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Dreksler H, Nagpal SK, Hajjar G, Roberts DJ. Successful surgical management of a suspected high-flow inferior mesenteric artery aneurysm in a patient with chronic celiac and superior mesenteric artery occlusions. J Vasc Surg Cases Innov Tech 2024; 10:101438. [PMID: 38445064 PMCID: PMC10912906 DOI: 10.1016/j.jvscit.2024.101438] [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: 11/04/2023] [Accepted: 01/11/2024] [Indexed: 03/07/2024] Open
Abstract
Inferior mesenteric artery (IMA) aneurysms account for approximately 1% of visceral artery aneurysms and can occur secondary to high flow because of occlusive disease in other mesenteric arteries. We describe the case of a 79-year-old man who presented with a 3.3-cm IMA aneurysm and chronic total occlusions of the celiac artery and superior mesenteric artery (SMA). After an unsuccessful attempt at endovascular SMA recanalization, he underwent an uncomplicated retrograde aorta to SMA bypass and antegrade aorta to IMA bypass. We propose that an aorta to IMA bypass after SMA revascularization is safe and effective to treat suspected high-flow IMA aneurysms.
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Affiliation(s)
- Hannah Dreksler
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Sudhir K. Nagpal
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - George Hajjar
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Derek J. Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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2
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Khatri S, Parikh R, Smith M, Friedman J. Endovascular management of colic artery pseudoaneurysm: A case report of successful intervention in a 59-year-old male with abdominal hematoma. Radiol Case Rep 2024; 19:449-454. [PMID: 38046917 PMCID: PMC10692486 DOI: 10.1016/j.radcr.2023.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
Visceral artery pseudoaneurysms, including inferior mesenteric artery pseudoaneurysms, are rare, occurring at an estimated incidence of 0.01%-0.2%. The literature reports only around 60 cases of inferior mesenteric pseudoaneurysm to date. The management of this condition lacks a consensus; nevertheless, coil embolization remains the preferred approach for stable patients. Here, we present a unique clinical scenario involving a 59-year-old male who underwent exploratory laparotomy for a retroperitoneal hematoma. Subsequently, he was diagnosed with an inferior mesenteric pseudoaneurysm, specifically affecting the left colic artery, and successfully managed using coil embolization.
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Affiliation(s)
| | | | - Matthew Smith
- Department of Radiology, Jamaica Hospital Medical Center, Queens, NY 11418, USA
| | - Joseph Friedman
- Department of Radiology, Jamaica Hospital Medical Center, Queens, NY 11418, USA
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3
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Christie O, Isaac N, Hanumaiah R. A unique proposed etiology for inferior mesenteric artery aneurysm: A case report. Radiol Case Rep 2022; 17:2047-2051. [PMID: 35450145 PMCID: PMC9018125 DOI: 10.1016/j.radcr.2022.03.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/13/2022] [Indexed: 11/18/2022] Open
Abstract
The etiology of large artery aneurysms has long been established as secondary to atherosclerotic disease and degenerative changes in the vessel walls. Less common, are aneurysms of the visceral arteries; the splanchnic and renal arteries. Rarer yet, are inferior mesenteric artery aneurysms, accounting for approximately 1% of visceral artery aneurysms. While causes range from inflammatory to congenital disease, a proposed etiology of proximal, solitary inferior mesenteric artery aneurysms, is correlated to the “jet disorder phenomenon,” first described in a 1990 case report by Sugrue, and Hederman. This paradigm states that aneurysm formation may occur secondary to celiac and superior mesenteric artery occlusion, causing increased, and turbulent arterial flow distally. We present a case that demonstrates a small inferior mesenteric artery aneurysm without findings of celiac or superior mesenteric artery stenosis or occlusion. This patient did, however, have a large thrombosed common hepatic artery aneurysm which may serve as an alternate cause of jet disorder phenomenon. The findings in this case offers support for focused screening of proximal arterial vasculature when an inferior mesenteric artery aneurysm is encountered.
