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Khan A, Fosby B, Labori KJ, Lanari J, Dorenberg E, Line PD. Management of Coeliac and Hepatic Artery Aneurysms: An Experience of 84 Cases. Eur J Vasc Endovasc Surg 2023; 66:814-820. [PMID: 37722651 DOI: 10.1016/j.ejvs.2023.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 08/22/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To report outcomes following open or endovascular treatment of true hepatic and coeliac artery aneurysms at a single referral centre. METHODS This was a retrospective cohort study of consecutive patients treated for true hepatic and coeliac artery aneurysms between May 2002 and December 2021. Outcome measures included complications, graft patency, and survival rate. RESULTS Overall, 84 patients were included with a median age of 63 years (interquartile range 55, 79). The majority (76%) of the patients were men. Frequent comorbidities included a history of tobacco (69%), hypertension (65%), hyperlipidaemia (32%), and diabetes (15%). Multiple synchronous aneurysms were detected in 22 patients (26%). There were 33 (39%) symptomatic aneurysms (abdominal pain without rupture [n = 18], rupture [n = 10], and sepsis [n = 5]). Seventeen patients (20%) had mycotic aetiology. Fifty patients (60%) underwent endovascular treatment with either covered stent placement (n = 29) or coil embolisation (n = 21), and 34 patients (40%) were treated with open surgery using allogenic iliac artery (n = 15), autologous saphenous vein (n = 15), GoreTex graft (n = 2), or ligation (n = 2). The complication rate was 32% in the open group and 18% in the endovascular group (p = .048). The overall 90 day post-operative mortality rate was 1.2%, five year primary patency was 90.0%, five year survival rate was 81.2%, and mean follow up was 6.9 ± 4.2 years. CONCLUSION Endovascular treatment is the preferred approach whenever technically possible. Despite higher post-operative morbidity, an open approach with vascular reconstruction using autologous or allogenic vascular grafts yields acceptable long term results.
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Affiliation(s)
- Ammar Khan
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Bjarte Fosby
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Knut J Labori
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Jacopo Lanari
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Eric Dorenberg
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Pål-Dag Line
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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2
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Zhu F, Zhang L, Shang D. The management of spontaneous isolated celiac artery dissection: A case report and literature review. Vascular 2023:17085381231197931. [PMID: 37604155 DOI: 10.1177/17085381231197931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Spontaneous isolated celiac artery dissection (SICAD) without associated aortic dissection is a rare disease. Complications are ischemia, aneurysm formation, and rupture. Different treatment options have been reported for managing SICAD, including conservative management, endovascular intervention, and open surgery. Despite the increased recognition of this disease, there are no consensus guidelines on management of this condition. To improve the knowledge and treatment of this disease, a case of SICAD was reported. METHODS AND RESULTS We describe the case of a 57-year-old woman with SICAD whose symptoms improved after endovascular treatment when conservative treatment failed and systematically analyze the management strategy for patients with SICAD. CONCLUSIONS SICAD is a rare disease and has no universally agreed upon guidelines for treatment. Most patients can be first treated conservatively for dissection with strict blood pressure control, antithrombotic therapy, and intensive surveillance. For SICAD patients with aneurysms located in the celiac trunk, stent grafts can be used in such patients without affecting the branch blood supply.
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Affiliation(s)
- Feng Zhu
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liqiang Zhang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Shang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Takata Y, Katayama K, Shimizu H, Inoue R, Takasaki T, Takahashi S. Treatment of celiac artery rupture with a hybrid procedure involving aortic stent grafting and open surgery in a patient with neurofibromatosis type 1. J Vasc Surg Cases Innov Tech 2022; 8:625-628. [PMID: 36248389 PMCID: PMC9556580 DOI: 10.1016/j.jvscit.2022.07.020] [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: 02/09/2022] [Accepted: 07/27/2022] [Indexed: 11/25/2022] Open
Abstract
Neurofibromatosis type 1 is associated with vascular fragility, and vascular disease is the second leading cause of death in these patients. A 42-year-old woman with neurofibromatosis type 1 was transferred to our hospital owing to shock. A computed tomography scan revealed a ruptured celiac artery aneurysm, which had expanded from 14 to 26 mm in 1 day. The survival rate of patients with celiac artery rupture is extremely low, and there is no consensus on treatment. Here, we successfully performed a hybrid procedure with emergent implantation of aortic stent grafts for life-saving treatment and subsequent laparotomy for complete hemostasis.
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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.
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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
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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.
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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
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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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Endovascular Oriented Classification and Treatment of Celiac Trunk Aneurysms: 10 Years Experience. Ann Vasc Surg 2021; 79:219-225. [PMID: 34644646 DOI: 10.1016/j.avsg.2021.07.012] [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] [Received: 05/16/2021] [Accepted: 07/07/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To propose an endovascular-oriented classification of celiac trunk aneurysms (CTa) and discuss single center results of this rare pathology. METHODS Data of all patients admitted to our institution for CTa from 2011 to 2021 were prospectively collected. Of them, those who underwent endovascular treatment were retrospectively analyzed. All preoperative CT scans were reviewed and CTa were classified in 4 different configurations based on progressive distal landing zone. We excluded from the classification all cases with median arcuate ligament syndrome (MALS), patients with coexistent aortic dilation or no endovascular proximal neck. Preoperative demographics, intraoperative data and post-operative complications were recorded. All-cause late mortality and complications were identified through a review of office charts and telephone assessment. RESULTS During the study period 19 patients were referred to our Institution for CTa. Ten patients underwent endovascular treatment (ET). In 6 cases a watchful waiting strategy was adopted, 2 (10.5 %) patients refused ET and one patient without suitable proximal landing zone (< 10 mm) was not proposed to open surgical repair for surgical contraindication but is followed by strict instrumental and clinical evaluation. Six (60%) patients presented type 2 CTa; all of them underwent ET requiring positioning of covered stent-graft and SA embolization. Three (30%) patients presented type 3 CTa; all of them underwent ET with covered stent-graft deployment over the GDA with preliminary embolization. One (10%) patient presented type 4 CTa that was treated by means of covered stent-graft deployment along the right hepatic artery with left hepatic artery embolization. Overall, no major complications and perioperative mortality was observed. CONCLUSION Celiac trunk aneurysms are rare, and no classifications have still been presented. Stent-graft exclusion provides excellent short-term outcome with no significant morbidity and mortality rate when technically feasible.
