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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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Hofmann A, Schuch P, Berger F, Taher F, Assadian A. Visceral Artery Aneurysms in the Presence of Upstream Stenoses. J Clin Med 2024; 13:3170. [PMID: 38892881 PMCID: PMC11172764 DOI: 10.3390/jcm13113170] [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: 03/31/2024] [Revised: 05/02/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Sutton-Kadir syndrome describes a rare pathology that commonly includes an aneurysm of the inferior pancreaticoduodenal artery in combination with a celiac trunk stenosis or occlusion, often caused by median arcuate ligament compression. Several therapeutic approaches exist including open surgical, endovascular, and hybrid treatments. Other combinations of visceral artery aneurysms and upstream stenoses exist but the cumulative body of evidence on these combinations is weak due to their rarity. Methods: A retrospective analysis of patient data from a single center was carried out. Electronic patient records were filtered for keywords including "visceral aneurysm", "Sutton-Kadir", and "median arcuate ligament". Imaging studies were re-examined by two blinded vascular surgeons with a third vascular surgeon as a referee in case of diverging results. Results: Sixteen patients had a visceral artery aneurysm with an upstream stenosis. All cases had a celiac trunk obstruction while one patient also had a concomitant superior mesenteric artery stenosis. Both median arcuate ligament compression and atherosclerotic lesions were identified. The location of the aneurysms varied even though the inferior pancreaticoduodenal artery was most frequently affected. A classification system based on the different combinations of stenoses and aneurysms is presented and introduced as a new pathologic entity: visceral artery aneurysm in the presence of upstream stenosis (VAPUS). Conclusions: The concomitant presence of visceral artery aneurysms, especially in the pancreaticoduodenal arteries, and blood flow impairment of the celiac axis or superior mesenteric artery is a rare pathology. The proposed VAPUS classification system offers an accessible and transparent route to the precise localization of the affected vessels.
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Affiliation(s)
- Amun Hofmann
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, 1160 Vienna, Austria
| | - Philipp Schuch
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, 1160 Vienna, Austria
| | - Franz Berger
- Department of General Surgery, Klinik Ottakring, 1160 Vienna, Austria
| | - Fadi Taher
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, 1160 Vienna, Austria
| | - Afshin Assadian
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, 1160 Vienna, Austria
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Pratesi C, Esposito D, Martini R, Novali C, Zaninelli A, Annese AL, Baggi P, Bellosta R, Bianchini Massoni C, Bonardelli S, Carriero S, Cervelli R, Chisci E, Cioni R, Corvino F, DE Cobelli F, Fanelli F, Fargion AT, Femia M, Freyrie A, Gaggiano A, Gallitto E, Gennai S, Giampalma E, Giurazza F, Grego F, Guazzarotti G, Ierardi AM, Kahlberg AL, Mascia D, Mezzetto L, Michelagnoli S, Nardelli F, Niola R, Lenti M, Perrone O, Piacentino F, Piffaretti G, Pulli R, Puntel G, Puppini G, Rossato D, Rossi M, Silingardi R, Sirignano P, Squizzato F, Tipaldi MA, Venturini M, Veraldi GF, Vizzuso A, Allievi S, Attisani L, Fino G, Ghirardini F, Manzo P, Migliari M, Steidler S, Miele V, Taurino M, Orso M, Cariati M. Guidelines on the diagnosis, treatment and management of visceral and renal arteries aneurysms: a joint assessment by the Italian Societies of Vascular and Endovascular Surgery (SICVE) and Medical and Interventional Radiology (SIRM). THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:49-63. [PMID: 38037721 DOI: 10.23736/s0021-9509.23.12809-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
The objective of these Guidelines is to provide recommendations for the classification, indication, treatment and management of patients suffering from aneurysmal pathology of the visceral and renal arteries. The methodology applied was the GRADE-SIGN version, and followed the instructions of the AGREE quality of reporting checklist. Clinical questions, structured according to the PICO (Population, Intervention, Comparator, Outcome) model, were formulated, and systematic literature reviews were carried out according to them. Selected articles were evaluated through specific methodological checklists. Considered Judgments were compiled for each clinical question in which the characteristics of the body of available evidence were evaluated in order to establish recommendations. Overall, 79 clinical practice recommendations were proposed. Indications for treatment and therapeutic options were discussed for each arterial district, as well as follow-up and medical management, in both candidate patients for conservative therapy and patients who underwent treatment. The recommendations provided by these guidelines simplify and improve decision-making processes and diagnostic-therapeutic pathways of patients with visceral and renal arteries aneurysms. Their widespread use is recommended.
