1
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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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2
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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.
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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
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3
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Dwivedi A, Wayne E, Sangroula D, Sigdel A. Endovascular Treatment of Giant Celiac Artery Aneurysm in Behcet's Disease. Vasc Endovascular Surg 2020; 55:398-401. [PMID: 33243094 DOI: 10.1177/1538574420975906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a case of a 17-year-old male with Behcet's disease (BD) with giant celiac artery aneurysm and impending rupture. Over the past 8 weeks, patient began having intermittent back and abdominal pain that worsened and became persistent over the past few days. This was accompanied by anorexia and non-bilious vomiting. Computed tomography angiogram (CTA) demonstrated a wide neck large celiac artery aneurysm (60 mm diameter). Endovascular repair of the aneurysm was performed using stent graft of the aorta and transcatheter coil embolization of the aneurysm sac. Technical success was confirmed by interruption of flow in the aneurysm, and preservation of distal native circulation at the conclusion of the procedure. One-week post-embolization, a CTA demonstrated complete thrombosis of the aneurysm. On follow-up CTA at 3, 6, and 12 months after embolization, the aneurysm has completely thrombosed and decreased in size to 24 mm. Patient remains asymptomatic till date.
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Affiliation(s)
- Arika Dwivedi
- Bioengineering, College of Engineering, 1848Northeastern University, Boston, MA, USA
| | - Erik Wayne
- 5170University of Louisville, Louisville, KY, USA
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4
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Yuan FK, Xi HL, Qin RH, Tian ZL, Li C, Lu F. Endovascular treatment with stenting of celiac artery aneurysms. Medicine (Baltimore) 2020; 99:e23448. [PMID: 33235130 PMCID: PMC7710262 DOI: 10.1097/md.0000000000023448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/20/2020] [Accepted: 10/23/2020] [Indexed: 10/29/2022] Open
Abstract
This study aimed to detail the clinical outcomes of patients suffering from celiac arterial aneurysm (CAA) that underwent treatment via stent occlusion.This is a single-center, retrospective study. A total of 8 consecutive CAA patients were treated via stent occlusion from March 2014 to September 2018 at our hospital. Follow-up computed tomography was conducted after stenting at 1, 3, 6, and 12-month time points and every year thereafter. Both short- and long-term outcomes were assessed.In total, 8 stents were inserted into these 8 patients, with 2 being uncovered and 6 being covered stents. In 2 patients, stents were positioned in the celiac artery, while in the remaining 6 patients they were placed in the celiac and common hepatic arteries. The median operative duration was 66 minutes. No patients exhibited procedure-associated complications, and the median follow-up duration was 39 months (range: 18-72). Abdominal contrast-enhanced CT analyses of these patients exhibited stent and distal artery patency in 100% of patients, together with CAA obliteration. Visceral necrosis did not occur in any patients over the follow-up period.Stent occlusion can be safely and effectively used to treat CAA patients.