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Li X, Zhang W, Zhou M, Ding Y, Wang Y, Xie T, Zhou Z, Cai L, Shi Z. A new classification and strategies for endovascular treatment of celiac artery aneurysms. Vascular 2021; 30:834-841. [PMID: 34263673 DOI: 10.1177/17085381211032768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Endovascular treatment is being increasingly used for celiac artery aneurysms (CAAs), but systematic endovascular treatment strategies have not been defined yet. This study intended to investigate the strategies of endovascular management of CAAs according to a single-center experience. METHODS Anatomically, CAAs were classified into two types: Type I CAAs located in the main trunk of celiac artery. Type II CAAs located on the branches of the celiac artery. Type I and Type II CAAs can be further divided into two different subtypes according to fusiform (a) or saccular or (b) morphology: type Ia, type Ib, type IIa, and type IIb. Patient demographics, clinical manifestations, aneurysm characteristics, endovascular intervention procedures, and perioperative and follow-up outcomes were reviewed and analyzed. RESULTS Between August 2012 and August 2020, 18 consecutive patients (12 men; mean age, 56.8 ± 14.5 years) with CAAs were identified and treated with endovascular procedures. There were seven patients with type Ia, three patients with type Ib, four patients with type IIa, and four patients with type IIb CAAs. One patient died of hemorrhagic shock due to a ruptured aneurysm. Technical success was achieved in 16 patients (88.9%). The mean follow-up period was 51.7 ± 19.4 months. No hepatic or intestinal ischemia or death developed perioperatively or during the follow-up period. No aneurysmal expansion was detected on CTA surveillance, except for one patient who was diagnosed with an endoleak during the follow-up and received reintervention. CONCLUSIONS The endovascular strategy based on the novel classification of CAAs was safe and effective, with a favorable mid-term clinical outcome.
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Affiliation(s)
- Xu Li
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, 92323Fudan University, Shanghai, China
| | - Wan Zhang
- Department of Vascular Surgery, 159396Huadong Hospital Fudan University, Shanghai, China
| | - Min Zhou
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, 92323Fudan University, Shanghai, China
| | - Yong Ding
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, 92323Fudan University, Shanghai, China
| | - Yonggang Wang
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, 92323Fudan University, Shanghai, China
| | - Tianchen Xie
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, 92323Fudan University, Shanghai, China
| | - Zhenyu Zhou
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, 92323Fudan University, Shanghai, China
| | - Liang Cai
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, 92323Fudan University, Shanghai, China
| | - Zhenyu Shi
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, 92323Fudan University, Shanghai, China
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9
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Al Baghdadi M, Yedla P. Visceral artery aneurysm: an unusual cause of abdominal pain. BMJ Case Rep 2020; 13:13/12/e238019. [PMID: 33370948 DOI: 10.1136/bcr-2020-238019] [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: 01/14/2023] Open
Abstract
Visceral artery aneurysms (VAAs) are uncommon with an approximate incidence of 0.01%-0.2%. Gastroduodenal artery (GDA) aneurysm is a rare subtype of these uncommon visceral aneurysms that can be fatal if ruptured. We present a case of a 58-year-old Caucasian woman with a VAA and a large haematoma arising from an actively bleeding GDA. While patients with VAA may remain asymptomatic, with some of the aneurysms found incidentally during imaging, they may also present with abdominal pain, anaemia and possible multiorgan failure which may be fatal.
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Affiliation(s)
- Maha Al Baghdadi
- Medicine, The University of Alabama at Birmingham School of Medicine Huntsville Campus, Huntsville, Alabama, USA
| | - Parekha Yedla
- Medicine, The University of Alabama at Birmingham School of Medicine Huntsville Campus, Huntsville, Alabama, USA
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Varma D, Chattuparambil B, Upadhya S, Devaraju S, Krishnan DK. Ligation of symptomatic celiac artery aneurysm without vascular reconstruction: Utilizing the natural collateral circulation of the celiac axis: A case report. Int J Surg Case Rep 2020; 78:187-191. [PMID: 33360333 PMCID: PMC7771040 DOI: 10.1016/j.ijscr.2020.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Celiac artery aneurysm is very rare visceral artery aneurysm. Symptomatic and ≥ 2.5 cm sized aneurysm requires treatment. Excision and revascularization is the most commonly employed procedure. CASE PRESENTATION We report a case of ligation and excision of celiac artery aneurysm extending onto the splenic and hepatic arteries without vascular reconstruction. The patient was a 52 year old lady who was evaluated for abdominal pain and was found to have a celiac artery aneurysm involving the hepatic and splenic arteries. She was evaluated with computerized tomography and digital subtraction angiography of the abdominal vessels. These confirmed good natural collaterals from the branches of superior mesenteric artery supplying the liver, stomach and spleen. We performed ligation and excision of the aneurysm and ligation and division of hepatic, splenic and left gastric arteries as the aneurysm was extending on to these vessels, without any vascular reconstruction, utilizing the natural collaterals from the superior mesenteric artery. DISCUSSION Ligation of celiac artery aneurysm without revascularization is often done in emergency situations. Excision and revascularization is the treatment of choice to ensure adequate blood supply to liver, spleen and stomach. We could utilize the natural collateral circulation of celiac artery from superior mesenteric artery avoiding a complex procedure of revascularization. CONCLUSION We present this because of the rarity of the disease as well as rarity of the technique of not performing vascular reconstruction. We emphasize on the pre-operative and operative evaluation of collateral circulation with conventional angiography and intraoperative Doppler respectively.
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Affiliation(s)
- Deepak Varma
- Department of GI and HPB Surgery, Health City Cayman Islands, Grand Cayman, Cayman Islands.
| | - Binoy Chattuparambil
- Department of Cardiovascular and Thoracic Surgery, Health City Cayman Islands, Grand Cayman, Cayman Islands
| | - Sripadh Upadhya
- Department of Cardiology, Health City Cayman Islands, Grand Cayman, Cayman Islands
| | - Sridhar Devaraju
- Department of Cardiovascular and Thoracic Surgery, Health City Cayman Islands, Grand Cayman, Cayman Islands
| | - Dhruva Kumar Krishnan
- Department of Anaesthesia and Critical Care, Health City Cayman Islands, Grand Cayman, Cayman Islands
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Case report of a successful non-operative management of postoperative bleeding from pseudoaneurysm of the gastroduodenal artery, following gastric surgery. Int J Surg Case Rep 2020; 78:54-57. [PMID: 33310471 PMCID: PMC7736902 DOI: 10.1016/j.ijscr.2020.11.157] [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: 11/22/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 11/22/2022] Open
Abstract
Postoperative pseudoaneurysms occur after upper gastrointestinal operations. Almost half (52%) of the pseudoaneurysms are diagnosed when a rupture occurs. Rupture of the pseudoaneurysm can be treated by embolism of the artery. The formation of the pseudoaneurysm, occured in less than 48h as in earlier CTA the gastroduodenal artery appeared normal.
