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Quaretti P, Corti R, D'Agostino AM, Bozzani A, Moramarco LP, Cionfoli N. Covered stent assisted coil embolization of large Buhler aneurysm in setting of chronic celiac trunk occlusion. CVIR Endovasc 2024; 7:9. [PMID: 38198119 PMCID: PMC10781915 DOI: 10.1186/s42155-023-00416-4] [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] [Accepted: 12/07/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND The arc of Bühler (AOB) is a residual embryonal anastomosis between the celiac artery (CA) and the superior mesenteric artery (SMA). Although usually asymptomatic, it has clinical relevance when compensatory reverse flow between the SMA and the CA in response to celiac artery obstruction leads to aneurysm formation and bleeding. Endovascular coiling is the mainstay therapy because of the deep AOB retropancreatic location, which hinders open surgery. CASE PRESENTATION We herein report a case of a 2.8-cm AOB saccular aneurysm and LAM compression of celiac trunk in a 47-year-old man during rehabilitation following motorcycle trauma and vertebral surgery. The patient was considered unsuitable for surgery. Neither conventional coiling nor bare-metal stent and balloon-assisted techniques for coiling were suitable because of the wide necked saccular shape of AOB aneurysm interposed between the SMA and the floor of celiac trunk. To exclude the aneurysm from direct SMA inflow and permit safe and efficient coiling to rule out retrograde sac perfusion, a 9-mm polytetrafluoroethylene stent graft (Viabahn; Gore, Phoenix, AZ, USA) was positioned in the mesenteric artery, followed by antegrade periprosthetic high-density packed coiling of the aneurysm. The AOB remained excluded from mesenteric perfusion. The patient's clinical condition and abdominal contrast-enhanced multislice computed tomographic findings were unremarkable at the 9-year follow-up. CONCLUSION The 9 year long-term efficacy in our case raises the possibility that perigraft coiling following stent-graft deployment in the SMA may represent a valuable technical option for large Bühler aneurysms that are not amenable to stand-alone coiling.
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Affiliation(s)
- Pietro Quaretti
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, V.Le Golgi 19, Pavia, 27100, Italy.
| | - Riccardo Corti
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, V.Le Golgi 19, Pavia, 27100, Italy
| | - Antonio Mauro D'Agostino
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, V.Le Golgi 19, Pavia, 27100, Italy
| | - Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Paolo Moramarco
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, V.Le Golgi 19, Pavia, 27100, Italy
| | - Nicola Cionfoli
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, V.Le Golgi 19, Pavia, 27100, Italy
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Yoshikawa Y, Kishimoto S, Takasugi S, Kishimoto Y, Onohara T, Kumagai K, Nii R, Kishimoto N, Yoshikawa Y, Yata S, Fujii S, Nishimura M. Role of Aggressive Aneurysm Sac Embolization Before Endovascular Abdominal Aneurysm Repair in Preventing Type II Endoleak and Sac Expansion. Yonago Acta Med 2023; 66:232-238. [PMID: 37229377 PMCID: PMC10203641 DOI: 10.33160/yam.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/10/2023] [Indexed: 05/27/2023]
Abstract
Background This study aimed to evaluate the effect of aggressive embolization of side branches arising from the aneurysmal sac before endovascular aneurysm repair. Methods This retrospective study included 95 patients who underwent endovascular infrarenal abdominal aortic aneurysm repair at Tottori University Hospital between October 2016 and January 2021. Of these, 54 underwent standard endovascular aneurysm repair (conventional group), and 41 underwent coiling of the inferior mesenteric and lumbar arteries before undergoing endovascular aneurysm repair (embolization group). The occurrence of type II endoleak, change in aneurysmal sac diameter, and reintervention rate due to type II endoleak during follow-up were evaluated. Results Compared to the conventional group, the embolization group had a significantly lower incidence of type II endoleak, more frequent aneurysmal sac shrinkage, and lower aneurysmal sac growth related to type II endoleak. Conclusion Our results demonstrated the effectiveness of aggressive aneurysmal sac embolization before endovascular aneurysm repair to prevent type II endoleak and the consequent long-term aneurysmal sac enlargement.
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Affiliation(s)
- Yasushi Yoshikawa
- Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan and
| | - Satoru Kishimoto
- Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan and
| | - Shohei Takasugi
- Department of Radiology, School of medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Yuichiro Kishimoto
- Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan and
| | - Takeshi Onohara
- Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan and
| | - Kunitaka Kumagai
- Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan and
| | - Rikuto Nii
- Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan and
| | - Nozomi Kishimoto
- Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan and
| | - Yuki Yoshikawa
- Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan and
| | - Shinsaku Yata
- Department of Radiology, School of medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Shinya Fujii
- Department of Radiology, School of medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Motonobu Nishimura
- Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan and
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