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Minici R, Guerriero P, Fontana F, Venturini M, Guzzardi G, Piacentino F, Coppola A, Spinetta M, Siciliano A, Serra R, Costa D, Ielapi N, Santoro R, Brunese L, Laganà D. Endovascular Treatment of Visceral Artery Pseudoaneurysms with Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs). MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1606. [PMID: 37763725 PMCID: PMC10537405 DOI: 10.3390/medicina59091606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Treatment of visceral artery pseudoaneurysms (VAPs) is always indicated regardless of their diameters, as their risk of rupture is significantly higher than that of visceral artery aneurysms. The invasiveness of surgery and its associated complications have led to a shift in favor of radiological interventions as the initial treatment of choice. However, there are still some unanswered questions on endovascular treatment of VAPs regarding the optimal endovascular technique and the efficacy and safety outcomes. The purpose of this multicenter study was to retrospectively evaluate the effectiveness and safety of endovascular treatment of visceral pseudoaneurysms using Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs). Materials and Methods: Consecutive patients who underwent endovascular embolization with EVOH-based NALEAs for visceral artery pseudoaneurysms between January 2018 and June 2023 were retrospectively evaluated. Results: 38 embolizations were performed. Technical success was achieved in all patients. The clinical success rate was high (92.1% overall), with no significant differences between ruptured and unruptured VAPs (p = 0.679). Seven patients (18.4%) experienced procedure-related complications, related to one case of non-target embolization, four splenic abscesses due to end-organ infarction, and two femoral pseudoaneurysms. The rates of procedure-related complications, end-organ infarction, and vascular access-site complications did not significantly differ between ruptured and unruptured VAPs (p > 0.05). Conclusions: Both ruptured and unruptured visceral pseudoaneurysms can be effectively and safely treated with NALEA-based endovascular embolization. We suggest considering the use of NALEAs, particularly in specific clinical cases that highlight their advantages, including patients with coagulopathy, fragile vessels, and embolization targets that are located at a considerable distance from the microcatheter tip and are otherwise difficult to reach.
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Affiliation(s)
- Roberto Minici
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (A.S.); (D.L.)
| | - Pasquale Guerriero
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy;
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (F.F.); (M.V.); (F.P.); (A.C.)
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (F.F.); (M.V.); (F.P.); (A.C.)
| | - Giuseppe Guzzardi
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy; (G.G.); (M.S.)
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (F.F.); (M.V.); (F.P.); (A.C.)
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (F.F.); (M.V.); (F.P.); (A.C.)
| | - Marco Spinetta
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy; (G.G.); (M.S.)
| | - Agostino Siciliano
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (A.S.); (D.L.)
| | - Raffaele Serra
- Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy;
| | - Davide Costa
- Department of Law, Economics and Sociology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Nicola Ielapi
- Department of Public Health and Infectious Disease, Sapienza University of Rome, 00185 Rome, Italy;
| | - Rita Santoro
- Haemophilia and Thrombosis Center, Dulbecco University Hospital, 88100 Catanzaro, Italy;
| | | | - Luca Brunese
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy;
| | - Domenico Laganà
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (A.S.); (D.L.)
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Porcaro P, Turchino D, Quarantelli M, Guercio LD, Accarino G, Serra R, Venetucci P, Bracale UM. Endovascular treatment of a wide-necked renal artery aneurysm with a flow diverter stent. Radiol Case Rep 2023; 18:2854-2859. [PMID: 37388268 PMCID: PMC10300470 DOI: 10.1016/j.radcr.2023.05.030] [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: 03/28/2023] [Revised: 05/03/2023] [Accepted: 05/08/2023] [Indexed: 07/01/2023] Open
Abstract
Renal artery aneurysm (RAA) is a rare, often asymptomatic disease (0.1% incidence in general population) and can be incidentally diagnosed during an abdominal imaging workup. The traditional, gold standard of treatment is open surgery, carrying with it, however, a high risk of nephrectomy, mortality, and collateral morbidity. The endovascular approach is currently the most valid alternative to treating RAAs reducing, as it does, the risks associated with the surgical approach/open surgery. Herein we report on our experience with a case of wide-necked RAA treated with the Pipeline Vantage (Medtronic) flow diverter stent. Wide-neck aneurysms are defined as having neck diameters greater than 4 mm. Our choice of endovascular treatment was preferred over the surgical option notwithstanding the large size of the neck and the involvement of the branching vessels.
