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Hogendoorn W, Lavida A, Hunink MGM, Moll FL, Geroulakos G, Muhs BE, Sumpio BE. Open repair, endovascular repair, and conservative management of true splenic artery aneurysms. J Vasc Surg 2014; 60:1667-76.e1. [PMID: 25264364 DOI: 10.1016/j.jvs.2014.08.067] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 08/11/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE True splenic artery aneurysms (SAAs) are a rare but potentially fatal pathology. For many years, open repair (OPEN) and conservative management (CONS) were the treatments of choice, but throughout the last decade endovascular repair (EV) has become increasingly used. The purpose of the present study was to perform a systematic review and meta-analysis evaluating the outcomes of the three major treatment modalities (OPEN, EV, and CONS) for the management of SAAs. METHODS A systematic review of all studies describing the outcomes of SAAs treated with OPEN, EV, or CONS was performed using seven large medical databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to ensure a high-quality review. All articles were subject to critical appraisal for relevance, validity, and availability of data regarding characteristics and outcomes. All data were systematically pooled, and meta-analyses were performed on several outcomes, including early and late mortality, complications, and number of reinterventions. RESULTS Original data of 1321 patients with true SAAs were identified in 47 articles. OPEN contained 511 patients (38.7%) in 31 articles, followed by 425 patients (32.2%) in CONS in 16 articles and 385 patients (29.1%) in EV in 33 articles. The CONS group had fewer symptomatic patients (9.5% vs 28.7% in OPEN and 28.8% in EV; P < .001) and fewer ruptured aneurysms (0.2% vs 18.4% in OPEN and 8.8% in EV; P < .001), but no significant differences were found in existing comorbidities. CONS patients were usually older and had smaller-sized aneurysms than patients in the OPEN and EV groups. The only identified difference in baseline characteristics between OPEN and EV was the number of ruptured aneurysms (18.4% vs 8.8%; P < .001). OPEN had a higher 30-day mortality than EV (5.1% vs 0.6%; P < .001), whereas minor complications occurred in a larger number of the EV patients. EV required more reinterventions per year (3.2%) compared with OPEN (0.5%) and CONS (1.2%; P < .001). The late mortality rate was higher in patients treated with CONS (4.9% vs 2.1% in OPEN and 1.4% in EV; P = .04). CONCLUSIONS EV of SAA has better short-term results compared with OPEN, including significantly lower perioperative mortality. OPEN is associated with fewer late complications and fewer reinterventions during follow-up. Patients treated with CONS showed a higher late mortality rate. Ruptured SAAs are predictors of a significantly higher perioperative mortality compared with nonruptured SAAs in the OPEN and EV groups.
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Affiliation(s)
- Wouter Hogendoorn
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn; Section of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
| | - Anthi Lavida
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn; Department of Vascular Surgery, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - M G Myriam Hunink
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Health Policy & Management, Harvard School of Public Health, Boston, Mass
| | - Frans L Moll
- Section of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
| | - George Geroulakos
- Department of Vascular Surgery, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - Bart E Muhs
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn
| | - Bauer E Sumpio
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn.
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Maignien C, Marcellin L, Anselem O, Silvera S, Dousset B, Grangé G, Goffinet F. [Embolization of a ruptured pseudo-aneurysm of the uterine artery at 26weeks of gestation: Materno-fetal consequences; a case-report]. ACTA ACUST UNITED AC 2014; 44:665-9. [PMID: 25201019 DOI: 10.1016/j.jgyn.2014.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 06/27/2014] [Accepted: 07/08/2014] [Indexed: 11/28/2022]
Abstract
Rupture of a uterine artery pseudo-aneurysm during pregnancy is a rare condition with potential life-threatening complications, and management should take into account the fetal impact of the therapeutic choice. We report the case of a 2cm left uterine artery pseudo-aneurysm revealed by pelvic pain, in a 30-year-old pregnant woman at 26(+0)weeks of gestation (WG). Diagnosis was suspected at ultrasound scan, and confirmed with Magnetic Resonance angiography that showed signs of pre-rupture. An emergency selective embolization attempted in utero allowed the complete exclusion of the aneurysmal sac. The patient gave birth one month later to a girl at 31(+1)WG, initially managed by neonatologists, who is currently in good health.
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Affiliation(s)
- C Maignien
- Maternité Port-Royal, hôpital Cochin Broca, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, université Paris Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France.
| | - L Marcellin
- Maternité Port-Royal, hôpital Cochin Broca, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, université Paris Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - O Anselem
- Maternité Port-Royal, hôpital Cochin Broca, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, université Paris Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - S Silvera
- Service de radiologie, hôpital Cochin Broca, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; DHU risques et grossesse, université Paris Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - B Dousset
- Service de chirurgie digestive, hépatobiliaire et endocrinienne, hôpital Cochin Broca, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - G Grangé
- Maternité Port-Royal, hôpital Cochin Broca, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, université Paris Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - F Goffinet
- Maternité Port-Royal, hôpital Cochin Broca, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, université Paris Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France
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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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Teixeira PG, Thompson E, Wartman S, Woo K. Infective endocarditis associated superior mesenteric artery pseudoaneurysm. Ann Vasc Surg 2014; 28:1563.e1-5. [PMID: 24704049 DOI: 10.1016/j.avsg.2014.03.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 03/16/2014] [Accepted: 03/24/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since William Osler first described mycotic aneurysms in the setting of endocarditis in 1885, few pseudoaneurysms (PAs) of the superior mesenteric artery (SMA) have been reported in the literature. We report 2 cases of SMA PA related to infective endocarditis that were managed with open surgery. RESULTS Here we report 2 cases of SMA PAs treated with different surgical techniques. A 59-year-old male with a history of intravenous drug use presented with abdominal pain and was found to have Streptococcus viridans endocarditis and an SMA PA. A laparotomy was performed, and proximal and distal control of the SMA PA was obtained. After ensuring that Doppler signals were still present in the distal mesentery and the entirety of the bowel was viable, the SMA was ligated proximal and distal to the PA. The patient recovered uneventfully. The second case is a 35-year-old female who presented with abdominal pain and was found to have Streptococcos gordonii endocarditis and an SMA PA for which the patient was initially observed. After several weeks, the patient's condition deteriorated and the patient underwent open ligation of the SMA, proximal and distal to the PA, with a bypass from the infrarenal abdominal aorta to a distal unnamed SMA branch and resection of 3 ft of ischemic small bowel. The patient continued to have recurrent bowel ischemia over the next several weeks and ultimately died. CONCLUSIONS SMA PAs associated with infective endocarditis are rare, but carry a high risk of rupture and associated morbidity and mortality. Delay in surgical management may increase this risk.