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Affiliation(s)
- Fu-Kang Yuan
- Xuzhou Institute of Cardiovascular disease; Department of Vascular Surgery, Xuzhou Clinical School of Xuzhou Medical University, 199 Jiefang Road
| | - Hai-Lin Xi
- Xuzhou Institute of Cardiovascular disease; Department of Vascular Surgery, Xuzhou Clinical School of Xuzhou Medical University, 199 Jiefang Road
| | - Rui-Hao Qin
- Xuzhou Institute of Cardiovascular disease; Department of Vascular Surgery, Xuzhou Clinical School of Xuzhou Medical University, 199 Jiefang Road
| | - Zhi-Long Tian
- Xuzhou Institute of Cardiovascular disease; Department of Vascular Surgery, Xuzhou Clinical School of Xuzhou Medical University, 199 Jiefang Road
| | - Cui Li
- Physiology Department of Basic Medical College, Xuzhou Medical University
| | - Fei Lu
- Xuzhou Central Hospital; Department of Critical Care Medicine, The Xuzhou School Of Clinical Medicine Of Nanjing Medical University, 199 Jiefang Road, Xuzhou, Jiangsu, China
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5
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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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Nzekwu E, Wang AY, Mirakhur A, Halliwell O, Bakshi D. Technical Considerations and Clinical Outcomes in the Endovascular Management of Celiac Arterial Aneurysms. J Vasc Interv Radiol 2019; 30:1743-1749.e1. [PMID: 31521454 DOI: 10.1016/j.jvir.2019.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 05/07/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022] Open
Abstract
This retrospective case series details a single-center experience of 8 patients (mean age, 54.4 years) with celiac artery aneurysms (CAAs) who underwent 1 parent vessel-sparing, 5 partial parent vessel-sparing, and 2 non-parent vessel-sparing procedures. Technical success was achieved in 6 of 8 (75%) patients. Both technical failures arose from type II endoleaks, which spontaneously resolved, resulting in clinical success of all cases. In-stent restenosis requiring reintervention complicated 3 of 5 (60%) partial parent vessel-sparing techniques, with 2 of 3 developing complete thrombosis. Two Society of Interventional Radiology grade C complications were recorded, none of which resulted in permanent sequelae. The endovascular management of CAAs is safe and amenable to various techniques.
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Affiliation(s)
- Emeka Nzekwu
- University of Calgary, Cumming School of Medicine, 3330 Hospital Dr. NW, Calgary, Alberta T2N 4N1, Canada
| | - Alice Y Wang
- University of Calgary, Cumming School of Medicine, 3330 Hospital Dr. NW, Calgary, Alberta T2N 4N1, Canada.
| | - Anirudh Mirakhur
- University of Calgary, Cumming School of Medicine, 3330 Hospital Dr. NW, Calgary, Alberta T2N 4N1, Canada
| | - Oliver Halliwell
- University of Calgary, Cumming School of Medicine, 3330 Hospital Dr. NW, Calgary, Alberta T2N 4N1, Canada
| | - Darshan Bakshi
- University of Calgary, Cumming School of Medicine, 3330 Hospital Dr. NW, Calgary, Alberta T2N 4N1, Canada
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7
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Borzelli A, Amodio F, Paladini A, de Magistris G, Giurazza F, Silvestre M, Corvino F, Corvino A, Frauenfelder G, Pane F, Coppola M, Zobel DB, Paladini L, Amodeo E, Cavaglià E, Niola R. Successful endovascular treatment of a recurrent giant celiac artery aneurysm. Radiol Case Rep 2019; 14:723-728. [PMID: 30988864 PMCID: PMC6447743 DOI: 10.1016/j.radcr.2019.03.024] [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: 03/07/2019] [Revised: 03/19/2019] [Accepted: 03/24/2019] [Indexed: 12/05/2022] Open
Abstract
Visceral artery aneurysms are very rare and aneurysms of the celiac trunk are the rarest ones: they are in most cases asymptomatic and their detection is frequently incidental. In this article we report the case of a man affected by severe abdominal pain with a huge aneurysm of the celiac trunk, first successfully treated with coil embolization, but, after 10 months, another endovascular embolization was required for deployment of the metallic coils previously released, ahead into the fund of the sac with recanalization of the aneurysm. A second endovascular treatment was performed with other coils and Amplatzer-Plug. The high risk of rupture makes treatment of such aneurysms mandatory and surgery is still considered the gold standard therapy of VAA, but, due to its high morbidity and mortality risks, in the last years, it has been widely replaced by endovascular embolization. An effective endovascular embolization requires not only the complete filling of the aneurysmal sac, but also the complete vascular exclusion of its in-flow and out-flow tracts, to reduce the risk of its anterograde or retrograde reperfusion.