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Affiliation(s)
- Carlo Pratesi
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Davide Esposito
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy -
| | - Romeo Martini
- Department of Angiology, San Martino Hospital, Belluno, Italy
| | - Claudio Novali
- Department of Vascular Surgery, GVM Maria Pia Hospital, Turin, Italy
| | | | - Antonio L Annese
- Department of Diagnostic and Interventional Radiology, Careggi University Hospital, Florence, Italy
| | - Paolo Baggi
- Department of Vascular Surgery, ASST Spedali Civili, Brescia, Italy
| | - Raffaello Bellosta
- Department of Vascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | | | | | - Serena Carriero
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosa Cervelli
- Department of Diagnostic and Interventional Radiology, A.O.U. Pisana, Pisa, Italy
| | - Emiliano Chisci
- Department of Vascular Surgery, S. Giovanni di Dio Hospital, Florence, Italy
| | - Roberto Cioni
- Department of Diagnostic and Interventional Radiology, A.O.U. Pisana, Pisa, Italy
| | - Fabio Corvino
- Department of Diagnostic and Interventional Radiology, AORN Cardarelli, Naples, Italy
| | - Francesco DE Cobelli
- Department of Diagnostic and Interventional Radiology, San Raffaele Hospital, Milan, Italy
| | - Fabrizio Fanelli
- Department of Diagnostic and Interventional Radiology, Careggi University Hospital, Florence, Italy
| | - Aaron T Fargion
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Marco Femia
- Department of Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Antonio Freyrie
- Department of Vascular Surgery, University Hospital of Parma, Parma, Italy
| | - Andrea Gaggiano
- Department of Vascular Surgery, Umberto I Mauriziano Hospital, Turin, Italy
| | - Enrico Gallitto
- Department of Vascular Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Stefano Gennai
- Department of Vascular Surgery, Baggiovara Hospital, Modena, Italy
| | - Emanuela Giampalma
- Department of Diagnostic and Interventional Radiology, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Francesco Giurazza
- Department of Diagnostic and Interventional Radiology, AORN Cardarelli, Naples, Italy
| | - Franco Grego
- Department of Vascular Surgery, University Hospital of Padua, Padua, Italy
| | - Giorgia Guazzarotti
- Department of Diagnostic and Interventional Radiology, San Raffaele Hospital, Milan, Italy
| | - Anna M Ierardi
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Daniele Mascia
- Department of Vascular Surgery, San Raffaele Hospital, Milan, Italy
| | - Luca Mezzetto
- Department of Vascular Surgery, University Hospital of Verona, Verona, Italy
| | | | - Floriana Nardelli
- Department of Diagnostic and Interventional Radiology, Città della Salute e della Scienza, Turin, Italy
| | - Raffaella Niola
- Department of Diagnostic and Interventional Radiology, AORN Cardarelli, Naples, Italy
| | - Massimo Lenti
- Department of Vascular Surgery, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Orsola Perrone
- Department of Diagnostic and Interventional Radiology, A.O.U. Pisana, Pisa, Italy
| | - Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Varese, Italy
| | | | - Raffaele Pulli
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Gino Puntel
- Department of Diagnostic and Interventional Radiology, University Hospital of Verona, Verona, Italy
| | - Giovanni Puppini
- Department of Diagnostic and Interventional Radiology, University Hospital of Verona, Verona, Italy
| | - Denis Rossato
- Department of Diagnostic and Interventional Radiology, Città della Salute e della Scienza, Turin, Italy
| | - Michele Rossi
- Department of Diagnostic and Interventional Radiology, Sant'Andrea University Hospital, Rome, Italy
| | | | | | | | - Marcello A Tipaldi
- Department of Diagnostic and Interventional Radiology, Sant'Andrea University Hospital, Rome, Italy
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Varese, Italy
| | - Gian F Veraldi
- Department of Vascular Surgery, University Hospital of Verona, Verona, Italy
| | - Antonio Vizzuso
- Department of Diagnostic and Interventional Radiology, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Sara Allievi
- Department of Vascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Luca Attisani
- Department of Vascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Gianluigi Fino
- Department of Vascular Surgery, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | - Paola Manzo
- Department of Vascular Surgery, Umberto I Mauriziano Hospital, Turin, Italy
| | - Mattia Migliari
- Department of Vascular Surgery, Baggiovara Hospital, Modena, Italy
| | - Stephanie Steidler
- Department of Diagnostic and Interventional Radiology, San Raffaele Hospital, Milan, Italy
| | - Vittorio Miele