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MESH Headings
- Adult
- Aneurysm, False/diagnosis
- Aneurysm, False/microbiology
- Aneurysm, False/surgery
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/surgery
- Endocarditis, Bacterial/complications
- Endocarditis, Bacterial/diagnosis
- Endocarditis, Bacterial/microbiology
- Fatal Outcome
- Female
- Humans
- Ligation
- Male
- Mesenteric Artery, Superior/diagnostic imaging
- Mesenteric Artery, Superior/microbiology
- Mesenteric Artery, Superior/surgery
- Mesenteric Ischemia/microbiology
- Middle Aged
- Streptococcal Infections/complications
- Streptococcal Infections/diagnosis
- Streptococcal Infections/microbiology
- Streptococcus gordonii/isolation & purification
- Substance Abuse, Intravenous/complications
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
- Vascular Grafting
- Viridans Streptococci/isolation & purification
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Affiliation(s)
- Pedro G Teixeira
- Division of Vascular Surgery and Endovascular Therapy, University of Southern California, Los Angeles, CA
| | - Eli Thompson
- Division of Vascular Surgery and Endovascular Therapy, University of Southern California, Los Angeles, CA
| | - Sarah Wartman
- Division of Vascular Surgery and Endovascular Therapy, University of Southern California, Los Angeles, CA
| | - Karen Woo
- Division of Vascular Surgery and Endovascular Therapy, University of Southern California, Los Angeles, CA.
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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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56
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Papakostas JC, Theodoropoulos E, Karydas G, Chatzigakis PK. Contained rupture of a celiac artery aneurysm treated with aortic endograft deployment and assisting percutaneous coil and thrombin infusion. Vascular 2013; 21:183-8. [DOI: 10.1177/1708538113478735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this report we present a case of a ruptured celiac artery aneurysm (CAA) with a thrombosed distal neck, which was treated as an emergently with a deployment of a tube thoracic endograft to the descending thoracic and upper abdominal aorta. The initial treatment was assisted with a second stage percutaneous, transhepatic, ultrasound guided needle infusion of coil and thrombin to the aneurysmal sac due to type Ib endoleak, with immediate thrombosis of the aneurysm. This technique, although not standard, could also be considered as a useful choice for the treatment of CAAs with wide proximal and patent distal neck.
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Affiliation(s)
| | - Emmanouil Theodoropoulos
- Department of Interventional Radiology, ‘G. Gennimatas’ General Hospital of Athens, Athens, Greece
| | - George Karydas
- Department of Interventional Radiology, ‘G. Gennimatas’ General Hospital of Athens, Athens, Greece
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57
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Endovascular treatment of a hepatic artery pseudoaneurysm associated with gastrointestinal tract bleeding. J Vasc Surg 2012; 55:1145-9. [PMID: 22370249 DOI: 10.1016/j.jvs.2011.11.136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 11/21/2011] [Accepted: 11/22/2011] [Indexed: 12/23/2022]
Abstract
Hemosuccus pancreaticus is a rare cause of gastrointestinal bleeding from the pancreatic duct originating from aneurysms or pseudoaneurysms of peripancreatic arteries. It is a life-threatening cause of gastrointestinal bleeding that should always be considered in patients with prolonged or intermittent obscure gastrointestinal blood loss, or both, especially in patients with pancreatic disorders or prior pancreatic surgery. We demonstrate an endovascular treatment strategy in a patient with a common hepatic pseudoaneurysm and upper gastrointestinal tract bleeding, with preserved flow in the hepatic artery. This treatment consisted of a covered stent placement in the hepatic artery, followed by transcatheter coil embolization of collateral feeding arteries.
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58
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Siddiqui ZR, Yousif OF, Halliday MW, Hubaishah NA, Adam KA. Ruptured ileocolic artery aneurysm: an unusual cause of hemoperitoneum. Saudi J Gastroenterol 2012; 18:342-4. [PMID: 23006464 PMCID: PMC3500025 DOI: 10.4103/1319-3767.101141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ruptured aneurysm of a branch of ileocolic artery is a rare finding and is an unusual cause of haemoperitoneum. Rapid diagnosis, and surgical or endovascular intervention are necessary to avoid devastating consequences and high mortality rates following an emergency operation after rupture. Resection is a good choice for surgical intervention for some aneurysms that are not suitable for endovascular repair. This report describes the case of a middle-aged man with a ruptured superior mesenteric artery branch aneurysm and his subsequent surgical management.