Introduction Post operative pseudoaneurysm of the gastroduodenal artery is a very rare entity. Rupture of the pseudoaneurysm can be treated by embolism of the artery. Presentation of case A 71 years old male with a perforated pyloric ulcer was treated with controlled external duodenal fistula. Due to postoperative bleeding a subtotal gastrectomy was performed. A second episode of bleeding occurred and rupture of a pseudoaneurysm of the gastroduodenal artery was diagnosed by computed angiography and treated by embolism of the artery. Three days later the duodenal stump was ruptured and a new controlled external duodenal fistula was surgically created. The patient died 6 weeks later due to multiple organ failure. Discussion Pseudoaneurysm is the result of self-contained ruptures of one or more layers of the vascular wall. Computed angiography is the golden standard to identify pseudoaneurysms (100% sensitivity). Early suspicion for the presence of a pseudoaneurysm is crucial, as when the rupture actually occurs, the mortality rate is remarkably high. Endovascular approach is a minimally invasive procedure with high success rates (70–100%) and significantly lower morbidity and mortality rates. Surgical is reserved in case of bleeding recurrence. The fact that is particularly interesting in this patient is the timing of the formation of the pseudoaneurysm, considering the fact that 48 h earlier the gastroduodenal artery appeared normal. Conclusion There are no guidelines regarding the treatment of the pseudoaneurysm of the gastroduodenal artery. It seems reasonable to treat them immediately after diagnosis because a possible rupture of the aneurysm has an extremely high mortality.
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Rosenberg A, Trebska-McGowan K, Reichman T, Sharma A, Cotterell A, Strife B, Khan AA, Kumaran V, Bruno DA, Levy MF, Bhati CS. Management of hepatic artery aneurysm: A case series. Ann Hepatobiliary Pancreat Surg 2020; 24:333-338. [PMID: 32843601 PMCID: PMC7452805 DOI: 10.14701/ahbps.2020.24.3.333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/16/2020] [Accepted: 07/09/2020] [Indexed: 01/17/2023] Open
Abstract
Hepatic artery aneurysms are rare, but their diagnosis is important because of high mortality and complications. Common risk factors for developing these aneurysms include hypertension, vascular disease, pancreatitis, diabetes, tobacco use, autoimmune diseases, and previous transplantation. Frequent imaging for trauma and tumor surveillance has increased the incidence of naive hepatic aneurysms. These aneurysms can be difficult to manage, and it can be challenging to decide the correct treatment modality for the patient. Hereby, we present four cases of hepatic artery aneurysm and discuss various treatment options. Patient 1 suffered from a proper and right hepatic artery aneurysm discovered incidentally; repaired with an endovascular intervention later complicated by an endoleak which was further managed by another stenting. Patient 2 had a common hepatic artery aneurysm followed with serial imaging without any intervention. Patient 3 had a hepatic artery aneurysm and liver mass diagnosed concurrently. The patient underwent an open surgical repair of his aneurysm with graft and liver resection which was complicated later with rupture of aneurysm followed by surgical bypass repair. Patient 4 suffered from a large hepatic artery aneurysm causing bile duct compression. Her aneurysm was repaired open with splenic artery grafting. Patients were managed from careful observation to surgery with different outcomes.
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Affiliation(s)
- Ashley Rosenberg
- Departments of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | | | - Trevor Reichman
- Departments of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Amit Sharma
- Departments of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Adrian Cotterell
- Departments of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Brian Strife
- Departments of Radiology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Aamir A Khan
- Departments of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Vinay Kumaran
- Departments of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - David A Bruno
- Departments of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Marlon F Levy
- Departments of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Chandra Shekhar Bhati
- Departments of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
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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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14
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Ghoniem BM, Shaker AA, Nasser M, Gad A. Management of mycotic visceral artery aneurysms in the endovascular era: short- and midterm outcome. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.18.04944-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Vittoria De Martini I, Pfammatter T, Puippe G, Clavien PA, Alkadhi H. Frequency and causes of delayed diagnosis of visceral artery pseudoaneurysms with CT: Lessons learned. Eur J Radiol Open 2020; 7:100221. [PMID: 32099872 PMCID: PMC7026741 DOI: 10.1016/j.ejro.2020.100221] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 11/27/2022] Open
Abstract
Objective Visceral artery pseudoaneurysms (VAPA) are associated with a high morbidity and mortality, but sometimes are missed in initial computed tomography (CT) examinations. The aims of this study were to determine the frequency and causes of misdiagnoses of VAPA with CT. Materials and Methods We retrospectively identified 77 patients with VAPA in our database who underwent contrast-enhanced CT. The frequency of delayed diagnosis was determined and the reasons were noted. We identified the etiology of VAPA, measured size, and noted the affected vessels. Results Forty-five of the 77 patients (58 %) had a delayed diagnosis of VAPA. There was no difference in the rate of missed VAPA in symptomatic compared to asymptomatic patients (p = 0.255). The majority of VAPA were associated with previous surgery or interventions (n = 48/62 %). The major affected vessel was the hepatic (n = 31) followed by the splenic artery (n = 17). The main reasons for misdiagnosis were a missed arterial phase in CT (n = 16/36 %), artifacts masking the aneurysm (n = 9/20 %), overlooked pseudoaneurysm (n = 19/42 %), and misinterpretation by attending radiologists (n = 1/2 %). Missed VAPA were smaller (median 8 mm) than those VAPA that were initially diagnosed (median 13 mm, p < 0.01), but occurred with a similar frequency in larger and smaller visceral arteries (p = 0.601). Conclusions Our study showed that 58 % of VAPA were diagnosed with delay, with the following four reasons for misdiagnosis: Lack of an arterial contrast phase in CT, no techniques for artifact reduction, and lack of awareness of the radiologists. Avoiding delayed diagnosis will most probably improve outcome of patients with VAPA.
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Affiliation(s)
- Ilaria Vittoria De Martini
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Thomas Pfammatter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Gilbert Puippe
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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16
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Xiao N, Mansukhani NA, Resnick SA, Eskandari MK. Giant celiac artery aneurysm. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:447-451. [PMID: 31660470 PMCID: PMC6806657 DOI: 10.1016/j.jvscit.2019.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/10/2019] [Indexed: 12/01/2022]
Abstract
Celiac artery aneurysms (CAAs) are rare but potentially devastating lesions. Given the high rates of mortality on rupture at large sizes, they should be treated promptly with either surgical or endovascular interventions in appropriate-risk patients. Several options exist for treatment, including surgical repair and endovascular embolization with or without stent or stent graft placement. Because of their rarity, there are few reports of successfully treated CAA lesions. Herein, we describe successful endovascular treatment of one of the largest CAAs reported in the literature.
