1
|
Lopera-Valle JS, Muñoz-Caicedo B, Muñoz Durán JA. Multiple Aneurysms or Pseudoaneurysms of the Gastroepiploic Artery: An Anecdotal Cause of Hemoperitoneum. Cureus 2024; 16:e56598. [PMID: 38646401 PMCID: PMC11031620 DOI: 10.7759/cureus.56598] [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] [Accepted: 03/08/2024] [Indexed: 04/23/2024] Open
Abstract
Gastroepiploic artery aneurysms and pseudoaneurysms pose diagnostic challenges due to their rarity and overlapping radiological features. This case report presents an 82-year-old woman with sudden-onset severe abdominal pain with computed tomography revealing hemoperitoneum and saccular dilations adjacent to the stomach's greater curvature, suggestive of vascular pathology. Selective abdominal arteriography confirmed three saccular dilatations in the gastroepiploic artery, which were managed successfully with coil embolization. The discussion emphasizes the importance of accurate diagnosis, distinguishing between aneurysms and pseudoaneurysms, and prompt intervention to mitigate the risk of hemorrhagic complications of either of them. The case underscores the significance of endovascular management in such rare and critical scenarios.
Collapse
|
2
|
Goto T, Fujimura H, Shintani T, Shibuya T, Miyagawa S. Use of selective visceral angiography in surgical strategy planning for celiac artery aneurysm in the celiacomesenteric trunk. J Cardiothorac Surg 2024; 19:11. [PMID: 38243244 PMCID: PMC10797990 DOI: 10.1186/s13019-024-02483-7] [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: 05/30/2023] [Accepted: 01/14/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The celiacomesenteric trunk (CMT) is a common duct of the celiac artery (CA) and the superior mesenteric artery originating from the aorta, which is an uncommon anatomical variant of visceral artery circulation. Because of the variety of visceral circulation in those with CMT, the visceral circulation associated with each branch should be evaluated prior to surgical treatment of visceral artery aneurysm in the CMT. CASE PRESENTATION A 64-year-old woman was diagnosed with a CA aneurysm in the CMT. Aneurysmectomy of the aneurysm was performed successfully. On preoperative selective visceral angiography, the CA was seen to bifurcate into the common hepatic and splenic artery. The left gastric artery was directly isolated from the aorta and perfused to the common hepatic and splenic artery through collateral circulation. These findings showed that celiac artery embolization is anatomically feasible, even in cases of celiac artery aneurysm rupture. CONCLUSIONS Selective visceral angiography can contribute to surgical strategy planning for CA aneurysm with CMT.
Collapse
Affiliation(s)
- Takasumi Goto
- Department of Cardiovascular Surgery, Toyonaka Municipal Hospital, 4-14-1, Shibahara, Toyonaka, Osaka, 560-8565, Japan.
| | - Hironobu Fujimura
- Department of Cardiovascular Surgery, Toyonaka Municipal Hospital, 4-14-1, Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Takashi Shintani
- Department of Cardiovascular Surgery, Nippon Life Hospital, Osaka, Japan
| | - Takashi Shibuya
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
3
|
Hamamoto K, Chiba E, Oyama-Manabe N, Yuzawa H, Edo H, Suyama Y, Shinmoto H. Ultra-short Echo-time MR Angiography Combined with a Modified Signal Targeting Alternating Radio Frequency with Asymmetric Inversion Slabs Technique to Assess Visceral Artery Aneurysm after Coil Embolization. Magn Reson Med Sci 2024; 23:110-121. [PMID: 36384909 PMCID: PMC10838713 DOI: 10.2463/mrms.tn.2022-0063] [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: 05/16/2022] [Accepted: 09/25/2022] [Indexed: 01/05/2024] Open
Abstract
Contrast-enhanced CT and MR angiography are widely used for follow-up of visceral artery aneurysms after coil embolization. However, potential adverse reactions to contrast agents and image deterioration due to susceptibility artifacts from the coils are major drawbacks of these modalities. Herein, we introduced a novel non-contrast-enhanced MR angiography technique using ultra-short TE combined with a modified signal targeting alternating radio frequency with asymmetric inversion slabs, which could provide a serial hemodynamic vascular image with fewer susceptibility artifacts for follow-up after coil embolization.