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Affiliation(s)
- Zakaur R. Siddiqui
- Department of Surgery, ArRayan Hospital, Dr. Sulaiman Alhabib Medical Group, Riyadh, Saudi Arabia,Address for correspondence: Dr. Zakaur Rab Siddiqui, Specialist General Surgeon, ArRayan Hospital, Dr. Sulaiman Alhabib Medical Group, Riyadh, Saudi Arabia, E-mail:
| | - Omer F. Yousif
- Department of Surgery, ArRayan Hospital, Dr. Sulaiman Alhabib Medical Group, Riyadh, Saudi Arabia
| | - Mark W. Halliday
- Department of Surgery, ArRayan Hospital, Dr. Sulaiman Alhabib Medical Group, Riyadh, Saudi Arabia
| | - Nasser A. Hubaishah
- Department of Surgery, ArRayan Hospital, Dr. Sulaiman Alhabib Medical Group, Riyadh, Saudi Arabia
| | - Khalid A. Adam
- Department of Surgery, ArRayan Hospital, Dr. Sulaiman Alhabib Medical Group, Riyadh, Saudi Arabia
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59
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Janmohamed A, Noronha L, Saini A, Elton C. An unusual cause of lower gastrointestinal haemorrhage. BMJ Case Rep 2011; 2011:bcr.11.2011.5102. [PMID: 22669967 DOI: 10.1136/bcr.11.2011.5102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A previously unreported cause of lower gastrointestinal haemorrhage in a 63-year-old female patient on clopidogrel for cardiac comorbidities is presented. Endoscopy suggested a small bowel or colonic aetiology but failed to accurately localise the source. The patient became haemodynamically unstable despite conservative management and temporary cessation of clopidogrel. CT angiography demonstrated a pseudoaneurysm arising from the superior rectal artery. Percutaneous embolisation using coils was performed to successfully occlude the pseudoaneurysm, prevent further haemorrhage and avoid emergency colonic resection.
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60
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Batt M, Baque J. Successful percutaneous embolization of a symptomatic celiac artery dissection with aneurysmal dilation with detachable vascular plugs. J Vasc Surg 2011; 54:1812-5. [DOI: 10.1016/j.jvs.2011.05.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 04/04/2011] [Accepted: 05/07/2011] [Indexed: 11/16/2022]
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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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62
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Xin J, Xiao-ping L, Wei G, Jiang X, Hong-peng Z, Xiao-hui M, Xin D, Min-hong Z. The endovascular management of splenic artery aneurysms and pseudoaneurysms. Vascular 2011; 19:257-61. [PMID: 21903857 DOI: 10.1258/vasc.2011.oa0289] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to evaluate outcomes of the endovascular treatment of splenic artery aneurysms (SAAs) and pseudoaneurysms (SAPAs). From April 2003 to December 2009, 12 patients (mean age 46.8 years, range 29–58) with SAAs ( n = 9) or SAPAs ( n = 3) underwent endovascular treatment. Four patients were asymptomatic and three had ruptured aneurysms. Lesions were in the proximal splenic artery ( n = 3), intermediate splenic artery ( n = 3) and distal splenic artery ( n = 6). Endovascular procedures included embolization by sac packing ( n = 5), sandwich occlusion of the splenic artery ( n = 4) or stent graft deployment ( n = 3). Computed tomography (CT) was done before the operation, 3 and 12 months after the operation, then yearly. Endovascular treatment was successful at the first attempt in all 12 (100%) patients, with complete angiographic exclusion of the aneurysm at the end of the operation. The mean amount of contrast medium used was 165 mL (range 100–230), and the mean total procedure time was 92 minutes (range 55–160). No major complications occurred. Postoperational CT scans showed splenic multisegmental infarcts in eight patients (66.7%, 8/12) and among them postembolization syndrome developed in six patients, manifesting as abdominal pain and fever. The mean follow-up was 32 months (range 9–51). No patient demonstrated gross evidence of aneurysm sac growth, and no significant decrease in aneurysm sac size postintervention was noted on follow-up. The endovascular management of SAAs and SAPAs is safe and effective and may induce less mortality than open surgery. Regardless of the etiology, endovascular treatment can provide excellent mid-term results.
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Affiliation(s)
- Jia Xin
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Liu Xiao-ping
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Guo Wei
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiong Jiang
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhang Hong-peng
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Ma Xiao-hui
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Du Xin
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhang Min-hong
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing 100853, China
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63
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Cochennec F, Riga C, Allaire E, Cheshire N, Hamady M, Jenkins M, Kobeiter H, Wolfe J, Becquemin J, Gibbs R. Contemporary Management of Splanchnic and Renal Artery Aneurysms: Results of Endovascular Compared with Open Surgery from Two European Vascular Centers. Eur J Vasc Endovasc Surg 2011; 42:340-6. [DOI: 10.1016/j.ejvs.2011.04.033] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 04/02/2011] [Indexed: 12/19/2022]
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64
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Jana M, Gamanagatti S, Mukund A, Paul S, Gupta P, Garg P, Chattopadhyay TK, Sahni P. Endovascular management in abdominal visceral arterial aneurysms: A pictorial essay. World J Radiol 2011; 3:182-7. [PMID: 21860714 PMCID: PMC3158896 DOI: 10.4329/wjr.v3.i7.182] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 07/08/2011] [Accepted: 07/15/2011] [Indexed: 02/06/2023] Open
Abstract
Visceral artery aneurysms (VAAs) include aneurysms of the splanchnic circulation and those of the renal artery. Their diagnosis is clinically important because of the associated high mortality and potential complications. Splenic, superior mesenteric, gastroduodenal, hepatic and renal arteries are some of the common arteries affected by VAAs. Though surgical resection and anastomosis still remains the treatment of choice in some of the cases, especially cases involving the proximal arteries, increasingly endovascular treatment is being used for more distal vessels. We present a pictorial review of various intra-abdominal VAAs and their endovascular management.