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Affiliation(s)
| | - Davide Turchino
- Department of Public Health, Unit of Vascular Surgery, University Federico II of Naples, Naples, Italy
| | - Mario Quarantelli
- Department of Radiology, University Federico II of Naples, Naples, Italy
| | - Luca del Guercio
- Department of Public Health, Unit of Vascular Surgery, University Federico II of Naples, Naples, Italy
| | - Giulio Accarino
- Department of Public Health, Unit of Vascular Surgery, University Federico II of Naples, Naples, Italy
| | - Raffaele Serra
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Pietro Venetucci
- Department of Radiology, University Federico II of Naples, Naples, Italy
| | - Umberto Marcello Bracale
- Department of Public Health, Unit of Vascular Surgery, University Federico II of Naples, Naples, Italy
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3
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Shalhub S, Nkansah R, El-Ghazali A, Hillenbrand CJ, Vaidya SS, Schwarze U, Byers PH. Splenic artery pathology presentation, operative interventions, and outcomes in 88 patients with Vascular Ehlers Danlos Syndrome. J Vasc Surg 2023:S0741-5214(23)01027-3. [PMID: 37068529 DOI: 10.1016/j.jvs.2023.04.007] [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: 11/20/2022] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Vascular Ehlers-Danlos Syndrome (VEDS) is rare and associated with arteriopathies. The aim of this study is to investigate the presentation, operative interventions, and outcomes of splenic arterial pathology in a population of more than 1,500 individuals with genetically confirmed VEDS due to pathogenic COL3A1 variants. METHODS Cross-sectional analysis of 1,547 individuals was performed. The data were assembled by harmonizing data from three overlapping cohorts with genetically confirmed VEDS: the VEDS Collaborative Natural History Study (N=242), a single center cohort (N=75), and the UW Collagen Diagnostic Lab cohort (N=1,231). Duplicates were identified and removed. Patients were selected for analysis if they had splenic artery aneurysm (SAA), pseudoaneurysm, dissection, thrombosis, or rupture. Demographics, COL3A1 variants, interventions, and outcomes were analyzed. Comparisons by splenic artery rupture were made. RESULTS A total of 88 patients presented between 1992 and 2021 with splenic artery pathology (5.7% of the cohort, Mean age at diagnosis 37+11.1 years, 50% male). One third were diagnosed with VEDS prior to the splenic artery pathology diagnosis and 17% were diagnosed post-mortem. Most had a positive family history (61%). Most had COL3A1 variants associated with minimal normal collagen production (71.589.7%). Median follow up was 8.5 (IQR 0.9-14.7) years. Initial presentation was rupture in 47% of the cases. Splenic artery rupture overall was 51% (N=45) including 4 cases of splenic rupture. There were no major differences in VEDS related manifestations or COL3A1 variant type by rupture status. SAA was noted in 39% of the cases. Only 12 patients had splenic artery diameter documented in 12 cases with a median diameter of 12 (IQR 10.3-19.3) mm. A total of 34 (38.6%) patients underwent 40 splenic arterial interventions: 21 open surgical, 18 embolization, and 1 unknown procedure. More than one splenic artery intervention was performed in 5 (14.7%) cases. Open repair complications included arteriovenous fistula (n=1), intestinal or pancreatic injury (1 each), and four intraoperative deaths. There were no deaths or access site complications related to splenic artery embolization. Four (23.5%) developed a new SAA in the remaining splenic artery post embolization. All-cause mortality was 35% (n=31) including 22 related to a ruptured splenic artery. CONCLUSIONS Splenic arteriopathy in VEDS is associated with variants that affect the structure and secretion of type III collagen and frequently present with rupture. Rupture and open repair are associated with high morbidity and mortality while embolization is associated with favorable outcomes. Suggest repair considerations at SAA diameter of 15 mm. Long term follow up is indicated as secondary splenic arteriopathy can occur.