Collapse
Affiliation(s)
- Kohei Hamamoto
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Emiko Chiba
- Department of Radiology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Hironao Yuzawa
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Hiromi Edo
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yohsuke Suyama
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hiroshi Shinmoto
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| |
Collapse
|
4
|
Shimohira M, Kawai T, Ohta K. An Update on Embolization for Pulmonary Arteriovenous Malformations. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:56-63. [PMID: 37485484 PMCID: PMC10359166 DOI: 10.22575/interventionalradiology.2021-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/26/2022] [Indexed: 07/25/2023]
Abstract
Pulmonary arteriovenous malformations are abnormal connections between a pulmonary artery and a pulmonary vein that can lead to ischemic stroke and brain abscess due to right-to-left shunting of blood. Embolization is currently considered the first treatment option for pulmonary arteriovenous malformations owing to its minimal invasiveness. This review updates the indications and techniques for the embolization of pulmonary arteriovenous malformations and determines the persistence of pulmonary arteriovenous malformations following embolization based on the most recent literature.
Collapse
Affiliation(s)
- Masashi Shimohira
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Tatsuya Kawai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Kengo Ohta
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Japan
| |
Collapse
|
5
|
Trehub Y, Vasiliev O, Malovanna A. Spontaneous cessation of postpancreatectomy hemorrhage in a patient with celiac artery stenosis. Radiol Case Rep 2022; 17:3142-3146. [PMID: 35801121 PMCID: PMC9253043 DOI: 10.1016/j.radcr.2022.05.066] [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: 03/17/2022] [Revised: 05/22/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
Abstract
Postpancreatectomy hemorrhage (PPH) is a severe complication of pancreatic surgery. This condition often develops on the background of pancreatic fistula. In our report, we demonstrate an unusual case of spontaneous cessation of severe postpancreatectomy common hepatic artery (СHA) hemorrhage after distal pancreatectomy in a patient with celiac artery stenosis (CAS). A 64-year-old male diagnosed with pancreatic tail tumor underwent extended distal pancreatectomy. He developed pancreatic fistula and was discharged with an abdominal drain, and was readmitted with severe postpancreatectomy hemorrhage from a pseudoaneurysm of the CHA. The bleeding stopped spontaneously due to CHA thrombosis. The patient developed no ischemic symptoms. Spontaneous severe postpancreatectomy hemorrhage cessation is an extremely rare phenomenon. Vascular anomalies must be considered when attempting interventional radiology treatment. CHA probably may be sacrificed with no ischemic consequences in case of severe hemorrhage in patients with CAS.
Collapse
|
6
|
Takahashi K, Ohyama H, Mikata R, Nagashima H, Ohno I, Takiguchi Y, Kato N. Intraperitoneal bleeding from the right gastroepiploic artery by endoscopic ultrasonography: a case report. J Rural Med 2022; 17:184-188. [PMID: 35847751 PMCID: PMC9263947 DOI: 10.2185/jrm.2022-002] [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: 01/17/2022] [Accepted: 03/29/2022] [Indexed: 11/27/2022] Open
Abstract
Objective: To describe the case of a patient with intraperitoneal bleeding
from the gastroepiploic artery by endoscopic ultrasound who was successfully treated with
transcatheter arterial coil embolization. Patient and Methods: An 87-year-old man was referred to our hospital for
examination of a gallbladder tumor. Endoscopic ultrasonography was performed using an
oblique-view echoendoscope. After the endoscopic ultrasound, the patient went into shock.