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65
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Al-Wahbi AM. Giant celiac artery aneurysm: Treatment by transcatheter coil embolization. Int J Surg Case Rep 2011; 2:191-3. [PMID: 22096724 PMCID: PMC3199628 DOI: 10.1016/j.ijscr.2011.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 05/10/2011] [Accepted: 06/02/2011] [Indexed: 11/26/2022] Open
Abstract
Celiac artery aneurysms (CAA) are one of the rarest forms of visceral artery aneurysms. Most patients are a symptomatic at the time of diagnosis and aneurysms are detected incidentally during diagnostic imaging for other diseases. We present the case of a 42-year-old man who had an asymptomatic giant CAA detected incidentally by an abdominal ultrasound investigating an abdominal pain. A contrast enhanced computed tomography angiogram (CTA) revealed a large CAA measuring 7.1 cm × 4.3 cm with extensive collaterals from the superior mesenteric artery (SMA). The aneurysm sac was mostly filled with thrombus with the celiac artery branches occluded. Pre-procedural angiography and transcatheter embolization procedures were performed at the same session. Endovascular exclusion was performed by transcatheter coil embolization and packing of the aneurysm sack. Technical success was achieved by the absence of flow in the aneurysm, and preservation of the native circulation on angiograms obtained just after the transcatheter coil embolization procedure. One week postembolization, a CTA confirmed thrombosis of the aneurysm. The patient returned for a follow-up CTA 3, 6, 12 and 48 months after embolization. The aneurysm was thrombosed and the patient remained a symptomatic. The surgical mode of treatment of CAA is increasingly being replaced by endovascular embolization because of the lower morbidity and mortality and high success rate. The accepted endovascular approach is by coil embolization of the aneurysmal lumen, the proximal and distal aneurysmal neck, or both.
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Affiliation(s)
- Abdullah M Al-Wahbi
- King Abdulaziz Medical City, Department of Surgery, Vascular Surgery Division, P. O Box 22490, Riyadh 11426, Saudi Arabia
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66
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Sachdev-Ost U. Visceral artery aneurysms: review of current management options. ACTA ACUST UNITED AC 2011; 77:296-303. [PMID: 20506455 DOI: 10.1002/msj.20181] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Visceral artery aneurysms are relatively rare clinical entities, although their detection is rising due to an increased use of cross-sectional imaging. Rupture is the most devastating complication, and is associated with a high morbidity and mortality. For this reason, elective repair is preferable in the appropriately chosen patient. In general, splenic artery aneurysms measuring 2 cm or larger and those found in women of childbearing age and in persons undergoing liver transplantation should be treated. Hepatic artery aneurysms 2 cm or larger and those that are multiple or nonatherosclerotic in nature should be repaired in the appropriate patient due to a higher risk of rupture. Endovascular coil embolization has excellent success rates and is the first-line treatment for anatomically suitable splenic artery aneurysms and intrahepatic hepatic artery aneurysms. However, reperfusion is an important complication of endovascular management. Aneurysms involving the celiac, superior mesenteric, pancreaticoduodenal, gastroduodenal, and inferior mesenteric arteries, as well as visceral artery pseudoaneurysms, are unpredictable and should be repaired in the appropriate medical patient. These aneurysms are often amenable to ligation due to the presence of collateral circulation. Endovascular management is particularly useful in the treatment of pseudoaneurysms where comorbidities and previous surgery make open surgical repair less desirable. Mt Sinai J Med 77:296-303, 2010. (c) 2010 Mount Sinai School of Medicine.
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67
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Fankhauser GT, Stone WM, Naidu SG, Oderich GS, Ricotta JJ, Bjarnason H, Money SR. The minimally invasive management of visceral artery aneurysms and pseudoaneurysms. J Vasc Surg 2011; 53:966-70. [PMID: 21216559 DOI: 10.1016/j.jvs.2010.10.071] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 10/14/2010] [Accepted: 10/14/2010] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Minimally invasive methods (MIMs) are now available for the management of visceral artery aneurysms and pseudoaneurysms (visceral artery aneurysms [VAA]). The purpose of this study was to review our 10-year experience with the MIM of treating VAA. METHODS All patients evaluated from June 1999 to June 2009 with VAAs were reviewed. Demographics, therapy, and results were analyzed. RESULTS MIM was attempted in 185 aneurysms in 176 patients. Initial intervention was successful in 98% ofaneurysms. Sixty-three (34%) aneurysms were located in the splenic artery, 56 (30%) in the hepatic, 28 (15%) in the gastroduodenal, 16 (8.6%) in the pancreaticoduodenal, six (3.2%) in the superior mesenteric, four (2.1%) in the gastric, four (2.1%) in the celiac, four (2.1%) in the gastroepiploic, two (1%) in the inferior mesenteric, and one (0.5%) in the middle colic artery. Pseudoaneurysms were more common than true aneurysms (64% vs 36%). Bleeding was the indication for intervention in 86 aneurysms (46%). Initial treatment was successful in 177 aneurysms (98%). Reintervention was required in five (3%) aneurysms within 30 days. Coiling was used alone in 139 aneurysms (75%) and in combination with at least one other technique in 20 (11%) cases. Thirty-day aneurysm-related mortality was 3.4% (six deaths). Five additional deaths occurred during 30-day follow-up, although none was related to complications of the aneurysms (2.8%). CONCLUSIONS MIM for visceral artery aneurysms can be used alone or in combination to effectively treat VAAs in elective or emergent conditions.