- Department of Diagnostic and Interventional Radiology, Careggi University Hospital, Florence, Italy
| | - Maurizio Taurino
- Department of Vascular Surgery, Sant'Andrea University Hospital, Rome, Italy
| | - Massimiliano Orso
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
| | - Maurizio Cariati
- Department of Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, Milan, Italy
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Yusef M, Barone SC, D'Angelo F, Aurello P, Silecchia G, Petrucciani N. Large and bleeding gastroduodenal artery aneurysm: Challenging diagnosis and treatment. A case report. Int J Surg Case Rep 2024; 114:109105. [PMID: 38134614 PMCID: PMC10800679 DOI: 10.1016/j.ijscr.2023.109105] [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: 11/01/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Visceral artery aneurysms (VAA), including gastroduodenal artery aneurysms (GAA), are rare pathologies that can be challenging to diagnose due to their often-asymptomatic nature. VAA are usually correlated to atherosclerosis, fibro dysplasia, or hemodynamics changes, while pseudo aneurysms are mostly correlated to infection, inflammation, traumas, or iatrogenic lesions. PRESENTATION OF CASE We report the case of an 82-years-old female presenting with abdominal pain and hematemesis. Upper gastrointestinal endoscopy retrieved a large duodenal mass and subsequent CT scans identified a large GAA with contrast extravasation. Endovascular procedure included selective arteriography, microcatheterization, and embolization. DISCUSSION VAA are mostly located in the splenic and hepatic artery. Symptoms of VAA are related to pressure on neighboring organs. VAA rupture is associated with a high mortality risk (over 76 %) and presents with symptoms like acute abdominal pain, hematemesis, and hemodynamic shock. Diagnosis is often made through CT scans and angiography. Treatment options for VAAs and GAAs include both surgical and endovascular methods. Endovascular treatment is preferred, with a success rate of 89 %-98 %. CONCLUSION This case provides an example of challenging diagnosis and treatment of a large and bleeding GAA.
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Affiliation(s)
- Marco Yusef
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy
| | - Sara Claudia Barone
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco D'Angelo
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy
| | - Paolo Aurello
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy
| | - Gianfranco Silecchia
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy
| | - Niccolò Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy.
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Stougiannou TM, Christodoulou KC, Georgakarakos E, Mikroulis D, Karangelis D. Promising Novel Therapies in the Treatment of Aortic and Visceral Aneurysms. J Clin Med 2023; 12:5878. [PMID: 37762818 PMCID: PMC10531975 DOI: 10.3390/jcm12185878] [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: 07/19/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Aortic and visceral aneurysms affect large arterial vessels, including the thoracic and abdominal aorta, as well as visceral arterial branches, such as the splenic, hepatic, and mesenteric arteries, respectively. Although these clinical entities have not been equally researched, it seems that they might share certain common pathophysiological changes and molecular mechanisms. The yet limited published data, with regard to newly designed, novel therapies, could serve as a nidus for the evaluation and potential implementation of such treatments in large artery aneurysms. In both animal models and clinical trials, various novel treatments have been employed in an attempt to not only reduce the complications of the already implemented modalities, through manufacturing of more durable materials, but also to regenerate or replace affected tissues themselves. Cellular populations like stem and differentiated vascular cell types, large diameter tissue-engineered vascular grafts (TEVGs), and various molecules and biological factors that might target aspects of the pathophysiological process, including cell-adhesion stabilizers, metalloproteinase inhibitors, and miRNAs, could potentially contribute significantly to the treatment of these types of aneurysms. In this narrative review, we sought to collect and present relevant evidence in the literature, in an effort to unveil promising biological therapies, possibly applicable to the treatment of aortic aneurysms, both thoracic and abdominal, as well as visceral aneurysms.
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Affiliation(s)
- Theodora M. Stougiannou
- Department of Cardiothoracic Surgery, University General Hospital of Alexandroupolis, Dragana, 68100 Alexandroupolis, Greece; (K.C.C.); (E.G.); (D.M.); (D.K.)
