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Talaie R, Torkian P, Spano A, Mahjoubnia A, Flanagan SM, Rosenberg M, Lin J, Golzarian J, Shrestha P. Comparative Efficacy and Safety of Self-Expandable vs. Balloon-Expandable Stent Grafts in Visceral Artery Aneurysm Management. Diagnostics (Basel) 2024; 14:1695. [PMID: 39125571 PMCID: PMC11311521 DOI: 10.3390/diagnostics14151695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/06/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
PURPOSE This study assesses the efficacy and safety of self-expandable (SE) versus balloon-expandable (BE) stent grafts for managing visceral artery aneurysms (VAAs), focusing on procedural success and complication rates. MATERIALS AND METHODS We conducted a retrospective analysis of VAA patients treated at our institution from April 2006 to September 2021. The study reviewed patient demographics, aneurysm characteristics, treatment details, and outcomes, including endoleaks. RESULTS Among the 23 patients analyzed, splenic artery aneurysms represented 44% of cases. Fifteen patients were treated with balloon-expandable stent grafts (BE SGs), and eight patients were treated with self-expandable stent grafts (SE SGs). For saccular aneurysms, the average neck size was 10.10 ± 8.70 mm in the BE group versus 18.50 ± 3.40 mm in the SE group (p = 0.23), with an average sac size of 20.10 ± 18.9 mm in the BE group versus 15.60 ± 12.7 mm in the SE group (p = 0.16). The average sac-to-neck ratio was 1.69 ± 2.23 in the BE group versus 1.38 ± 0.33 in the SE group (p = 0.63). The BE group exhibited a significantly higher endoleak rate (60%) compared to the SE group (12.5%; p = 0.03). CONCLUSIONS While further investigation is needed to fully assess the outcomes of stent graft treatment for VAAs, initial data show a significantly higher endoleak rate with BE SGs compared to SE SGs. The SE SGs may offer better outcomes due to their superior ability to conform to tortuous and mobile visceral arteries.
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Affiliation(s)
- Reza Talaie
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Pooya Torkian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Anthony Spano
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Alireza Mahjoubnia
- Department of Mechanical and Aerospace Engineering, University of Missouri, Columbia, MO 65211, USA
| | - Siobhan M. Flanagan
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Michael Rosenberg
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jian Lin
- Department of Mechanical and Aerospace Engineering, University of Missouri, Columbia, MO 65211, USA
| | - Jafar Golzarian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Preshant Shrestha
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
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Rossi M, Krokidis M, Kashef E, Peynircioglu B, Tipaldi MA. CIRSE Standards of Practice for the Endovascular Treatment of Visceral and Renal Artery Aneurysms and Pseudoaneurysms. Cardiovasc Intervent Radiol 2024; 47:26-35. [PMID: 38030849 PMCID: PMC10770226 DOI: 10.1007/s00270-023-03620-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/07/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Endovascular treatment of visceral and renal artery aneurysms and pseudoaneurysms is an effective, minimally invasive treatment that has been successfully used since the early 1990s, with refined and expanded techniques and tools currently offering excellent outcomes. Due to increased detection of such lesions in recent years, many of which are asymptomatic, revision of the indications for intervention and the correct endovascular treatment approaches has become essential. PURPOSE This document will presume that the indication for treatment is clear and approved by the multidisciplinary team and will define the standards required for the performance of each intervention, as well as their relative advantages and limitations. CIRSE Standards of Practice documents are not intended to impose a standard of clinical patient care, but recommend a reasonable approach to, and best practices for, the performance of the endovascular treatment of visceral and renal artery aneurysms and pseudoaneurysms. METHODS The writing group was established by the CIRSE Standards of Practice Committee and consisted of five clinicians with internationally recognised expertise in endovascular treatments. The writing group reviewed the existing literature on visceral and renal artery aneurysms and pseudoaneurysms, performing an evidence search using PubMed to identify publications in English and relating to human subjects from 1990 to 2022. The final recommendations were formulated through consensus. RESULTS Endovascular treatment has an established role in the successful management of visceral and renal artery aneurysms and pseudoaneurysms, and this Standards of Practice document provides up-to-date recommendations for its safe performance.
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Affiliation(s)
- Michele Rossi
- Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome-Sant'Andrea University Hospital, Rome, Italy.
| | - Miltiadis Krokidis
- National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Elika Kashef
- Imperial College Healthcare NHS Trust, London, UK
| | - Bora Peynircioglu
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Marcello Andrea Tipaldi
- Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome-Sant'Andrea University Hospital, Rome, Italy
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Rinaldi LF, Brioschi C, Marone EM. Endovascular and Open Surgical Treatment of Ruptured Splenic Artery Aneurysms: A Case Report and a Systematic Literature Review. J Clin Med 2023; 12:6085. [PMID: 37763025 PMCID: PMC10531855 DOI: 10.3390/jcm12186085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Ruptured splenic artery aneurysms (r-SAA), although rare, are burdened by high morbidity and mortality, even despite emergent surgical repair. It is suggested that endovascular treatment can achieve reduction in peri-operative death and complication rates, as in other vascular diseases, but evidence of such benefits is still lacking in this particular setting. We report a case of an r-SAA treated by trans-arterial embolization and then converted to open surgery for persistent bleeding, and we provide a systematic review of current results of open and endovascular repair of r-SAAs. MATERIALS AND METHODS A 50-year-old male presenting in shock for a giant r-SAA underwent emergent coil embolization and recovered hemodynamic stability. On the following day, he underwent laparotomy for evacuation of the huge intraperitoneal hematoma, but residual bleeding was noted from the splenic artery, which was ligated after coil removal, and a splenectomy was performed. A systematic literature review of the reported mortality and complications of r-SAA undergoing open (OSR) or endovascular (EVT) treatment was performed using the main search databases. All primary examples of research published since 1990 were included regardless of sample size. The main outcome measures were mortality and reinterventions. Secondary outcomes were post-operative complications. RESULTS We selected 129 studies reporting on 350 patients-185 treated with OSR and 165 with EVT. Hemodynamically unstable patients and ruptures during pregnancy were more frequently treated with open repair. Overall, there were 37 deaths (mortality: 10.6%)-24 in the OSR group and 13 in the EVTr group (mortality: 12.9% and 7.8% respectively, p-value: 0.84). There were 37 reinterventions after failed or complicated endovascular repair -6 treated with endovascular re-embolization and 31 with laparotomy and splenectomy (22.4%); there were 3 (1.6%) reinterventions after open repair. Overall complication rates were 7.3% in the EVT group (n: 12) and 4.2% in the OSR group (n: 7), and did not require reintervention. No significant differences in overall complications or in any specific complication rate were observed between the two groups. CONCLUSIONS Current results of r-SAA treatment show equipoise terms of morbidity and mortality between open and endovascular repair; however, in case of hemodynamic instability and rupture during pregnancy, open surgery might still be safer. Moreover, endovascular repair is still burdened by a significantly higher rate of reinterventions, mostly with conversions to open surgery.
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Affiliation(s)
- Luigi Federico Rinaldi
- Vascular Surgery, Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, 16132 Genoa, Italy
- Vascular Surgery, Ospedale Policlinico di Monza, 20900 Monza, Italy; (C.B.); (E.M.M.)
| | - Chiara Brioschi
- Vascular Surgery, Ospedale Policlinico di Monza, 20900 Monza, Italy; (C.B.); (E.M.M.)
| | - Enrico Maria Marone
- Vascular Surgery, Ospedale Policlinico di Monza, 20900 Monza, Italy; (C.B.); (E.M.M.)
- Vascular Surgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
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Minici R, Guerriero P, Fontana F, Venturini M, Guzzardi G, Piacentino F, Coppola A, Spinetta M, Siciliano A, Serra R, Costa D, Ielapi N, Santoro R, Brunese L, Laganà D. Endovascular Treatment of Visceral Artery Pseudoaneurysms with Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs). MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1606. [PMID: 37763725 PMCID: PMC10537405 DOI: 10.3390/medicina59091606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Treatment of visceral artery pseudoaneurysms (VAPs) is always indicated regardless of their diameters, as their risk of rupture is significantly higher than that of visceral artery aneurysms. The invasiveness of surgery and its associated complications have led to a shift in favor of radiological interventions as the initial treatment of choice. However, there are still some unanswered questions on endovascular treatment of VAPs regarding the optimal endovascular technique and the efficacy and safety outcomes. The purpose of this multicenter study was to retrospectively evaluate the effectiveness and safety of endovascular treatment of visceral pseudoaneurysms using Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs). Materials and Methods: Consecutive patients who underwent endovascular embolization with EVOH-based NALEAs for visceral artery pseudoaneurysms between January 2018 and June 2023 were retrospectively evaluated. Results: 38 embolizations were performed. Technical success was achieved in all patients. The clinical success rate was high (92.1% overall), with no significant differences between ruptured and unruptured VAPs (p = 0.679). Seven patients (18.4%) experienced procedure-related complications, related to one case of non-target embolization, four splenic abscesses due to end-organ infarction, and two femoral pseudoaneurysms. The rates of procedure-related complications, end-organ infarction, and vascular access-site complications did not significantly differ between ruptured and unruptured VAPs (p > 0.05). Conclusions: Both ruptured and unruptured visceral pseudoaneurysms can be effectively and safely treated with NALEA-based endovascular embolization. We suggest considering the use of NALEAs, particularly in specific clinical cases that highlight their advantages, including patients with coagulopathy, fragile vessels, and embolization targets that are located at a considerable distance from the microcatheter tip and are otherwise difficult to reach.
