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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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2
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Gong C, Sun MS, Leng R, Ren HL, Zheng K, Wang SX, Zhu RM, Li CM. Endovascular embolization of visceral artery aneurysm: a retrospective study. Sci Rep 2023; 13:6936. [PMID: 37117396 PMCID: PMC10147652 DOI: 10.1038/s41598-023-33789-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/19/2023] [Indexed: 04/30/2023] Open
Abstract
To assess the safety and efficacy of endovascular embolization techniques, we compared the short- to medium-term prognosis of coil embolization for symptomatic visceral aneurysms (SVAA) and asymptomatic visceral aneurysms (ASVAA) to identify risk factors associated with 30-day mortality. Explore the symptom profile and intrinsic associations of SVAA. A retrospective study of 66 consecutive patients at two tertiary care hospitals from 2010 to 2020 compared the short- to mid-term outcomes of 22 symptomatic VAAs and 44 asymptomatic VAAs treated with coil embolization. Univariate and log-rank tests were used to analyze the prognostic impact of SVAA and ASVAA. SVAA group had significantly higher 30-day mortality than ASVAA group (2(9.1%) vs 0, P = 0.042), both patients who died had symptomatic pseudoaneurysms. Perioperative complications such as end-organ ischemia (P = 0.293) and reintervention (P = 1) were similar in both groups. No difference in event-free survival was identified between the two groups (P = 0.900), but we found that the majority of pseudoaneurysms were SVAA (4/5) and that they had a much higher event rate than true aneurysms. In addition, dyslipidemia may be an influential factor in the development of VAA (P = 0.010). Coil embolization is a safe and effective method of treatment for VAA. Most pseudoaneurysms have symptoms such as abdominal pain and bleeding, and in view of their risk, more attention should be paid to symptomatic patients and the nature of the aneurysm should be determined as soon as possible to determine the next stage of treatment.
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Affiliation(s)
- Chi Gong
- Department of Vascular Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ming-Sheng Sun
- Department of Vascular Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Rui Leng
- Department of General Surgery, Beijing Huai-Rou Hospital, Beijing, China
| | - Hua-Liang Ren
- Department of Vascular Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Kai Zheng
- Department of Vascular Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Sheng-Xing Wang
- Department of Vascular Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ren-Ming Zhu
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Chun-Min Li
- Department of Vascular Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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3
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Fu H, Kang W. A Rare Case of an Abdominal Giant Mass Induced by Pancreatitis. Gastroenterology 2023; 164:e3-e6. [PMID: 35964691 DOI: 10.1053/j.gastro.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Hongjiang Fu
- Hulunbuir Clinical Medical College, Inner Mongolia University for Nationalities, Hailar District, Hulunbuir City, Inner Mongolia Autonomous Region, China
| | - Wendi Kang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China.
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Schroeder G, Edalati M, Tom G, Kuntjoro N, Gutin M, Gurian M, Cuniberto E, Hirth E, Martiri A, Sposato MT, Aminzadeh S, Eichenbaum J, Alizadeh P, Baidya A, Haghniaz R, Nasiri R, Kaneko N, Mansouri A, Khademhosseini A, Sheikhi A. Assessing the aneurysm occlusion efficacy of a shear-thinning biomaterial in a 3D-printed model. J Mech Behav Biomed Mater 2022; 130:105156. [PMID: 35397405 PMCID: PMC9060636 DOI: 10.1016/j.jmbbm.2022.105156] [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: 07/11/2021] [Revised: 02/13/2022] [Accepted: 02/27/2022] [Indexed: 12/26/2022]
Abstract
Metallic coil embolization is a common method for the endovascular treatment of visceral artery aneurysms (VAA) and visceral artery pseudoaneurysms (VAPA); however, this treatment is suboptimal due to the high cost of coils, incomplete volume occlusion, poor reendothelialization, aneurysm puncture, and coil migration. Several alternative treatment strategies are available, including stent flow diverters, glue embolics, gelfoam slurries, and vascular mesh plugs-each of which have their own disadvantages. Here, we investigated the in vitro capability of a shear-thinning biomaterial (STB), a nanocomposite hydrogel composed of gelatin and silicate nanoplatelets, for the minimally-invasive occlusion of simple necked aneurysm models. We demonstrated the injectability of STB through various clinical catheters, engineered an in vitro testing apparatus to independently manipulate aneurysm neck diameter, fluid flow rate, and flow waveform, and tested the stability of STB within the models under various conditions. Our experiments show that STB is able to withstand at least 1.89 Pa of wall shear stress, as estimated by computational fluid dynamics. STB is also able to withstand up to 10 mL s-1 pulsatile flow with a waveform mimicking blood flow in the human femoral artery and tolerate greater pressure changes than those in the human aorta. We ultimately found that our in vitro system was limited by supraphysiologic pressure changes caused by aneurysm models with low compliance.