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Affiliation(s)
- A. Borzelli
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
- Corresponding author.
| | - F. Amodio
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
| | - A. Paladini
- Department of Services Diagnosis and Therapies, Radiology Institute, Maggiore della Carità Hospital, University of Eastern Piedmont - UPO University, Corso G. Mazzini 18, 28100 Novara, Italy
| | - G. de Magistris
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
| | - F. Giurazza
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
| | - M. Silvestre
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
| | - F. Corvino
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
| | - A. Corvino
- Dipartimento di scienze biomediche avanzate, Università degli studi di Napoli “Federico II”, Via S.Pansini, 80131 Naples, Italy
| | - G. Frauenfelder
- Department of Radiology, Campus Bio-medico University, Via Alvaro del Portillo, 200, 00100 Rome, Italy
| | - F. Pane
- Dipartimento di scienze biomediche avanzate, Università degli studi di Napoli “Federico II”, Via S.Pansini, 80131 Naples, Italy
| | - M. Coppola
- Dipartimento di scienze biomediche avanzate, Università degli studi di Napoli “Federico II”, Via S.Pansini, 80131 Naples, Italy
| | - D. Beomonte Zobel
- Division of Interventional Radiology, IFO Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144 Rome, Italy
| | - L. Paladini
- Università Cattolica del Sacro Cuore, Rome- Fondazione Gemelli, Rome, Italy
| | - E.M. Amodeo
- Università Cattolica del Sacro Cuore, Rome- Fondazione Gemelli, Rome, Italy
| | - E. Cavaglià
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
| | - R. Niola
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
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8
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Bae E, Vo TD. Endovascular Repair of Concomitant Celiac and Splenic Artery Aneurysms Using a Combination of Coil Embolization and Aortic Cuff Stent Graft. Ann Vasc Surg 2017; 42:62.e1-62.e4. [PMID: 28286185 DOI: 10.1016/j.avsg.2016.10.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/28/2016] [Accepted: 10/24/2016] [Indexed: 11/29/2022]
Abstract
Large celiac artery aneurysms are associated with a high rupture and mortality risk. Traditionally, open surgical repair has been the mainstay of treatment. Endovascular alternatives have been increasingly described, ranging from coil embolization to exclusion with covered stent grafts. Certain features such as a short wide neck, small vessel diameters, and severe vessel tortuosity can limit these two options. We describe a 75-year-old man with a splenic and celiac trunk aneurysm that was treated using a combination of coil embolization to occlude the outflow artery and aneurysm sac, followed by an aortic stent graft cuff to block the inflow. This resulted in successful exclusion of the splenic and celiac artery aneurysms while preserving flow to both the spleen and liver through collateral pathways.
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Affiliation(s)
- Esther Bae
- Department of General Surgery, Arrowhead Regional and Kaiser Permanente Fontana Medical Centers, Fontana, CA
| | - Trung Duong Vo
- Department of General and Vascular Surgery, Kaiser Permanente Fontana, CA.
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9
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Pattakos G, Tolpin D, Ott DA. Resection of Celiac Artery Aneurysm with Bypass Grafting to the Splenic and Common Hepatic Arteries. Tex Heart Inst J 2017; 44:77-79. [PMID: 28265220 DOI: 10.14503/thij-16-5802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Celiac artery aneurysms are rare and typically warrant surgical treatment. Atherosclerosis is their chief cause. Symptomatic patients usually present with abdominal pain. Surgical resection of celiac artery aneurysms is associated with low morbidity and mortality rates. We report the case of a patient whose 2.2-cm celiac artery aneurysm we resected, with subsequent saphenous vein bypass grafting from the celiac trunk to the splenic and common hepatic arteries. In addition, we briefly discuss other treatment options.
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10
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deFreitas D, Phade S, Stoner M, Bogey W, Powell CS, Parker F. Endovascular Stent Exclusion of a Hepatic Artery Pseudoaneurysm. Vasc Endovascular Surg 2016; 41:161-4. [PMID: 17463211 DOI: 10.1177/1538574406298517] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Presented is a patient with an iatrogenic hepatic artery pseudoaneurysm that was treated by endovascular stent grafting. Endovascular stent grafting of a hepatic artery pseudoaneurysm offers a safe and potentially less morbid alternative to an open repair. The report stresses the necessity of careful preoperative evaluation with angiography to determine the feasibility of the procedure. An aggressive approach to treating hepatic artery pseudoaneurysms is advocated because of the poor correlation between size and their tendency to rupture. With an increasing rate of diagnosis of visceral artery aneurysms in elderly, debilitated patients, endovascular repair is anticipated to have an increasing role and should be considered a first-line therapy in anatomically suitable candidates.