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Affiliation(s)
- Roberto Minici
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (A.S.); (D.L.)
| | - Pasquale Guerriero
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy;
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (F.F.); (M.V.); (F.P.); (A.C.)
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (F.F.); (M.V.); (F.P.); (A.C.)
| | - Giuseppe Guzzardi
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy; (G.G.); (M.S.)
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (F.F.); (M.V.); (F.P.); (A.C.)
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (F.F.); (M.V.); (F.P.); (A.C.)
| | - Marco Spinetta
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy; (G.G.); (M.S.)
| | - Agostino Siciliano
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (A.S.); (D.L.)
| | - Raffaele Serra
- Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy;
| | - Davide Costa
- Department of Law, Economics and Sociology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Nicola Ielapi
- Department of Public Health and Infectious Disease, Sapienza University of Rome, 00185 Rome, Italy;
| | - Rita Santoro
- Haemophilia and Thrombosis Center, Dulbecco University Hospital, 88100 Catanzaro, Italy;
| | | | - Luca Brunese
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy;
| | - Domenico Laganà
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (A.S.); (D.L.)
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Walia D, Saraya A, Gunjan D. Vascular complications of chronic pancreatitis and its management. World J Gastrointest Surg 2023; 15:1574-1590. [PMID: 37701688 PMCID: PMC10494584 DOI: 10.4240/wjgs.v15.i8.1574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/16/2023] [Accepted: 06/06/2023] [Indexed: 08/25/2023] Open
Abstract
Chronic pancreatitis is a chronic fibro-inflammatory disorder of the pancreas, resulting in recurrent abdominal pain, diabetes mellitus, and malnutrition. It may lead to various other complications such as pseudocyst formation, benign biliary stricture, gastric outlet obstruction; and vascular complications like venous thrombosis, variceal and pseudoaneurysmal bleed. Development of varices is usually due to chronic venous thrombosis with collateral formation and variceal bleeding can easily be tackled by endoscopic therapy. Pseudoaneurysmal bleed can be catastrophic and requires radiological interventions including digital subtraction angiography followed by endovascular obliteration, or sometimes with a percutaneous or an endoscopic ultrasound-guided approach in technically difficult situations. Procedure-related bleed is usually venous and mostly managed conservatively. Procedure-related arterial bleed, however, may require radiological interventions.
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Affiliation(s)
- Dinesh Walia
- Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anoop Saraya
- Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Deepak Gunjan
- Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
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Khairallah MK, Morgan RA, Das R. Technical considerations of endovascular management of true visceral artery aneurysms. CVIR Endovasc 2023; 6:31. [PMID: 37284993 DOI: 10.1186/s42155-023-00368-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/18/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND True visceral artery aneurysms are potentially complex to treat but with advances in technology and increasing interventional radiology expertise over the past decade are now increasingly the domain of the interventional radiologist. BODY: The interventional approach is based on localization of the aneurysm and identification of the anatomical determinants to treat these lesions to prevent aneurysm rupture. Several different endovascular techniques are available and should be selected carefully, dependent on the aneurysm morphology. Standard endovascular treatment options include stent-graft placement and trans-arterial embolisation. Different strategies are divided into parent artery preservation and parent artery sacrifice techniques. Endovascular device innovations now include multilayer flow-diverting stents, double-layer micromesh stents, double-lumen balloons and microvascular plugs and are also associated with high rates of technical success. CONCLUSION Complex techniques such as stent-assisted coiling and balloon-remodeling techniques are useful techniques and require advanced embolisation skills and are further described.
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Affiliation(s)
- M K Khairallah
- Department of Radiology, St.George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
- Assiut University Hospital, Assiut, Egypt
| | - R A Morgan
- Department of Radiology, St.George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
| | - R Das
- Department of Radiology, St.George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK.
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Lin YM, Lin EY, Tseng HS, Lee RC, Huang HE, Wang SE, Shyr YM, Liu CA. Preventive covered stent placement at the gastroduodenal artery stump in angiogram-negative sentinel hemorrhage after pancreaticoduodenectomy. Abdom Radiol (NY) 2021; 46:4995-5006. [PMID: 34037809 DOI: 10.1007/s00261-021-03123-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/03/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the clinical outcomes of preventive covered stent placement at the gastroduodenal artery stump in patients with angiogram-negative sentinel hemorrhage after pancreaticoduodenectomy. METHODS Between July 2006 and September 2018, patients undergoing computed tomography angiography or diagnostic angiography for sentinel hemorrhage after pancreaticoduodenectomy were retrospectively reviewed. Patients having angiogram-negative angiography and undergoing preventive covered stent placement or conservative treatment were included. Clinical outcomes, technique success, and complications were evaluated. RESULTS A total of 25 patients (mean age 62.5 years) were evaluated, including 15 patients underwent preventive covered stent placement at the gastroduodenal artery stump and 10 patients received conservative treatments. The clinical success rates were 50% (5/10) and 86.7% (13/15) for conservative treatments and covered stent groups, respectively (p = 0.07). In the conservative treatment group, delayed massive hemorrhage occurred in five patients, two of whom died of recurrent bleeding due to gastroduodenal artery pseudoaneurysm within 16 days, and two had intraluminal hemorrhage within 5 days. In the covered stent group, one patient had inferior pancreaticoduodenal artery pseudoaneurysm 1 day after the placement of the covered stent, and one had recurrent bleeding due to duodenal ulcer within 14 days. The 30-day mortality was 40% (4/10) and 0 in the conservative treatment and covered stent groups, respectively (p = 0.02). The difference in the overall survival was nonsignificant between the two groups (p = 0.23). CONCLUSIONS The preventive covered stent placement at the gastroduodenal artery stump is safe and reduces delayed massive hemorrhage and short-term mortality in patients with angiogram-negative sentinel hemorrhage after pancreaticoduodenectomy.
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8
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Johal M, Kalaravy M, Ali F, Barve R, Ahmed A, Francis CT, Harky A. Evolving Diagnostic and Therapeutic Options for Visceral Artery Aneurysms. Ann Vasc Surg 2021; 76:488-499. [PMID: 33823252 DOI: 10.1016/j.avsg.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/09/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Visceral artery aneurysms (VAAs) are associated with a very high mortality rate when ruptured and may present as a surgical emergency. Due to their rarity and varying pathophysiology, literature concerning the optimal management of VAAs is limited. This review evaluates the evolving management options for VAAs with a focus on open and endovascular repair. METHODS A combination of databases including OVID, PubMed and Medline were used to perform a literature search. Search terms employed include 'visceral artery aneurysms', 'angiography', '3D-volumetric rendering', 'management', 'open repair' and 'endovascular repair', amongst others. RESULTS 3D modelling in conjunction with existing diagnostic techniques, such as computed tomography and angiography, may improve diagnostic sensitivity. The literature surrounding operative management of VAAs highlights the effectiveness of endovascular repair for anatomically suitable aneurysms. Advances in endovascular technologies may expand the type and number of aneurysms amenable to catheter-based treatment approaches. For aneurysms not amenable to endovascular treatment, or those with an emergency indication, open repair remains an appropriate management choice. CONCLUSION Although rare, VAAs pose a high mortality risk, especially when ruptured. Practical limitations that restrict current operative approaches may be overcome by recent developments including novel neurointerventional techniques that have been applied in VAA management.
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Affiliation(s)
- Monika Johal
- Imperial College School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Mayurey Kalaravy
- Imperial College School of Medicine, Faculty of Medicine, Imperial College London, London, UK; Guy's, King's and St Thomas' School of Medicine, King's College London, London, UK
| | - Fahad Ali
- Imperial College School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Rajas Barve
- Imperial College School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Amna Ahmed
- Imperial College School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Chris T Francis
- Department of Vascular Surgery, Countess of Chester Hospital, Chester, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
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Alekyan BG, Lusnikov VP, Varava AB, Kriger AG. [Endovascular treatment of arterial bleeding after pancreatic surgery]. Khirurgiia (Mosk) 2021:76-83. [PMID: 34363449 DOI: 10.17116/hirurgia202108176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pancreatic surgery is complex and associated with a risk of complications including bleeding. Bleeding after pancreatic surgery is rare, but characterized by high mortality. This review is devoted to classification, diagnosis and treatment strategies for bleeding after pancreatic surgery. Methods and results of endovascular surgery are of special attention.