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Affiliation(s)
- Omari Christie
- SUNY Upstate University Hospital, 750 E Adams St. Syracuse, NY 13210
- Corresponding author.
| | - Naomi Isaac
- Touro College of Osteopathic Medicine, 60 Prospect Ave, Middletown, NY 10940
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4
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Yamashita Y, Nakagawa S, Sakamoto K, Kitamoto S, Horii T. A Case of Thrombosed Inferior Mesenteric Artery Aneurysm Concomitant with Abdominal Aortic Aneurysm Treated by Endovascular Aneurysm Repair. Ann Vasc Dis 2021; 14:177-180. [PMID: 34239646 PMCID: PMC8241543 DOI: 10.3400/avd.cr.20-00171] [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: 12/17/2020] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
A 71-year-old man was referred to our hospital under a diagnosis of abdominal aortic aneurysm (AAA). The past history of the patient included a sigmoid colectomy at 64 years old for an ischemic colitis. The maximum diameter of AAA was still 45 mm, and the inferior mesenteric artery (IMA) was aneurysmal and was 30 mm in diameter and thrombosed. The growth rate in the diameter of IMA aneurysm was 5 mm per year for the last 3 years. The patient successfully underwent endovascular aneurysm repair (EVAR), and the postoperative course was good. At 5 years after EVAR, computed tomography revealed a decrease in the diameter of both aneurysms.
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Affiliation(s)
- Yoichi Yamashita
- Department of Cardiovascular Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, Japan
| | - Sayako Nakagawa
- Shikoku Medical Center for Children and Adults, Zentsuji, Kagawa, Japan
| | - Kosuke Sakamoto
- Department of Cardiovascular Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, Japan
| | - Shohei Kitamoto
- Department of Cardiovascular Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, Japan
| | - Taiko Horii
- Department of Cardiovascular Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, Japan
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5
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Successful Conservative Management of Inferior Mesenteric Artery Aneurysm with Arteriovenous Fistula: A Case Report. Ann Vasc Surg 2020; 64:410.e11-410.e15. [DOI: 10.1016/j.avsg.2019.10.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 09/05/2019] [Accepted: 10/02/2019] [Indexed: 01/10/2023]
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6
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Current management strategies for visceral artery aneurysms: an overview. Surg Today 2019; 50:38-49. [PMID: 31620866 PMCID: PMC6949316 DOI: 10.1007/s00595-019-01898-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 09/28/2019] [Indexed: 12/16/2022]
Abstract
Visceral artery aneurysms (VAAs) are rare and affect the celiac artery, superior mesenteric artery, and inferior mesenteric artery, and their branches. The natural history of VAAs is not well understood as they are often asymptomatic and found incidentally; however, they carry a risk of rupture that can result in death from hemorrhage in the peritoneal cavity, retroperitoneal space, or gastrointestinal tract. Recent advances in imaging technology and its availability allow us to diagnose all types of VAA. VAAs can be treated by open surgery, laparoscopic surgery, endovascular therapy, or a hybrid approach. However, there are still no specific indications for the treatment of VAAs, and the best strategy depends on the anatomical location of the aneurysm as well as the clinical presentation of the patient. This article reviews the literature on the etiology, clinical features, diagnosis, and anatomic characteristics of each type of VAA and discusses the current options for their treatment and management.
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7
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Tan C, Reul R. Inferior mesenteric artery aneurysm in the setting of celiac and superior mesenteric artery occlusion. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:197-199. [PMID: 31193925 PMCID: PMC6545348 DOI: 10.1016/j.jvscit.2018.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/07/2018] [Indexed: 11/25/2022]
Abstract
Inferior mesenteric artery (IMA) aneurysm is a rare type of visceral aneurysm. We present the case of a 77-year-old woman with an IMA aneurysm in the setting of chronic complete occlusion of the origins of her celiac artery and superior mesenteric artery. The patient was managed successfully with surgical excision of the IMA aneurysm with an end-to-side anastomosis of the IMA to the left common iliac artery. The case report is followed by a discussion based on a literature review of the few previously reported occurrences of IMA aneurysm.
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Affiliation(s)
- Corinne Tan
- Division of Cardiothoracic Surgery, Baylor College of Medicine/Texas Heart Institute, Houston, TX, USA
| | - Ross Reul
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
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8
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Rahman Q, Naidu SG, Chong BW, Stone WM. Percutaneous Embolization of an Inferior Mesenteric Artery Aneurysm in a Patient With Type IV Ehlers-Danlos Syndrome. Vasc Endovascular Surg 2019; 53:343-347. [DOI: 10.1177/1538574418824185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ehlers-Danlos syndrome (EDS) refers to a group of genetic disorders involving the connective tissues. Type IV EDS impairs type III collagen that is responsible for vessel integrity. Patients with type IV EDS are susceptible to vascular and visceral complications, including aortic aneurysms, pseudoaneurysms, dissections, and spontaneous rupture of internal organs. Treating aneurysms with open surgery versus endovascular techniques each carry a unique risk-to-benefit ratio that must be applied to each individual carefully. We present a patient with type IV EDS who presented with a rapidly growing inferior mesenteric artery aneurysm. The patient was treated with a percutaneous endovascular technique using coils and n-butyl-cyanoacrylate glue.