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Affiliation(s)
- Nicholas Xiao
- Department of Surgery, Northwestern University, Chicago, Ill.,Department of Radiology, Northwestern University, Chicago, Ill
| | | | - Scott A Resnick
- Department of Radiology, Northwestern University, Chicago, Ill
| | - Mark K Eskandari
- Department of Surgery, Northwestern University, Chicago, Ill.,Department of Radiology, Northwestern University, Chicago, Ill
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17
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Sousa J, Costa D, Mansilha A. Visceral artery aneurysms: review on indications and current treatment strategies. INT ANGIOL 2019; 38:381-394. [DOI: 10.23736/s0392-9590.19.04194-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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18
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Lee D, Chung BH, Heo SH, Park YJ, Kim DI. Case Report of a Large Common Hepatic Artery Aneurysm. Ann Vasc Surg 2018; 52:316.e11-316.e13. [PMID: 29886208 DOI: 10.1016/j.avsg.2018.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 04/01/2018] [Indexed: 12/01/2022]
Abstract
Hepatic artery aneurysm is rare, but appropriate treatment is mandatory. We report a 50-year-old woman with an asymptomatic large hepatic artery aneurysm. The aneurysm was found as a result of abdominal computed tomography (CT) performed as a part of the screening. An open surgery was performed due to the size of the aneurysm. Aneurysmectomy was achieved, and the proper hepatic artery was anastomosed with gastroduodenal artery for adequate blood flow to the liver. Adequate hepatic circulation was confirmed postoperatively by duplex ultrasonography and CT. The patient was discharged on the 9th postoperative day.
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Affiliation(s)
- Dongheon Lee
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byeoung-Hoon Chung
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seon-Hee Heo
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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19
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Galanakis V. Pseudoaneurysm of the gastroduodenal artery: an unusual cause for hyperamylasaemia. BMJ Case Rep 2018; 2018:bcr-2017-223882. [PMID: 29643139 DOI: 10.1136/bcr-2017-223882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A 79-year-old man was admitted electively for investigation of weight loss. While he was an inpatient, he developed severe epigastric pain and an initial blood test revealed an acutely raised amylase (>2000) and deranged liver function tests. A contrast CT angiography showed a large haematoma adjacent to the duodenum, spreading in the retroperitoneal space, arising from a 2 cm bleeding pseudoaneurysm in the region of the gastroduodenal artery. Due to his underlying comorbidities, he was deemed unfit for surgical repair and he had coil embolisation with successful haemostasis. The gastroduodenal artery aneurysms are rare and constitute 1.5% of all visceral artery aneurysms. They can be an incidental finding or they can present with haemorrhagic shock, abdominal pain and rarely with obstructive jaundice or hyperamylasaemia. The diagnosis is usually made with an angiography. Variable treatment options are available depending on the patient's fitness and haemodynamic stability.
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20
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Logaldo D, Costantini Brancadoro E, Ballabio A, Zurleni T. Splenic Artery Transposition Graft for Hepatic Artery Aneurysm and Occlusion. Ann Vasc Surg 2017; 42:300.e7-300.e10. [PMID: 28279726 DOI: 10.1016/j.avsg.2016.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/09/2016] [Accepted: 10/17/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hepatic artery aneurysms are rare but potentially fatal if undiagnosed or left untreated. Several open surgical and endovascular techniques for hepatic artery aneurysm (HAA) repair have been described. Splenic artery transposition has been reported in selected cases. CASE REPORT We herein present the case of a 73-year-old man with asymptomatic HAA and concomitant occlusion at the most proximal tract. The aneurysm involved the common and proper hepatic artery and was supplied by the gastroduodenal artery. Aneurysmectomy was performed, and the arterial blood flow was restored to the liver by splenic artery transposition graft. No signs of liver or spleen ischemia were detected at control computed tomography angiography. The patient is doing fine 3 months after surgery. CONCLUSIONS This case presented multiple challenges because of HAA location and extension and lack of a traditional inflow site for hepatic revascularization. In such setting, splenic artery transposition was shown to represent a feasible and successful technique.
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Affiliation(s)
- Davide Logaldo
- Department of Vascular and Endovascular Surgery, Hospital of Busto Arsizio, Busto Arsizio, Italy.
| | | | - Andrea Ballabio
- Department of General Surgery, Hospital of Busto Arsizio, Busto Arsizio, Italy
| | - Tommaso Zurleni
- Department of General Surgery, Hospital of Busto Arsizio, Busto Arsizio, Italy
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21
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Successfully-treated asymptomatic celiac artery aneurysm: A case report. Int J Surg Case Rep 2017; 33:115-118. [PMID: 28292664 PMCID: PMC5348600 DOI: 10.1016/j.ijscr.2017.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 01/19/2023] Open
Abstract
Although rare, celiac artery aneurysm may carry a definite risk for rupture and other complications. Because of its rarity, no strong consensus concerning indications for intervention of asymptomatic celiac artery aneurysm exists in the literature. Clinicians awareness regarding this rare entity and efforts to discover before rupturing are imperative.
Background Celiac artery aneurysm is a rare vascular lesion. It is frequently discovered after rupture, which leads to death in most cases. We present a case of an asymptomatic celiac artery aneurysm discovered in a 72-year-old female during an evaluation for high grade fever and general fatigue. Case presentation The patient visited our department with complaints of fever and general fatigue. The patient’s medical history included type 2 diabetes mellitus with poor control and hypertension. Blood culture and urine culture that were submitted at arrival presented E. Coli. Then, she was diagnosed with bacteremia by urinary tract infection. Transesophageal echocardiography revealed no vegetation at her valves. Computed tomography was performed for investigating her urological abnormalities, revealing a 28 × 30 mm aneurysm at the trunk of the celiac artery. Blood and urine cultures submitted at arrival were positive for E. coli. Surgical repair performed after the improvement of her urinary tract infection revealed a non-infective aneurysm; thus, aneurysm closure and prosthetic grafting were conducted. Conclusion Clinician awareness regarding this rare entity and discovery efforts to discover the splanchnic aneurysm before rupturing are imperative.
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22
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Trauma associated splenic artery aneurysms: an analysis of the National Trauma Data Bank. Am J Surg 2016; 211:739-43. [DOI: 10.1016/j.amjsurg.2015.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 11/12/2015] [Accepted: 11/23/2015] [Indexed: 12/18/2022]
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23
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Kaihara T, Komiyama K, Fukamizu S, Ashikaga T, Sakurada H. An isolated spontaneous dissecting celiac artery aneurysm with successful endovascular treatment using stenting and coil embolization. J Cardiol Cases 2016; 13:155-157. [PMID: 30546633 DOI: 10.1016/j.jccase.2016.01.005] [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: 06/24/2015] [Revised: 12/29/2015] [Accepted: 01/19/2016] [Indexed: 11/16/2022] Open
Abstract
Isolated spontaneous dissecting celiac artery aneurysm (DCAA) is a rare event. We report the case of a 50-year-old Japanese man with sudden post-prandial epigastric pain. He was diagnosed as having an isolated DCAA based on the results of contrast-enhanced multi-slice computed tomography (CT). Initially, we gave him conservative therapy, but the aneurysm grew and then we performed endovascular treatment. The DCAA did not cause a rupture, and there were rich collateral channels between the superior mesenteric artery and the common hepatic artery. However, the neck of the aneurysm was too broad to indwell coils, and it was thought that coils might drop out from the aneurysm. We chose endovascular therapy with a self-expanding stent and coil embolization, and the aneurysm was extinguished. He was successfully treated and has recovered favorably. To our knowledge, few cases of a DCAA treated with both a self-expanding stent and coil embolization have been reported and this strategy may be one of the endovascular treatment options for a DCAA. More data accumulation of this method and investigation of long-term treatment effect are required in the future. <Learning objective: A dissecting celiac artery aneurysm is a rare event. Conservative, endovascular, and surgical therapies have been described, but no optimum treatment exists. For the present patient, we chose endovascular therapy with a stent and coil embolization, and he was successfully treated. To our knowledge, few cases of this condition treated with both stenting and coiling have been reported. We suggest that this strategy be one of the endovascular treatment options for this condition.>.