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Affiliation(s)
- B G Alekyan
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - V P Lusnikov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A B Varava
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A G Kriger
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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10
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Omar MKM, Othman MHM, Morgan R, Abdallah AH, Seif H, Zidan M, Khairallah M, El-Aleem RA. Analysis of outcomes of endovascular embolisation: A cross-sectional two-center study on 46 visceral artery pseudoaneurysms. CVIR Endovasc 2021; 4:60. [PMID: 34269932 PMCID: PMC8285451 DOI: 10.1186/s42155-021-00248-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/08/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose Visceral artery pseudoaneurysms (VAPAs) are uncommon in clinical practice but may have serious clinical outcomes up to death. Endovascular management is a safe effective alternative option to traditional surgical procedures. This study assesses the outcome of different embolic materials and techniques used in the endovascular management of VAPAs. Materials and methods This is a two-center retrospective analysis of endovascular embolisation of 46 VAPAs, with a mean pseudoaneurysm size of 13 ± 11.35 mm, that were urgently managed between July 2018 and March 2020. Patients’ presentations were GIT hemorrhage, intrabdominal hemorrhage, hematuria, and abdominal pain in 34.78%, 30.43%, 23.91%, and 10.87% respectively. Management using coils only was done in 28/46 patients (60.87%), NBCA glue only in 16/46 patients (34.78%), combined coils and NBCA glue in 1/46 patient (2.17%), and Amplatzer plugs only in 1 patient (2.17%). The management techniques were sac packing in 9/46 patients (19.57%), inflow occlusion in 28/46 patients (60.87%) and trapping in 9/46 patients (19.57%). All patients were followed-up for 1 year after the procedure. Results The overall clinical success and periprocedural complication rates were 93.48%, and 15.22% respectively, and 30-day mortality was zero. Clinical success was 92.86% in the coil subgroup (n = 28), and 93.75% in the NBCA glue subgroup (n = 16). The technical success rate was 100%. Effectiveness of the procedures during the follow-up was 97.83%. Target lesion re-intervention rate was 2.17%. Conclusion Transarterial embolisation can provide high technical and clinical success rates with low periprocedural complication and re-intervention rates, as well as satisfactory procedure effectiveness in the management of VAPAs.
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Affiliation(s)
| | - Moustafa H M Othman
- Department of Diagnostic and Interventional Radiology, Assiut University Hospitals, Assiut, Egypt
| | - Robert Morgan
- Department of Interventional Radiology, St. George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Hany Seif
- Department of Diagnostic and Interventional Radiology, Assiut University Hospitals, Assiut, Egypt
| | - Mohamed Zidan
- Department of Diagnostic and Interventional Radiology, Assiut University Hospitals, Assiut, Egypt
| | - Mahmoud Khairallah
- Department of Diagnostic and Interventional Radiology, Assiut University Hospitals, Assiut, Egypt.
| | - Reham Abd El-Aleem
- Department of Diagnostic and Interventional Radiology, Assiut University Hospitals, Assiut, Egypt
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Borghese O, Ganimede MP, Briatico Vangosa A, Pisani A, Vidali S, Di Stasi C, Burdi N, Semeraro V. The Minimally Invasive Treatment of Visceral Artery Pseudoaneurysms: A Retrospective Observational Single Centre Cohort Study on Glue Embolization. Vasc Endovascular Surg 2021; 55:831-837. [PMID: 34261391 DOI: 10.1177/15385744211028730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The objective is to report a single centre experience in the embolization of visceral artery pseudoaneurysms with N-butyl-cyanoacrylate-methacryloxy sulfolane (NBCA-MS). METHODS A retrospective observational cohort study was conducted on data about all consecutive patients treated for visceral artery pseudoaneurysms in the Interventional Radiology Unit of SS Annunziata Hospital, in Taranto (Italy) between January 2016 and July 2020. Only patients treated with NBCA-MS embolization were included. Clinical and technical outcomes were evaluated during in-hospital stay and at 3-month follow-up by computed angiotomography (CTA). RESULTS Among 89 patients undergoing treatment for visceral artery pseudoaneurysm, a total of 58 (65.2%) patients (n = 32, 55.2% men; median age 45.8 years, range: 35-81) treated with NBCA-MS only were enrolled. Pseudoaneurysms were located in the renal artery (n = 18 cases, 31%), in the splenic artery (n = 27, 46.6%), in the intra-parenchymal hepatic artery (n = 3, 5.2%), in the common hepatic artery (n = 4, 6.9%) or in the pancreatic artery (n = 6, 10.3%). N-butyl-cyanoacrylate was diluted 1:1 with Lipiodol ultra-fluid, and mean volume injected was 0.6 ± 0.3 mL (range: 0.2-2.8 mL). Embolization was technically and clinically successful in all patients (n = 58, 100%) with an immediate total thrombosis of the pseudoaneurysm at the completion angiography. No systemic complications were noted in all cases. Five cases (8.6%) of non-target vessel embolization occurred without any clinical complication. No pseudoaneurysm recurrence was detected at the CTA control 1 day postoperatively. In one case (1.7%), a recurrence was detected 4 days after the initial treatment and successfully managed by a repeated NBCA-MS embolization. During the hospital stay, 56 patients recovered well but 2 (3.4%) died from multi-organ failure not related to the embolization. No recurrences were detected at the 3-month postoperative CTA in the remaining patients. CONCLUSIONS In properly selected patients affected with visceral artery pseudoaneurysms, NBCA-MS represents a definitive and safe embolization agent.
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Affiliation(s)
- Ottavia Borghese
- Department of Vascular and Endovascular Surgery, 55183Nord Laennec Hospital, Saint-Herblain, France.,9311University Sapienza of Rome, Rome, Italy
| | | | | | - Angelo Pisani
- Department of Cardiothoracic Surgery, 47165Pinata Grande Hospital, Castel Volturno, Italy
| | | | - Carmine Di Stasi
- Interventional Radiology Unit, 170131SS Annunziata Hospital, Taranto, Italy
| | - Nicola Burdi
- Interventional Radiology Unit, 170131SS Annunziata Hospital, Taranto, Italy
| | - Vittorio Semeraro
- Interventional Radiology Unit, 170131SS Annunziata Hospital, Taranto, Italy
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12
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Castiglione D, Tipaldi MA, Rossi M, Krokidis M. Endovascular Treatment of Giant Visceral Aneurysms: An Overview. VASCULAR AND ENDOVASCULAR REVIEW 2021. [DOI: 10.15420/ver.2020.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Giant visceral aneurysms (or pseudoaneurysms) are aneurysmal lesions of the splanchnic vessels that are larger than 5 cm in diameter. As with other visceral aneurysms, treatment may be either surgical or endovascular. Both treatments face challenges given the anatomical complexity of such lesions. However, in the era of novel tools and techniques that have been developed in this field, an increasing number of giant visceral aneurysms can now be treated using endovascular approaches. The purpose of this article is to offer an overview of the most current techniques and trends in the endovascular treatment of giant visceral artery aneurysms.
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Affiliation(s)
- Davide Castiglione
- Department of Radiological Science, AOUP Paolo Giaccone, BiND, Università di Palermo, Palermo, Italy
| | | | - Michele Rossi
- Department of Radiology, Sant’Andrea University Hospital La Sapienza, Rome, Italy
| | - Miltiadis Krokidis
- 1st Department of Radiology, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
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13
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Abstract
Endovascular management of small visceral artery aneurysms is an established treatment with satisfactory outcomes. However, when size exceeds 5 cm visceral aneurysms are considered as “giant” (giant visceral artery aneurysms or GVAAs) and management is significantly more complex. Between August 2007 and June 2019 eleven cases of GVAAs that were endovascularly treated were retrospectively reviewed and included in this single center study. Mean size was 80 mm (± 26.3 mm) x 46 mm (+ \-11.8 mm). Nine of the lesions were true aneurysms, and two were pseudoaneurysms. In 8 patients, the lesion was causing compression symptoms in the surrounding organs, one patient developed a contained rupture while 2 patients were completely asymptomatic. However, all patients were hemodynamically stable at the time of treatment. Technical success was defined as immediate complete exclusion of the aneurysmal sac, and clinical success as complete relief from clinical symptoms. Follow-up was performed with CT angiography, ultrasound and clinical examination. Mean follow-up was 45 months (range 6–84). Technical and clinical success were both 91%. Complications were one lack of control of contained rupture that was subsequently operated, one case of self-limiting non-target spleen embolization and one case of splenic abscess. Three patients died, one due to the contained rupture 15 days after procedure, the other two for other causes and occurred during the long-term follow-up. This series suggests that endovascular treatment of giant visceral artery aneurysms and pseudoaneuryms is a valid minimally invasive solution with very satisfactory immediate and long-term outcomes unless the aneurysm is already ruptured. A variety of endovascular tools may be required for successful treatment.