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6
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Girardi N, Denney R, LaGrone L. Superior mesenteric artery mycotic aneurysm repaired with bifurcated saphenous vein graft. J Vasc Surg Cases Innov Tech 2023; 9:101244. [PMID: 37799837 PMCID: PMC10547743 DOI: 10.1016/j.jvscit.2023.101244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/26/2023] [Indexed: 10/07/2023] Open
Abstract
A mycotic aneurysm of the superior mesenteric artery caused by Enterococcus faecalis was successfully treated with aneurysmectomy and reconstruction with a bifurcated saphenous vein graft. A 49-year-old man with a history of type 2 diabetes mellitus and a recent left transmetatarsal amputation for osteomyelitis presented to the emergency department with severe abdominal pain, an unexplained 30-lb weight loss, and wound dehiscence. Computed tomography angiography showed an aneurysm of the superior mesenteric artery and a splenic abscess. The patient underwent splenectomy, surgical resection of the aneurysm, and reconstruction with a bifurcated saphenous vein. Follow-up revealed normal gastrointestinal function and graft patency.
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Affiliation(s)
- Nicholas Girardi
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Richard Denney
- Vascular Surgery, UCHealth Medical Center of the Rockies, Loveland, CO
| | - Lacey LaGrone
- Trauma Acute Care Surgery, UCHealth Medical Center of the Rockies, Loveland, CO
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7
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Johnson GGRJ, Dhaliwal S, Launcelott S, Hyun E, Helewa R, Shariff F, Hochman D. Ruptured Middle Colic Artery Aneurysm Presenting with Symptoms of Acute Cholecystitis: A Case Report and Literature Review. Int Med Case Rep J 2022; 15:761-768. [PMID: 36597475 PMCID: PMC9805738 DOI: 10.2147/imcrj.s372294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/29/2022] [Indexed: 12/29/2022] Open
Abstract
Background Ruptured middle colic artery aneurysm is extremely uncommon. Diagnosis can be challenging, as symptomatology can be attributed to more common abdominal pathologies. Due to the rarity of this condition, only case reports are available to inform management. Case Presentation We present the case of a 72-year-old woman with a ruptured middle colic artery aneurysm presenting with signs and symptoms more suggestive of acute calculous cholecystitis. Her co-existing bleed was confirmed on CT angiogram. Coil embolization was initially attempted unsuccessfully. She underwent laparotomy, a middle colic artery ligation, and extended right hemicolectomy with intra-aortic balloon placement for emergency proximal vascular control. Post-operatively, she had a re-bleed that was successfully managed with covered stent placement in the proximal superior mesenteric artery after an unsuccessful re-attempt at coil embolization. Her apparent associated cholecystitis was managed with antibiotics and resolved uneventfully. Conclusion A middle colic artery aneurysm can be challenging to diagnose and treat. Management options include endovascular techniques, open surgery, or a combination approach. Intra-aortic balloon placement for emergency vascular control is a novel approach that could avoid hemorrhage when intra-abdominal vascular access is challenging.
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Affiliation(s)
- Garrett G R J Johnson
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada,Clinician Investigator Program, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Surinder Dhaliwal
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sebastian Launcelott
- Department of Surgery, Section of Vascular Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eric Hyun
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ramzi Helewa
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Farhana Shariff
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Hochman
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada,Correspondence: David Hochman, Department of Surgery, Section of General Surgery, University of Manitoba, 343 Tache Avenue, Winnipeg, Manitoba, R2H 2A5, Canada, Tel +1 204-925-9592, Fax +1 204-231-2283, Email
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8
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Tseng Y, Liu C, Lee C, Chiu N, Su C. Splenic artery pseudoaneurysm as a fatal complication of acute pancreatitis. ADVANCES IN DIGESTIVE MEDICINE 2022. [DOI: 10.1002/aid2.13328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yu‐Hsuan Tseng
- Division of Gastroenterology and Hepatology, Department of Medicine Taipei Veterans General Hospital Taipei Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
| | - Chuen‐Huei Liu
- Division of Gastroenterology and Hepatology, Department of Medicine Taipei Veterans General Hospital Taipei Taiwan
| | - Chun‐Yang Lee
- Division of Gastroenterology and Hepatology, Department of Medicine Taipei Veterans General Hospital Taipei Taiwan
| | - Nai‐Chi Chiu
- Department of Internal Medicine, School of Medicine, College of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Department of Radiology Taipei Veterans General Hospital Taipei Taiwan
| | - Chien‐Wei Su
- Division of Gastroenterology and Hepatology, Department of Medicine Taipei Veterans General Hospital Taipei Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Hospitalist Ward, Department of Medicine Taipei Veterans General Hospital Taipei Taiwan
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9
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Two Cases of Duodenal Ulcers That Developed after Transcatheter Procedures for Unruptured Visceral Artery Aneurysms. Case Rep Gastrointest Med 2022; 2022:9988216. [PMID: 35433061 PMCID: PMC9010178 DOI: 10.1155/2022/9988216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/29/2022] [Indexed: 12/17/2022] Open
Abstract
Herein, we report two cases of duodenal ulcers that developed after transcatheter procedures for the treatment of unruptured artery aneurysms. Both patients recovered after the administration of nothing by mouth, intravenous fluids, and proton-pump inhibitors. Notably, the duodenal ulcer was unchanged in one patient six days after endovascular treatment and improved in the other patient 13 days after angiography. These cases suggest that conservative treatment is acceptable in patients with duodenal ischemia that develops as an adverse effect of endovascular procedures. The usefulness of esophagogastroduodenoscopy in such patients has also been highlighted.