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Affiliation(s)
- Sherene Shalhub
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Reginald Nkansah
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine. Seattle, WA, USA
| | - Asmaa El-Ghazali
- Department of Surgery, University of Washington School of Medicine. Seattle, WA, USA
| | - C J Hillenbrand
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine. Seattle, WA, USA
| | - Sandeep S Vaidya
- Division of Interventional radiology. University of Washington Department of Radiology. University of Washington School of Medicine. Seattle, WA, USA
| | - Ulrike Schwarze
- Department of Laboratory Medicine and Pathology. University of Washington, Seattle, WA, USA
| | - Peter H Byers
- Department of Laboratory Medicine and Pathology. University of Washington, Seattle, WA, USA
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Spüntrup E, Fares A, Stavrou GA, Steffen MS. Behandlung eines großen Aneurysmas der Arteria hepatica propria mit einem Flowdiverter. GEFÄSSCHIRURGIE 2022. [DOI: 10.1007/s00772-022-00958-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Qiao Y, Patel S, Burney I, Mega JD, Kuban JD, Pisimisis GT. A case report: Retrograde arterial embolization of locally-injected SpaceOAR hydrogel material into the right common iliac artery bifurcation. Radiol Case Rep 2022; 18:719-726. [PMID: 36569226 PMCID: PMC9768241 DOI: 10.1016/j.radcr.2022.02.042] [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: 02/12/2022] [Accepted: 02/13/2022] [Indexed: 12/15/2022] Open
Abstract
Biodegradable hydrogel-based matrices are becoming more widely utilized for a variety of medical applications, including SpaceOAR which is a hydrogel injected into the recto-prostatic space under ultrasound guidance to protect the rectum during prostate radiation therapy. Although a greater number of these procedures are being performed, there are no case reports on the potential complications which may result. In this report, we present the first case of retrograde embolization of SpaceOAR hydrogel into the right common iliac artery during routine office administration, as well as subsequent interventional angiography, inpatient and outpatient management, and clinical and imaging results at 1.5-month patient follow-up.
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Affiliation(s)
- Yang Qiao
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, 7000 Fannin St. Suite #1200, Houston, TX 77030, USA,Department of Interventional Radiology, The University of Texas MD Anderson Cancer, Center, 1515 Holcombe Blvd., Houston, TX 77030, USA,Corresponding author.
| | - Shrey Patel
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, 7000 Fannin St. Suite #1200, Houston, TX 77030, USA
| | - Iftikhar Burney
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, 7000 Fannin St. Suite #1200, Houston, TX 77030, USA,Department of Interventional Radiology, The University of Texas MD Anderson Cancer, Center, 1515 Holcombe Blvd., Houston, TX 77030, USA,Department of Radiology, Baylor College of Medicine, 1 Baylor Plz., Houston, TX 77030, USA
| | - James D. Mega
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, 7000 Fannin St. Suite #1200, Houston, TX 77030, USA,Department of Interventional Radiology, The University of Texas MD Anderson Cancer, Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Joshua D. Kuban
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, 7000 Fannin St. Suite #1200, Houston, TX 77030, USA,Department of Interventional Radiology, The University of Texas MD Anderson Cancer, Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - George T. Pisimisis
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer, Center, 1515 Holcombe Blvd., Houston, TX 77030, USA,Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
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Semeraro V, Arpesani R, Della Malva G, Gasparrini F, Vidali S, Ganimede MP, Marrazzo A, Rosella F, Biraschi F, Gandini R, Burdi N, Di Stasi C. Flow-diverter treatment for renal artery aneurysms: One-year follow-up of a multicentric preliminary experience. Diagn Interv Radiol 2022; 28:609-615. [PMID: 36550762 PMCID: PMC9885726 DOI: 10.5152/dir.2022.211015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Renal artery aneurysms (RAAs) are rare in the general population, although the true incidence and natural history remain elusive. Conventional endovascular therapies such as coil embolization or covered stent graft may cause sidebranches occlusion, leading to organ infarction. Flow-diverters (FD) have been firstly designed to treat cerebrovascular aneurysms, but their use may be useful to treat complex RAAs presenting sidebraches arising from aneurysmal sac. To evaluate mid-term follow-up (FUP) safety and efficacy of FD during treatment of complex RAAs. METHODS Between November 2019 and April 2020, 7 RAAs were identified in 7 patients (4 men, 3 women; age range 55-82 years; median 67 years) and treated by FD. Procedural details, complications, morbidity and mortality, aneurysm occlusion and segmental artery patency were retrospectively reviewed. Twelve months computed tomography angiography (CTA) FUP was evaluated for all cases. RESULT Deployment of FD was successful in all cases. One intraprocedural technical complication was encountered with one FD felt down into aneurism sac which requiring additional telescopic stenting. One case at 3 months CTA FUP presented same complication, requiring same rescue technique. At 12 months CTA FUP 5 cases of size shrinkage and 2 cases of stable size were documented. No rescue surgery or major intraprocedural or mid-term FUP complication was seen. CONCLUSION Complex RAAs with two or more sidebranches can be safely treated by FD. FD efficacy for RAA needs a further validation at long term FUP by additional large prospective studies.