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Ter-Akopian AV, Abramov AS, Nikitin NE, Kalinin AA, Kriuchkova OV. [Endovascular treatment of aneurysms and pseudoaneurysms of visceral arteries]. ANGIOLOGIIA I SOSUDISTAIA KHIRURGIIA = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:34-40. [PMID: 35050247 DOI: 10.33529/angio2021406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIM The purpose of the study was to demonstrate the possibilities and efficacy of endovascular interventions in patients with visceral artery aneurysms. PATIENTS AND METHODS From 2013 to June 2020, we performed 15 embolizations of visceral artery aneurysms in 15 patients (8 men and 7 women). The technical success rate was 100%. The patients' age varied from 32 to 71 years. In 8 cases, the aneurysm was located in the basin of the splenic artery, in 3 cases in the gastroduodenal artery, in 2 cases in the superior mesenteric artery and in 2 cases in the renal artery. Three aneurysms were classified as false, and 12 as true. All aneurysms were saccular, with their diameter ranging from 6 to 32 mm. In 2 patients aneurysms were detected after endured infective endocarditis, in 8 during examination in abdominal pain syndrome, and in 5 cases as an incidental finding while performing computed tomography of abdominal organs. One patient was subjected to embolization of the afferent vessel, two underwent implantation of stent grafts into the aneurysmal neck area, and eleven underwent aneurysmal sac embolization with microcoils. In 9 cases, embolization was performed using microcoils only in 1 case using microcoils with balloon assistance, and in 2 cases using microcoils with stent assistance. We used from 1 to 12 microcoils, with a diameter of from 2 to 30 mm. RESULTS During endovascular embolization of visceral artery aneurysms there were no target-organ infarctions, haemorrhagic complications, nor lethal outcomes. In the early postoperative period, 7 patients developed pain syndrome. In 1 case pain syndrome was relieved by narcotic analgesics, in 4 cases by spasmolytics, and in 2 cases by a combination of spasmolytics and non-narcotic analgesics. CONCLUSION Endovascular treatment of visceral arterial aneurysms is an efficient and safe method.
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Affiliation(s)
- A V Ter-Akopian
- Central Clinical Hospital and Polyclinic of the RF President's Affairs Administration, Moscow, Russia
| | - A S Abramov
- Central Clinical Hospital and Polyclinic of the RF President's Affairs Administration, Moscow, Russia
| | - N E Nikitin
- Central Clinical Hospital and Polyclinic of the RF President's Affairs Administration, Moscow, Russia
| | - A A Kalinin
- Central Clinical Hospital and Polyclinic of the RF President's Affairs Administration, Moscow, Russia
| | - O V Kriuchkova
- Central Clinical Hospital and Polyclinic of the RF President's Affairs Administration, Moscow, Russia
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15
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Bonardelli S, Spampinato B, Ravanelli M, Cuomo R, Zanotti C, Paro B, Nodari F, Barbetta I, Portolani N. The role of emergency presentation and revascularization in aneurysms of the peripancreatic arteries secondary to celiac trunk or superior mesenteric artery occlusion. J Vasc Surg 2020; 72:46S-55S. [DOI: 10.1016/j.jvs.2019.11.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
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16
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van Veenendaal P, Maingard J, Kok HK, Ranatunga D, Buckenham T, Chandra RV, Lee MJ, Brooks DM, Asadi H. Endovascular flow-diversion of visceral and renal artery aneurysms using dual-layer braided nitinol carotid stents. CVIR Endovasc 2020; 3:33. [PMID: 32596773 PMCID: PMC7321844 DOI: 10.1186/s42155-020-00125-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 05/13/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Visceral and renal artery aneurysms (VRAAs) are uncommon but are associated with a high mortality rate in the event of rupture. Endovascular treatment is now first line in many centres, but preservation of arterial flow may be difficult in unfavourable anatomy including wide necked aneurysms, parent artery tortuosity and proximity to arterial bifurcations. Endovascular stenting, and in particular flow-diversion, is used in neurovascular intervention to treat intracranial aneurysms but is less often utilised in the treatment of VRAAs. The CASPER stent is a low profile dual-layer braided nitinol stent designed for carotid stenting with embolic protection and flow-diversion properties. We report the novel use of the CASPER stent for the treatment of VRAAs. We present a case series describing the treatment of six patients with VRAAs using the CASPER stent. RESULTS Six patients with unruptured VRAAs were treated electively. There were three splenic artery aneurysms and three renalartery aneurysms. Aneurysms were treated with the CASPER stent, with or without loose aneurysm coil packing or liquid embolic depending on size and morphology. All stents were successfully deployed with no immediate or periprocedural complications. Four aneurysms completely occluded after serial imaging follow up with one case requiring repeat CASPER stenting for complete occlusion. In one patient a single aneurysm remained patent at last follow up, A single case was complicated by delated splenic infarction and surgical splenectomy. CONCLUSION Preliminary experience with the CASPER stent suggests it is technically feasible and effective for use in the treatment of VRAAs.
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Affiliation(s)
| | - Julian Maingard
- Interventional Neuroradiology Unit, Monash Health, Melbourne, Australia. .,School of Medicine - Faculty of Health, Deakin University, Waurn Ponds, Australia. .,Monash Hospital, Clayton, Victoria, Australia.
| | - Hong Kuan Kok
- School of Medicine - Faculty of Health, Deakin University, Waurn Ponds, Australia.,Interventional Radiology Service - Department of Radiology, Northern Hospital, Melbourne, Australia
| | - Dinesh Ranatunga
- Interventional Radiology Service - Department of Radiology, Austin Hospital, Melbourne, Australia
| | - Tim Buckenham
- Interventional Radiology Unit - Monash Imaging, Monash Health, Melbourne, Australia
| | - Ronil V Chandra
- Interventional Neuroradiology Unit, Monash Health, Melbourne, Australia.,Department of Imaging, Monash University, Melbourne, Australia
| | - Michael J Lee
- Interventional Radiology Service - Department of Radiology, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Duncan Mark Brooks
- School of Medicine - Faculty of Health, Deakin University, Waurn Ponds, Australia.,Interventional Radiology Service - Department of Radiology, Austin Hospital, Melbourne, Australia.,Interventional Neuroradiology Service - Radiology Department, Austin Hospital, Melbourne, Australia
| | - Hamed Asadi
- Interventional Radiology Unit - Monash Imaging, Monash Health, Melbourne, Australia.,Interventional Neuroradiology Unit, Monash Health, Melbourne, Australia.,School of Medicine - Faculty of Health, Deakin University, Waurn Ponds, Australia.,Interventional Radiology Service - Department of Radiology, Austin Hospital, Melbourne, Australia.,Interventional Neuroradiology Service - Radiology Department, Austin Hospital, Melbourne, Australia
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17
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Hamid HKS, Suliman AEA, Piffaretti G, Spiliopoulos S, Tetreau R, Tozzi M, Pulli R. A systematic review on clinical features and management of true giant splenic artery aneurysms. J Vasc Surg 2020; 71:1036-1045.e1. [PMID: 31727456 DOI: 10.1016/j.jvs.2019.09.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/16/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND True giant splenic artery aneurysms (GSAAs) >5 cm are rare and present unique therapeutic challenges. The aim of this study was to evaluate the anatomic and clinical characteristics of these lesions and the current surgical and endovascular techniques available for their treatment. METHODS A systematic review of the literature from 2004 to 2018 and the personal experience of the authors with management of GSAAs are presented. A total of 92 GSAA cases were reviewed. Analyses were performed on anatomic and clinical features and management modalities and outcomes of GSAA, including reintervention, morbidity, and mortality. RESULTS GSAA presented at a mean age of 56.1 ± 17.3 years, with no sex predilection; 73% were symptomatic at presentation. Abdominal pain was the presenting symptom in >50% of cases; 34% percent were ruptured, with an overall mortality rate of 12.5%. This group often presented with gastrointestinal bleeding or hemodynamic collapse. The aneurysms were almost evenly distributed across the splenic artery and were not uncommonly associated with arteriovenous fistula formation (8.7%). There were 88 patients who had surgical (53.4%), endovascular (44.3%), or combination (2.3%) therapy. The most commonly performed procedure was aneurysmectomy and splenectomy with or without additional resection. Overall, surgical treatment had a lower morbidity (P = .041) than endovascular therapy and comparable reintervention and mortality rates. CONCLUSIONS GSAAs are uncommon vascular lesions, with distinct clinical features and aneurysm characteristics. Considering their high risk of rupture, timely diagnosis and management are essential to attain a satisfactory outcome. Surgery remains the standard treatment of these lesions. Endovascular intervention is a viable alternative in high-risk patients, particularly those with lesions <10 cm or with anomalous origin.