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10
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Sangster GP, Malikayil K, Donato M, Ballard DH. MDCT Findings of Splenic Pathology. Curr Probl Diagn Radiol 2022; 51:262-269. [PMID: 33461801 PMCID: PMC8267054 DOI: 10.1067/j.cpradiol.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/18/2020] [Accepted: 12/31/2020] [Indexed: 01/28/2023]
Abstract
The delineation and characterization of splenic lesions and other abnormalities can be challenging on computed tomography. Many splenic lesions are incidentally found, imaging features tend to overlap, and without the appropriate clinical context, differentials can range from benign to malignant. Radiologists should be familiar with the wide variety of pathologies seen on computed tomography as it is often the first imaging modality a splenic lesion is seen. The purpose of this MDCT-focused review is to understand normal splenic anatomy and its variants, to illustrate and describe typical and atypical imaging patters of inflammatory, infectious, vascular, traumatic, benign, and malignant tumors of the spleen and provide clues in reaching the appropriate differential diagnosis and management.
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Affiliation(s)
- Guillermo P Sangster
- Department of Radiology, Louisiana State University Health Shreveport, Shreveport, LA.
| | - Kiran Malikayil
- Department of Radiology, Louisiana State University Health Shreveport, Shreveport, LA
| | - Maren Donato
- Fundación Medica de Río Negro y Neuquén, Cipolletti, Río Negro, Argentina
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
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11
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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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Shelton J, Raviraj S. A Case Report: Hepatic artery pseudoaneurysm causing life-threatening haemobilia. Int J Surg Case Rep 2021; 86:106350. [PMID: 34482204 PMCID: PMC8426515 DOI: 10.1016/j.ijscr.2021.106350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/22/2021] [Accepted: 08/22/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction & importance Hepatic artery aneurysms (HAA) are rare and it accounts 20% of all visceral artery aneurysms. Commonly HAAs are autopsy findings, but rupture and bleeding carrying significant morbidity and can manifest as haemobilia. Case presentation A 63-year-old Sri Lankan male presented with severe melaena upper abdominal pain and features of obstructive jaundice was found to have a giant pseudoaneurysm at the right hepatic artery with the possible arterio-biliary fistula. The etiology for the pseudoaneurysm was not identified. Despite massive transfusion, the patient died before the endovascular intervention. Clinical discussion Atherosclerosis is the leading cause of HAA formation but can be associated with connective tissue disorders and arteritis. Most of the HAA are asymptomatic. Aneurysms can be managed with surgical or endovascular interventions. Conclusion Life-threatening haemobilia is a notorious complication of the rapture of HAA into the biliary system. The incidents of hepatic artery aneurysms and pseudoaneurysms due to percutaneous transhepatic interventions and minimal invasive hepatobiliary surgeries are in the rising trend. Nonleaking VAA can be best treated with endovascular treatment. The knowledge on this topic is important for the early detection and intervention of this rare entity. Massive Gastrointestinal bleeding can be haemobilia. Rupture of vascular aneurysms into the biliary system can cause severe haemobilia. Incidents of Hepatic artery aneurysms due to minimal invasive transhepatic procedures are in a rising trend. Non-leaking Visceral artery aneurysms can be managed best with Endovascular treatment.
