, Scottsdale, AZ 85259, USA.
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19
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Ferrari AP, Ferreira JPA, de Paulo GA, Líbera ED. Hemobilia caused by a mycotic aneurysm of the hepatic artery treated by enbucrilate injection during ERCP. Gastrointest Endosc 2003; 57:260-3. [PMID: 12556800 DOI: 10.1067/mge.2003.65] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
MESH Headings
- Adult
- Aneurysm, False/complications
- Aneurysm, False/diagnosis
- Aneurysm, False/therapy
- Aneurysm, Infected/complications
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/therapy
- Aneurysm, Ruptured/complications
- Aneurysm, Ruptured/diagnosis
- Aneurysm, Ruptured/therapy
- Cholangiopancreatography, Endoscopic Retrograde/adverse effects
- Cholangiopancreatography, Endoscopic Retrograde/methods
- Disease Progression
- Down Syndrome
- Embolization, Therapeutic/methods
- Enbucrilate/therapeutic use
- Endoscopy, Digestive System
- Fatal Outcome
- Hemobilia/diagnosis
- Hemobilia/etiology
- Hemobilia/therapy
- Hepatic Artery
- Humans
- Male
- Risk Assessment
- Tomography, X-Ray Computed
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Affiliation(s)
- Angelo Paulo Ferrari
- Digestive Endoscopy Unit-Gastroenterology Division, Department of Medicine, Hospital São Paulo, Universidade Federal de São Paulo, Brazil
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20
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Sreedharan VK, Shenoy KR, Shenoy MG. Upper gastrointestinal bleeding in tropical pancreatitis due to pseudoaneurysm rupture. Trop Doct 2003; 33:57. [PMID: 12568530 DOI: 10.1177/004947550303300128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
MESH Headings
- Adult
- Aneurysm, False/diagnosis
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/etiology
- Aneurysm, False/surgery
- Aneurysm, Ruptured/diagnosis
- Aneurysm, Ruptured/diagnostic imaging
- Aneurysm, Ruptured/etiology
- Aneurysm, Ruptured/surgery
- Diagnosis, Differential
- Gastrointestinal Hemorrhage/diagnosis
- Gastrointestinal Hemorrhage/diagnostic imaging
- Gastrointestinal Hemorrhage/etiology
- Gastrointestinal Hemorrhage/surgery
- Humans
- Male
- Pancreatitis/complications
- Rupture, Spontaneous/diagnosis
- Rupture, Spontaneous/diagnostic imaging
- Rupture, Spontaneous/etiology
- Rupture, Spontaneous/surgery
- Tomography, X-Ray Computed
- Ultrasonography
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Affiliation(s)
- V K Sreedharan
- Department of Surgery, Kasturba Medical College, Manipal, Karnataka, India 576119.
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21
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Harries AD, Hargreaves NJ, Kwanjana JH, Salaniponi FM. The diagnosis of extrapulmonary tuberculosis in Malawi. Trop Doct 2003; 33:7-11. [PMID: 12568510 DOI: 10.1177/004947550303300106] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is little information on a country-wide basis in sub-Saharan Africa about how the diagnosis of extra-pulmonary tuberculosis (EPTB) is made. A country-wide cross-sectional study was carried out in 40 non-private hospitals in Malawi which register and treat (TB) patients in order to assess diagnostic practices in adults registered with EPTB. All patients aged 15 years and above in hospital on treatment for EPTB were reviewed usingTB registers, case note files and clinical assessment. There were 244 patients, 132 men and 112 women whose mean age was 36 years. In 138 (57%) patients, all appropriate procedures and investigations, commensurate with hospital resources, had been carried out. Of 171 EPTB patients with cough for 3 weeks or longer, 138 (81%) submitted sputum specimens for smear microscopy of acid-fast bacilli (AFB). A confirmed diagnosis ofTB was made in 15 (6%) patients based on finding AFB or caseating granulomas in specimens. In 157 (64%) patients, the diagnosis of EPTB was considered to be correct. In 46 (19%) patients the diagnosis was considered to be TB, although different from the type of EPTB with which the patient was registered. In 39 (16%) patients an alternative non-TB diagnosis was made and in two (1%) patients it was not possible to make a decision. Diagnostic practices need to be improved, and ways of doing this are discussed.
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Affiliation(s)
- Anthony D Harries
- National Tuberculosis Control Programme, Ministry of Health, PO Box 30377, Capital City, Lilongwe 3, Malawi, UK.
