1
|
Matsubara K, Taniguchi R, Shirasu T, Miyahara K, Mochizuki Y, Takayama T, Hoshina K. Giant Coeliac Artery Aneurysm Treated with a Hybrid Approach: A Case Report. EJVES Vasc Forum 2023; 61:16-19. [PMID: 38111855 PMCID: PMC10727929 DOI: 10.1016/j.ejvsvf.2023.11.005] [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: 06/12/2023] [Revised: 10/15/2023] [Accepted: 11/21/2023] [Indexed: 12/20/2023] Open
Abstract
Introduction Coeliac artery aneurysms are rare and have a high mortality rate when ruptured. Although they are often asymptomatic, treatment is recommended for patients with true coeliac aneurysms >2.5 cm, noted enlargement, or associated symptoms. Less invasive endovascular treatment is predominantly performed for coeliac artery aneurysms, while open surgery is preferred for patients with compression symptoms. Here, a case of symptomatic giant coeliac artery aneurysm that was successfully treated with hybrid surgery is reported. Report A 73 year old man was referred with continuous epigastric discomfort and loss of appetite for two weeks. Abdominal ultrasound and computed tomography revealed a 12 cm aneurysm of the coeliac artery. The splenic and common hepatic arteries were severely distorted and compressed by the aneurysm, making their origins unclear. Considering the risk of rupture, semi-urgent surgery was performed with interruption of the inflow and outflow arteries using open and endovascular techniques together with aneurysmorrhaphy. Vascular reconstruction was omitted because abundant collateral flow to the liver and spleen was confirmed on angiography. Discussion With the hybrid approach, aneurysmorrhaphy was performed safely with minimal incision and dissection. Short term outcomes were satisfactory, with complete resolution of compression symptoms and remarkable sac shrinkage at 12 months. Owing to the possibility of the pancreaticoduodenal arcade developing as a collateral pathway, periodic surveillance for de novo aneurysms is warranted.
Collapse
Affiliation(s)
- Kazuyoshi Matsubara
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Taniguchi
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takuro Shirasu
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiro Miyahara
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuaki Mochizuki
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshio Takayama
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuyuki Hoshina
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
2
|
Mulpuri VB, Gupta V, Kumarasamy S, Gupta P. Giant celiac artery aneurysm – a rare experience. Ann R Coll Surg Engl 2022; 104:e143-e146. [DOI: 10.1308/rcsann.2021.0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Giant celiac artery aneurysm is a rare entity. We describe a case of a 45-year-old male with chronic kidney disease who presented with abdominal pain for the past 6 months. CT showed a celiac artery aneurysm of size 6×6.2cm involving the common hepatic artery and compressing the portal vein posteriorly. During the procedure the supra celiac aorta was exposed, and the neck of the aneurysm was identified. After taking control of branches of the celiac and common hepatic arteries, the neck of the aneurysm was clamped and divided. In view of diminished flow in the hepatic arteries aorto hepatic bypass was done using PTFE graft from supra celiac aorta to right hepatic artery; as there was retrograde flow from the left hepatic artery it was ligated. Post operatively the patient's liver functions were normal, and he was followed up by Doppler sonography which detected good flow in the hepatic artery distal to anastomosis. Celiac artery aneurysms are rare, and management options vary from the endovascular to surgery; regardless of the approach used, revascularisation is needed if there is no adequate collateral flow.