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Affiliation(s)
- Vittorio Semeraro
- Department Diagnostic Imaging and Interventional Radiology, "Santissima Annunziata" Hospital, Taranto, Italy
| | - Roberto Arpesani
- Department of Diagnostic Imaging and Interventional Radiology, "Ospedali Riuniti", Livorno, Italy
| | - Giuseppina Della Malva
- Department of Neuroscience, Imaging and Clinical Sciences - Università degli Studi di Chieti "G. D'Annunzio", Chieti, IT
| | - Fulvio Gasparrini
- Department of Integrated Assistance Processes, Complex Operative Unit of Diagnostic Imaging, Policlinico Tor Vergata, Rome, Italy
| | - Sofia Vidali
- Department of Integrated Assistance Processes, Complex Operative Unit of Diagnostic Imaging, Policlinico Tor Vergata, Rome, Italy
| | - Maria Porzia Ganimede
- Department Diagnostic Imaging and Interventional Radiology, "Santissima Annunziata" Hospital, Taranto, Italy
| | - Antonio Marrazzo
- Department Diagnostic Imaging and Interventional Radiology, "Santissima Annunziata" Hospital, Taranto, Italy
| | - Francesco Rosella
- Department of Interventional Radiology, Operative Unit of Radiology, Mater Olbia Hospital, Olbia, Italy
| | | | - Roberto Gandini
- Department of Integrated Assistance Processes, Complex Operative Unit of Diagnostic Imaging, Policlinico Tor Vergata, Rome, Italy
| | - Nicola Burdi
- Department Diagnostic Imaging and Interventional Radiology, "Santissima Annunziata" Hospital, Taranto, Italy
| | - Carmine Di Stasi
- Department Diagnostic Imaging and Interventional Radiology, "Santissima Annunziata" Hospital, Taranto, Italy
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Pothula V, Ray N, Dhanasekaran J, S S S, Joseph S. ENDOVASCULAR REPAIR OF TRANSPLANT RENAL ARTERY ANASTOMOTIC SITE PSEUDOANEURYSM USING FLOW DIVERTER STENT. J Vasc Interv Radiol 2022; 34:719-721. [PMID: 35691492 DOI: 10.1016/j.jvir.2022.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/24/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022] Open
Affiliation(s)
- Venkatesh Pothula
- Neuro & Interventional Radiology resident, Department of Neuro & Interventional Radiology, Sri Ramachandra Institute of Higher Education and Research.
| | - Nirmalya Ray
- Assistant Professor, Department of Neuro & Interventional Radiology, Sri Ramachandra Institute of Higher Education and Research.
| | - Jagadeesan Dhanasekaran
- Associate Professor, Department of Neuro & Interventional Radiology, Sri Ramachandra Institute of Higher Education and Research.
| | - Sabarish S S
- Assistant Professor, Department of Neuro & Interventional Radiology, Sri Ramachandra Institute of Higher Education and Research.
| | - Santhosh Joseph
- Prof. & HOD, Department of Neuro & Interventional Radiology, Sri Ramachandra Institute of Higher Education and Research.