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22
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Rocek M, Peregrin JH, Dutka J, Ryska M, Bêlina F, Lastovcková J. Percutaneous treatment of a superior mesenteric artery pseudoaneurysm using a stent-graft. AJR Am J Roentgenol 2002; 178:1459-61. [PMID: 12034618 DOI: 10.2214/ajr.178.6.1781459] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Miloslav Rocek
- Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Vídeská 1958/9, 140 21 Prague 4, Czech Republic
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23
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Hossain A, Reis ED, Dave SP, Kerstein MD, Hollier LH. Visceral Artery Aneurysms: Experience in a Tertiary-Care Center. Am Surg 2001. [DOI: 10.1177/000313480106700510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Visceral artery aneurysms (VAAs) often rupture and cause serious morbidity or death. The purpose of this study was to identify conditions associated with VAA in a series of 30 patients treated at our institution from 1988 through 1998. Demographics, types of aneurysms, associated conditions, diagnoses, treatments, and outcomes were recorded and analyzed. Thirty patients (16 men and 14 women) with VAA were identified. The arteries involved were splenic (eight), renal (ten), hepatic (nine), hypogastric (one), celiac (one), and pancreaticoduodenal (one). Five of eight (63%) splenic artery aneurysms occurred in women; however, gender was not a factor in other aneurysmal groups. Splenic artery aneurysm also was associated with cirrhosis in four of the eight (50%) patients. Five of the nine (56%) hepatic artery aneurysms were associated with cirrhosis; two of these were pseudoaneurysms that occurred after liver transplantation. Five of ten (50%) renal artery aneurysms were associated with juxtarenal abdominal aortic aneurysms. Celiac and pancreaticoduodenal aneurysms were associated with gastrointestinal bleeding. Treatments included surgery (19), embolization (eight), and observation alone (three). These data demonstrate that association with other conditions varies according to subgroups of VAA. Despite advances in diagnosis and therapy the heterogeneity of VAA suggests that management must remain individualized.
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Affiliation(s)
- Azhar Hossain
- Department of Surgery, The Mount Sinai Medical Center, New York, New York
| | - Ernane D. Reis
- Department of Surgery, The Mount Sinai Medical Center, New York, New York
| | - Sandeep P. Dave
- Department of Surgery, The Mount Sinai Medical Center, New York, New York
| | - Morris D. Kerstein
- Department of Surgery, The Mount Sinai Medical Center, New York, New York
| | - Larry H. Hollier
- Department of Surgery, The Mount Sinai Medical Center, New York, New York
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24
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Glehen O, Feugier P, Ducerf C, Chevalier JM, Baulieux J. [Hepatic artery aneurysms]. ANNALES DE CHIRURGIE 2001; 126:26-33. [PMID: 11255968 DOI: 10.1016/s0003-3944(00)00453-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIM OF THE STUDY The aim of this retrospective study was to report a series of nine aneurysms of the hepatic arteries, including real aneurysms (n = 4), pseudoaneurysms (n = 3) and false aneurysms (n = 2) observed from 1987 to 1999. PATIENTS There were 7 men and 2 women (mean age: 58 years). In 3 cases, the aneurysm was asymptomatic and detected by sonography; in 4 cases it was revealed by rupture with a severe hemorrhage and in 2 cases by cholestasis. The aneurysm was located on right (n = 3), proper and common (n = 3), proper (n = 2), and common (n = 1) hepatic arteries. The aneurysm was associated with hepatocellular carcinoma (n = 1), carcinoma of the head of the pancreas (n = 1) and liver metastases (n = 1). METHODS AND RESULTS Eight patients were operated and one of them was operated three times. Hepatic arterial blood supply was restored in 6 patients with simple suture (n = 1), Goretex graft (n = 2), allograft (n = 2) and autologous vein (n = 1), with one failure which required liver retransplantation. Only one of the three attempts of embolization was successful. One patient with surgical contraindications died from hemobilia after embolization failure. During follow-up, there was one thrombosis of the common hepatic artery which had been excluded and two late deaths: one from rupture of a false aneurysm after bypass with an allograft and one by terminal progression of the cancer. The other 6 patients were alive at the time of this study. CONCLUSION Clinical characteristics and therapeutic indications of hepatic arterial aneurysm are variable. Management is usually surgical, while embolization is reserved for special circumstances. Restoration of the hepatic arterial blood supply is necessary in aneurysms located on the proper hepatic artery.
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Affiliation(s)
- O Glehen
- Service de chirurgie générale et thoracique, centre hospitalier Lyon-Sud, 69495 Pierre Bénite, France.