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Affiliation(s)
- Grant T Fankhauser
- Division of Vascular Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
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68
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Ahmed I, Tanveer UH, Sajjad Z, Munazza B, Azeem UD, Basit S. Cystic artery pseudo-aneurysm: a complication of xanthogranulomatous cholecystitis. Br J Radiol 2010; 83:e165-7. [PMID: 20675459 DOI: 10.1259/bjr/34623636] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 54-year-old man presented for radiology with pain and a feeling of fullness in the upper abdomen and an epigastric mass. Ultrasound revealed a large cystic mass with internal echoes, lying posterior and inferior to left lobe of the liver. The gallbladder was thick-walled and contracted, and contained a calculus and echogenic sludge. A cystic structure that produced swirling flow signals on colour Doppler was demonstrated within the gallbladder. The CT scan showed a thickened gallbladder with adjacent inflammation and a 2-cm pseudo-aneurysm in its wall. High-density material was present in the gallbladder lumen, in the extra-hepatic bile ducts and around the gastrohepatic ligament. A thick haemorrhagic pus, from which Escherichia coli was cultured, was drained from the gastrohepatic collection. An elective coeliac angiogram demonstrated a solitary pseudo-aneurysm of the medial branch of the cystic artery. Selective catheterisation of this artery with a micro-catheter enabled complete exclusion of the pseudo-aneurysm by a single micro-coil. Histological examination of the gallbladder, which was ultimately removed at open cholecystectomy, demonstrated xanthogranulomatous cholecystitis.
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Affiliation(s)
- I Ahmed
- Department of Radiology, Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
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69
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Domínguez Bahamonde J, Hernández Lahoz I, García Casas R, Caicedo Valdés D, Cubillas Martín H. Tratamiento endovascular secuencial de aneurisma gigante de arteria esplénica. ANGIOLOGIA 2010. [DOI: 10.1016/s0003-3170(10)70055-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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70
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Gordon P, O'Donnell ME, Collins A, Gardiner KR, Irwin T. Successful endovascular treatment of multiple mesenteric arterial aneurysms associated with alpha-1-antitrypsin deficiency. J Vasc Surg 2010; 52:467-70. [DOI: 10.1016/j.jvs.2010.02.291] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 02/23/2010] [Accepted: 02/25/2010] [Indexed: 10/19/2022]
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71
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Sutherland DE, Williams SB, Rice D, Jarrett TW, Engel JD. Vascular Pseudoaneurysms in Urology: Clinical Characteristics and Management. J Endourol 2010; 24:915-21. [DOI: 10.1089/end.2009.0662] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | - Stephen B. Williams
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dana Rice
- Department of Urology, George Washington University, Washington, District of Columbia
| | - Thomas W. Jarrett
- Department of Urology, George Washington University, Washington, District of Columbia
| | - Jason D. Engel
- Department of Urology, George Washington University, Washington, District of Columbia
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Hara K, Yoshida H, Taniai N, Mineta S, Kawano Y, Uchida E. Successful management of a symptomatic splenic artery aneurysm with transcatheter embolization. J NIPPON MED SCH 2010; 76:308-18. [PMID: 20035097 DOI: 10.1272/jnms.76.308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We describe a symptomatic splenic artery aneurysm (SAA) with occasional left-sided abdominal pain which was successfully treated with transcatheter embolization. A 65-year-old man was referred to a nearby clinic because of left shoulder and abdominal pain developing the day after blunt trauma to the shoulder and abdomen. Radiography revealed no fracture, and the patient went home. He stopped working for 7 months. Left-sided abdominal pain then developed several times after strenuous physical labor, and the patient was referred to a nearby hospital. The patient had a history of asthma and untreated hypertension; the use of iodinated contrast material was therefore avoided. Unenhanced computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen revealed a hematoma in the splenic hilum. The patient was referred to Nippon Medical School Hospital. His neurologic status was stable. Unenhanced CT of the abdomen at a nearby hospital revealed a low-density area in the splenic hilum. Fat-suppressed, T1-weighted images showed a hyperintense lesion adjacent to the splenic hilum. Fat-suppressed, T2-weighted images showed a dark hemosiderin rim, a bright ring, and an intermediate central core, which indicated a recurrent chronic hematoma in the abdomen. Dynamic contrast-enhanced MRI revealed a small hyperenhanced lesion adjacent to the hematoma, which appeared to be an SAA. After an injection of corticosteroids, selective splenic arteriography was performed. The splenic artery was catheterized via a right femoral approach. Arteriography showed an SAA, 1 cm in diameter with extravasation of contrast material. The neck of the SAA was catheterized with a microcatheter, and coils were placed successfully into the SAA to prevent recurrent bleeding. Postembolization angiography showed total occlusion of the SAA. The patient was discharged 7 days after embolization and has since resumed normal activities, with no residual symptoms.
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Affiliation(s)
- Keisuke Hara
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
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73
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A rare case of 'Spontaneous rupture of partially thrombosed pseudoaneurysm of gastroduodenal artery associated with chronic pancreatitis'. Indian J Surg 2009; 71:282-3. [PMID: 23133174 DOI: 10.1007/s12262-009-0070-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Accepted: 03/20/2009] [Indexed: 10/20/2022] Open
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74
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Abstract
Vascular embolizations are complex and sophisticated procedures and can be a powerful alternative or useful adjunct to surgery in many clinical situations. Hemorrhage, vascular malformations, and tumors are the main indications for embolization procedures. Establishing the correct indication for intervention as well as the proper embolic agent and the most suitable catheterization technique requires advanced knowledge in interventional radiology, and an interdisciplinary approach is a prerequisite. A broad spectrum of microcatheters and embolization materials is available for these therapies. The desired level of occlusion and the individual vascular territory determine the choice of mechanical devices, particles, or liquid substances. Sclerosing agents and thrombin are used in special situations such as varicoceles and pseudoaneurysms.