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Affiliation(s)
- Toshiki Kaihara
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Kota Komiyama
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Takashi Ashikaga
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Harumizu Sakurada
- Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital, Tokyo, Japan
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24
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Shawky MS, Tan J, French R. Gastroduodenal Artery Aneurysm: A Case Report and Concise Review of Literature. Ann Vasc Dis 2015; 8:331-3. [PMID: 26730262 DOI: 10.3400/avd.cr.15-00086] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 11/04/2015] [Indexed: 01/17/2023] Open
Abstract
Gastroduodenal artery (GDA) aneurysm is a rare but potentially fatal vascular disease, with chronic pancreatitis being reported as the commonest aetiological factor. Its main complication is rupture, which is not uncommon and carries high risk of mortality. Clinical suspicion and advanced imaging tools should be employed in a timely fashion to make a diagnosis before this ominous event. We report a case of successfully treated GDA aneurysm who presented with minor bleeding episodes before suffering a major bleed and briefly discuss this pathology in light of the existing literature.
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Affiliation(s)
- Michael S Shawky
- Department of Surgery, Waikato Hospital, Hamilton, New Zealand; Department of Head and Neck and Endocrine Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Jeffrey Tan
- Department of Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Rowan French
- Department of Surgery, Waikato Hospital, Hamilton, New Zealand
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25
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Operative management of hepatic artery aneurysms. J Vasc Surg 2015; 62:610-5. [DOI: 10.1016/j.jvs.2015.03.077] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 03/31/2015] [Indexed: 12/12/2022]
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26
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Schatz RA, Schabel S, Rockey DC. Idiopathic Splenic Artery Pseudoaneurysm Rupture as an Uncommon Cause of Hemorrhagic Shock. J Investig Med High Impact Case Rep 2015; 3:2324709615577816. [PMID: 26425639 PMCID: PMC4528868 DOI: 10.1177/2324709615577816] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Splenic artery pseudoaneurysms are infrequently encountered but critical to recognize. Limited literature to date describes associations with pancreatitis, trauma, and rarely peptic ulcer disease. Hemorrhage and abdominal pain are the most common manifestations. There is typically overt gastrointestinal blood loss but bleeding can also extend into the peritoneum, retroperitoneum, adjacent organs, or even a pseudocyst. Most patients with ruptured splenic artery pseudoaneurysms present with hemodynamic instability. Here, we describe a patient recovering from acute illness in the intensive care unit but with otherwise no obvious risk factors or precipitants for visceral pseudoaneurysm. He presented with acute onset altered mental status, nausea, and worsening back and abdominal pain and was found to be in hypovolemic shock. The patient was urgently stabilized until more detailed imaging could be performed, which ultimately revealed the source of blood loss and explained his rapid decompensation. He was successfully treated with arterial coiling and embolization. Thus, we herein emphasize the importance of prompt recognition of hemorrhagic shock and of aggressive hemodynamic stabilization, as well as a focused diagnostic approach to this problem with specific treatment for splenic artery pseudoaneurysm. Finally, we recommend that multidisciplinary management should be the standard approach in all patients with splenic artery pseudoaneurysm.
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Affiliation(s)
- Richard A Schatz
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Stephen Schabel
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Don C Rockey
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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27
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Cost-effectiveness of endovascular repair, open repair, and conservative management of splenic artery aneurysms. J Vasc Surg 2015; 61:1432-40. [PMID: 25827968 DOI: 10.1016/j.jvs.2014.12.064] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 12/21/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Open repair (OPEN) and conservative management (CONS) have been the treatments of choice for splenic artery aneurysms (SAAs) for many years. Endovascular repair (EV) has been increasingly used with good short-term results. In this study, we evaluated the cost-effectiveness of OPEN, EV, and CONS for the treatment of SAAs. METHODS A decision analysis model was developed using TreeAge Pro 2013 software (TreeAge Inc, Williamstown, Mass) to evaluate the cost-effectiveness of the different treatments for SAAs. A hypothetical cohort of 10,000 55-year-old female patients with SAAs was assessed in the reference-case analysis. Perioperative mortality, disease-specific mortality rates, complications, rupture risks, and reinterventions were retrieved from a recent and extensive meta-analysis. Costs were analyzed with the 2014 Medicare database. The willingness to pay was set to $60,000/quality-adjusted life years (QALYs). Outcomes evaluated were QALYs, costs from the health care perspective, and the incremental cost-effectiveness ratio (ICER). Extensive sensitivity analyses were performed and different clinical scenarios evaluated. Probabilistic sensitivity analysis was performed to include the uncertainty around the variables. A flowchart for clinical decision-making was developed. RESULTS For a 55-year-old female patient with a SAA, EV has the highest QALYs (11.32; 95% credibility interval [CI], 9.52-13.17), followed by OPEN (10.48; 95% CI, 8.75-12.25) and CONS (10.39; 95% CI, 8.96-11.87). The difference in effect for 55-year-old female patients between EV and OPEN is 0.84 QALY (95% CI, 0.42-1.34), comparable with 10 months in perfect health. EV is more effective and less costly than OPEN and more effective and more expensive compared with CONS, with an ICER of $17,154/QALY. Moreover, OPEN, with an ICER of $223,166/QALY, is not cost-effective compared with CONS. In elderly individuals (age >78 years), the ICER of EV vs CONS is $60,503/QALY and increases further with age, making EV no longer cost-effective. Very elderly patients (age >93 years) have higher QALYs and lower costs when treated with CONS. The EV group has the highest number of expected reinterventions, followed by CONS and OPEN, and the number of expected reinterventions decreases with age. CONCLUSIONS EV is the most cost-effective treatment for most patient groups with SAAs, independent of the sex and risk profile of the patient. EV is superior to OPEN, being both cost-saving and more effective in all age groups. Elderly patients should be considered for CONS, based on the high costs in relation to the very small gain in health when treated with EV. The very elderly should be treated with CONS.