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Affiliation(s)
- Hytham K S Hamid
- Vascular Surgery Division, Department of Surgery, Soba University Hospital, Khartoum, Sudan.
| | - Abd Elaziz A Suliman
- Vascular Surgery Division, Department of Surgery, Soba University Hospital, Khartoum, Sudan
| | - Gabriele Piffaretti
- Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Stavros Spiliopoulos
- Department of Diagnostic and Interventional Radiology, Patras University Hospital, Rion, Greece
| | - Raphael Tetreau
- Centre d'Imagerie Médicale, Institut du Cancer, Montpellier, France
| | - Matteo Tozzi
- Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Raffaelle Pulli
- Vascular and Endovascular Surgery Unit, University of Bari, Bari, Italy
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18
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Martinelli O, Giglio A, Irace L, Di Girolamo A, Gossetti B, Gattuso R. Single-Center Experience in the Treatment of Visceral Artery Aneurysms. Ann Vasc Surg 2019; 60:447-454. [DOI: 10.1016/j.avsg.2019.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/05/2019] [Accepted: 01/13/2019] [Indexed: 02/09/2023]
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19
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Goto T, Shimohira M, Ohta K, Suzuki K, Sawada Y, Shibamoto Y. Combination of the double-microcatheter technique and triaxial system in coil packing for visceral and renal artery aneurysms. Acta Radiol 2019; 60:1057-1062. [PMID: 30396286 DOI: 10.1177/0284185118810983] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background In coil packing for visceral artery aneurysms (VAAs), difficulties are sometimes associated with preserving the patency of the parent artery, particularly for wide-neck aneurysms. However, the double-microcatheter technique effectively prevents coil migration, while the triple-coaxial (triaxial) system is useful for reducing microcatheter kick-back. Purpose To assess the feasibility of combining these two techniques in coil packing for VAAs. Material and Methods Coil packing using the double-microcatheter technique and triaxial system was attempted for seven VAAs in six patients between August 2015 and January 2018. The technical success rate, packing density of aneurysms, complications related to the procedure, and occlusion status were evaluated. Technical success was defined as the completion of coil packing by immediate post-embolic angiography. The occlusion status was evaluated using time-resolved magnetic resonance angiography. Results There were three renal, three splenic, and one anterior superior pancreaticoduodenal aneurysms. The median size of VAAs was 13 mm (range = 8–21 mm), with five being classified as wide-neck aneurysms. The completion of coil packing was confirmed for all VAAs and the technical success rate was 100%. The median packing density was 28% (range = 22–40%). There were no complications related to the procedure. The median follow-up period was 14 months (range = 8–24 months). In six VAAs that were followed up, there were three complete occlusions, three neck remnants, and no body filling; re-treatment was not required in any patient. Conclusion The combination of the double-microcatheter technique and triaxial system is a feasible method of coil packing for VAAs.
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Affiliation(s)
- Taeko Goto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masashi Shimohira
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kengo Ohta
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazushi Suzuki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yusuke Sawada
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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20
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Biondetti P, Fumarola EM, Ierardi AM, Carrafiello G. Bleeding complications after pancreatic surgery: interventional radiology management. Gland Surg 2019; 8:150-163. [PMID: 31183325 DOI: 10.21037/gs.2019.01.06] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Surgical intervention in the pancreas region is complex and carries the risk of complications, also of vascular nature. Bleeding after pancreatic surgery is rare but characterized by high mortality. This review reports epidemiology, classification, diagnosis and treatment strategies of hemorrhage occurring after pancreatic surgery, focusing on the techniques, roles and outcomes of interventional radiology (IR) in this setting. We then describe the roles and techniques of IR in the treatment of other less common types of vascular complications after pancreatic surgery, such as portal vein (PV) stenosis, portal hypertension and bleeding of varices.
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Affiliation(s)
- Pierpaolo Biondetti
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Enrico Maria Fumarola
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
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21
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Prette PR, Fagundes FB, Marchon LRC, Maciel RDRT, Martins IM, Riguetti-Pinto CR. Endovascular treatment of acute gastrointestinal bleeding from a large splenic artery pseudoaneurysm: case report and literature review. J Vasc Bras 2018; 17:234-242. [PMID: 30643510 PMCID: PMC6326128 DOI: 10.1590/1677-5449.005517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/19/2018] [Indexed: 11/22/2022] Open
Abstract
Pseudoaneurysm of the splenic artery is a rare entity, with little more than 150 cases described in the literature. Pancreatitis is the most common etiology, followed by trauma. In contrast with true aneurysms, pseudoaneurysms are frequently symptomatic, with a 47% risk of rupture and 90% mortality if left untreated. We describe the case of a 48-year-old female patient who suffered a gastrointestinal hemorrhage associated with acute-on-chronic pancreatitis. During workup, endoscopy revealed signs of recent bleeding and magnetic resonance angiography of the abdomen showed a large pseudoaneurysm of the splenic artery. The patient underwent endovascular treatment with microcoil embolization and no further bleeding episodes occurred. Endovascular treatment is now an effective option with low morbidity and mortality and success rates in the range of 79-100%, making it a viable technique for patients with active abdominal inflammation. We conducted a review of endovascular techniques and embolization agents used to treat this pathology.
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Affiliation(s)
- Paulo Roberto Prette
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
| | - Felipe Borges Fagundes
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
| | - Livia Ramos Carvalho Marchon
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
| | - Rodrigo de Rezende Teixeira Maciel
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
| | - Igor Miguel Martins
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
| | - Cristina Ribeiro Riguetti-Pinto
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
- Curso de Formação em Cirurgia Endovascular – Endocurso, Rio de Janeiro, RJ, Brasil.
- Vascularis Centro de Angiologia e Cirurgia Endovascular, Rio de Janeiro, RJ, Brasil.
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22
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Are iatrogenic renal artery pseudoaneurysms more challenging to embolize when associated with an arteriovenous fistula? Radiol Med 2018; 123:742-752. [DOI: 10.1007/s11547-018-0906-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/20/2018] [Indexed: 12/25/2022]
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23
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Coil embolization of renal artery bifurcation and branch aneurysms with flow preservation. J Vasc Surg 2018; 68:451-458.e2. [PMID: 29544994 DOI: 10.1016/j.jvs.2017.12.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 12/05/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Coil embolization is one of the most common endovascular approaches to treatment of renal artery aneurysms (RAAs). The purpose of this retrospective study was to compare complications, mortality, and morbidity associated with sac packing, coil trapping, and inflow occlusion. METHODS The records of all patients with RAAs treated with coil embolization at our center from June 2003 to May 2017 were retrospectively reviewed. Demographics of the patients, aneurysm characteristics, management strategies, perioperative and long-term outcomes, and complications were analyzed. RESULTS A total of 52 patient records were reviewed; 28 patients received sac packing and 24 patients underwent coil trapping/inflow occlusion. There was no significant difference in patients' demographics or RAA characteristics between the groups. The mean aneurysm diameter was 25.6 ± 8.4 mm in the sac packing group and 31.1 ± 16.8 mm in the coil trapping/inflow occlusion group (P = .130). Most aneurysms in the sac packing group originated from the main renal artery bifurcation (67.9%), whereas in the coil trapping/inflow occlusion group, most aneurysms originated from the renal segmental branch arteries (54.2%). The immediate technical success rate was 100%, and the in-hospital mortality rate was 0% in both groups. Sac packing was more likely to be associated with endoleak immediately after the procedure (28.6% vs 8.3%; P = .065). The overall perioperative complication rate was not statistically different between the groups (7.1% vs 16.7%; P = .284). The mean duration of follow-up was 37.67 ± 29.84 months and 49.35 ± 28.11 months in the sac packing and coil trapping/inflow occlusion groups, respectively (P = .192). No deaths related to RAAs or aneurysm rupture occurred in either group. The overall morbidity rate was similar between groups (12.5% vs 25%; P = .284). Partial renal infarction occurred in two and five patients in the sac packing and coil trapping/inflow occlusion groups, respectively (8.3% vs 25%; P = .132). Impaired renal function was more frequent after coil trapping/inflow occlusion (0% vs 15%; P = .049). A single patient in the sac packing group required further intervention for reperfusion of the aneurysmal sac at 4 months (4.2% vs 0%; P = .356). CONCLUSIONS Sac packing might be a safe and effective way to treat RAAs located at the main bifurcation or in branch arteries and may be preferable to coil trapping/inflow occlusion, considering the potential loss of functional renal mass.
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24
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Zhang W, Shi Z, Fu W, Chen B, Xu X, Guo D. Morphologic characteristics and endovascular treatment of primary infrarenal aortic dissections. J Vasc Surg 2017; 67:1380-1388.e1. [PMID: 28822662 DOI: 10.1016/j.jvs.2017.05.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 05/18/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We report the morphologic characteristics and endovascular treatment of primary infrarenal aortic dissections (PIRADs). METHODS A retrospective study was conducted with 38 consecutive PIRAD patients between January 2010 and May 2016 in our vascular center. Patient demographics, morphologic characteristics, endovascular modalities, and periprocedural and follow-up outcomes were recorded. Patients with symptomatic PIRADs or asymptomatic PIRADs of a maximum diameter >30 mm were indicated for endovascular aneurysm repair (EVAR). We proposed a morphologic categorization of PIRADs into two types (I and II) according to the location of the entry tears and an endovascular strategy for treating type I PIRADs with tubular stent grafts (SGs) and type II PIRADs with bifurcated SGs. RESULTS According to the categorization, the study recruited 13 patients with type I and 25 patients with type II PIRADs. The patients were predominantly men, with an average age of 60.8 ± 15.2 years. Type I PIRADs usually had larger true lumens (22.6 ± 6.3 vs 13.6 ± 4.0 mm; P = .002) and relatively smaller false lumens (8.4 ± 2.3 vs 19.9 ± 16.1 mm; P = .012). Type II PIRADs had more entry tears (2.2 ± 0.6 vs 1.7 ± 0.6; P = .024) and longer dissections (109.4 ± 38.8 vs 73.9 ± 39.0 mm; P = .011). All patients underwent EVAR, with 19 tubular and 22 bifurcated SGs. One patient died during the hospital stay. The technical success rate was 94.8% (36/38), and the clinical success rate was 97.4% (37/38). During follow-up of 36 patients for 28.8 ± 17.7 months, 2 patients with type II PIRADs developed left iliac extension occlusion at 3 and 6 months after EVAR, and only 1 patient underwent reintervention. All patients survived throughout the follow-up. No endoleak or aortic enlargement was observed. Computed tomography angiography demonstrated a patent infrarenal aorta with completely thrombosed false lumen in all PIRAD patients (36/36 [100.0%]). In both types of PIRAD, EVAR yielded a significant decrease in the maximum diameter of the infrarenal aorta, with a significant increase in the true lumen size and a significant decrease in the false lumen size (P < .05). CONCLUSIONS The morphologic categorization of PIRADs based on the location of the entry tears appeared to be feasible. The endovascular strategy was safe and effective, with high rates of technical success and clinical success and favorable follow-up outcomes.