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75
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Zhao J. Massive upper gastrointestinal bleeding due to a ruptured superior mesenteric artery aneurysm duodenum fistula. J Vasc Surg 2008; 48:735-7. [PMID: 18727971 DOI: 10.1016/j.jvs.2008.04.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Revised: 04/08/2008] [Accepted: 04/08/2008] [Indexed: 02/05/2023]
Abstract
This case report describes sudden massive upper gastrointestinal bleeding due to a ruptured superior mesenteric artery aneurysm-duodenal fistula following mitral and aortic valvular replacement surgery due to infectious endocarditis. The superior mesenteric artery false aneurysm was diagnosed by computed tomography scanning. The intraoperative findings included a rupture at the trunk of superior mesenteric artery (SMA) and a perforation on the anterior wall of the third portion of the duodenum. The patient was treated by emergency surgery, which consisted of an interposition repair of the SMA with a saphenous vein graft for the superior mesenteric artery and a duodenojejunal Roux-en-Y anastomosis for the perforation of the duodenum. At 30-months follow-up, the patient is alive and well with no abdominal pain and eating a regular diet.
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MESH Headings
- Adult
- Anastomosis, Roux-en-Y
- Aneurysm, False/complications
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/etiology
- Aneurysm, False/surgery
- Aneurysm, Infected/complications
- Aneurysm, Infected/diagnostic imaging
- Aneurysm, Infected/etiology
- Aneurysm, Infected/surgery
- Blood Vessel Prosthesis Implantation
- Catheterization
- Duodenal Diseases/complications
- Duodenal Diseases/diagnostic imaging
- Duodenal Diseases/etiology
- Duodenal Diseases/surgery
- Endocarditis/complications
- Endocarditis/surgery
- Female
- Gastrointestinal Hemorrhage/diagnostic imaging
- Gastrointestinal Hemorrhage/etiology
- Gastrointestinal Hemorrhage/surgery
- Heart Valve Prosthesis Implantation
- Humans
- Intestinal Fistula/complications
- Intestinal Fistula/diagnostic imaging
- Intestinal Fistula/etiology
- Intestinal Fistula/surgery
- Intestinal Perforation/diagnostic imaging
- Intestinal Perforation/etiology
- Intestinal Perforation/surgery
- Mesenteric Artery, Superior/diagnostic imaging
- Mesenteric Artery, Superior/surgery
- Rupture, Spontaneous
- Tomography, X-Ray Computed
- Treatment Outcome
- Vascular Fistula/complications
- Vascular Fistula/diagnostic imaging
- Vascular Fistula/etiology
- Vascular Fistula/surgery
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Affiliation(s)
- Jichun Zhao
- Division of Vascular Surgery, West China Hospital, Sichuan, China.
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76
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Yeo KK, Dawson DL, Brooks JL, Laird JR. Percutaneous treatment of a large superior mesenteric artery pseudoaneurysm and arteriovenous fistula: A case report. J Vasc Surg 2008; 48:730-4. [DOI: 10.1016/j.jvs.2008.03.056] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 03/23/2008] [Accepted: 03/29/2008] [Indexed: 12/30/2022]
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77
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Hemorrhage associated with hepatic artery pseudoaneurysms after regional chemotherapy with floxuridine: case report. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2008; 5:17. [PMID: 18620556 PMCID: PMC2478651 DOI: 10.1186/1477-7800-5-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 07/11/2008] [Indexed: 11/10/2022]
Abstract
Pseudoaneurysms of the hepatic artery are a rare complication in patients with primary or secondary liver tumors treated with intra-arterial chemotherapy. We present two patients who developed this complication after placement of a catheter system into the gastroduodenal artery and initiation of regional chemotherapy with floxuridine. Diagnosis was made after symptomatic bleeding occurred, necessitating emergency angiography with coil embolization. Pseudoaneurysms usually occur after mechanical damage of the vessel wall, but the chemical toxicity of floxuridine may add to the development of vascular impairment.
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78
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Kueper MA, Ludescher B, Koenigsrainer I, Kirschniak A, Mueller K, Wiskirchen J, Koenigsrainer A. Successful coil embolization of a ruptured gastroduodenal artery aneurysm. Vasc Endovascular Surg 2008; 41:568-71. [PMID: 18166643 DOI: 10.1177/1538574407305461] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aneurysms of the gastroduodenal artery are rare. Reported here is the case of a 60-year-old woman suffering from the covered rupturing of a twin aneurysm of the gastroduodenal artery. The patient presented herself in the surgical emergency unit with abdominal discomfort. Diagnostics showed free fluid in the abdominal cavity together with anemia of 9.9 g/dL. A computed tomography scan and an angiography revealed the covered rupturing of a twin aneurysm of the gastroduodenal artery, which was treated by endovascular coiling of the gastroduodenal and pancreaticoduodenal arteries. The patient's hemoglobin level remained stable after treatment, and she was released from the hospital after 18 days. Visceral artery aneurysms are rare. Although endovascular therapy is preferred in cases involving active bleeding, surgery remains the primary therapy in those cases in which bleeding becomes uncontrollable.
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79
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Carroccio A, Jacobs TS, Faries P, Carroccio A, Jacobs TS, Faries P, Ellozy SH, Teodorescu VJ, Ting W, Marin ML. Endovascular treatment of visceral artery aneurysms. Vasc Endovascular Surg 2008; 41:373-82. [PMID: 17942851 DOI: 10.1177/1538574407308552] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Visceral artery aneurysms, although uncommon, can present with life-threatening hemorrhage. The increasing use of imaging studies has allowed for earlier identification and intervention of these aneurysms, thus avoiding the high morbidity and mortality associated with rupture. The treatment options for visceral artery aneurysms range from conventional open surgical repair to minimally invasive techniques using covered stents or embolization materials. Anatomic features and patient selection determine which treatment option would result in the most durable treatment and outcome. This article reviews our experience with the endovascular treatment of visceral artery aneurysms.