Computed tomography revealed a huge intraperitoneal hematoma and an aneurysm in the right
gastroepiploic artery that were not seen on previous computed tomography images. Thus,
urgent catheter angiography was performed, which showed a pseudoaneurysm of the right
gastroepiploic artery and extravasation of the contrast medium from the
pseudoaneurysm. Results: Transcatheter arterial coil embolization was subsequently
performed, and the bleeding stopped. Thereafter, his hemodynamics stabilized and his
general condition improved. The patient was discharged 22 days post-treatment with an
uneventful course. Conclusion: Observation-only endoscopic ultrasound without invasive
procedures can cause intraperitoneal bleeding due to a ruptured splanchnic artery. Thus,
endoscopic ultrasonography should be performed more carefully in elderly patients.
Collapse
Affiliation(s)
- Koji Takahashi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
| | - Hiroshi Ohyama
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
| | - Rintaro Mikata
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
| | - Hiroki Nagashima
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
| | - Izumi Ohno
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
| | - Yuichi Takiguchi
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
| |
Collapse
|
7
|
Venturini M, Piacentino F, Coppola A, Bettoni V, Macchi E, De Marchi G, Curti M, Ossola C, Marra P, Palmisano A, Cappelli A, Basile A, Golfieri R, Cobelli FD, Piffaretti G, Tozzi M, Carcano G, Fontana F. Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives. J Clin Med 2021; 10:2520. [PMID: 34200171 PMCID: PMC8201262 DOI: 10.3390/jcm10112520] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 12/24/2022] Open
Abstract
Visceral artery aneurysms (VAAs) are rare, usually asymptomatic and incidentally discovered during a routine radiological examination. Shared guidelines suggest their treatment in the following conditions: VAAs with diameter larger than 2 cm, or 3 times exceeding the target artery; VAAs with a progressive growth of at least 0.5 cm per year; symptomatic or ruptured VAAs. Endovascular treatment, less burdened by morbidity and mortality than surgery, is generally the preferred option. Selection of the best strategy depends on the visceral artery involved, aneurysm characteristics, the clinical scenario and the operator's experience. Tortuosity of VAAs almost always makes embolization the only technically feasible option. The present narrative review reports state of the art and new perspectives on the main endovascular and other interventional options in the treatment of VAAs. Embolization techniques and materials, use of covered and flow-diverting stents and percutaneous approaches are accurately analyzed based on the current literature. Visceral artery-related considerations and targeted approaches are also provided and discussed.
Collapse
Affiliation(s)
- Massimo Venturini
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.P.); (A.C.); (V.B.); (E.M.); (G.D.M.); (F.F.)
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; (M.C.); (C.O.); (G.P.); (M.T.); (G.C.)
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.P.); (A.C.); (V.B.); (E.M.); (G.D.M.); (F.F.)
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.P.); (A.C.); (V.B.); (E.M.); (G.D.M.); (F.F.)
| | - Valeria Bettoni
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.P.); (A.C.); (V.B.); (E.M.); (G.D.M.); (F.F.)
| | - Edoardo Macchi
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.P.); (A.C.); (V.B.); (E.M.); (G.D.M.); (F.F.)
| | - Giuseppe De Marchi
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.P.); (A.C.); (V.B.); (E.M.); (G.D.M.); (F.F.)
| | - Marco Curti
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; (M.C.); (C.O.); (G.P.); (M.T.); (G.C.)
| | - Christian Ossola
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; (M.C.); (C.O.); (G.P.); (M.T.); (G.C.)
| | - Paolo Marra
- Department of Diagnostic Radiology, Giovanni XXIII Hospital, Milano-Bicocca University, 24127 Bergamo, Italy;
| | - Anna Palmisano
- Department of Radiology, IRCCS San Raffaele Scientific Institute, San Raffaele School of Medicine Vita-Salute University, 20132 Milan, Italy; (A.P.); (F.D.C.)
| | - Alberta Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.C.); (R.G.)
| | - Antonio Basile
- Department of Medical and Surgical Sciences and Advanced Technologies, Radiodiagnostic and Radiotherapy Unit, University Hospital “Policlinico-Vittorio Emanuele”, 95123 Catania, Italy;
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.C.); (R.G.)
| | - Francesco De Cobelli
- Department of Radiology, IRCCS San Raffaele Scientific Institute, San Raffaele School of Medicine Vita-Salute University, 20132 Milan, Italy; (A.P.); (F.D.C.)
| | - Gabriele Piffaretti
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; (M.C.); (C.O.); (G.P.); (M.T.); (G.C.)
