Endovascular treatment of a traumatic visceral aneurysm

A rare case of fusiform celiac artery aneurysm after penetrating trauma

INTRODUCTION

Visceral artery aneurysms are an uncommon clinical problem with aneurysms of the celiac artery only making up a small percentage of all visceral artery aneurysms. The more common splenic and hepatic aneurysms are often symptomatic with pain or rupture and associated hemorrhage.

PRESENTATION OF CASE

We present a case of an otherwise healthy 30 yo male with an asymptomatic, posttraumatic arterial aneurysm of the celiac artery. He initially presented to our trauma center after sustaining multiple gunshot wounds which required multiple abdominal surgeries. He represented four weeks later with 3 days of flank pain and fever. Extensive workup yielded an incidental finding of 14 mm fusiform aneurysm of the celiac artery with associated dissection. This was not present on imaging during his initial hospitalization. The patient underwent successful endovascular management.

DISCUSSION

Visceral artery aneurysms are rare and when identified often require early intervention. Posttraumatic etiologies are often due to penetrating trauma as in the case presented. Modern high resolution imaging can identify those that are not yet symptomatic.

CONCLUSION

Posttraumatic visceral artery aneurysms are rare with an incidence of 0.01-0.2%, however they have a potential for high mortality if undiagnosed or untreated. An aggressive operative approach can lead to favorable outcomes.

Sinister Splenic Artery Pseudoaneursym: A Rare Case of Unidentified Aetiology

Splenic Artery Pseudoaneurysms (SAP) are very rare. Giant SAPs are those which are more than 5 cm in diameter and are rarer. SAPs are usually caused by pancreatitis, trauma, surgery or other iatrogenic interventions, vasculitis, local infective or inflammatory processes. We report the successful surgical management of a giant SAP of unidentified aetiology. This case report highlights the significance that this entity may present atypically and hence, early recognition and aggressive management may be life saving.

Endovascular treatment of superior mesenteric artery pseudoaneurysms using covered stents in six patients

OBJECTIVE

The objective of our study was to evaluate our experience with the use of endovascular treatments for superior mesenteric artery (SMA) pseudoaneurysms using covered stents.

MATERIALS AND METHODS

Between 2002 and 2011, six patients (mean age, 41.7 years; range, 23-65 years) with SMA pseudoaneurysms were treated percutaneously with the placement of covered stents at our institution. The causes of SMA pseudoaneurysms were penetrating trauma (n = 2), blunt trauma (n = 1), and previous surgical procedures (n = 3). The mean diameter of the SMA pseudoaneurysms was 16 mm (range, 4-24 mm). Technical success and clinical success were retrospectively analyzed.

RESULTS

Immediate technical success, defined as exclusion of the pseudoaneurysm and lack of active extravasation, was achieved in all six patients. Secondary balloon angioplasty was needed in one patient with residual narrowing. There was a small dissection of the proximal SMA necessitating placement of a second bare stent across the dissection. A second covered stent (Fluency stent, 8 mm) was placed in the same patient because of recurrent bleeding due to a type II endoleak 5 days after the first covered stent had been placed. This patient had no subsequent episodes of bleeding or bowel ischemia. Follow-up CT in the remaining five patients (mean, 21 months; range, 1-58 months) confirmed stent patency and preserved distal arterial flow to the bowel without episodes of bleeding or bowel ischemia during follow-up (mean, 27 months; range, 11-58 months).

CONCLUSION

Percutaneous endovascular treatment using a covered stent may be a safe and feasible tool for SMA pseudoaneurysms.

Endovascular treatment of visceral artery aneurysms and pseudoaneurysms: our experience

PURPOSE

The aim of this study was to analyse our 8 years of experience with endovascular treatment of visceral aneurysms and pseudoaneurysms.

MATERIALS AND METHODS

From January 2002 to September 2009, we used an endovascular approach to treat 30 patients (22 men, eight women) affected by aneurysm (n=18) or pseudoaneurysm (n=13) of the splenic (n=11), hepatic (n=6), renal (n=5), pancreaticoduodenal (n=3), left gastric (n=2), gastroduodenal (n=1), rectal (n=1) or middle colic (n=1) arteries and the coeliac axis (n=1). Of these, 26/31 were treated with metal coils, 3/31 with Cardiatis multilayer stent, 1/31 with a coated stent and 1/31 with coils and Amplatzer plug. Procedures were performed electively in 10/30 cases and during haemorrhage in 20/30 cases. Follow-up was performed clinically (cessation of bleeding) and at 1, 6 and 12 months by colour-Doppler ultrasound (CDUS) and computed tomography (CT) angiography.

RESULTS

In 31/31 aneurysms and pseudoaneurysms we obtained immediate exclusion. In four patients with aneurysm and in four with pseudoaneurysm, parenchymal ischaemia occurred; one was treated with surgical splenectomy. One patient with pseudoaneurysm of the coeliac axis died 10 days later because of new bleeding. During follow-up, all aneurysms and pseudoaneurysms remained excluded.

CONCLUSIONS

Percutaneous treatment is effective and safe, with a small number of complications, especially when compared with traditional surgery.