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Affiliation(s)
- Dorian deFreitas
- Section of Vascular and Endovascular Surgery, East Carolina University, Greenville, North Carolina 27834, USA
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11
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Untereiner X, Kretz B, Camin-Kretz A, Tibuleac A, Gu WM, Faller B, Matysiak L. Dissecting Aneurysm of the Celiac Trunk: A Case Report. Ann Vasc Surg 2014; 28:1037.e1-4. [DOI: 10.1016/j.avsg.2013.08.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 07/19/2013] [Accepted: 08/12/2013] [Indexed: 10/25/2022]
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12
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Neychev V, Krol E, Dietzek A. Unusual presentation and treatment of spontaneous celiac artery dissection. J Vasc Surg 2013; 58:491-5. [DOI: 10.1016/j.jvs.2012.10.136] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 10/08/2012] [Accepted: 10/16/2012] [Indexed: 11/29/2022]
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13
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Two-stage hybrid repair of a complex symptomatic celiac aneurysm. Ann Vasc Surg 2013; 27:975.e15-8. [PMID: 23871199 DOI: 10.1016/j.avsg.2012.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 10/21/2012] [Accepted: 10/24/2012] [Indexed: 11/21/2022]
Abstract
We report the case of a novel 2-stage hybrid repair of a complex celiac artery aneurysm. The patient was a 42-year-old man with a proximal celiac artery aneurysm giving rise to distinct right and left hepatic arterial branches. Repair was performed using a staged approach. First, a bifurcated aortohepatic bypass was constructed to the common and left hepatic arteries. After recovering from surgery, he underwent percutaneous embolization of the aneurysm. Completion angiograms demonstrated flow into all celiac branches with successful thrombosis of the aneurysm. At 12-month follow-up, the patient had remained symptom-free with patent bypass grafts and complete aneurysm exclusion. We describe the treatment option we used, which involves repair of a complex celiac aneurysm using a 2-stage, open, endovascular approach.
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14
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Treatment of a Traumatic Celiac Trunk Detachment by Bridging with a Stent Graft. Cardiovasc Intervent Radiol 2011; 35:422-5. [DOI: 10.1007/s00270-011-0299-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 09/18/2011] [Indexed: 10/14/2022]
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15
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Batt M, Baque J. Successful percutaneous embolization of a symptomatic celiac artery dissection with aneurysmal dilation with detachable vascular plugs. J Vasc Surg 2011; 54:1812-5. [DOI: 10.1016/j.jvs.2011.05.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 04/04/2011] [Accepted: 05/07/2011] [Indexed: 11/16/2022]
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16
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Carrafiello G, Rivolta N, Annoni M, Fontana F, Piffaretti G. Endovascular repair of a celiac trunk aneurysm with a new multilayer stent. J Vasc Surg 2011; 54:1148-50. [DOI: 10.1016/j.jvs.2011.03.274] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 03/24/2011] [Accepted: 03/25/2011] [Indexed: 10/18/2022]
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17
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Quintini C, Di Benedetto F, Pinna AD. Transplantation of a fresh cadaveric iliac homograft after celiac artery aneurysmectomy. Surg Innov 2010; 18:66-9. [PMID: 21059608 DOI: 10.1177/1553350610385828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors describe a case of a 34-year-old woman who presented to the ER with acute epigastric pain caused by an 8-cm celiac artery aneurysm. The patient underwent total aneurysmectomy, distal splenopancreasectomy, and reconstruction of the hepatic arterial inflow using a fresh cadaveric iliac artery homograft. The patient was discharged home on postoperative day 8 in good clinical condition. After 60 months of follow-up, the patient is well and with a patent vascular homograft. The use of a fresh cadaveric iliac homograft described here may represent an option in young patients with low operative risk undergoing visceral artery aneurysm repair.