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Affiliation(s)
- Wan Zhang
- Department of Vascular Surgery, Zhongshan Hospital, Affiliated with Fudan University, Shanghai, China
| | - Zhenyu Shi
- Department of Vascular Surgery, Zhongshan Hospital, Affiliated with Fudan University, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Affiliated with Fudan University, Shanghai, China.
| | - Bin Chen
- Department of Vascular Surgery, Zhongshan Hospital, Affiliated with Fudan University, Shanghai, China
| | - Xin Xu
- Department of Vascular Surgery, Zhongshan Hospital, Affiliated with Fudan University, Shanghai, China
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital, Affiliated with Fudan University, Shanghai, China
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25
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Cappucci M, Zarco F, Orgera G, López-Rueda A, Moreno J, Laurino F, Barnes D, Tipaldi MA, Gomez F, Macho Fernandez J, Rossi M. Endovascular treatment of visceral artery aneurysms and pseudoaneurysms with stent-graft: Analysis of immediate and long-term results. Cir Esp 2017; 95:283-292. [PMID: 28583724 DOI: 10.1016/j.ciresp.2017.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/14/2017] [Accepted: 04/28/2017] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The aim of this study is to analyze the safety and efficacy of stent-graft endovascular treatment for visceral artery aneurysms and pseudoaneurysms. METHODS Multicentric retrospective series of patients with visceral aneurysms and pseudoaneurysms treated by means of stent graft. The following variables were analyzed: Age, sex, type of lesion (aneurysms/pseudoaneurysms), localization, rate of success, intraprocedural and long term complication rate (SIR classification). Follow-up was performed under clinical and radiological assessment. RESULTS Twenty-five patients (16 men), with a mean age of 59 (range 27-79), were treated. The indication was aneurysm in 19 patients and pseudoaneurysms in 6. The localizations were: splenic artery (12), hepatic artery (5), renal artery (4), celiac trunk (3) and gastroduodenal artery (1). Successful treatment rate was 96% (24/25 patients). Intraprocedural complication rate was 12% (4% major; 8% minor). Complete occlusion was demonstrated during follow up (mean 33 months, range 6-72) in the 24 patients with technical success. Two stent migrations (2/24; 8%) and 4stent thrombosis (4/24; 16%) were detected. Mortality rate was 0%. CONCLUSION In our study, stent-graft endovascular treatment of visceral aneurysmns and pseudoaneurysms has demonstrated to be safe and is effective in the long-term in both elective and emergent cases, with a high rate of successful treatment and a low complication rate.
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Affiliation(s)
- Matteo Cappucci
- Unidad de Intervencionismo, Servicio de Diagnóstico por Imagen, Policlínico Universitario S. Andrea Sapienza, Roma, Italia
| | - Federico Zarco
- Sección de Intervencionismo Vascular, Centro de Diagnóstico por Imagen, Hospital Universitario Clinic i Provincial de Barcelona, Barcelona, España
| | - Gianluigi Orgera
- Unidad de Intervencionismo, Servicio de Diagnóstico por Imagen, Policlínico Universitario S. Andrea Sapienza, Roma, Italia
| | - Antonio López-Rueda
- Sección de Intervencionismo Vascular, Centro de Diagnóstico por Imagen, Hospital Universitario Clinic i Provincial de Barcelona, Barcelona, España
| | - Javier Moreno
- Sección de Diagnóstico Vascular, Centro de Diagnóstico por Imagen, Hospital Universitario Clinic i Provincial de Barcelona, Barcelona, España
| | - Florindo Laurino
- Unidad de Diagnóstico de Patología Vascular, Servicio de Diagnóstico por Imagen, Policlínico Universitario S. Andrea Sapienza, Roma, Italia
| | - Daniel Barnes
- Sección de Intervencionismo Vascular, Centro de Diagnóstico por Imagen, Hospital Universitario Clinic i Provincial de Barcelona, Barcelona, España
| | - Marcello Andrea Tipaldi
- Unidad de Diagnóstico de Patología Vascular, Servicio de Diagnóstico por Imagen, Policlínico Universitario S. Andrea Sapienza, Roma, Italia
| | - Fernando Gomez
- Sección de Intervencionismo Vascular, Centro de Diagnóstico por Imagen, Hospital Universitario Clinic i Provincial de Barcelona, Barcelona, España.
| | - Juan Macho Fernandez
- Sección de Intervencionismo Vascular, Centro de Diagnóstico por Imagen, Hospital Universitario Clinic i Provincial de Barcelona, Barcelona, España
| | - Michele Rossi
- Unidad de Intervencionismo, Servicio de Diagnóstico por Imagen, Policlínico Universitario S. Andrea Sapienza, Roma, Italia
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Cappucci M, Zarco F, Orgera G, López-Rueda A, Moreno J, Laurino F, Barnes D, Tipaldi MA, Gomez F, Macho Fernandez J, Rossi M. Endovascular Treatment of Visceral Artery Aneurysms and Pseudoaneurysms With Stent-Graft: Analysis of Immediate and Long-Term Results. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.cireng.2017.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Spezia L, Sozzi C, Contro A, Mansueto G. Successful Post-Pancreatitis Pseudoaneurysm Coagulation by Percutaneous Computed Tomography (CT)-Guided Thrombin Injection. Pol J Radiol 2017; 82:24-27. [PMID: 28203308 PMCID: PMC5266204 DOI: 10.12659/pjr.899431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 05/27/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Pseudoaneurysm is a rare but potentially life-threatening vascular complication of acute pancreatitis, with a mortality rate of 20-43% in untreated patients. The treatment usually involves trans-arterial embolization or surgical resection. CASE REPORT A 44-year-old man with a history of acute pancreatitis developed a pseudoaneurysm of the pancreatic tail, diagnosed as a splenic artery pseudoaneurysm by CT. Selective arteriography performed with the purpose of embolization did not reveal the pseudoaneurysm. The day after, under CT guidance, human thrombin (1,000 IU) was injected inside the aneurysmatic sac with its complete occlusion. A control MRI 6 months later confirmed a complete resolution of the pseudoaneurysm. CONCLUSIONS Percutaneous coagulation of a post-pancreatitis pseudoaneurysm is a relatively easy and safe procedure, and it can be considered as an alternative to trans-arterial embolization when the pseudoaneurysm cannot be visualized on selective arteriography.
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Affiliation(s)
- Laura Spezia
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Carlo Sozzi
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Alberto Contro
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Giancarlo Mansueto
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
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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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Ultrasound-guided thrombin injection for treatment of superficial traumatic pseudoaneurysms and associated expanding hematomas: experience in five patients. J Trauma Manag Outcomes 2016; 10:4. [PMID: 26929774 PMCID: PMC4770383 DOI: 10.1186/s13032-016-0034-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 02/16/2016] [Indexed: 11/24/2022]
Abstract
Background Angiography allows for excellent characterization and treatment of traumatic pseudoaneurysms. However, ultrasound-guided thrombin injection for pseudoaneurysm thrombosis allows for radiation-free treatment of superficial pseudoaneurysms and superficial expanding hematomas. Methods A retrospective review of 5 patient cases treated under this paradigm was performed following institutional review board approval. Outcomes following intervention were recorded and compared amongst the patient cohort. Results Ultrasound-guided closure of traumatic pseudoaneurysms allowed for reduced procedural times and procedural invasiveness. Conclusions As demonstrated by the following cases, ultrasound guided thrombin injection is a good method of primary treatment for superficial pseudoaneurysms, or as an alternative treatment in cases where transcatheter embolization fails.