- Vascular Surgery Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
| | - Matteo Tozzi
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; (M.C.); (C.O.); (G.P.); (M.T.); (G.C.)
- Vascular Surgery Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
| | - Giulio Carcano
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; (M.C.); (C.O.); (G.P.); (M.T.); (G.C.)
- Department of General, Emergency and Transplants Surgery, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.P.); (A.C.); (V.B.); (E.M.); (G.D.M.); (F.F.)
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; (M.C.); (C.O.); (G.P.); (M.T.); (G.C.)
| |
Collapse
|
8
|
Panagrosso M, De Gregorio C, Peluso A, Venetucci P, Buono G, Bracale UM. Double-Microcatheter Technique through Tortuous Anatomy for Coil Embolization of a Saccular $plenic Aneurysm: a Technical Report. Transl Med UniSa 2020; 21:31-34. [PMID: 32123679 PMCID: PMC7039270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We report on a case of an asymptomatic splenic artery aneurysm (SAA) with a large neck in a 53-year-old female with an extreme vessel tortuosity which was treated with a Double Microcatheter Technique. This endovascular procedure consists of embolization of the aneurysm using detachable coils with no application of any glue, stent or balloon. At the end of procedure, no complications occurred. At the three-month follow-up an MRI showed the aneurysm's complete exclusion and patency of the splenic artery.
Collapse
Affiliation(s)
- M Panagrosso
- Department of Public Health, Unit of Vascular Surgery, University Federico II of Naples, Italy
| | - C De Gregorio
- Department of Public Health, Unit of Vascular Surgery, University Federico II of Naples, Italy
| | - A Peluso
- Department of Public Health, Unit of Vascular Surgery, University Federico II of Naples, Italy
| | - P Venetucci
- Department of Radiology, University Federico II of Naples, Italy
| | - G Buono
- Department of Radiology, University Federico II of Naples, Italy
| | - UM Bracale
- Department of Public Health, Unit of Vascular Surgery, University Federico II of Naples, Italy
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
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]
|
11
|
Kuruma S, Kikuyama M, Kamisawa T, Chiba K. Hyper-dense fluid on plain computed tomography may reveal a ruptured aneurysm in patients with median arcuate ligament syndrome. Clin J Gastroenterol 2019; 12:473-478. [PMID: 30997671 DOI: 10.1007/s12328-019-00968-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 03/16/2019] [Indexed: 11/26/2022]
Abstract
Rupture of abdominal aneurysms associated with median arcuate ligament syndrome (MALS) is a serious condition and requires accurate diagnosis in a clinical setting. We examined three patients with this condition: two women aged 45 and 71 years, and a 61-year-old man. They complained of abdominal pain and had fluid collection around the duodenum. Plain computed tomography (CT) of the fluid collection revealed hyper density, which suggests the presence of blood. Moreover, contrast-enhanced CT revealed aneurysms in the pancreatic head area. Angiography revealed aneurysms of the branches of the gastroepiploic artery, which were treated by endovascular embolization in all patients. Thus, patients with abdominal pain and high-density fluid collection around the duodenum on plain CT may suffer from hemorrhage following rupture of MALS-associated aneurysms.