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Affiliation(s)
- J Shelton
- General Surgery, Teaching Hospital Jaffna, Sri Lanka.
| | - S Raviraj
- University Surgical Unit, Teaching Hospital Jaffna, Sri Lanka
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13
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Jeffrey D, Tronidjaja JT, Mott N. Endovascular management of ruptured left gastric artery pseudoaneurysm giving rise to replaced left hepatic artery following radical cystectomy: A case report. Radiol Case Rep 2021; 16:2328-2335. [PMID: 34194600 PMCID: PMC8239440 DOI: 10.1016/j.radcr.2021.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/23/2021] [Accepted: 05/23/2021] [Indexed: 11/15/2022] Open
Abstract
Visceral artery pseudoaneurysms are rare and potentially fatal unless recognized and treated immediately. Here we present to our mind the first documented case of a ruptured pseudoaneurysm involving the left gastric artery giving rise to Michels' Type II replaced left hepatic artery. An 84-year-old female presented with an acute rupture of such an aneurysm post radical cystectomy. CT Angiogram prior to intervention was key for appropriate catheter selection. Endovascular embolization proved effective, and the patient recovered unremarkably. The case report includes a brief discussion regarding the investigation and management of such ruptures, as well as the rarity of the variant anatomy described.
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14
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Lowis E, Simpson M. P.124 Ruptured renal artery aneurysm in pregnancy. Int J Obstet Anesth 2021. [DOI: 10.1016/j.ijoa.2021.103122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Batagini NC, Constantin BD, Kirksey L, Vallentsits Estenssoro AE, Puech-Leão P, De Luccia N, Simão da Silva E. Natural History of Splanchnic Artery Aneurysms. Ann Vasc Surg 2020; 73:290-295. [PMID: 33346122 DOI: 10.1016/j.avsg.2020.10.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/15/2020] [Accepted: 10/25/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Splanchnic artery aneurysms (SAAs) represent a rare and potential life-threatening disease with a documented incidence of 0.1-2.0%. The risk of rupture and the diameter to recommend surgery are still controversial. The purpose of this study was to review surveillance computed tomography scans (CTs) at a high-volume institution in order to better define the natural history of the SAA. METHODS Between January 2000 and February 2019, all SAAs patients in follow-up at a single center institution were selected for analysis. CTs from patients managed nonoperatively and CTs before surgery from patients submitted to surgery were studied. The first CTs were used to determine aneurysm size, morphology, and anatomic characteristics, and the last CTs performed during nonoperative follow-up were used to compare the diameter with the previous CTs. Primary endpoint included growth rate for all SAAs location, and secondary endpoint included the clinical or anatomical characteristic associated with a faster growth rate. RESULTS In total, 116 consecutive patients were identified with SAAs and 74 patients with 87 SAAs who had at least 2 CTs during follow-up were analyzed. From those 74 patients, 12 were submitted to surgery and only their preoperative CTs were analyzed. The SAAs' locations were: splenic (55.4%), hepatic (12.2%), superior mesenteric artery (17.6%), celiac trunk (27.0%), gastric and gastroepiploic arteries (1.4%), pancreaticoduodenal and gastroduodenal arteries (4.1%). The median follow-up for all patients was 46.7 months (±35.3), and the median of growth for all aneurysms was 0.63 mm/year (±2.19). Only the splenic aneurysms presented growth with statistic significance of 1.08 mm per/year (±1.99) (P < 0.001). Only portal hypertension showed statistically significance to splenic aneurysm growth (P = 0.002). Multivariate analysis for variables associated with splenic aneurysm growth ≥1 mm/year showed that portal hypertension was the only variable with statistical significance (P < 0.01, IC 95% 2.0-186.9, β = 19.5). CONCLUSIONS Although longer-term follow-up and larger sample size are needed to better understand the natural history of SAAs, the majority of SAAs tends to remain stable in size through follow-up. Portal hypertension was the only risk factor found for true splenic aneurysm growth, and so those patients must have a closer follow-up.
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Affiliation(s)
- Nayara Cioffi Batagini
- Vascular and Endovascular Division, Surgery Department, Hospital das Clinicas - LIM 02, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil.