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Berczeli M, Chinnadurai P, McFall RG, Diaz O, Lumsden AB. Endovascular treatment of pancreaticoduodenal aneurysm with braided stent-assisted coil embolization using intraoperative cone-beam computed tomography guidance. J Vasc Surg Cases Innov Tech 2022; 8:265-270. [PMID: 35586675 PMCID: PMC9108329 DOI: 10.1016/j.jvscit.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/16/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Marton Berczeli
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
- Correspondence: Marton Berczeli, MD, Department of Cardiovascular Surgery, Houston Methodist Hospital, 6550 Fannin St, Houston, TX
| | - Ponraj Chinnadurai
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
- Advanced Therapies, Siemens Medical Solutions USA Inc, Malvern, PA
| | - Ross G. McFall
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
| | - Orlando Diaz
- Department of Neuroradiology, Houston Methodist Hospital, Houston, TX
| | - Alan B. Lumsden
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
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9
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Qiu C, Liu Z, Huang L, Guo L, Lu W, Zhang H, He Y, Tian L, Li D, Wang X, Jin Y, Wu Z. Covered Stents for Visceral Artery Aneurysms: A Multicenter Study. J Vasc Interv Radiol 2022; 33:640-647. [DOI: 10.1016/j.jvir.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 02/24/2022] [Accepted: 03/04/2022] [Indexed: 02/07/2023] Open
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10
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Laurin T, Borghese O, Branchereau J, Karam G, Brisard L, Corvec TLE, Chaillou P, Desal H, Bourcier R, Maurel B. Single Centre Experience in Open and Endovascular Treatment of Renal Artery Aneurysms. Ann Vasc Surg 2021; 79:17-24. [PMID: 34644627 DOI: 10.1016/j.avsg.2021.07.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND The true incidence and natural history of renal artery aneurysm (RAA) remain unclear and still exists controversy over indication for treatment. Several techniques of conventional surgical reconstructions are described in literature, and more recently endovascular therapies have been reported with satisfying results and lower complication rate. This paper aims to investigate the outcomes of both endovascular and open repair of RAA achieved in a single institution involving 3 medical teams (urology, vascular surgery and neuroradiology). MATERIAL AND METHODS We conducted a single-centre retrospective observational study about all patients surgically or endovascularly treated for RAA over a 15-year period. Pre-operative, procedural and post-operative data at the early, mid- and long-term follow-up were collected and analysed, focusing on operative technique used for repair and related outcomes. RESULTS A total of 27 patients (n = 17 (63%) women, mean age 58 ± 13.2, n = 26 saccular RAA) were included. Mean aneurysm was size was 18.8 ± 6.3 mm. Most diagnosis were accidental. Symptomatic RAA showed with macroscopic haematuria (n = 3, 25.9%), unstable hypertension (n = 2; 7%), chronic lumbar pain (n = 1, 3.7%) and renal infarct (n = 1, 3.7%). Conventional surgery (ex-vivo repair, aneurysmorraphy, aneurysm resection and end-to-end anastomosis) was performed in 14 (51.8%) cases and endovascular coiling embolization in 13 (48.2%). Mean hospital length of stay was 5.4 ± 3.6 days. Intensive Care Unit stay was needed only in the surgically treated patients (mean 1.1 ± 1.2 days). During the early follow-up, morbidity rate was 7/14 in surgically treated patients vs. 1/13 in endovascular group; it included bleeding, retroperitoneal hematoma, arterial thrombosis and bowel obstruction. The discharge imaging showed complete aneurysm exclusion and renal artery patency in all cases. At a mean follow-up of 39 ± 42 months, 3 patients (11%) were lost to follow up and 2 (7.4 %) died from unrelated cause. None of these patients required dialysis but a statistically significant (P = 0.09) decrease in GFR was noted between the preoperative period and last follow-up control. RAA repair neither showed blood pressure control improvement nor reduced the need for anti-hypertensive drug use. CONCLUSION Open or endovascular techniques are both safe and efficient to treat RAA. Even though, surgical management is burdened with higher morbidity rate, the operative technique should be selected according to anatomical features, diameters and location of RRA; and the number of renal branches involved. Further larger studies are needed to define the feasibility and safety for a wider application of the endovascular approach.
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Affiliation(s)
- Thomas Laurin
- CHU Nantes, service de chirurgie cardio-vasculaire, L'institut du thorax, Nantes, FRANCE
| | - Ottavia Borghese
- CHU Nantes, service de chirurgie cardio-vasculaire, L'institut du thorax, Nantes, FRANCE
| | | | - Georges Karam
- CHU Nantes, service d'urologie, Nantes, FRANCE; Université de Nantes, Nantes, FRANCE
| | - Laurent Brisard
- CHU Nantes, service d'anesthésie réanimation, Nantes, FRANCE
| | - Tom LE Corvec
- CHU Nantes, service de chirurgie cardio-vasculaire, L'institut du thorax, Nantes, FRANCE
| | - Philippe Chaillou
- CHU Nantes, service de chirurgie cardio-vasculaire, L'institut du thorax, Nantes, FRANCE
| | - Hubert Desal
- CHU Nantes, service de neuroradiologie, L'institut du thorax, Nantes, FRANCE; Université de Nantes, Nantes, FRANCE
| | - Romain Bourcier
- CHU Nantes, service de neuroradiologie, L'institut du thorax, Nantes, FRANCE; Université de Nantes, Nantes, FRANCE
| | - Blandine Maurel
- CHU Nantes, service de chirurgie cardio-vasculaire, L'institut du thorax, Nantes, FRANCE; Université de Nantes, Nantes, FRANCE.