Collapse
Affiliation(s)
- Sawako Kuruma
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
| | - Masataka Kikuyama
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Terumi Kamisawa
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Kazuro Chiba
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| |
Collapse
|
12
|
Wojtaszek M, Lamparski K, Wnuk E, Ostrowski T, Maciąg R, Rix T, Maj E, Milczarek K, Korzeniowski K, Rowiński O. Selective occlusion of splenic artery aneurysms with the coil packing technique: the impact of packing density on aneurysm reperfusion correlated between contrast-enhanced MR angiography and digital subtraction angiography. Radiol Med 2019; 124:450-459. [PMID: 30712163 DOI: 10.1007/s11547-019-00993-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 01/23/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim was to evaluate the relationship between coil packing densities after splenic artery aneurysm (SAA) treatment using detachable microcoils and rates of SAA reperfusion and to suggest a post-treatment surveillance protocol using contrast-enhanced MRA. MATERIALS AND METHODS Evaluated were 16 patients (4 men; mean age 46.7), who underwent true SAA embolization using detachable microcoils (Concerto, Medtronic). SAAs were treated by selective coil packing (CP) or stent-assisted coil exclusion (SAC). Contrast-enhanced magnetic resonance angiography (CE-MRA) and digital subtraction angiography (DSA) were performed at 3 months post-procedure and correlated. RESULTS Primary CP was used in 13 patients, while SAC was used in three patients. On follow-up, complete aneurysm occlusion was seen in seven patients (43.8%). Sac reperfusion occurred in nine patients (56.2%) and was demonstrated in all CE-MRA and six DSA studies. Mean aneurysm packing density was 20.10 ± 8.05% for the CP group and 32.90 ± 11.95% for the SAC group (p = 0.038). There was a significant difference in the incidence of aneurysm sac reperfusion on CE-MRA study between CP and SAC (9 vs. 0). No sac reperfusion was seen in aneurysms with packing densities ≥ 29%, irrespective of either embolization method. CONCLUSION Favorable midterm results for coil packing of SAAs seem to depend on the coil packing density with a coil volume approximately a quarter of the aneurysm volume being most effective. Follow-up should involve the use of CE-MRA as this modality has been shown to be superior over DSA in detecting aneurysm reperfusion and coil compaction. LEVEL OF EVIDENCE Level IV, therapeutic study.
Collapse
Affiliation(s)
- Mikołaj Wojtaszek
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland. .,Vascular Unit, Kent & Canterbury Hospital, East Kent Hospital University NHS Trust, Canterbury, Kent, CT1 3NG, UK.
| | - Krzysztof Lamparski
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| | - Emilia Wnuk
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| | - Tomasz Ostrowski
- Department of General and Endocrine Surgery, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| | - Rafał Maciąg
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| | - Thomas Rix
- Vascular Unit, Kent & Canterbury Hospital, East Kent Hospital University NHS Trust, Canterbury, Kent, CT1 3NG, UK
| | - Edyta Maj
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| | - Krzysztof Milczarek
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| | - Krzysztof Korzeniowski
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| | - Olgierd Rowiński
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| |
Collapse
|
13
|
Ishimine T, Tengan T, Nakasu A, Takara H. Successful transcatheter arterial embolization of a ruptured right gastroepiploic artery aneurysm: A case report. Int J Surg Case Rep 2018; 51:158-160. [PMID: 30172054 PMCID: PMC6122313 DOI: 10.1016/j.ijscr.2018.08.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/18/2018] [Accepted: 08/20/2018] [Indexed: 11/23/2022] Open
Abstract
GEAAs are extremely rare. We describe a case of a ruptured right GEAA treated by TAE. An elderly woman with abdominal pain was diagnosed as having a ruptured right GEAA. The patient was at high risk for surgery so we performed TAE for the ruptured GEAA. The patient had an uneventful recovery and was discharged 10 days after TAE.
