Treatment of an aneurysm of the coeliac axis by transluminal steel wire occlusion

Surgical repair of a celiac artery aneurysm using a sutureless proximal anastomosis device

Some celiac artery aneurysms are not suitable for endovascular therapy. We describe the case of a 63-year-old man with a celiac trunk aneurysm extending to the hepatosplenic bifurcation. The aneurysm was resected and oversewn at the origin from the abdominal aorta. A saphenous vein bypass from the supraceliac aorta to the celiac artery bifurcation was performed using a sutureless anastomotic device (PAS-Port system; Cardica, Redwood City, Calif) to create the proximal anastomosis, eliminating the need for aortic clamping. This system is thought to make direct proximal aortic anastomosis safe and easy in patients requiring surgical reconstruction of celiac artery aneurysms.

Endovascular Management of Visceral Artery Aneurysm

Purpose:

To retrospectively review our experience with visceral artery aneurysms (VAAs) treated with percutaneous coil embolization techniques.

Methods:

Patient records were retrospectively reviewed between 1988 and 1998 for VAA cases treated with catheter-based techniques. Nine patients (5 women; mean age 64 ± 11 years) with 12 (8 false and 4 true) VAAs were identified. The majority (67%) of these patients presented with symptoms of aneurysm rupture. The etiology of the aneurysm was iatrogenic in 4, pancreatitis in 4, and idiopathic in 4. Ten cases involved the hepatic artery; the other 2 aneurysmal arteries were the middle colic and the gastroduodenal. Selective and superselective catheter techniques were used to obtain access to the VAA. A variety of microcoils were delivered to entirely fill saccular aneurysms, whereas fusiform aneurysms were thrombosed by occluding the inflow and outflow vessels.

Results:

Aneurysm exclusion was achieved in 9 (75%) of the 12 cases. The 3 technical failures resulted from the inability to cannulate the aneurysm neck. Coil embolization of the neck of the aneurysm sac did not result in occlusion of the native vessel, with a single exception. No procedure-related complications or deaths were noted. All patients remained symptom free during a mean follow-up of 46.0 ± 29.6 months.

Conclusions:

Percutaneous transcatheter coil embolotherapy is an effective alternative to open surgery for the management of VAAs. This therapy may decrease the morbidity and mortality associated with an open surgical procedure in patients with ruptured aneurysms and pseudoaneurysms, selectively thrombosing the aneurysm while preserving flow in the native vessel.

Celiac artery aneurysm repair in Behcet disease complicated by recurrent thoracoabdominal aortic aneurysms

Behçet's disease is a chronic, relapsing multisystemic inflammatory disorder characterized by recurrent orogenital aphthous ulcers, uveitis, and skin lesions. Vascular involvement occurs in up to 38% of these patients. Herein, we report a 19-year-old male who initially presented with an isolated celiac artery aneurysm that was treated with open surgical repair. The patient was subsequently diagnosed with Behçet's disease after the development of oral aphthous ulcers and multiple recurrent postoperative deep venous thromboses and thoracoabdominal arterial aneurysms. Ultimately, a hybrid approach was undertaken. This is the fifth celiac artery aneurysm ever reported in this patient group and the first to present with an isolated celiac artery aneurysm as the initial manifestation of Behçet's disease.

Clinical outcome of endovascular therapeutic occlusion of the celiac artery

OBJECTIVE

Endovascular occlusion of the celiac artery can be performed along with occlusion of a celiac trunk aneurysm or stenting of a thoracoabdominal aortic aneurysm to prevent a type II endoleak. Because only a few individual cases have been previously available for study, the aim of this study was to examine the technical details, clinical course, and outcome of this procedure based on a group of patients.

METHODS

This retrospective study included 10 patients who underwent endovascular occlusion of the celiac artery between 1998 and 2006 (female/male = 1:4, mean age, 62.5 +/- 9.8 years). There were five aneurysms of the celiac artery, two cases each of thoracoabdominal aortic aneurysms and dissecting thoracoabdominal aortic aneurysms, and one mycotic pseudoaneurysm of the aorta. The mean follow-up period was 21.4 +/- 29.1 months.