| | - Bruno Donegá Constantin
- Vascular and Endovascular Division, Surgery Department, Hospital das Clinicas - LIM 02, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Lee Kirksey
- Vascular and Endovascular Division, Vascular and Endovascular Surgery Departament, The Cleveland Clínic, Cleveland, OH
| | - Andre Echaime Vallentsits Estenssoro
- Vascular and Endovascular Division, Surgery Department, Hospital das Clinicas - LIM 02, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Pedro Puech-Leão
- Vascular and Endovascular Division, Surgery Department, Hospital das Clinicas - LIM 02, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Nelson De Luccia
- Vascular and Endovascular Division, Surgery Department, Hospital das Clinicas - LIM 02, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Erasmo Simão da Silva
- Vascular and Endovascular Division, Surgery Department, Hospital das Clinicas - LIM 02, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
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Reicher J, Tsiakkis D, Green BR, Walker P. Endovascular management of a large hepatic artery aneurysm related to type B aortic dissection. BJR Case Rep 2020; 6:20200009. [PMID: 33299582 PMCID: PMC7709067 DOI: 10.1259/bjrcr.20200009] [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: 01/11/2020] [Revised: 05/24/2020] [Accepted: 06/21/2020] [Indexed: 11/08/2022] Open
Abstract
Management of visceral artery aneurysms can be challenging: there is limited evidence to determine size thresholds for intervention and it is often technically difficult to exclude the aneurysms while preserving visceral perfusion. We present the case of a 68-year-old male with a rapidly enlarging hepatic artery aneurysm related to type B aortic dissection extending into the coeliac axis, which presented unique difficulties due to its morphology and filling via the false lumen. Endovascular treatment involved stent–graft placement from the coeliac axis into the splenic artery with the intention of excluding the coeliac supply to the common hepatic artery. Despite early stent–graft occlusion, the aneurysm was successfully excluded and adequate hepatic and splenic perfusion was maintained. The patient made a good recovery.
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Affiliation(s)
- John Reicher
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | | | | | - Paul Walker
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
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17
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Belmir H, Tijani Y, Kettani CE, Ghanmi AE, Chtata H, Taberkant M. [Case study of ruptured gastroduodenal artery aneurysm revealed by hematemesis]. Pan Afr Med J 2020; 37:244. [PMID: 33552362 PMCID: PMC7847208 DOI: 10.11604/pamj.2020.37.244.22380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/27/2020] [Indexed: 12/02/2022] Open
Abstract
L'anévrisme de l'artère gastroduodénale est une lésion vasculaire rare, asymptomatique dans la majorité des cas. Cependant, en cas de rupture de l’anévrisme, le pronostic est mauvais et la mortalité peut atteindre 40%. Nous rapportons le cas d’un patient âgé de 83 ans, qui a présenté brutalement des douleurs abdominales non spécifiques, associées à des hématémèses, et chez qui une fibroscopie a révélé une formation battante comprimant le bulbe duodénal avec un saignement actif, une tomodensitométrie abdominale a été réalisé et a mis en évidence un anévrisme de l’artère gastroduodénale englobant son ostium, et rendant une prise en charge endovasculaire impossible. Une chirurgie ouverte a donc été réalisée, et a consisté en une mise à plat associée à une exclusion de l’anévrisme, puis complétée par une plastie du bulbe. Une tomodensitométrie post-opératoire a confirmé l’exclusion totale de l’anévrisme avec la conservation de la circulation hépatique.
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Affiliation(s)
- Hicham Belmir
- Département de Chirurgie Vasculaire, Université Mohammed VI des Sciences de la Santé, Casablanca, Maroc
| | - Youssef Tijani
- Département de Chirurgie Vasculaire, Université Mohammed VI des Sciences de la Santé, Casablanca, Maroc
| | - Chafik El Kettani
- Département d'Anesthésie-Réanimation, Université Mohammed VI des Sciences de la Santé, Casablanca, Maroc
| | - Adil El Ghanmi
- Département de Gynécologie et Obstétrique, Université Mohammed VI des Sciences de la Santé, Casablanca, Maroc
| | - Hassan Chtata
- Département de Chirurgie Vasculaire, Université Mohammed V, Rabat, Maroc
| | - Mustapha Taberkant
- Département de Chirurgie Vasculaire, Université Mohammed V, Rabat, Maroc
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Alam W, Kamareddine MH, Geahchan A, Ghosn Y, Feghaly M, Chamseddine A, Bou Khalil R, Farhat S. Celiacomesenteric trunk associated with superior mesenteric artery aneurysm: A case report and review of literature. SAGE Open Med Case Rep 2020; 8:2050313X20938243. [PMID: 32843965 PMCID: PMC7418225 DOI: 10.1177/2050313x20938243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 06/03/2020] [Indexed: 12/27/2022] Open
Abstract
In rare cases, the celiac artery and the superior mesenteric artery arise from a common origin known as a common celiacomesenteric trunk. Celiac trunk stenosis or occlusion has been reported to accompany this anatomical aberrancy. Even rarer, are aneurysms associated with this common celiacomesenteric trunk. In general, visceral artery aneurysms are uncommon. We hereby present a 39-year-old female patient with a 1-month history of mild diffuse abdominal pain, with an incidental finding of superior mesenteric artery aneurysm on abdominal ultrasound. Subsequent contrast-enhanced computed tomography revealed severe narrowing of the celiac trunk and saccular aneurysmal dilatation of the superior mesenteric artery. Coil embolization of the aneurysm was performed, while maintaining persistent flow in the superior mesenteric artery and celiacomesenteric trunk. Visceral artery aneurysms are increasingly being identified incidentally with improvement in imaging techniques. The question lies whether to treat these aneurysms or observe. No universal guidelines exist regarding that matter, but the decision to intervene is made based on aneurysm location, size, and patient characteristics.