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18
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Carrafiello G, Rivolta N, Fontana F, Piffaretti G, Mariscalco G, Bracchi E, Ferrario M. Combined Endovascular Repair of a Celiac Trunk Aneurysm Using Celiac–Splenic Stent Graft and Hepatic Artery Embolization. Cardiovasc Intervent Radiol 2009; 33:352-4. [DOI: 10.1007/s00270-009-9721-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 09/14/2009] [Indexed: 11/30/2022]
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19
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Grotemeyer D, Duran M, Park EJ, Hoffmann N, Blondin D, Iskandar F, Balzer KM, Sandmann W. Visceral artery aneurysms—follow-up of 23 patients with 31 aneurysms after surgical or interventional therapy. Langenbecks Arch Surg 2009; 394:1093-100. [DOI: 10.1007/s00423-009-0482-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 03/02/2009] [Indexed: 10/21/2022]
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20
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An impending rupture of a celiac artery aneurysm in a patient with Behçet’s disease — Extra-anatomic aorto-common hepatic artery bypass: Report of a case. Surg Today 2008; 38:163-5. [DOI: 10.1007/s00595-007-3584-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 05/27/2007] [Indexed: 11/25/2022]
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21
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Dinter DJ, Rexin M, Kaehler G, Neff W. Fatal Coil Migration into the Stomach 10 Years after Endovascular Celiac Aneurysm Repair. J Vasc Interv Radiol 2007; 18:117-20. [PMID: 17296711 DOI: 10.1016/j.jvir.2006.10.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Celiac trunk aneurysms are rare and can be treated with coil embolization. Migration of the coil with erosion of the arterial wall and further perforation to an extravascular structure, although infrequent, can occur. The authors describe a lethal aortogastric fistula in a patient who had undergone embolization of a celiac trunk aneurysm with tungsten coils and alcohol prolamine solution 10 years earlier. Gastroscopy, performed due to acute hematemesis, showed the coil placed 10 years previously inside the stomach without active bleeding. Two days later, the patient died of a recurrent gastrointestinal bleeding. Autopsy showed abscess formation at the celiac trunk resulting in an aortogastric fistula. The authors discuss the possible cause of this remote complication of the embolotherapy.
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Affiliation(s)
- Dietmar Joerg Dinter
- Department of Clinical Radiology, University Hospital Mannheim, University of Heidelberg, Theodor Kutzer Ufer 1-3, D-68167 Mannheim, Germany.
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22
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Taberkant M, Elkaoui H, Bouchentouf M, Ibrahima S, Zentar A, Janati MI. [Aneurysm of the coeliac trunk. A case report]. JOURNAL DES MALADIES VASCULAIRES 2006; 31:284-6. [PMID: 17202982 DOI: 10.1016/s0398-0499(06)76628-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Aneurysm of the coeliac artery is a rare vascular problem. The most serious clinical complication of coeliac artery aneurysm is rupture. Because of this, surgery is traditionally recommended. This paper presents a case of a coeliac artery aneurysm treated by open surgery.
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Affiliation(s)
- M Taberkant
- Service de Chirurgie Viscérale et Vasculaire, Hôpital militaire d'instruction Mohamed V, Rabat, Maroc.
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Basile A, Lupattelli T, Magnano M, Giulietti G, Privitera G, Battaglia G, Monaca V, Ettorre G. Treatment of a Celiac Trunk Aneurysm Close to the Hepato-splenic Bifurcation by Using Hepatic Stent-graft Implantation and Splenic Artery Embolization. Cardiovasc Intervent Radiol 2006; 30:126-8. [PMID: 16967221 DOI: 10.1007/s00270-005-0339-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We present a case of a 73-year-old man in whom a celiac trunk aneurysm close to the hepato-splenic bifurcation was discovered and treated by using celiac-hepatic stent-grafts implantation and splenic artery embolization.
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Affiliation(s)
- Antonio Basile
- Department of Radiology, Ospedale Ferrarotto, via Citelli 16, Catania, Italy.