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Affiliation(s)
- Grant Schroeder
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Masoud Edalati
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA; Department of Mechanical Engineering Rowan University, Rowan Hall 201 Mullica Hill Rd. Glassboro, NJ, 08028, USA
| | - Gregory Tom
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Nicole Kuntjoro
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Mark Gutin
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA; Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Melvin Gurian
- Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Edoardo Cuniberto
- Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Elisabeth Hirth
- Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Alessia Martiri
- Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Maria Teresa Sposato
- Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Selda Aminzadeh
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - James Eichenbaum
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Parvin Alizadeh
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA; Department of Materials Science & Engineering, Faculty of Engineering & Technology, Tarbiat Modares University, Tehran, Iran
| | - Avijit Baidya
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Reihaneh Haghniaz
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA; Terasaki Institute for Biomedical Innovation (TIBI), Los Angeles, CA, 90024, USA
| | - Rohollah Nasiri
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Naoki Kaneko
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Abraham Mansouri
- Department of Mechanical Engineering, Higher College of Technology, Dubai, 15825, United Arab Emirates
| | - Ali Khademhosseini
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA; Terasaki Institute for Biomedical Innovation (TIBI), Los Angeles, CA, 90024, USA.
| | - Amir Sheikhi
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA; Department of Chemical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA; Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA.
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5
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Bramucci A, Miceli F, Fontana A, Tusini N, Sereni G, Sassatelli R. Successful Endovascular and Endoscopic Treatment of a Symptomatic Celiac Artery Aneurysm for Obstructive Jaundice: A Clinical Case Report. Ann Vasc Surg 2021; 80:395.e1-395.e7. [PMID: 34808263 DOI: 10.1016/j.avsg.2021.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 10/04/2021] [Accepted: 10/27/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Celiac artery aneurysm (CAA) is an infrequent aneurysm of the celiac visceral branch and is potentially life-threatening, mainly due to the risk of rupture. CAA is often diagnosed following rupture and rarely diagnosed secondary to a primary manifestation; obstructive jaundice is extremely rare and poorly described. This clinical case report reports a combined endovascular and endoscopic noninvasive treatment. METHODS A 51-year old male was admitted to the emergency department at the Arcispedale Santa Maria Nuova in Reggio Emilia following several days of jaundice. The patient did not have any history of abdominal trauma, chronic pancreatitis, bile duct calculus or alcohol abuse. Cholestatic impairment was demonstrated by blood analyses and abdominal ultrasound revealed a large cephalo-pancreatic mass. Contrast-enhanced computed tomography (CT) showed a 40 mm CAA, causing a common bile duct (CBD) compression and dilatation of the hepatic bile ducts. After a multidisciplinary team consultation, a noninvasive, combined endovascular and endoscopic approach was programmed in a hybrid room. RESULTS Immediate results confirmed successful exclusion of the CAA, stent graft patency and the absence of endoleak with correct positioning of a plastic stent in the CBD. At 1 month, an abdominal CT-angiography (CTA) evidenced a type II endoleak, successfully treated with an endovascular secondary procedure and an asymptomatic, partial downward dislodgement of the plastic stent in the CBD was correct with the positioning of 2 plastic stents. At 3-months cholangiography showed no dilation of intraepatic biliary ducts. CONCLUSIONS Symptomatic CAA with common bile duct compression could be amenable to a combined endovascular and endoscopic noninvasive treatment.
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Affiliation(s)
- Alberto Bramucci
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Francesca Miceli
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL-IRCCS Reggio nell' Emilia, Reggio Emilia, Italy
| | - Antonio Fontana
- Vascular Surgery, AO Reggio Emilia, Arcispedale S.Maria Nuova, Reggio Emilia, Italy
| | - Nicola Tusini
- Vascular Surgery, AO Reggio Emilia, Arcispedale S.Maria Nuova, Reggio Emilia, Italy
| | - Giuliana Sereni
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL-IRCCS Reggio nell' Emilia, Reggio Emilia, Italy
| | - Romano Sassatelli
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL-IRCCS Reggio nell' Emilia, Reggio Emilia, Italy
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6
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Abstract
Abdominal aortic aneurysms account for nearly 9000 deaths annually, with ruptured abdominal aortic aneurysms being the thirteenth leading cause of death in the United States. Abdominal aortic aneurysms can be detected by screening, but a majority are detected incidentally. Visceral artery aneurysms are often discovered incidentally, and treatment is guided by symptoms, etiology, and size. A timely diagnosis and referral to a vascular specialist are essential for timely open or endovascular repair and to ensure successful patient outcomes.