RESULTS

The celiac artery was successfully occluded in all cases, along with exclusion of the celiac artery aneurysm or thoracoabdominal aortic aneurysm, respectively. The pancreaticoduodenal arteries were the main collateral pathways, but other anastomoses and, especially, vascular variations of the celiac artery and its territory were also significant. In one patient, abdominal angina was treated by percutaneous angioplasty and stenting of the superior mesenteric artery.

CONCLUSIONS

Endovascular occlusion of the celiac artery is both safe and feasible. Some vascular variations may make occlusion of the celiac trunk impossible. Liver function disorder is a relative contraindication for this procedure.

[Treatment of celiac trunk aneurysms: personal experience and review of the literature]

INTRODUCTION

Celiac trunk aneurysms represent 4% of all splanchnic artery aneurysms. These lesions are thus extremely rare but yet have a significant clinical importance. Mortality, mainly related to site characteristics, is a significant risk (14%) in the event of rupture.

PATIENTS AND METHODS

We put forward our experience in both diagnosis and treatment in three patients, two women and one man (average age 55.3 years, range 35-74), presenting aneurysms involving the celiac trunk. The preoperative diagnosis was established successively with ultrasonography, CT scan and angiography. Two patients were treated via an open surgical approach while endovascular percutaneous treatment was performed for the third patient.

RESULTS

Mortality was null at 13 days on average from admission for the surgical patients and 4 days for the patient treated endovascularly. Postoperative complications were modest: pulmonary thickening with pleural effusion for the two surgical patients (spontaneous resolution), while for the third patient treated with an endovascular method, the stent migrated to a splanchnic arterial branch, with no consequence for the spleen. The average follow-up was 19 months (range 14-24). Full exclusion of the aneurysm was maintained at four months for the aneurysm treated percutaneously. A patent celiac was also maintained for the patients treated surgically.

CONCLUSIONS

Considering the largely unforeseeable outcome and the high risk of rupture, we suggest that all the patients presenting this type of aneurysmal lesion should be treated. This attitude is widely advocated in the literature. Moreover, we noted null mortality in our small series, with only one percutaneous "re-do" case; resolutive at last control. With the present improvement in stent technology, endovascular treatment should be preferred. Patients should be treated surgically only if a percutaneous procedure would be risky or technically unfeasible due to the size of the aneurysm or its anatomic features.

Celiac Artery Aneurysm Embolization by Coil Occlusion

We present here an extremely rare case of celiac artery aneurysm treated by embolization coil occlusion and review the literature on celiac artery aneurysm and its treatment. This case documents how celiac artery aneurysms can be successfully treated in a single setting with a good long-term outcome. In this unique case the technical and clinical details specific to this very complex and unusual aneurysm embolization are highlighted.

Endovascular treatment of visceral artery aneurysms

PURPOSE

To review a 10-year experience with endovascular embolization of visceral artery aneurysms.

METHODS

Twenty-five patients (13 men; mean age 52.1 years, range 31-80) presented with VAAs of varying locations and etiologies: 10 splenic, 3 gastroduodenal, 2 pancreaticoduodenal, 3 hepatic, 3 superior mesenteric, 2 celiac, 1 left gastric, and 1 jejunoileal. Ten patients were asymptomatic; 7 aneurysms were ruptured. Transcatheter coil embolization was the treatment of choice in all patients.

RESULTS

Coil placement was initially (<7 days) successful in 23 (92%) patients. One superior mesenteric artery aneurysm remained perfused, and recurrent bleeding occurred 2 days after intervention in 1 case, but repeated embolization excluded the aneurysm. One patient with necrotizing pancreatitis died from sepsis 10 days after endovascular treatment and surgery (4% 30-day mortality). Long-term follow-up revealed excellent results after an average 48.7 months (range 14-75) with only 1 recurrence after 12 months.

CONCLUSIONS

Embolotherapy is the treatment of choice in visceral artery aneurysms, regardless of etiology, location, or clinical presentation.