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Affiliation(s)
- Alfio Carroccio
- Mount Sinai School of Medicine, New York, NY 10029, USA. alfio.carroccio@ mountsinai.org
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80
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Waldenberger P, Bendix N, Petersen J, Tauscher T, Glodny B. Clinical outcome of endovascular therapeutic occlusion of the celiac artery. J Vasc Surg 2007; 46:655-61. [PMID: 17764875 DOI: 10.1016/j.jvs.2007.05.033] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 05/10/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Endovascular occlusion of the celiac artery can be performed along with occlusion of a celiac trunk aneurysm or stenting of a thoracoabdominal aortic aneurysm to prevent a type II endoleak. Because only a few individual cases have been previously available for study, the aim of this study was to examine the technical details, clinical course, and outcome of this procedure based on a group of patients. METHODS This retrospective study included 10 patients who underwent endovascular occlusion of the celiac artery between 1998 and 2006 (female/male = 1:4, mean age, 62.5 +/- 9.8 years). There were five aneurysms of the celiac artery, two cases each of thoracoabdominal aortic aneurysms and dissecting thoracoabdominal aortic aneurysms, and one mycotic pseudoaneurysm of the aorta. The mean follow-up period was 21.4 +/- 29.1 months. RESULTS The celiac artery was successfully occluded in all cases, along with exclusion of the celiac artery aneurysm or thoracoabdominal aortic aneurysm, respectively. The pancreaticoduodenal arteries were the main collateral pathways, but other anastomoses and, especially, vascular variations of the celiac artery and its territory were also significant. In one patient, abdominal angina was treated by percutaneous angioplasty and stenting of the superior mesenteric artery. CONCLUSIONS Endovascular occlusion of the celiac artery is both safe and feasible. Some vascular variations may make occlusion of the celiac trunk impossible. Liver function disorder is a relative contraindication for this procedure.
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Affiliation(s)
- Peter Waldenberger
- Department of Radiology, Innsbruck Medical University, Innsbruck, Austria.
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81
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Infected splenic artery aneurysm with associated splenic abscess formation secondary to bacterial endocarditis: case report and review of the literature. J Vasc Surg 2007; 45:1066-8. [PMID: 17466802 DOI: 10.1016/j.jvs.2006.12.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Accepted: 12/08/2006] [Indexed: 01/16/2023]
Abstract
Infected aneurysms are rare and may present with rupture or sepsis. Surgical treatment is often required to prevent catastrophic sequelae. Bacterial endocarditis is one of the classic causes of infected aneurysm. We present a case of a 6.1-cm infected splenic artery aneurysm secondary to endocarditis. Surgical treatment consisted of aortic and mitral valve replacements, splenic artery aneurysm resection, and splenectomy. We reviewed five other reported infected splenic artery aneurysms in which documented ruptured had occurred in three patients. Because the rate of rupture in these patients appears to be quite high, infected splenic artery aneurysms require prompt treatment.
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82
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Piffaretti G, Tozzi M, Lomazzi C, Rivolta N, Riva F, Caronno R, Castelli P. Splenic artery aneurysms: postembolization syndrome and surgical complications. Am J Surg 2007; 193:166-70. [PMID: 17236842 DOI: 10.1016/j.amjsurg.2006.09.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Revised: 09/13/2006] [Accepted: 09/13/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study assessed the endovascular embolization of splenic artery aneurysms and false aneurysms with special consideration given to postoperative complications. METHODS Fifteen patients (11 women; mean age, 56 y; range, 39-80 y) with splenic artery aneurysm (n = 13) or false aneurysm (n = 2) were treated with coil embolization. The lesion was asymptomatic in 9 patients, symptomatic in 5 patients, and ruptured in 1 patient. The mean aneurysm diameter was 33 +/- 23 mm (range, 15-80 mm). Postoperative follow-up evaluation included a clinical visit and spiral computed tomography at 1, 4, and 12 months, and yearly thereafter. RESULTS Endovascular treatment was possible in 14 patients (93%) (1 failure: neck cannulation). Perioperative mortality was not observed. Morbidity included postembolization syndrome in 5 patients (30%). Neither pancreatitis nor spleen abscess occurred. The mean follow-up period was 36 months (range, 3-60 mo). During follow-up evaluation we detected 1 sac reperfusion that was sealed successfully with additional coils. Surgical conversion or open repair were never required. CONCLUSIONS At our institute, endovascular treatment represents the first-line treatment for splenic artery aneurysms. Postembolization syndrome and infarcts are common events but generally resolve without sequelae.
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Affiliation(s)
- Gabriele Piffaretti
- Vascular Surgery, Department of Surgery, University of Insubria-Varese, Ospedale di Circolo, 21100 viale Borri 57, Varese, Italy.
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83
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Miller MT, Comerota AJ, Disalle R, Kaufman A, Pigott JP. Endoluminal embolization and revascularization for complicated mesenteric pseudoaneurysms: A report of two cases and a literature review. J Vasc Surg 2007; 45:381-6. [PMID: 17264020 DOI: 10.1016/j.jvs.2006.09.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Accepted: 09/04/2006] [Indexed: 11/16/2022]
Abstract
Mesenteric artery pseudoaneurysms are a rare and complex complication after abdominal trauma, surgery, or inflammatory disease. These lesions can be associated with compression or erosion into adjacent structures and may result in life-threatening hemorrhage. Traditional management has been open surgical ligation, aneurysm resection with interposition grafts, or resection or partial resection of the end organ involved. We present two cases of endovascular repair of complex mesenteric pseudoaneurysms. One patient presented with a recurrent pseudoaneurysm of the superior mesenteric artery and the second presented as recurrent gastrointestinal bleeding secondary to a traumatic celiac artery pseudoaneurysm-to-pancreatic duct fistula. A systematic review of the literature on endovascular management of mesenteric vascular disease and mesenteric pseudoaneurysms is included in this report to allow these cases to be put into proper perspective.