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Affiliation(s)
- Indrani Sen
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 2nd Street SW, Rochester, MN 55902, USA
| | - Camila Franco-Mesa
- Department of Vascular Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Young Erben
- Department of Vascular Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Randall R DeMartino
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 2nd Street SW, Rochester, MN 55902, USA.
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7
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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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8
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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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Rossi UG, Petrocelli F. Hepatic artery aneurysms: Endovascular therapeutic techniques. Ann Hepatobiliary Pancreat Surg 2021; 25:167-170. [PMID: 34053918 PMCID: PMC8180405 DOI: 10.14701/ahbps.2021.25.2.167] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 11/17/2022] Open
Abstract
Hepatic Artery Aneurysm (HAA) is a rare disease, but it can be a life-threatening pathology if it is ruptured. Multi-Detector Computed Tomography has to be considered the “gold standard” diagnostic imaging in detecting HAA and it is essential for treatment planning. Treatment for HAA can be surgical or endovascular. Endovascular approaches in HAA, compare to conventional abdominal surgery, benefit in less invasive treatments. The aim of our paper is to emphasize the three possible endovascular therapeutic techniques in HAA: packing embolization, isolation embolization and stenting deployment.
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Affiliation(s)
- Umberto Geremia Rossi
- Department of Radiological Area, Interventional Radiology Unit, E.O. Galliera Hospital, Genova, Italy
| | - Francesco Petrocelli
- Department of Radiology and Interventional Radiology, IRCCS San Martino Policlinic University Hospital, Genova, Italy
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10
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Kavitha TK, Madabhavi P, Takia L, Awasthi P, Chaluvashetty SB, Aneja A, Menon P, Nallasamy K, Angurana SK, Lal S, Jayashree M. Life-threatening Upper Gastrointestinal Bleeding Due to Ruptured Gastroduodenal Artery Aneurysm in a Child. JPGN REPORTS 2021; 2:e034. [PMID: 37206949 PMCID: PMC10191588 DOI: 10.1097/pg9.0000000000000034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 05/21/2023]
Abstract
Gastroduodenal artery (GDA) aneurysm is a rare cause of massive life-threatening upper gastrointestinal (UGI) bleeding in children. Prompt resuscitation with fluids, administration of large amount of blood products (massive transfusion), prompt diagnostic evaluation using computed tomography (CT) angiography or digital subtraction angiography (DSA), and therapeutic endovascular or catheter-based interventions are life-saving. In cases with failed endovascular interventions, open surgical approach to ligate aneurysm is required. We report a 10-year-male with life-threatening UGI bleed due to ruptured GDA aneurysm possibly secondary to sepsis requiring resuscitation, massive transfusion, CT angiography and DSA, endovascular intervention, and ultimately surgical management with good outcome.