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Venturini M, Piacentino F, Coppola A, Bettoni V, Macchi E, De Marchi G, Curti M, Ossola C, Marra P, Palmisano A, Cappelli A, Basile A, Golfieri R, Cobelli FD, Piffaretti G, Tozzi M, Carcano G, Fontana F. Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives. J Clin Med 2021; 10:2520. [PMID: 34200171 PMCID: PMC8201262 DOI: 10.3390/jcm10112520] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 12/24/2022] Open
Abstract
Visceral artery aneurysms (VAAs) are rare, usually asymptomatic and incidentally discovered during a routine radiological examination. Shared guidelines suggest their treatment in the following conditions: VAAs with diameter larger than 2 cm, or 3 times exceeding the target artery; VAAs with a progressive growth of at least 0.5 cm per year; symptomatic or ruptured VAAs. Endovascular treatment, less burdened by morbidity and mortality than surgery, is generally the preferred option. Selection of the best strategy depends on the visceral artery involved, aneurysm characteristics, the clinical scenario and the operator's experience. Tortuosity of VAAs almost always makes embolization the only technically feasible option. The present narrative review reports state of the art and new perspectives on the main endovascular and other interventional options in the treatment of VAAs. Embolization techniques and materials, use of covered and flow-diverting stents and percutaneous approaches are accurately analyzed based on the current literature. Visceral artery-related considerations and targeted approaches are also provided and discussed.
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Affiliation(s)
- Massimo Venturini
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.P.); (A.C.); (V.B.); (E.M.); (G.D.M.); (F.F.)
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; (M.C.); (C.O.); (G.P.); (M.T.); (G.C.)
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.P.); (A.C.); (V.B.); (E.M.); (G.D.M.); (F.F.)
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.P.); (A.C.); (V.B.); (E.M.); (G.D.M.); (F.F.)
| | - Valeria Bettoni
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.P.); (A.C.); (V.B.); (E.M.); (G.D.M.); (F.F.)
| | - Edoardo Macchi
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.P.); (A.C.); (V.B.); (E.M.); (G.D.M.); (F.F.)
| | - Giuseppe De Marchi
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.P.); (A.C.); (V.B.); (E.M.); (G.D.M.); (F.F.)
| | - Marco Curti
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; (M.C.); (C.O.); (G.P.); (M.T.); (G.C.)
| | - Christian Ossola
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; (M.C.); (C.O.); (G.P.); (M.T.); (G.C.)
| | - Paolo Marra
- Department of Diagnostic Radiology, Giovanni XXIII Hospital, Milano-Bicocca University, 24127 Bergamo, Italy;
| | - Anna Palmisano
- Department of Radiology, IRCCS San Raffaele Scientific Institute, San Raffaele School of Medicine Vita-Salute University, 20132 Milan, Italy; (A.P.); (F.D.C.)
| | - Alberta Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.C.); (R.G.)
| | - Antonio Basile
- Department of Medical and Surgical Sciences and Advanced Technologies, Radiodiagnostic and Radiotherapy Unit, University Hospital “Policlinico-Vittorio Emanuele”, 95123 Catania, Italy;
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.C.); (R.G.)
| | - Francesco De Cobelli
- Department of Radiology, IRCCS San Raffaele Scientific Institute, San Raffaele School of Medicine Vita-Salute University, 20132 Milan, Italy; (A.P.); (F.D.C.)
| | - Gabriele Piffaretti
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; (M.C.); (C.O.); (G.P.); (M.T.); (G.C.)
- Vascular Surgery Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
| | - Matteo Tozzi
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; (M.C.); (C.O.); (G.P.); (M.T.); (G.C.)
- Vascular Surgery Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
| | - Giulio Carcano
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; (M.C.); (C.O.); (G.P.); (M.T.); (G.C.)
- Department of General, Emergency and Transplants Surgery, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.P.); (A.C.); (V.B.); (E.M.); (G.D.M.); (F.F.)
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; (M.C.); (C.O.); (G.P.); (M.T.); (G.C.)
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