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25
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Carr JA, Cho JS, Shepard AD, Nypaver TJ, Reddy DJ. Visceral pseudoaneurysms due to pancreatic pseudocysts: rare but lethal complications of pancreatitis. J Vasc Surg 2000; 32:722-30. [PMID: 11013036 DOI: 10.1067/mva.2000.110055] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Erosion of pancreatic pseudocysts into adjacent vessels is a rare but highly lethal cause of intra-abdominal hemorrhage. Percutaneous angiographic embolization (PAE) of the bleeding artery has recently been advocated as the preferred therapy. This study was undertaken to survey the outcome after treatment of this complication and to make recommendations for its management. METHODS An 11-year retrospective analysis was performed of all patients treated at a large tertiary care referral center for visceral artery pseudoaneurysms associated with pancreatic pseudocysts. RESULTS From 1988 to 1998, 256 patients were admitted for complications of pancreatic pseudocysts. Sixteen patients (11 men and 5 women) were identified in whom a pseudocyst had eroded into a major blood vessel with hemorrhage or development of a false aneurysm. The mean age was 45 years (range, 23-67 years). Active bleeding was present in 13 patients, whereas three had evidence of recent hemorrhage. Ten of 16 patients initially underwent operative therapy, four elective and six emergency, whereas six stable patients were initially treated with PAE. Technical failures of the initial treatment or secondary complications required both therapeutic modalities in six patients, which resulted in 13 total surgical interventions and 10 PAEs. The surgical morbidity rate was 62% (8 of 13), whereas that of PAE was 50% (5 of 10). Three deaths occurred after emergency operations, two of which failed to stop the bleeding, accounting for all of the deaths in the series (3 [19%] of 16). A trend was noted toward increased death with necrotizing pancreatitis (P =.07) and emergency surgery (P =.06). Ranson's criteria were not found to be predictive of death in this series. Surgical drainage procedures were required in seven (44%) of 16 patients for infections (n = 3) or mass effect of the pseudoaneurysm (n = 3). The mean size of pseudoaneurysms that required operative intervention for secondary complications was 13.9 cm, compared with 7.7 cm for all others in the series (P =.046). Long-term follow-up was available in all 13 survivors at a mean of 44 months (range, 1-108 months). CONCLUSIONS The management of pancreatic pseudocyst-associated pseudoaneurysms remains a challenging problem with high morbidity and death rates. Operation and PAE play complementary management roles. PAE is recommended as the initial therapy for hemodynamically stable patients. Surgery should be reserved for actively bleeding, hemodynamically unstable patients; for failed embolization; and for other secondary complications such as infection or extrinsic compression.
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Affiliation(s)
- J A Carr
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI 48202, USA
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26
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Nyman U, Svendsen P, Jivegård L, Klingenstierna H, Risberg B. Multiple pancreaticoduodenal aneurysms: treatment with superior mesenteric artery stent-graft placement and distal embolization. J Vasc Interv Radiol 2000; 11:1201-5. [PMID: 11041479 DOI: 10.1016/s1051-0443(07)61364-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- U Nyman
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
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27
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Konstantakos AK, Coogan SM, Husni EA, Raaf JH. Aneurysm of the Gastroduodenal Artery: An Unusual Cause of Obstructive Jaundice. Am Surg 2000. [DOI: 10.1177/000313480006600720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Splanchnic artery aneurysms are among the most infrequent aneurysms that affect the arterial circulation. Aneurysms of the gastroduodenal artery are the rarest splanchnic artery aneurysms, comprising fewer than 10 per cent of all such lesions. The most typical presentations include abdominal pain and acute gastrointestinal bleeding. However, the diagnosis is often missed preoperatively. We report the successful surgical management of a patient with a gastroduodenal artery aneurysm who presented with isolated obstructive jaundice and review the literature on this unusual finding.
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Affiliation(s)
| | | | - Elias A. Husni
- Department of Surgery, Meridia Huron Hospital, Cleveland, Ohio
| | - John H. Raaf
- Department of Surgery, Case Western Reserve University, Cleveland, Ohio
- Surgical Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
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28
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McGraw JK, Patzik SB, Gale SS, Dodd JT, Boorstein JM. Autogenous vein-covered stent for the endovascular management of a superior mesenteric artery pseudoaneurysm. J Vasc Interv Radiol 1998; 9:779-82. [PMID: 9756066 DOI: 10.1016/s1051-0443(98)70391-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- J K McGraw
- Department of Radiology, St. Vincent Mercy Medical Center, Toledo, OH 43608, USA
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29
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Marty B, Sanchez LA, Wain RA, Ohki T, Marin ML, Bakal C, Veith FJ. Endovascular treatment of a ruptured lumbar artery aneurysm: case report and review of the literature. Ann Vasc Surg 1998; 12:379-83. [PMID: 9676937 DOI: 10.1007/s100169900172] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Lumbar artery aneurysms are uncommon lesions that usually present as pseudoaneurysms secondary to vessel injury. Despite their small size and retroperitoneal location, these lesions are potentially lethal once they rupture. This report describes a ruptured lumbar artery aneurysm which was successfully treated in a minimally invasive fashion. The diagnosis was suggested by computed tomography scan and confirmed with angiography. Successful treatment consisted of placing intravascular metallic coils into the lumbar artery. The literature contains only seven previous reports of ruptured lumbar artery aneurysms and these were managed either operatively or via an endovascular approach. Based upon the outcome of all reported cases, we believe that coil embolization of lumbar artery aneurysms following diagnostic angiography is an appropriate and effective mean of treating these lesions.
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Affiliation(s)
- B Marty
- Division of Vascular Surgery, Montefiore Medical Center, New York, New York 10467, USA
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