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Affiliation(s)
| | | | - Lalit Takia
- From the Pediatric Critical Care Unit, Department of Pediatrics
| | - Puspraj Awasthi
- From the Pediatric Critical Care Unit, Department of Pediatrics
| | | | | | - Prema Menon
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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11
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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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Chaer RA, Abularrage CJ, Coleman DM, Eslami MH, Kashyap VS, Rockman C, Murad MH. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg 2020; 72:3S-39S. [DOI: 10.1016/j.jvs.2020.01.039] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/18/2022]
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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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Embolisation d’hémostase du thorax, de l’abdomen et du pelvis. Presse Med 2019; 48:398-410. [DOI: 10.1016/j.lpm.2019.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 03/22/2019] [Indexed: 11/21/2022] Open
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Branchi V, Meyer C, Verrel F, Kania A, Bölke E, Semaan A, Koscielny A, Kalff JC, Matthaei H. Visceral artery aneurysms: evolving interdisciplinary management and future role of the abdominal surgeon. Eur J Med Res 2019; 24:17. [PMID: 30819253 PMCID: PMC6396446 DOI: 10.1186/s40001-019-0374-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/14/2019] [Indexed: 01/17/2023] Open
Abstract
Background Visceral artery aneurysms (VAA) are rare vascular lesions. Clinically silent VAA are increasingly detected by cross-sectional imaging but some lesions are at risk for rupture with severe bleeding. The aim of the present study was to evaluate the trends in the interdisciplinary management at a tertiary center. Methods Patients who underwent treatment for VAA at University Hospital of Bonn between 2005 and 2018 were enrolled in this retrospective study. Demographic, clinical, VAA-specific data as well as information on therapy, early and long-term outcome were collected and statistically analyzed. Results Forty-two consecutive patients, 19 females and 23 males with a median age of 59 years (range 30–91 years), were diagnosed with 56 VAA. The majority were true aneurysms (N = 32; 57%), whereas 43% (N = 24) were pseudoaneurysms. The most common localization was the splenic artery (N = 18; 32%) and the average diameter was 3 cm (range 1–5 cm). Twenty-five patients (59.5%) had VAA-related symptoms such as chronic abdominal pain and hemorrhage at primary diagnosis, while the diagnosis was incidental in 17 patients (40.5%). Eleven patients (26%) underwent open surgery whereas 29 patients (69%) received an endovascular treatment. Patients with pseudoaneurysms were significantly older (P = 0.003), suffered more often from associated symptoms (P < 0.001) and required more emergency interventions (P < 0.0001) compared to those with true VAA. In the last years, the number and proportion of true VAA increased significantly (P < 0.001) while a significantly larger proportion could be managed interventionally (P = 0.017). Conclusions VAA are increasingly detected on imaging with lesions presenting very heterogeneously. Due to the risk of lethal rupture and in the absence of reliable prognostic markers, all the patients with VAA should be offered definite treatment. Localization, anatomy and the end-organ perfusion after intervention or operation are the most important aspects to consider when planning a treatment for VAA. For this reason, a multidisciplinary evaluation of every individual patient is necessary for an optimized outcome.
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Affiliation(s)
- Vittorio Branchi
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Carsten Meyer
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Frauke Verrel
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Alexander Kania
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Edwin Bölke
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine, Henirich-Heine Universität, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Alexander Semaan
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Arne Koscielny
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Jörg C Kalff
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Hanno Matthaei
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
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Venturini M, Marra P, Colombo M, Panzeri M, Gusmini S, Sallemi C, Salvioni M, Lanza C, Agostini G, Balzano G, Tshomba Y, Melissano G, Falconi M, Chiesa R, De Cobelli F, Del Maschio A. Endovascular Repair of 40 Visceral Artery Aneurysms and Pseudoaneurysms with the Viabahn Stent-Graft: Technical Aspects, Clinical Outcome and Mid-Term Patency. Cardiovasc Intervent Radiol 2017; 41:385-397. [PMID: 29164308 DOI: 10.1007/s00270-017-1844-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/13/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE Endovascular repair of true visceral artery aneurysms (VAAs) and pseudoaneurysms (VAPAs) with stent-grafting (SG) can simultaneously allow aneurysm exclusion and vessel preservation, minimizing the risk of ischemic complications. Our aim was to report a single-center experience on SG of visceral aneurysms, focusing on technical aspects, clinical outcome and mid-term patency. MATERIALS AND METHODS Consecutive patients affected by VAAs-VAPAs and submitted to endovascular treatment were retrospectively reviewed, and SG cases with the self-expandable peripheral Viabahn stent-graft were analyzed (2003-2017). Aneurysm type, patient number, SG clinical setting, procedural data, peri-procedural complications, technical success, 30-day clinical success, 30-day mortality and follow-up period (aneurysm exclusion, stent-graft patency, ischemic complications) were analyzed. RESULTS SG was performed in 40 patients (24 VAPAs/16 VAAs) and in 44 procedures (25 in emergency, 19 in elective treatments), via transfemoral in 37 cases (transaxillary in 7 cases). One peri-procedural complication was recorded (a splenic artery dissection successfully converted to transcatheter embolization). The overall technical and clinical success rates were, respectively, 96 and 84%, with excellent trend in elective treatments (both 100%). Overall 30-day mortality was 12.5% (septic shock after pancreatic surgery). Stent-graft thrombosis occurred in 2 patients within 3 months, with aneurysm exclusion and without ischemic complications. Stent-graft patency and aneurysm exclusion were confirmed at 6, 12 and 36 months in 18, 12 and 7 patients, respectively. CONCLUSION SG of VAAs and VAPAs was safe and effective, particularly in elective treatments. The Viabahn stent-graft, flexible and without shape memory, is suitable for endovascular repair of tortuous visceral arteries.