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Affiliation(s)
- Walid Alam
- Department of Internal Medicine, Saint George Hospital University Medical Center, Beirut, Lebanon
| | | | - Amine Geahchan
- Department of Radiology, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Youssef Ghosn
- Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Michel Feghaly
- Department of Vascular Surgery, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Abbas Chamseddine
- Department of Interventional Radiology, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Rola Bou Khalil
- Department of Endocrinology, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Said Farhat
- Department of Gastroenterology, Saint George Hospital University Medical Center, Beirut, Lebanon
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Ghoniem BM, Shaker AA, Nasser M, Gad A. Management of mycotic visceral artery aneurysms in the endovascular era: short- and midterm outcome. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.18.04944-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Nguyen AT, Jensen RJ, Pedersen BL. Gigantic Ruptured Aneurysm of the Gastroduodenal Artery Successfully Treated by Coiling. EJVES Short Rep 2019; 45:10-13. [PMID: 31646206 PMCID: PMC6804465 DOI: 10.1016/j.ejvssr.2019.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/07/2019] [Accepted: 08/05/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction Visceral aneurysms are rare and a life threatening condition in the case of rupture. Report A 78 year old woman presented with sudden brief loss of consciousness and complained of abdominal tenderness on examination. Computed tomography revealed a gigantic 100 × 130 × 200 mm ruptured true aneurysm of the gastroduodenal artery, which was successfully treated by endovascular coiling. Post-operative observation was uneventful and the six week follow up duplex ultrasound confirmed absence of luminal flow in the aneurysm. Discussion The treatment threshold of visceral aneurysms and treatment modalities are reviewed. Giant ruptured visceral aneurysm successfully treated endovascularly. Visceral aneurysms are rare and mostly asymptomatic. Rupture is associated with high mortality. Endovascular approach for treatment is fast and safe. Wide consensus on treatment threshold is lacking.
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Affiliation(s)
- An Tuyet Nguyen
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Ruben Juhl Jensen
- Department of Interventional Radiology, Rigshospitalet, Copenhagen, Denmark
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Matsuoka M, Suto T, Hio S, Saito S. Cesarean section following idiopathic rupture of renal artery aneurysm leading to fetal dysfunction. JA Clin Rep 2019; 5:17. [PMID: 32025971 PMCID: PMC6967259 DOI: 10.1186/s40981-019-0237-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/25/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Renal artery aneurysms (RAAs) in pregnancy are uncommon, with most found after rupturing. The risk of RAA rupture increases during pregnancy and delivery. CASE PRESENTATION A 29-year-old woman at 36 weeks and 5 days of gestation presented with severe back and abdominal pain. No fetal movements were identified. Cesarean section (C/S) was performed due to severe fetal bradycardia. No signs of placental abruption or abnormalities of the placenta were apparent intraoperatively, but gross hematoma was identified intraoperatively in the left retroperitoneal space. To evaluate persistent hypotension and retroperitoneal hematoma, contrast-enhanced computed tomography was performed and revealed ruptured RAA in the left kidney. Transcatheter arterial embolization (TAE) was performed. CONCLUSIONS This case report describes fetal dysfunction caused by RAA rupture and controlled by TAE.
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Affiliation(s)
- Misa Matsuoka
- Department of Anesthesiology, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi-shi, Gunma 371-8511 Japan
| | - Takashi Suto
- Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22, showa-machi, Maebashi-shi, Gunma 371-8511 Japan
| | - Sayaka Hio
- Intensive Care Unit, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi-shi, Gunma 371-8511 Japan
| | - Shigeru Saito
- Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22, showa-machi, Maebashi-shi, Gunma 371-8511 Japan
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