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Kok HK, Asadi H, Sheehan M, Given MF, Lee MJ. Systematic Review and Single-Center Experience for Endovascular Management of Visceral and Renal Artery Aneurysms. J Vasc Interv Radiol 2016; 27:1630-1641. [DOI: 10.1016/j.jvir.2016.07.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 07/30/2016] [Accepted: 07/31/2016] [Indexed: 02/06/2023] Open
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Guo B, Guo D, Xu X, Chen B, Shi Z, Luo J, Jiang J, Fu W. Early and intermediate results of endovascular treatment of symptomatic and asymptomatic visceral artery aneurysms. J Vasc Surg 2016; 64:140-8. [DOI: 10.1016/j.jvs.2016.02.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
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Luckhurst CM, Perez C, Collinsworth AL, Trevino JG. Atypical presentation of a hepatic artery pseudoaneurysm: A case report and review of the literature. World J Hepatol 2016; 8:779-784. [PMID: 27366305 PMCID: PMC4921800 DOI: 10.4254/wjh.v8.i18.779] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/25/2016] [Accepted: 06/03/2016] [Indexed: 02/06/2023] Open
Abstract
Classically, hepatic artery pseudoaneurysms (HAPs) arise secondary to trauma or iatrogenic causes. With an increasing prevalence of laparoscopic procedures of the hepatobiliary system the risk of inadvertent injury to arterial vessels is increased. Pseudoaneurysm formation post injury can lead to serious consequences of rupture and subsequent hemorrhage, therefore intervention in all identified visceral pseudoaneurysms has been advocated. A variety of interventional methods have been proposed, with surgical management becoming the last step intervention when minimally invasive therapies have failed. The authors present a case of a HAP in a 56-year-old female presenting with jaundice and pruritis suggestive of a Klatskin’s tumor. This presentation of HAP in a patient without any significant past medical or surgical intervention is atypical when considering that the majority of HAP cases present secondary to iatrogenic causes or trauma. Multiple minimally invasive approaches were employed in an attempt to alleviate the symptomology which included jaundice and associated inflammatory changes. Ultimately, a right hepatic trisegmentectomy was required to adequately relieve the mass effect on biliary outflow obstruction and definitively address the HAP. The presentation of a HAP masquerading as a malignancy with jaundice and pruritis, rather than the classic symptoms of abdominal pain, anemia, and melena, is unique. This presentation is only further complicated by the absent history of either trauma or instrumentation. It is important to be aware of HAPs as a potential cause of jaundice in addition to the more commonly thought of etiologies. Furthermore, given the morbidity and mortality associated with pseudoaneurysm rupture, intervention in identifiable cases, either by minimally invasive or surgical interventions, is recommended.
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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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Madhusudhan KS, Venkatesh HA, Gamanagatti S, Garg P, Srivastava DN. Interventional Radiology in the Management of Visceral Artery Pseudoaneurysms: A Review of Techniques and Embolic Materials. Korean J Radiol 2016; 17:351-63. [PMID: 27134524 PMCID: PMC4842855 DOI: 10.3348/kjr.2016.17.3.351] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 01/25/2016] [Indexed: 12/15/2022] Open
Abstract
Visceral artery pseudoaneurysms occur mostly as a result of inflammation and trauma. Owing to high risk of rupture, they require early treatment to prevent lethal complications. Knowledge of the various approaches of embolization of pseudoaneurysms and different embolic materials used in the management of visceral artery pseudoaneurysms is essential for successful and safe embolization. We review and illustrate the endovascular, percutaneous and endoscopic ultrasound techniques used in the treatment of visceral artery pseudoaneurysm and briefly discuss the embolic materials and their benefits and risks.
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Affiliation(s)
| | | | - Shivanand Gamanagatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Pramod Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
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Pedersoli F, Isfort P, Keil S, Goerg F, Zimmermann M, Liebl M, Schulze-Hagen M, Schmeding M, Kuhl CK, Bruners P. Stentgraft Implantation for the Treatment of Postoperative Hepatic Artery Pseudoaneurysm. Cardiovasc Intervent Radiol 2016; 39:575-81. [PMID: 26797022 DOI: 10.1007/s00270-015-1274-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 11/29/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE Hepatic artery pseudoaneurysms are a rare but potentially life-threatening complication of major pancreaticobiliary surgery. We evaluated the safety and efficacy of endovascular stentgraft implantation for the management of such vascular lesions. MATERIALS AND METHODS Between May 2013 and October 2015, ten patients with postoperative hepatic artery pseudoaneurysm, of which eight presented with active hemorrhage, were treated with endovascular stentgraft implantation. All patients had undergone major pancreatic or hepatic surgery before (pylorus-preserving pancreaticoduodenectomy, pancreatectomy, hemihepatectomy, extended hemihepatectomy). The pseudoaneurysms were diagnosed 13-202 days after surgery and were associated with postsurgical complications (e.g., leakage of pancreaticojejunal anastomosis). RESULTS In 9/10 patients, the pseudoaneurysm was completely excluded via stentgraft implantation. In 1/10 patient, the pseudoaneurysm ruptured during the procedure and was successfully treated by immediate open surgery. In 1/10 patient, a second intervention was performed after 6 days because of rebleeding; this was successfully treated by implantation of a second overlapping stentgraft. Mean follow-up time is 51 days. None of the patients died due to stentgraft- or aneurysm-related complications. Further episodes of hemorrhage were not observed. In one patient, clinically asymptomatic complete occlusion of the stentgraft was discovered at follow-up imaging. CONCLUSION Stentgraft implantation is a safe and effective technique to treat hepatic artery pseudoaneurysms related to major pancreatic or hepatic surgery, especially in the setting of acute hemorrhage.
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Affiliation(s)
- F Pedersoli
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - P Isfort
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - S Keil
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - F Goerg
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - M Zimmermann
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - M Liebl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - M Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - M Schmeding
- Clinic for General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - C K Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - P Bruners
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
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Naganuma M, Matsui H, Koizumi J, Fushimi K, Yasunaga H. Short-term outcomes following elective transcatheter arterial embolization for splenic artery aneurysms: data from a nationwide administrative database. Acta Radiol Open 2015; 4:2047981615574354. [PMID: 26443101 PMCID: PMC4580119 DOI: 10.1177/2047981615574354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 02/01/2015] [Indexed: 12/14/2022] Open
Abstract
Background Splenic artery aneurysm (SAA) rupture is life-threatening. Although elective transcatheter arterial embolization (TAE) suggested low in-hospital death in previous studies, there has been no large multi-center study of elective TAE for SAA. Purpose To examine the short-term outcomes of TAE for splenic artery aneurysm (SAA) and analyze the factors associated with the outcomes, including liver cirrhosis, using a nationwide administrative inpatient database. Material and Methods We identified patients who received elective TAE with a principal diagnosis of SAA. We assessed the patient background characteristics, comprising age, sex, and specific co-morbidities, including liver cirrhosis. The outcomes included the rate of TAE-related complications (acute pancreatitis, splenic infarction, splenic abscess, or intraperitoneal hematoma), length of stay, and in-hospital mortality. Results Among 18.3 million inpatients in the database between July 2010 and March 2013, we identified 534 patients who received elective TAE for SAA at 229 participating hospitals. Fifty-four (10.1%) patients had liver cirrhosis. No in-hospital deaths were observed. Thirty-two (6.0%) patients had at least one TAE-related complication. A multivariate linear regression analysis revealed that liver cirrhosis was significantly associated with longer length of stay (9.5 days; 95% confidence interval [CI], 7.0–12.0 days; P < 0.001). A logistic regression analysis showed that liver cirrhosis was not significantly associated with TAE-related complications (odds ratio, 0.99; 95% CI, 0.29–3.39; P = 0.980). Conclusion The results revealed no in-hospital mortality and a low complication rate associated with elective TAE for SAA including liver cirrhosis patients.
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Affiliation(s)
- Michio Naganuma
- Department of Radiology, Shonan Izumi Hospital, Kanagawa, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Jun Koizumi
- Department of Diagnostic Radiology, School of Medicine, Tokai University, Kanagawa, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Chiaradia M, Novelli L, Deux JF, Tacher V, Mayer J, You K, Djabbari M, Luciani A, Rahmouni A, Kobeiter H. Ruptured visceral artery aneurysms. Diagn Interv Imaging 2015; 96:797-806. [DOI: 10.1016/j.diii.2015.03.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
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Hogendoorn W, Lavida A, Hunink MGM, Moll FL, Geroulakos G, Muhs BE, Sumpio BE. Open repair, endovascular repair, and conservative management of true splenic artery aneurysms. J Vasc Surg 2014; 60:1667-76.e1. [PMID: 25264364 DOI: 10.1016/j.jvs.2014.08.067] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 08/11/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE True splenic artery aneurysms (SAAs) are a rare but potentially fatal pathology. For many years, open repair (OPEN) and conservative management (CONS) were the treatments of choice, but throughout the last decade endovascular repair (EV) has become increasingly used. The purpose of the present study was to perform a systematic review and meta-analysis evaluating the outcomes of the three major treatment modalities (OPEN, EV, and CONS) for the management of SAAs. METHODS A systematic review of all studies describing the outcomes of SAAs treated with OPEN, EV, or CONS was performed using seven large medical databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to ensure a high-quality review. All articles were subject to critical appraisal for relevance, validity, and availability of data regarding characteristics and outcomes. All data were systematically pooled, and meta-analyses were performed on several outcomes, including early and late mortality, complications, and number of reinterventions. RESULTS Original data of 1321 patients with true SAAs were identified in 47 articles. OPEN contained 511 patients (38.7%) in 31 articles, followed by 425 patients (32.2%) in CONS in 16 articles and 385 patients (29.1%) in EV in 33 articles. The CONS group had fewer symptomatic patients (9.5% vs 28.7% in OPEN and 28.8% in EV; P < .001) and fewer ruptured aneurysms (0.2% vs 18.4% in OPEN and 8.8% in EV; P < .001), but no significant differences were found in existing comorbidities. CONS patients were usually older and had smaller-sized aneurysms than patients in the OPEN and EV groups. The only identified difference in baseline characteristics between OPEN and EV was the number of ruptured aneurysms (18.4% vs 8.8%; P < .001). OPEN had a higher 30-day mortality than EV (5.1% vs 0.6%; P < .001), whereas minor complications occurred in a larger number of the EV patients. EV required more reinterventions per year (3.2%) compared with OPEN (0.5%) and CONS (1.2%; P < .001). The late mortality rate was higher in patients treated with CONS (4.9% vs 2.1% in OPEN and 1.4% in EV; P = .04). CONCLUSIONS EV of SAA has better short-term results compared with OPEN, including significantly lower perioperative mortality. OPEN is associated with fewer late complications and fewer reinterventions during follow-up. Patients treated with CONS showed a higher late mortality rate. Ruptured SAAs are predictors of a significantly higher perioperative mortality compared with nonruptured SAAs in the OPEN and EV groups.