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28
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Dohan A, Dautry R, Guerrache Y, Fargeaudou Y, Boudiaf M, Le Dref O, Sirol M, Soyer P. Three-dimensional MDCT angiography of splanchnic arteries: Pearls and pitfalls. Diagn Interv Imaging 2015; 96:187-200. [DOI: 10.1016/j.diii.2014.06.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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29
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Tijani Y, Chtata H, Elkaoui H, Hatim A, Drissi M, Abissegue Y, Taberkant M. [The aneurysms of digestive system arteries: three cases]. Ann Cardiol Angeiol (Paris) 2014; 64:109-12. [PMID: 24856656 DOI: 10.1016/j.ancard.2014.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 04/08/2014] [Indexed: 11/16/2022]
Abstract
The aneurysms of digestive arteries are a rare pathological entity, with a risk of rupture associated to a high mortality rate, often asymptomatic, then they are discovered incidentally during a exam for other diagnostic purposes. We report three cases of digestive aneurysms, one of celiac trunk, one of mesenteric artery on behçet disease, and one of splenic artery, which were treated surgically with success.
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Affiliation(s)
- Y Tijani
- Service de chirurgie vasculaire de l'HMIMV, université Mohammed V Soussi, angle rue souss-qahira résidence le nid, immeuble 16, n(o) 06 Kénitra, 14000 Kénitra Maamora, Rabat, Maroc.
| | - H Chtata
- Service de chirurgie vasculaire de l'HMIMV, université Mohammed V Soussi, angle rue souss-qahira résidence le nid, immeuble 16, n(o) 06 Kénitra, 14000 Kénitra Maamora, Rabat, Maroc
| | - H Elkaoui
- Service de chirurgie viscérale de l'HMIMV, université Mohammed V Soussi, Rabat, Maroc
| | - A Hatim
- Service d'anesthésie réanimation de chirurgie cardiaque et vasculaire HMIMV, université Mohammed V Soussi, Rabat, Maroc
| | - M Drissi
- Service d'anesthésie réanimation de chirurgie cardiaque et vasculaire HMIMV, université Mohammed V Soussi, Rabat, Maroc
| | - Y Abissegue
- Service de chirurgie vasculaire de l'HMIMV, université Mohammed V Soussi, angle rue souss-qahira résidence le nid, immeuble 16, n(o) 06 Kénitra, 14000 Kénitra Maamora, Rabat, Maroc
| | - M Taberkant
- Service de chirurgie vasculaire de l'HMIMV, université Mohammed V Soussi, angle rue souss-qahira résidence le nid, immeuble 16, n(o) 06 Kénitra, 14000 Kénitra Maamora, Rabat, Maroc
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30
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Han YM, Lee JY, Choi IJ, Kim CG, Cho SJ, Lee JH, Kim HB, Choi JM. Endoscopic removal of a migrated coil after embolization of a splenic pseudoaneurysm: a case report. Clin Endosc 2014; 47:183-7. [PMID: 24765602 PMCID: PMC3994262 DOI: 10.5946/ce.2014.47.2.183] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/17/2013] [Accepted: 07/08/2013] [Indexed: 12/26/2022] Open
Abstract
Splenic artery pseudoaneurysms can be caused by pancreatitis, trauma, or operation. Traditionally, the condition has been managed through surgery; however, nowadays, transcatheter arterial embolization is performed safely and effectively. Nevertheless, several complications of pseudoaneurysm embolization have been reported, including coil migration. Herein, we report a case of migration of the coil into the jejunal lumen after transcatheter arterial embolization of a splenic artery pseudoaneurysm. The migrated coil was successfully removed by performing endoscopic intervention.
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Affiliation(s)
- Yoo Min Han
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Yeul Lee
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Il Ju Choi
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Chan Gyoo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Soo-Jeong Cho
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Jun Ho Lee
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Hyun Beom Kim
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Ji Min Choi
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Abstract
Idiopathic spontaneous intraperitoneal hemorrhage (ISIH), or abdominal apoplexy, is due to nontraumatic, small vessel rupture; excluded by definition is hemorrhage associated with aortic aneurysm, gynecologic conditions (including ruptured ectopic pregnancy), and bleeding tumors. As defined, this condition is rare and etiologically complex. We report a case of ISIH associated with ruptured dissection of the gastroduodenal artery (GDA) which occurred following two paracentesis procedures for ascites due to cirrhosis. Severe acute inflammation of the vessel wall and resolving endocardial thrombosis suggest an infectious or “mycotic” etiology for this arterial dissection. Direct vascular injury during paracentesis was excluded as a cause of death. Small artery hemorrhage may be associated with aneurysmal rupture or other vasculopathies. Visceral small vessel aneurysms are rare, and GDA aneurysms are even less common. Although the regional vascular anatomy is complex and finding a bleeding point within a bloody field with no intravascular pressure may be impossible, careful dissection of the smaller vascular branches can be rewarding. Clinical management of ISIH is also challenging since findings may be nonspecific and limited to hemodynamic instability and atypical abdominal pain; however, immediate exploratory surgery is the treatment of choice, and the non-operative mortality approaches 100%.
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Affiliation(s)
- Varsha Podduturi
- Department of Pathology at Baylor University Medical Center in Dallas, TX
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32
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Endograft-assisted Coil Embolization of a Celiac Trunk Aneurysm. Ann Vasc Surg 2014; 28:263.e1-5. [DOI: 10.1016/j.avsg.2013.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 02/05/2013] [Accepted: 02/06/2013] [Indexed: 11/17/2022]
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Badea R, Chiorean L, Chira O, Caraiani C. Associated gastroduodenal artery aneurysm aortic aneurysm: the diagnostic contribution of contrast-enhanced ultrasound in correlation with computed tomography angiography. J Med Ultrason (2001) 2013; 41:217-21. [PMID: 27277776 DOI: 10.1007/s10396-013-0507-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 10/02/2013] [Indexed: 11/30/2022]
Abstract
Splanchnic aneurysms are rare conditions, with localization at the level of the gastroduodenal artery being encountered in only 1.5 % of the cases. Due to the high mortality risk, early detection and optimal treatment are required. We stress the importance of ultrasonography as a primary method of detection as well as the role of contrast-enhanced ultrasound in characterization of visceral aneurysms. Due to its noninvasive nature, the examination could be used for follow-up after therapeutic procedures or in cases were a curative intervention is not possible.
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Affiliation(s)
- Radu Badea
- Department of Ultrasonography, "Octavian Fodor" Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Liliana Chiorean
- Department of Radiology and Computed Tomography, "Octavian Fodor" Institute of Gastroenterology and Hepatology, Str. Croitorilor 19-21, 400 162, Cluj-Napoca, Romania.
| | - Olimpia Chira
- Department of Gastroenterology, "Octavian Fodor" Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cosmin Caraiani
- Department of Radiology and Computed Tomography, "Octavian Fodor" Institute of Gastroenterology and Hepatology, Str. Croitorilor 19-21, 400 162, Cluj-Napoca, Romania
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Abstract
Peripheral arterial aneurysms are uncommon; for some aneurysm types, data are limited to case reports and small case series. There is no Level A evidence in most cases to determine the choice between open or endovascular intervention. The evolution of endovascular technology has vastly improved the armamentarium available to the vascular surgeon and interventionalists in the management of these rare and unusual aneurysms. The choice of operative approach will ultimately be determined on an individual basis, dependent on the patient risk factors, and aneurysm anatomy. After consideration, some aneurysms (femoral, subclavian, carotid and ECAA) fare better with an open first approach; renal, splenic and some visceral artery aneurysms do better with an endovascular first approach. In our practice PAAs are treated with an endovascular first approach. For these rare conditions, both open and endovascular therapy will continue to work in harmony to enhance and extend the capabilities of modern surgical management.