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Affiliation(s)
- Qasim Rahman
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Sailen G. Naidu
- Division of Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Brian W. Chong
- Division of Neurointerventional Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - William M. Stone
- Division of Vascular Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
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9
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Jesus-Silva SGD, Moraes-Silva MAD, Rieira BC, Nasser F, Cardoso RS. Short- and long-term follow-up after transarterial embolization of a giant inferior mesenteric artery aneurysm. J Vasc Surg Cases Innov Tech 2018; 4:315-318. [PMID: 30761376 PMCID: PMC6298940 DOI: 10.1016/j.jvscit.2018.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/24/2018] [Indexed: 11/13/2022] Open
Abstract
Among the cases of visceral artery aneurysms, those that involve the inferior mesenteric artery are the most uncommon, with a prevalence of <1%. This study reports a giant symptomatic inferior mesenteric artery aneurysm and its endovascular treatment by means of percutaneous embolization with the implantation of pushable coils. After complete occlusion of the aneurysm, adequate maintenance of arterial supply of the left colon and resolution of the symptoms were observed. In the 2-year follow-up, a significant reduction in the aneurysm's volume and maintenance of the clinical condition were observed.
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Affiliation(s)
| | | | - Bruno Cardoso Rieira
- Department of Vascular and Endovascular Surgery, Hospital de Clínicas de Itajuba, Itajubá/MG, Brazil
| | - Felipe Nasser
- Department of Interventional Radiology, Albert Einstein Israeli Hospital, São Paulo, Brazil
| | - Rodolfo Souza Cardoso
- Department of Vascular and Endovascular Surgery, Hospital de Clínicas de Itajuba, Itajubá/MG, Brazil
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10
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Pisavadia B, Hanif M, Rana K, Budhoo M, Zaman S. A rare case of haemorrhagic shock secondary to spontaneous rupture of a branch of the left colic artery and the right gastric artery. Ann R Coll Surg Engl 2018; 100:e125-e127. [PMID: 29658342 DOI: 10.1308/rcsann.2018.0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spontaneous splanchnic artery rupture is associated with up to 70% mortality. Affected vessels are often aneurysmal, secondary to atherosclerosis. We report, to our knowledge, the only case of spontaneous rupture of a branch of the left colic artery and the right gastric artery, possibly secondary to vasculitis.
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Affiliation(s)
- B Pisavadia
- Sandwell General Hospital , Lyndon, West Bromwich , UK
| | - M Hanif
- Sandwell General Hospital , Lyndon, West Bromwich , UK
| | - K Rana
- Sandwell General Hospital , Lyndon, West Bromwich , UK
| | - M Budhoo
- Sandwell General Hospital , Lyndon, West Bromwich , UK
| | - S Zaman
- Sandwell General Hospital , Lyndon, West Bromwich , UK
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11
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Inferior Mesenteric Artery Aneurysm Complicated With Occluded Celiac and Superior Mesenteric Artery After Replacement of Thoracoabdominal Aorta for Chronic Dissected Thoracoabdominal Aortic Aneurysm. Ann Vasc Surg 2017; 44:420.e7-420.e10. [PMID: 28479427 DOI: 10.1016/j.avsg.2017.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 02/12/2017] [Accepted: 04/25/2017] [Indexed: 11/24/2022]
Abstract
We report a case of inferior mesenteric artery aneurysm (IMAA) after the replacement of the thoracoabdominal aorta for a chronic dissected thoracoabdominal aortic aneurysm in which the celiac artery and superior mesenteric artery were occluded. We performed the resection of the IMAA and the revascularization of the superior mesenteric artery, inferior mesenteric artery, and meandering artery. The patient's postoperative course was uneventful, without bowel ischemia. From the findings of intraoperative flow measurement of the visceral arteries, revascularization of the superior mesenteric artery was judged to be appropriate in this situation.