Collapse
Affiliation(s)
- V B Mulpuri
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - V Gupta
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Kumarasamy
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P Gupta
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
3
|
Smet N, Buimer T, Van Meel T. Combined endovascular and surgical treatment of a giant celiac artery aneurysm with consequent gastric outlet obstruction: a case report and literature review. Acta Chir Belg 2022:1-5. [PMID: 34970945 DOI: 10.1080/00015458.2021.2024963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Visceral artery aneurysms (VAA) are rare with an incidence of up to 0.2% and mortality of up to 40%. Aneurysms larger than 5 cm are referred to as giant visceral artery aneurysms (GVAA). We present a case of a celiac artery aneurysm of 14 cm which required endovascular and surgical management. A review of the literature with focus on treatment is also provided. CASE PRESENTATION In this case report, a 76-year-old male presented with postprandial nausea and vomitus. An ultrasound and computed tomography scan showed an aneurysm of the celiac artery of approximately 14 cm. Initial treatment was conducted with coiling. Despite this treatment, patient presented again with the same complaints, most likely due to gastric outlet syndrome caused by the aneurysm sac. Partial open removal of the aneurysm sac was performed with release of the duodenum. Due to recurring dysphagia and postprandial nausea, a gastroenterostomy was created, which was later supplemented with a Roux-en-Y anastomosis due to gastroparesis. Patient recovered uneventful after the Roux-en-Y and was discharged from the hospital. CONCLUSION Giant visceral artery aneurysms sometimes need multimodal treatment. We showed that an endovascular first approach of a giant visceral artery aneurysm is not only technically feasible, but it also facilitates subsequent open surgery due to limiting blood loss and reducing the need for extensive mobilisation of the viscera to gain arterial control.
Collapse
Affiliation(s)
- Nick Smet
- Vascular Surgery, Amphia Hospital, Breda, Netherlands
| | - Thijs Buimer
- Vascular Surgery, Amphia Hospital, Breda, Netherlands
| | - Tim Van Meel
- Vascular Surgery, Amphia Hospital, Breda, Netherlands
| |
Collapse
|
4
|
Salimi J, Mangouri A, Baradaran AF. Endovascular treatment of a large saccular aneurysm of the celiac artery: a case report and review of literature. J Surg Case Rep 2021; 2021:rjab437. [PMID: 34659738 PMCID: PMC8515838 DOI: 10.1093/jscr/rjab437] [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: 07/12/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 11/21/2022] Open
Abstract
Celiac artery is a visceral abdominal vasculature whose aneurysms are very rare, accounting for less than 0.01% of all aneurysms. This condition can be treated by open aneurysmectomy or aneurysmorrhaphy and endovascular intervention. Due to the high mortality and morbidity associated with open surgery, endovascular intervention may be a better treatment option. Here, we present a case related to a 40-year-old man who had been experiencing vague epigastric pain for 4 months prior to admission and was managed endovascularly.
Collapse
Affiliation(s)
- Javad Salimi
- Department of Vascular and Endovascular Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Mangouri
- Department of Vascular and Endovascular Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Farahanchi Baradaran
- Department of Vascular and Endovascular Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
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.
Collapse
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.
| |
Collapse
|
6
|
Castiglione D, Tipaldi MA, Rossi M, Krokidis M. Endovascular Treatment of Giant Visceral Aneurysms: An Overview. VASCULAR AND ENDOVASCULAR REVIEW 2021. [DOI: 10.15420/ver.2020.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Giant visceral aneurysms (or pseudoaneurysms) are aneurysmal lesions of the splanchnic vessels that are larger than 5 cm in diameter. As with other visceral aneurysms, treatment may be either surgical or endovascular. Both treatments face challenges given the anatomical complexity of such lesions. However, in the era of novel tools and techniques that have been developed in this field, an increasing number of giant visceral aneurysms can now be treated using endovascular approaches. The purpose of this article is to offer an overview of the most current techniques and trends in the endovascular treatment of giant visceral artery aneurysms.
Collapse
Affiliation(s)
- Davide Castiglione
- Department of Radiological Science, AOUP Paolo Giaccone, BiND, Università di Palermo, Palermo, Italy
| | | | - Michele Rossi
- Department of Radiology, Sant’Andrea University Hospital La Sapienza, Rome, Italy
| | - Miltiadis Krokidis
- 1st Department of Radiology, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| |
Collapse
|