Background Gastroepiploic artery aneurysms (GEAAs) are extremely rare. Ruptured GEAAs are related to high mortality and often treated by open surgery. We describe a case of a ruptured right GEAA that was successfully treated by transcatheter arterial embolization (TAE). Presentation of case An 80-year-old woman presented to the emergency department with sudden abdominal pain. We diagnosed her as having a ruptured right GEAA based on the contrast-enhanced computed tomography finding. We performed TAE for the GEAA after resuscitation. The patient had an uneventful recovery and was discharged 10 days after TAE. Discussion A ruptured GEAA causes high mortality; thus, immediate and adequate treatment is mandatory. Previously, many cases of successful surgical resections of ruptured GEAAs have been reported. In our case, we decided that the patient was not suitable for surgery because of her advanced age and bronchiectasis; therefore, we performed TAE and had a good outcome. Conclusion In patients at high risk for surgery, TAE can be an effective treatment for a ruptured GEAA.
Collapse
Affiliation(s)
- Tohru Ishimine
- Department of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, 281, Miyazato, Uruma-shi, Okinawa 904-2293, Japan.
| | - Toshiho Tengan
- Department of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, 281, Miyazato, Uruma-shi, Okinawa 904-2293, Japan
| | - Akio Nakasu
- Department of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, 281, Miyazato, Uruma-shi, Okinawa 904-2293, Japan
| | - Hiroaki Takara
- Department of Radiology, Okinawa Prefectural Chubu Hospital, 281, Miyazato, Uruma-shi, Okinawa 904-2293, Japan
| |
Collapse
|
14
|
Time-resolved magnetic resonance angiography as a follow-up method for visceral artery aneurysm treated with coil-embolisation. Pol J Radiol 2018; 83:e137-e142. [PMID: 30038691 PMCID: PMC6047089 DOI: 10.5114/pjr.2018.75622] [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: 07/19/2017] [Accepted: 11/29/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study is to assess the feasibility and usefulness of time-resolved magnetic resonance angiography (TR-MRA) for follow-up of visceral artery aneurysms (VAAs) after embolotherapy. Material and methods Twenty-one VAAs (11 splenic, six renal, three internal iliac, and one superior pancreaticoduodenal artery aneurysms) in 18 patients (median age, 64 years; range, 36-88 years) previously treated by embolisation with platinum coils, were evaluated. The mean size of the aneurysm was 10.5 cm3 (range, 0.3-132 cm3). Among them, 19 lesions were treated by aneurysmal packing with or without distal-to-proximal embolisation. For the remaining two lesions, distal-to-proximal embolization alone was performed. The mean observation period after embolotherapy was 35 weeks (range, 4-216). All patients underwent TR-MRA following an intravenous bolus injection of gadolinium chelate. Recanalisation was diagnosed when any portion of the aneurysmal sac was enhanced in the arterial phase. Results On TR-MRA, two lesions were diagnosed as recanalised. They were confirmed by transcatheter arteriography and re-treated by embolotherapy. For the remaining 19 lesions, there were no findings of recanalisation on TR-MRA. Conclusions TR-MRA appears to be a feasible method for follow-up examination of VAAs treated by embolotherapy.
Collapse
|
15
|
Ashrafi AS, Horkoff MJ, Yousuf J, Stedman A. Ruptured gastroepiploic artery aneurysm: A case report. Int J Surg Case Rep 2017; 41:132-133. [PMID: 29073550 PMCID: PMC5655424 DOI: 10.1016/j.ijscr.2017.08.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/05/2017] [Accepted: 08/08/2017] [Indexed: 11/16/2022] Open
Abstract
Gastroepiploic artery aneurysms are extremely rare but carry a high risk of rupture. In cases of a ruptured gastroepiploic artery aneurysms, urgent laparotomy and control of hemorrhage is required. A laparoscopic approach to gastroepiploic artery aneurysms has been described in non-acute settings.