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Affiliation(s)
- Irwin V Mohan
- Westmead Hospital, University of Sydney Medical School, Sydney, NSW 2145, Australia.
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35
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Superior Mesenteric Artery Pseudoaneurysm. J Emerg Med 2013; 45:e21-2. [DOI: 10.1016/j.jemermed.2013.01.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Revised: 10/29/2012] [Accepted: 01/30/2013] [Indexed: 11/23/2022]
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36
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Jesinger RA, Thoreson AA, Lamba R. Abdominal and Pelvic Aneurysms and Pseudoaneurysms: Imaging Review with Clinical, Radiologic, and Treatment Correlation. Radiographics 2013; 33:E71-96. [DOI: 10.1148/rg.333115036] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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37
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Saito Y, Yoshizumi T, Harada N, Kayashima H, Yamasaki K, Sadanaga N, Matsuura H, Okadome K. Hepatic artery aneurysm in a patient with hepatitis C liver cirrhosis: report of a case. Clin J Gastroenterol 2013; 6:169-72. [PMID: 26181457 DOI: 10.1007/s12328-013-0372-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 02/18/2013] [Indexed: 11/28/2022]
Abstract
Visceral artery aneurysms are rare, with an incidence rate of only 0.01-0.2 % in routine autopsies, and hepatic artery aneurysms account for approximately 20 % of these aneurysms. Despite recent advances in therapeutic techniques and diagnostic tools, the management of visceral artery aneurysms remains clinically challenging. We report a case of hepatic artery aneurysm with liver cirrhosis due to hepatitis C in an 81-year-old woman. A computed tomography scan demonstrated a hepatic artery aneurysm 4.4 cm in diameter. She underwent successful aneurysmectomy with vascular anastomosis. A computed tomography scan on postoperative day 7 demonstrated patent hepatic artery. The patient was followed-up for 1 year after surgery and died owing to progressive liver failure. However, she did not show any hepatic artery problem such as hepatic arterial thrombosis or occlusion. We discuss the risk factors of atherosclerosis in patients with liver cirrhosis, and present an overview of the treatment of hepatic artery aneurysms.
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Affiliation(s)
- Yu Saito
- Department of Surgery, The University of Tokushima, Tokushima, 770-8501, Japan.,Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, 810-0001, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan. .,Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, 810-0001, Japan.
| | - Noboru Harada
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan.,Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, 810-0001, Japan
| | - Hiroto Kayashima
- Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, 810-0001, Japan
| | - Koji Yamasaki
- Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, 810-0001, Japan
| | - Noriaki Sadanaga
- Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, 810-0001, Japan
| | - Hiroshi Matsuura
- Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, 810-0001, Japan
| | - Kenichiro Okadome
- Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, 810-0001, Japan
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38
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Twine C, Wood A, Williams I. Surgical repair of a coeliac artery aneurysm. J Vasc Surg 2013; 57:848. [PMID: 23446127 DOI: 10.1016/j.jvs.2011.11.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 05/16/2011] [Accepted: 11/05/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Christopher Twine
- Department of Vascular Surgery, Cardiff Regional Vascular Unit, University Hospital of Wales, Cardiff, United Kingdom
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39
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Mitkov M, Al-Khatib WK, Zhou W. Concurrent treatment of acute pancreatitis and multiple visceral artery aneurysms using endovascular techniques. Vasc Endovascular Surg 2012; 46:283-6. [PMID: 22566183 DOI: 10.1177/1538574412440509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Multiple aneurysms involving the celiac axis are extremely rare. Celiac artery aneurysms account for only 4% of all visceral aneurysms with 40% having concomitant aneurysms such as gastroduodenal artery (GDA) aneurysms. Development of a GDA aneurysm is associated with pancreatitis. If a GDA aneurysm ruptures, traditional repair is through open surgical techniques with significant morbidity and mortality as up to 50% occur in the setting of chronic pancreatitis. However, a ruptured GDA aneurysm causing pancreatitis has not been described previously. We report a case of successful endovascular treatment of a ruptured GDA aneurysm and concomitant celiac artery aneurysm leading to the resolution of acute pancreatitis.
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Affiliation(s)
- Mario Mitkov
- Division of Vascular and Endovascular Surgery, Palo Alto VA Health System, Surgery, Stanford University, Stanford, CA 94305, USA
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40
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Arifi M. Percutaneous Treatment of a Large Celiac Artery Aneurysm Using a Stent Graft. Qatar Med J 2011. [DOI: 10.5339/qmj.2011.2.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Celiac trunk aneurysm is a rare finding. Most patients are symptomatic at the time of diagnosis but occasionally such aneurysms are detected incidentally during diagnostic imaging for other diseases. Since the anomaly was first described in 1745(1) fewer than 180 cases have been reported in the international medical literature.(2) Atherosclerotic aneurysms of the celiac artery (CAAs) comprise approximately 4–6% of all visceral aneurysms.(3–4) Early surgical intervention has reduced the rupture rate to 7% in recent years.(5) Early recognition and intervention are crucial because the operative mortality rate associated with ruptured celiac artery aneurysms is around 40%.(6) There are no absolute size criteria associated with significant rates of CAA rupture, but 2 cm appears to warrant intervention in most series.(7–8) Surgical reconstruction, surgical ligation, intraluminal embolization, thrombin injection and endovascular grafting have all been reported with success/9”11) We present a case of a 6.9 cm symptomatic celiac artery aneurysm treated successfully with endovascular stenting.
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Affiliation(s)
- M. Arifi
- Vascular Surgery Department, Tripoli Medical Center, Tripoli, Libya
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41
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Skipworth JRA, Morkane C, Raptis DA, Kennedy L, Johal K, Pendse D, Brennand DJ, Olde Damink S, Malago M, Shankar A, Imber C. Coil migration--a rare complication of endovascular exclusion of visceral artery pseudoaneurysms and aneurysms. Ann R Coll Surg Engl 2011; 93:e19-23. [PMID: 21944789 DOI: 10.1308/003588411x13008844298652] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION We describe a case of metallic, angiographic coil migration, following radiological exclusion of a gastroduodenal artery pseudoaneurysm secondary to chronic pancreatitis. PATIENTS AND METHODS A 55-year-old man presented to the out-patient clinic with chronic, intermittent, post-prandial, abdominal pain, associated with nausea, vomiting and weight loss. He was known to have chronic pancreatitis and liver disease secondary to alcohol abuse and previously underwent angiographic exclusion of a gastroduodenal artery pseudoaneurysm. During subsequent radiological and endoscopic investigation, an endovascular coil was discovered in the gastric pylorus, associated with ulceration and cavitation. This patient was managed conservatively and enterally fed via naso-jejunal catheter endoscopically placed past the site of the migrated coil. This patient is currently awaiting biliary bypass surgery for chronic pancreatitis, and definitive coil removal will occur concurrently. CONCLUSIONS Literature review reveals that this report is only the eighth to describe coil migration following embolisation of a visceral artery pseudoaneurysm or aneurysm. Endovascular embolisation of pseudoaneurysms and aneurysms is generally safe and effective. More common complications of visceral artery embolisation include rebleeding, pseudoaneurysm reformation and pancreatitis.