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Affiliation(s)
- Wouter Hogendoorn
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn; Section of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
| | - Anthi Lavida
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn; Department of Vascular Surgery, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - M G Myriam Hunink
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Health Policy & Management, Harvard School of Public Health, Boston, Mass
| | - Frans L Moll
- Section of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
| | - George Geroulakos
- Department of Vascular Surgery, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - Bart E Muhs
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn
| | - Bauer E Sumpio
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn.
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Maignien C, Marcellin L, Anselem O, Silvera S, Dousset B, Grangé G, Goffinet F. [Embolization of a ruptured pseudo-aneurysm of the uterine artery at 26weeks of gestation: Materno-fetal consequences; a case-report]. ACTA ACUST UNITED AC 2014; 44:665-9. [PMID: 25201019 DOI: 10.1016/j.jgyn.2014.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 06/27/2014] [Accepted: 07/08/2014] [Indexed: 11/28/2022]
Abstract
Rupture of a uterine artery pseudo-aneurysm during pregnancy is a rare condition with potential life-threatening complications, and management should take into account the fetal impact of the therapeutic choice. We report the case of a 2cm left uterine artery pseudo-aneurysm revealed by pelvic pain, in a 30-year-old pregnant woman at 26(+0)weeks of gestation (WG). Diagnosis was suspected at ultrasound scan, and confirmed with Magnetic Resonance angiography that showed signs of pre-rupture. An emergency selective embolization attempted in utero allowed the complete exclusion of the aneurysmal sac. The patient gave birth one month later to a girl at 31(+1)WG, initially managed by neonatologists, who is currently in good health.
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Affiliation(s)
- C Maignien
- Maternité Port-Royal, hôpital Cochin Broca, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, université Paris Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France.
| | - L Marcellin
- Maternité Port-Royal, hôpital Cochin Broca, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, université Paris Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - O Anselem
- Maternité Port-Royal, hôpital Cochin Broca, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, université Paris Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - S Silvera
- Service de radiologie, hôpital Cochin Broca, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; DHU risques et grossesse, université Paris Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - B Dousset
- Service de chirurgie digestive, hépatobiliaire et endocrinienne, hôpital Cochin Broca, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - G Grangé
- Maternité Port-Royal, hôpital Cochin Broca, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, université Paris Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - F Goffinet
- Maternité Port-Royal, hôpital Cochin Broca, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, université Paris Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France
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Barbiero G, Battistel M, Susac A, Miotto D. Percutaneous thrombin embolization of a pancreatico-duodenal artery pseudoaneurysm after failing of the endovascular treatment. World J Radiol 2014; 6:629-635. [PMID: 25170402 PMCID: PMC4147445 DOI: 10.4329/wjr.v6.i8.629] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/24/2014] [Accepted: 06/18/2014] [Indexed: 02/07/2023] Open
Abstract
Pancreatico-duodenal artery (PDA) pseudoaneurysms are rare vascular conditions with high mortality rates after rupture and they are frequently secondary to pancreatitis, surgery, trauma or infection. Due to the high risk of rupture and bleeding, it is mandatory to treat all pseudoaneurysms, regardless of their size or symptomatology. First option of treatment is open surgical repair, but it has high mortality rate, especially in hemodynamically unstable patients. In the recent years, percutaneous ultrasonography (US)- or computed tomography-guided thrombin injection was proposed as an alternative method for treating visceral aneurysms and pseudoaneurysms, but few reports described this therapy in case of peri-pancreatic pseudoaneurysms. We present a rare case of pseudoaneurysm of the PDA in a patient with no previous history of pancreatitis nor major surgery but with an occlusive lesion of the celiac axis. To the best of our knowledge this is the first reported case of PDA pseudoaneurysm successfully treated in emergency by single transabdominal US-guided injection of thrombin after failed attempts of percutaneous catheterization of the feeding vessel of the pseudoaneurysm.
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Endovascular embolisation of visceral artery pseudoaneurysms. Radiol Res Pract 2014; 2014:258954. [PMID: 25132992 PMCID: PMC4123623 DOI: 10.1155/2014/258954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 06/08/2014] [Accepted: 06/10/2014] [Indexed: 12/27/2022] Open
Abstract
Objective. To evaluate the technical success, safety, and outcome of endovascular embolization procedure in management of visceral artery pseudoaneurysms. Materials and Methods. 46 patients were treated for 53 visceral pseudoaneurysms at our institution. Preliminary diagnostic workup in all cases was performed by contrast enhanced abdominal CT scan and/or duplex ultrasound. In all patients, embolization was performed as per the standard departmental protocol. For data collection, medical records and radiology reports of all patients were retrospectively reviewed. Technical success, safety, and outcome of the procedure were analyzed. Results. Out of 46 patients, 13 were females and 33 were males. Mean patient age was 44.79 ± 13.9 years and mean pseudoaneurysm size was 35 ± 19.5 mm. Technical success rate for endovascular visceral pseudoaneurysm coiling was 93.47% (n = 43). Complication rate was 6.52% (n = 3). Followup was done for a mean duration of 21 ± 1.6 months (0.5–69 months). Complete resolution of symptoms or improvement in clinical condition was seen in 36 patients (80%) out of those 45 in whom procedure was technically successful. Conclusion. Results of embolization of visceral artery pseudoaneurysms with coils at our center showed high success rate and good short term outcome.
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Endovascular treatment of pseudoaneurysms in pancreatitis. Wideochir Inne Tech Maloinwazyjne 2014; 9:138-44. [PMID: 25097678 PMCID: PMC4105666 DOI: 10.5114/wiitm.2014.41621] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 10/15/2013] [Accepted: 11/05/2013] [Indexed: 12/26/2022] Open
Abstract
Introduction Haemorrhagic complications are commonly reported in the course of acute pancreatitis (AP). The most dangerous are pseudoaneurysms secondary to wall erosion of the vessels crossing the inflammation area. Aim To evaluate the efficacy of different embolisation techniques of pseudoaneurysms secondary to AP. Material and methods The treatment outcomes in 10 AP patients were analysed in a follow-up period of 1 to 10 months (most frequently: splenic or gastroduodenal artery aneurysms). A total of 12 endovascular procedures were performed (thrombin embolisation, coil embolisation or combined). The efficacy of aneurysm sac exclusion and the patency of the treated vessel were compared. Results The follow-up examination on postprocedural day 7 revealed aneurysm refilling in 3 out of 11 cases. Three patients showed an occlusion of the aneurysm-parent vessel. One month after the procedures, involving 10 patients, a vessel occlusion was confirmed in 3 and aneurysm sac refilling in another 2 patients. Taking into consideration the type of the procedure performed, treatment failure in the form of sac refilling was observed in half of thrombin-based procedures, 25% of coil embolisations and 33% of sandwich technique procedures. Similar failure distribution was noted for vessel occlusion. Conclusions It seems that thrombin injection was least successful, whereas thrombin injection into the sac and implantation of coils into the aneurysm neck seems to be the optimal procedure, in respect to both the cost-effectiveness of the procedure and late outcomes.
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Treatment of Visceral Aneurysm Using Multilayer Stent: Two-Year Follow-Up Results in Five Consecutive Patients. Cardiovasc Intervent Radiol 2013; 36:1256-61. [DOI: 10.1007/s00270-013-0705-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/03/2013] [Indexed: 11/25/2022]
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Verzini F, Biello A, Marucchini A, Parente B, Parlani G, Cao P. Total endovascular solution for complex visceral aneurysms. J Vasc Surg 2013; 58:1412-6. [PMID: 23827335 DOI: 10.1016/j.jvs.2013.05.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 03/28/2013] [Accepted: 05/10/2013] [Indexed: 10/26/2022]
Abstract
Visceral aneurysms are rare in the general population (<2%), and the most serious complication is represented by aneurysm rupture. The use of stent grafts to exclude visceral aneurysms is described in several reports but is reserved for patients with favorable anatomy. We report here on a hepatic artery pseudoaneurysm in a liver transplant patient and a patient with an aneurysmal vein graft degeneration of a renal bypass, both with no suitable proximal neck for standard stent grafting. Both patients were successfully treated with a custom-made aortic endograft with a single fenestration for the hepatic or renal artery, together with a visceral covered stent. Although initial results are promising, long-term follow-up is required to assess durability.
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Affiliation(s)
- Fabio Verzini
- Unit of Vascular and Endovascular Surgery, Ospedale S. Maria della Misericordia, Università degli Studi di Perugia, Perugia, Italy.
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