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Affiliation(s)
- Massimo Venturini
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy.
| | - Paolo Marra
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Michele Colombo
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Marta Panzeri
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Simone Gusmini
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Claudio Sallemi
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Marco Salvioni
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Carolina Lanza
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Giulia Agostini
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Gianpaolo Balzano
- Department of Vascular Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Yamume Tshomba
- Department of Pancreatic Surgery, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Germano Melissano
- Department of Pancreatic Surgery, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Falconi
- Department of Vascular Surgery, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Chiesa
- Department of Pancreatic Surgery, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Del Maschio
- Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Kalabin A, Mani VR, Dinesh A, Landa M, Davis-Joseph B. Retroperitoneal Pseudoaneurysm Mimicking Ureteral Calculus: Pitfalls in Diagnosis. Cureus 2017; 9:e1758. [PMID: 29226048 PMCID: PMC5722636 DOI: 10.7759/cureus.1758] [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] [Indexed: 11/05/2022] Open
Abstract
Arterial aneurysms (AA) can be classified as true aneurysms, characterized by the persistence of all three layers of the arterial wall with progressive dilation and wall thinning; arterial pseudoaneurysms (APAs) are characterized by a tear in the vessel wall and a periarterial hematoma formation. They could occur due to a visceral, retroperitoneal, or peripheral origin. Most AA/APA are usually found incidentally, and it is imperative to be vigilant in order to diagnose and manage them due to their potentially life-threatening complications. We present a case of a 35-year-old woman presenting with right-sided abdominal pain mimicking renal colic with an initial misdiagnosis of ureteral calculus. Post-cystoscopy, a misdiagnosis was confirmed, and subsequently, the patient had a right retroperitoneal mass excision. The histopathology report concluded the calcified retroperitoneal mass to be pseudoaneurysm. Such pitfalls in diagnosis are essential to be shared with the larger medical community for increased vigilance and optimal management of pseudoaneurysms.
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Affiliation(s)
- Aleksandr Kalabin
- Department of General Surgery, Columbia University College of Physicians and Surgeons at Harlem Hospital Center
| | - Vishnu R Mani
- Department of Surgery, New York University School of Medicine, and the Laura and Isaac Perlmutter Cancer Center, Columbia University School of Physicians and Surgeons at Harlem Hospital Center
| | - Anant Dinesh
- Department of General Surgery, Columbia University College of Physicians and Surgeons at Harlem Hospital Center
| | - Marina Landa
- Pathology, Columbia University College of Physicians and Surgeons at Harlem Hospital Center
| | - Brian Davis-Joseph
- General Surgery and Urology, Columbia University College of Physicians and Surgeons at Harlem Hospital Center
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Ikeda A, Nakajima T, Hiramatsu Y, Jikuya T. Localized Aortic Root Dissection with a Superior Mesenteric Artery Aneurysm. Ann Vasc Dis 2017; 10:cr.16-00127. [PMID: 29147150 PMCID: PMC5684149 DOI: 10.3400/avd.cr.16-00127] [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: 11/24/2016] [Accepted: 04/10/2017] [Indexed: 11/21/2022] Open
Abstract
In this study, the case of a 46-year-old female patient with localized aortic root dissection and a superior mesenteric artery (SMA) aneurysm is described. Computed tomographic angiography could not clearly delineate an intimal flap in the aortic root, but it detected SMA aneurysm, which implied the presence of a vulnerability of the aortic wall. Finally, transesophageal echocardiography (TEE) evidently showed the intimal flap localized in the aortic root. The present case suggests that TEE is of paramount importance for detecting localized aortic root dissection. In addition, a coexisting vascular lesion may be a clue to diagnose another vascular lesion.
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Affiliation(s)
- Akihiko Ikeda
- Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Tomomi Nakajima
- Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Yuji Hiramatsu
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tomoaki Jikuya
- Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
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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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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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Successful endovascular treatment of delayed arterial rupture from celiac artery dissection in a patient with type IV Ehlers-Danlos syndrome. Diagn Interv Imaging 2015; 97:261-3. [PMID: 26471911 DOI: 10.1016/j.diii.2015.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 08/14/2015] [Accepted: 08/28/2015] [Indexed: 11/21/2022]
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Vascular emergencies: Diagnosis and treatment. Diagn Interv Imaging 2015; 96:655-6. [DOI: 10.1016/j.diii.2015.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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