Introduction Gastroepiploic artery aneurysms are extremely rare, with few reported cases in the literature. The risk of rupture however, is high and thus warrants attention. Presentation of case Here we present a rare case of a women who presented to the emergency department in shock and was found to have a ruptured gastroepiploic artery aneurysm during surgical exploration. Suture ligation of the aneurysm was completed. Discussion Although rare, gastroepiploic artery aneurysms have up to a 90% rate of rupture and therefore require intervention. A laparoscopic approach has been described however, in cases where rupture has occurred, urgent laparotomy and control of hemorrhage is needed. Conclusion We describe a rare case of a ruptured gastroepiploic aneurysm that was successfully managed with urgent laparotomy and aneurysmal resection.
Collapse
Affiliation(s)
- Ahmad S Ashrafi
- Division of Thoracic Surgery, Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; UBC Department of Surgery, Faculty of Medicine, 950 West 10(th) Ave., Vancouver, British Columbia V5Z 1M9, Canada
| | - Michael J Horkoff
- Division of General Surgery, University of Calgary, 1403 29(th) Street NW, Calgary, Alberta T2N 2T9, Canada.
| | - Junaid Yousuf
- Division of Radiation Oncology, Windsor Regional Hospital, 2220 Kildare Rd, Windsor, Ontario N8W 1L9, Canada
| | - Alfred Stedman
- Division of General Surgery, Ottawa Hospital, Riverside Campus, 1081 Carling Avenue, Ottawa, Ontario K1Y 4G2, Canada
| |
Collapse
|
16
|
Pancreaticoduodenal Artery Aneurysm Associated with Celiac Trunk Stenosis: Case Illustration and Literature Review. Case Rep Radiol 2017; 2017:6989673. [PMID: 28815097 PMCID: PMC5549485 DOI: 10.1155/2017/6989673] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/19/2017] [Indexed: 11/17/2022] Open
Abstract
Pancreaticoduodenal artery aneurysms (PDA) are rare visceral aneurysms. Celiac trunk stenosis represents a common attributable aetiology for those aneurysms. Therefore, an alternative treatment approach, which differs from those isolated aneurysms, is recommended. We hereby present a 77-year-old male patient who was admitted with sudden onset of severe abdominal pain and significant drop in haemoglobin, occurring within a 24-hour interval. Contrast-enhanced computed tomography revealed a ruptured visceral aneurysm arising from the anterior branch of the inferior pancreaticoduodenal artery. A severe stenosis was also noted at the take-off of the celiac trunk. Selective catheterization of the supplying branch of the superior mesenteric artery, followed by coil embolization of the aneurysm, was performed, resulting in cessation of flow within the aneurysm, with preservation of the posterior branch, supplying the celiac territory. PDAs are usually asymptomatic and discovered incidentally at rupture. The risk of rupture is independent of the aneurysmal size and is associated with a 50% mortality rate. The consensus on coping with aneurysms is to treat them whenever they are discovered. Selective angiography followed by coil embolization represents a less invasive, and frequently definitive, approach than surgery. The risk for ischemia mandates that the celiac territory must not be compromised after embolization.
Collapse
|
17
|
Abstract
Hydrogel-coated coils are truly detachable coils with a platinum core covered with hydrogel. The coils are available in 0.018- and 0.035-in systems. These coils have the ability to expand up to four times their size ∼20 minutes after deployment, thus providing a very effective mechanical vascular occlusion effect. The vessel-occlusive effect of these coils is a volume, space-occupying effect, not a thrombotic effect, as seen in fibered coils. Hydrogel-coated coils were originally developed and designed to treat brain aneurysms; however, their use has expanded to peripheral applications. Hydrogel-coated coils have been used in the management of visceral aneurysms, high-flow vascular arteriovenous fistulae, and endoleaks after endovascular thoracic and abdominal aneurysm repair. The purpose of this article is to describe the hydrogel-coated coil system, the mechanism of action, technical details for optimal deployment, and clinical applications.