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Affiliation(s)
- J R A Skipworth
- Department of Hepatopancreaticobiliary Surgery, University College London Hospital, UK.
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42
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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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43
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Harris K, Chalhoub M, Koirala A. Gastroduodenal artery aneurysm rupture in hospitalized patients: An overlooked diagnosis. World J Gastrointest Surg 2010; 2:291-4. [PMID: 21160898 PMCID: PMC2999693 DOI: 10.4240/wjgs.v2.i9.291] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 09/15/2010] [Accepted: 09/22/2010] [Indexed: 02/06/2023] Open
Abstract
Gastroduodenal artery (GDA) aneurysm rupture is a rare serious condition. The diagnosis requires a high level of suspicion with specific attention to warning signs. Early diagnosis can prevent fatal outcomes. In this report, we describe a case of GDA aneurysm rupture presenting as recurrent syncope and atypical back and abdominal discomfort. The rupture manifested as hemorrhagic shock. The diagnosis was made by computed tomography of the abdomen which showed acute peritoneal and retroperitoneal bleeding. Angiographic intervention failed to coil the GDA and surgery with arterial ligation was the definitive treatment.
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Affiliation(s)
- Kassem Harris
- Kassem Harris, Michel Chalhoub, Pulmonary/Critical Care Department, Staten Island University Hospital, 475 Seaview Ave, Staten Island, New York, NY 10305, United States
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44
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Horton KM, Fishman EK. CT Angiography of the Mesenteric Circulation. Radiol Clin North Am 2010; 48:331-45, viii. [DOI: 10.1016/j.rcl.2010.02.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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45
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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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46
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Matsuno Y, Mori Y, Umeda Y, Imaizumi M, Takiya H. Surgical repair of true gastroduodenal artery aneurysm: a case report. Vasc Endovascular Surg 2009; 42:497-9. [PMID: 19000986 DOI: 10.1177/1538574408316916] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Gastroduodenal artery aneurysms are uncommon. The majority of them are false or pseudoaneurysms, often seen in the setting of inflammation, specifically with pancreatitis. True aneurysms of gastroduodenal artery are extremely rare. As risk for rupture is unrelated to size, any gastroduodenal artery aneurysm should be considered for definitive treatment once the diagnosis has been made. A successful case of surgical repair of true gastroduodenal artery aneurysm in a patient with liver cirrhosis is reported in this study.
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Affiliation(s)
- Yukihiro Matsuno
- Department of Cardiovascular Surgery, Gifu Prefectural General Medical Center, Gifu, Japan.
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47
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Peña Fernández E, de la Cruz Burgos R, Del Cerro González JV, Rebollo Polo M. [Spontaneous rupture of the spleen secondary to intrasplenic aneurysm]. RADIOLOGIA 2008; 49:424-6. [PMID: 18021673 DOI: 10.1016/s0033-8338(07)73813-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Spontaneous rupture of the spleen is an uncommon emergency that usually occurs in a spleen affected by hematologic, neoplastic, or infectious diseases or as a complication of acute or chronic pancreatitis. This condition requires early diagnosis and appropriate treatment. Intrasplenic aneurysms are rare and rupture of the spleen secondary to intrasplenic aneurysm is extremely rare. We present the imaging findings for a case of splenic rupture secondary to an intrasplenic aneurysm. The patient was treated by percutaneous embolization, with excellent results. We review the literature on this entity and its endovascular treatment.
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Affiliation(s)
- E Peña Fernández
- Servicio de Diagnóstico por Imagen, Fundación Hospital Alcorcón, Alcorcón, Madrid, España.
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48
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Raad E, Demaria R, Rouvière P, Prudhomme M, Frapier JM, Dauzat M, Albat B. Les anévrismes des artères digestives. À propos d'un cas clinique de localisation anévrismale multiple et revue de la littérature. ACTA ACUST UNITED AC 2007; 32:216-20. [PMID: 17658233 DOI: 10.1016/j.jmv.2007.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 06/13/2007] [Indexed: 11/29/2022]
Abstract
Visceral artery aneurysms constitute a rare vascular disease, with a risk of rupture associated to a high mortality. Often asymptomatic, they are discovered following a routine radiological examination. We present the case of a 71-year-old patient with multiple aneurysms involving the celiac trunk, the splenic artery, and the common hepatic artery. The surgical treatment consisted of an aortohepatic bypass using polytetrafluoroethylene prosthesis, after exclusion of all the aneurysms. The angiography and postoperative angioscan demonstrated the perfect patency of the prosthesis, totally excluding the aneurysms. Given the variety of presentations and the absence of precise predictive factors, there is no therapeutic consensus so far. Surgery is the first therapeutic choice. Endovascular treatment by angioembolization must be reserved for particular conditions. The purpose of this article is to propose the best therapeutic approach on the basis of evidence in the literature.
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Affiliation(s)
- E Raad
- Service de chirurgie cardiovasculaire, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 371, avenue du Doyen-G.-Giraud, 34295 Montpellier, France
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49
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Left Gastric Artery Aneurysm: Successful Embolization with Ethylene Vinyl Alcohol Copolymer (Onyx). Cardiovasc Intervent Radiol 2007; 31:418-21. [DOI: 10.1007/s00270-007-9119-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Horton KM, Smith C, Fishman EK. MDCT and 3D CT angiography of splanchnic artery aneurysms. AJR Am J Roentgenol 2007; 189:641-7. [PMID: 17715112 DOI: 10.2214/ajr.07.2210] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The purpose of this article is to review our experience with the use of MDCT and 3D imaging in the detection and management of patients with both symptomatic and asymptomatic splanchnic artery aneurysms. CONCLUSION Although splanchnic artery aneurysms are relatively rare, they are being diagnosed with increased frequency given the widespread availability of MDCT and 3D imaging capabilities. It is important that these aneurysms be diagnosed accurately because they can carry a high morbidity and mortality, even in asymptomatic patients.
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Affiliation(s)
- Karen M Horton
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N Caroline St., Rm. 3253, Baltimore, MD 21287, USA
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