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24
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Abstract
Celiac artery aneurysms (CAA) are uncommon. Most are asymptomatic, but up to 20 per cent will present as surgical emergencies. We present a case of an asymptomatic CAA discovered in a 56-year-old male during evaluation for nephrolithiasis. Only rough estimates of the prevalence of CAA are available, ranging between 0.005 per cent and 0.05 per cent. There appears to be a slight male predominance, and atherosclerotic degeneration is the most common cause. Although most patients are asymptomatic, some will present with vague abdominal pain, nausea, vomiting, or symptoms of mesenteric ischemia. Rupture is a devastating presentation, with reported mortality rates from 35 per cent to 80 per cent. Repair is performed by ligation or reconstruction. Ligation should be considered in an urgent setting, with reconstruction preferred for elective repair. Morbidity and mortality from elective repair should not exceed 5 per cent. Repair of CAA should be undertaken unless major comorbid factors are prohibitive.
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Affiliation(s)
- John M. Connell
- Division of Vascular Surgery, Department of General Surgery, Penn State College of Medicine, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - David C. Han
- Division of Vascular Surgery, Department of General Surgery, Penn State College of Medicine, Penn State Hershey Medical Center, Hershey, Pennsylvania
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25
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Saltzberg SS, Maldonado TS, Lamparello PJ, Cayne NS, Nalbandian MM, Rosen RJ, Jacobowitz GR, Adelman MA, Gagne PJ, Riles TS, Rockman CB. Is Endovascular Therapy the Preferred Treatment for All Visceral Artery Aneurysms? Ann Vasc Surg 2005; 19:507-15. [PMID: 15986089 DOI: 10.1007/s10016-005-4725-3] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Endovascular intervention can provide an alternative method of treatment for visceral artery aneurysms. We conducted a retrospective review of all patients with visceral artery aneurysms at a single university medical center from 1990 to 2003, focusing on the outcome of endovascular therapy. Sixty-five patients with visceral artery aneurysms were identified: 39 splenic (SAA), 13 renal, seven celiac, three superior mesenteric (SMA), and three hepatic. Eleven patients (16.9%) had symptoms attributable to their aneurysms, which included a total of four ruptures (6.2%): three splenic and one hepatic. Management consisted of 18 (27.7%) endovascular interventions, nine (13.9%) open surgical repairs, and 38 (58.5%) observations. Mean aneurysm diameter for patients treated expectantly was significantly less than for those who underwent intervention (p = 0.001). Endovascular interventions included 15 (83.3%) embolizations (11 SAA, three renal, one hepatic) and three (16.7%) stent grafts (two SMA, one renal). The initial technical success rate of the endovascular procedures was 94.4% (17/18). However, there were four patients (22.2%) with major endovascular procedure-related complications: one late recurrence requiring open surgical repair, two large symptomatic splenic infarcts, and one episode of severe pancreatitis. These four patients had distal splenic artery aneurysms at or adjacent to the splenic hilum. There were no endovascular procedure-related deaths. Reasons for performing open surgical repair included three SAA ruptures diagnosed at laparotomy and complex anatomy not amenable to endovascular intervention (six patients). One surgical patient had a postoperative small bowel obstruction treated nonoperatively; and there was one perioperative death in a patient operated on emergently for rupture. Endovascular management of visceral artery aneurysms is a reasonable alternative to open surgical repair in carefully selected patients. Individual anatomic considerations play an important role in determining the best treatment strategy if intervention is warranted. However, four of 11 (36.4%) patients with distal splenic artery aneurysms treated with endovascular embolization developed major complications. Based on our experience, traditional surgical treatment of SAA with repair or ligation and concomitant splenectomy when necessary may be preferred in these cases.
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Affiliation(s)
- Stephanie S Saltzberg
- Division of Vascular Surgery, New York University Medical Center, New York, NY, USA.
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26
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Abstract
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.
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Affiliation(s)
- Mubin Syed
- Division of Interventional Radiology, Mercy Medical Center, Springfield, OH 45505, USA.
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