Collapse
Affiliation(s)
- Hector Ferral
- Department of Radiology, Section of Interventional Radiology, NorthShore University HealthSystem, Evanston, Illinois
| |
Collapse
|
18
|
Aneurysm resection and vascular reconstruction for true aneurysm at the initial segment of splenic artery. ACTA ACUST UNITED AC 2015; 35:439-444. [PMID: 26072086 DOI: 10.1007/s11596-015-1450-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 04/24/2015] [Indexed: 12/24/2022]
Abstract
The aneurysms at the initial segment of splenic artery are rare. This paper aimed to investigate the methods to treat the true aneurysm at the initial segment of splenic artery by aneurysmectomy plus vascular reconstruction. Retrospectively reviewed were 11 cases of true aneurysm at the initial segment of splenic artery who were treated in our hospital from January 2000 to June 2013. All cases were diagnosed by color ultrasonography, computer tomography (CT) and angiography. Upon resection of the aneurysm, the auto-vein transplantation was performed in situ between the hepatic artery and the distal part of the splenic artery in 1 case; the artificial vessel bypass was done between the infra-renal aorta and distal portion of the splenic artery in 7 cases; the splenectomy was done in 2 cases; the splenectomy in combination with ligation of multiple small aneurysms were performed in 1 case. All cases were cured and discharged from the hospital 10-14 days after operation. A 1-14 year follow-up showed that 9 cases survived, and 2 cases died, including 1 case who died of acute myocardial infarction 2 years after aorta-splenic artery bypass operation and 1 case who died of acute cerebral hemorrhage 5 years after aneurysm resection and the splenectomy. Among 6 cases receiving aorta-splenic artery bypass, 1 gradually developed stenosis at anatomosed site, which eventually progressed to complete occlusion 2 years to 6 years after operation, without suffering from splenic infarction because the spleen was supplied by the short gastric vessel and its collaterals. The other 5 cases receiving aorta-splenic artery bypass and 1 case undergoing autologous vascular transplantation did not develop stricture or pseudoaneurysm at the stoma. Our study showed that the aneurysmectomy plus vascular reconstruction is a better treatment for aneurysm at the initial segment of splenic artery.
Collapse
|
19
|
Shimohira M, Hashizume T, Kawai T, Muto M, Ohta K, Suzuki K, Shibamoto Y. Triaxial system in re-embolization for recanalization of pulmonary arteriovenous malformations. Pol J Radiol 2015; 80:67-71. [PMID: 25691920 PMCID: PMC4322549 DOI: 10.12659/pjr.892378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 10/27/2014] [Indexed: 11/11/2022] Open
Abstract
Background Recanalization occurs occasionally, following coil embolization of pulmonary arteriovenous malformations (PAVM), and can lead to ischemic stroke; therefore re-embolization is important. A 1.9-Fr. no-taper microcatheter that can be inserted into a 2.7-Fr. microcatheter (named the triaxial system) has recently become available, and contributes to super-selective catheterization for small or tortuous vessels. The aim of this study was to evaluate the usefulness of re-embolization for recanalization of PAVM using the triaxial system. Material/Methods Recanalization was diagnosed in 8 patients with 13 PAVMs between June 2011 and November 2012, and re-embolization was attempted with a conventional microcatheter at first in all 13 PAVMs. However, in three of them it failed with the conventional microcatheter, and then the system was exchanged to the triaxial system. Thus, re-embolization using the triaxial system was performed in 3 PAVMs of 3 female patients, with a median age of 63 years (range, 46–73 years). We assessed technical success, complications, and outcome. Results The disappearance of recanalization was confirmed by angiography in all re-embolization procedures (technical success rate was 100%). Re-embolization was then successfully achieved inside the original coils, and no branch artery of normal lung tissue was embolized. There were no complications related with this procedure. The blood flow of recanalization was decreased in all cases in a follow-up of 27–33 months (median, 31). Conclusions Triaxial system appears to be useful for recanalization of PAVM, especially in difficult cases with a conventional system.
Collapse
Affiliation(s)
- Masashi Shimohira
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Takuya Hashizume
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Tatsuya Kawai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Masahiro Muto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Kengo Ohta
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Kazushi Suzuki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| |
Collapse
|