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12
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Hansraj N, Hamdi A, Wise ES, DiChiacchio L, Sarkar R, Toursavadkohi S. Open and Endovascular Management of Inferior Mesenteric Artery Aneurysms: A Report of Two Cases. Ann Vasc Surg 2017; 43:316.e9-316.e14. [PMID: 28479424 DOI: 10.1016/j.avsg.2017.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 04/12/2017] [Accepted: 04/12/2017] [Indexed: 11/28/2022]
Abstract
Inferior mesenteric artery (IMA) aneurysms are a rare entity, attributing to 1% of Splanchnic aneurysms (Edogawa S, Shibuya T, Kurose K et al. Inferior mesenteric artery aneurysm: case report and literature review. Ann Vasc Dis 2013;6:98-101), often found incidentally on evaluation for other intra-abdominal pathologies. Similar to other visceral arterial aneurysms, there is an estimated 20-50% risk of potentially fatal rupture and repair is generally recommended. We report 2 patients with IMA aneurysms, using them as cases to illustrate feasibility of both open and endovascular management options. Patient 1 is a 69-year-old male with bilateral claudication found to have an asymptomatic 20-mm IMA aneurysm. This patient underwent aortobifemoral bypass with branch polytetrafluoroethylene graft to distal IMA after excision of IMA aneurysm. Patient 2 is a 32-year-old male who underwent an ex vivo renal artery aneurysm repair and was noted on routine follow-up to have an incidental saccular 1.5-cm IMA aneurysm for which he underwent endovascular coil embolization. Both patients had an unremarkable postoperative course with a notable absence of stigmata of bowel ischemia.
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Affiliation(s)
- Natasha Hansraj
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
| | - Abdulrahman Hamdi
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Eric S Wise
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Laura DiChiacchio
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Rajabrata Sarkar
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Shahab Toursavadkohi
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
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13
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Radak D, Sevkovic M, Kecmanovic V, Tanaskovic S. Rare case of inferior mesenteric artery aneurysm with associated pelvic arteriovenous malformation. ANZ J Surg 2016; 88:1202-1203. [PMID: 27723256 DOI: 10.1111/ans.13788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/09/2016] [Accepted: 08/19/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Djordje Radak
- Vascular Surgery Clinic, 'Dedinje' Cardiovascular Institute, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milorad Sevkovic
- Vascular Surgery Clinic, 'Dedinje' Cardiovascular Institute, Belgrade, Serbia
| | | | - Slobodan Tanaskovic
- Vascular Surgery Clinic, 'Dedinje' Cardiovascular Institute, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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14
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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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15
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Abstract
Visceral artery aneurysms are rare entities involving the celiac, superior mesenteric or inferior mesenteric arteries and their branches. While the natural history of these aneurysms is not well known as many are found incidentally, a definite risk of rupture and subsequent mortality has been demonstrated. There are several endovascular methods that an operator may choose to treat visceral artery aneurysms, and selection of the appropriate technique depends on the type and size of aneurysm and the anatomy of the affected artery. It is the aim of this paper to describe the indications, technical considerations and endovascular methods of treatment of visceral artery aneurysms and pseudoaneurysms. The following techniques of angiographic intervention are presented and discussed: isolation, covered stents, coil packing, liquid embolic agents and percutaneous thrombin injection. Where appropriate, individual aneurysm and artery specific treatment considerations are emphasized. To guide and assist practice, a suggested treatment algorithm is presented.
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Affiliation(s)
- Jeanette H Hemp
- Department of Radiology, University of Virginia Health System, Charlottesville, VA
| | - Saher S Sabri
- Department of Radiology, University of Virginia Health System, Charlottesville, VA.
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16
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Mycotic Inferior Mesenteric Artery Aneurysm Secondary to Native Valve Endocarditis Caused by Coagulase-Negative Staphylococcus. Ann Vasc Surg 2014; 28:1312.e13-5. [DOI: 10.1016/j.avsg.2013.08.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 08/19/2013] [Indexed: 11/19/2022]
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17
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Abstract
Visceral artery aneurysms (VAA) and pseudoaneurysms (VAPA) can be life-threatening conditions with high incidence of rupture and hemorrhage. Greater availability and increased use of advanced imaging technology has led to the increased incidental detection of asymptomatic visceral aneurysms. In addition, increased percutaneous endovascular interventions have raised the incidence of iatrogenic pseudoaneurysms. Due to this, both VAA and VAPA have become an increasingly frequent diagnosis confronting the vascular surgeon. Over the past decade, there has been steady increase in the utilization of minimally invasive, non-operative interventions, for vascular occlusive and aneurysmal disease. All VAA and VAPA can technically be fixed by endovascular techniques but that does not mean they should. These catheter-based techniques constitute an excellent approach in the elective setting, particularly in patients who are poor surgical candidates due to their comorbidities or who present a hostile abdomen. However, in the emergent setting it may carry a higher morbidity and mortality. We review the literature about open and endovascular approach for the treatment of VAA and VAPA both in the elective and emergent setting.
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Affiliation(s)
- Alfredo C Cordova
- Department of Surgery, Memorial Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Pawtucket, Rhode Island, USA ; Department of Vascular Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Bauer E Sumpio
- Department of Vascular Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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