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84
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Lara-Hernández R, Sena-Ruiz F, Riera-Vázquez R, Manuel-Rimbau E, Corominas-Roura C, Lozano-Vilardell P. Aneurismas sintomáticos de arterias viscerales. Tratamiento quirúrgico y endovascular: a propósito de dos casos. ANGIOLOGIA 2007. [DOI: 10.1016/s0003-3170(07)75052-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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85
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Heyn J, Sommerey S, Schmid R, Hallfeldt K, Schmidbauer S. Fistula Between Cystic Artery Pseudoaneurysm and Cystic Bile Duct Cause of Acute Anemia One Year After Laparoscopic Cholecystectomy. J Laparoendosc Adv Surg Tech A 2006; 16:609-12. [PMID: 17243879 DOI: 10.1089/lap.2006.16.609] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
We present a case of hemorrhage from a cystic artery pseudoaneurysm one year after laparoscopic cholecystectomy. A 78-year-old male with a history of recurrent melena, hematemesis, and right upper abdominal pain was admitted to our emergency department. His blood pressure was 60/30 mm Hg with a pulse rate of 100 beats per minute. Hemoglobin was 7.6 g/dL and white blood cell count 19500/mm(3). Computed tomography scan of the abdomen and selective digital subtraction arteriography showed a pseudoaneurysm in the region of the former bed of the gallbladder. During gastroscopy, a pulsatile bleeding out of the papilla of Vater was found. Surgery by the open approach confirmed the presence of a cystic artery pseudoaneurysm and showed an additional fistula between the pseudoaneurysm and the cystic bile duct. Resection of the pseudoaneurysm and revision of the common bile duct with implantation of a T-tube was performed. The patient recovered well and was discharged from our hospital three weeks after surgery.
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Affiliation(s)
- Jens Heyn
- Department of Surgery, Ludwig-Maximilians-University, Munich, Germany.
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86
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Taberkant M, Elkaoui H, Bouchentouf M, Ibrahima S, Zentar A, Janati MI. [Aneurysm of the coeliac trunk. A case report]. JOURNAL DES MALADIES VASCULAIRES 2006; 31:284-6. [PMID: 17202982 DOI: 10.1016/s0398-0499(06)76628-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Aneurysm of the coeliac artery is a rare vascular problem. The most serious clinical complication of coeliac artery aneurysm is rupture. Because of this, surgery is traditionally recommended. This paper presents a case of a coeliac artery aneurysm treated by open surgery.
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Affiliation(s)
- M Taberkant
- Service de Chirurgie Viscérale et Vasculaire, Hôpital militaire d'instruction Mohamed V, Rabat, Maroc.
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87
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Teng W, Sarfati MR, Mueller MT, Kraiss LW. A Ruptured Pancreaticoduodenal Artery Aneurysm Repaired by Combined Endovascular and Open Techniques. Ann Vasc Surg 2006; 20:792-5. [PMID: 17080233 DOI: 10.1007/s10016-006-9123-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Aneurysms of the pancreaticoduodenal arteries (PDA) are rare, accounting for <2% of all visceral aneurysms. An association with celiac artery stenosis has been reported. Many present with rupture, and a high mortality can be expected. Treatment is therefore challenging. Arterial ligation, anuerysmectomy, or bypass has been the mainstay of treatment. We recently treated a patient (who had no celiac axis) with a ruptured PDA aneurysm with combined open and endovascular techniques. A 46-year-old man was transferred to our hospital with a 1-day history of abdominal pain and syncope. On admission, an abdominal and pelvis computerized tomographic (CT) scan identified a large mesenteric hematoma, a 1.9 cm PDA aneurysm, and an occluded celiac axis. Mesenteric angiography revealed no active aneurysm leak and a stenotic superior mesenteric artery (SMA) origin. All hepatic blood flow originated from the stenotic SMA via markedly enlarged PDA collaterals. The patient was brought to the operating room, where absence of the celiac axis was confirmed. An aorto-to-proper hepatic and SMA bypass was performed using a bifurcated polyester graft. The next day, the patient was brought to the angiography suite, where the PDA aneurysm was coiled. Postprocedure CT scans confirmed thrombosis of the aneurysm. Ruptured mesenteric artery aneurysms are a challenging problem for the vascular surgeon. PDA aneurysms are rare and often occur in an unfavorable location. There appears to be an association with anatomic anomalies of the mesenteric circulation. Prompt invasive and noninvasive diagnostic studies aid in the definitive management of this often fatal problem. Combined endovascular and open techniques can be used for successful treatment.
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Affiliation(s)
- Wang Teng
- Division of Vascular Surgery, University of Utah Health Sciences Center, Salt Lake City, UT, USA
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88
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Sachdev U, Baril DT, Ellozy SH, Lookstein RA, Silverberg D, Jacobs TS, Carroccio A, Teodorescu VJ, Marin ML. Management of aneurysms involving branches of the celiac and superior mesenteric arteries: a comparison of surgical and endovascular therapy. J Vasc Surg 2006; 44:718-24. [PMID: 17011997 DOI: 10.1016/j.jvs.2006.06.027] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 06/25/2006] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Aneurysms involving branches of the superior mesenteric and celiac arteries are uncommon and require proper management to prevent rupture and death. This study compares surgical and endovascular treatment of these aneurysms and analyzes outcome. METHODS Patients at the Mount Sinai Medical Center in New York who were treated for aneurysms in the branches of the celiac artery and superior mesenteric artery were identified through a search of the institution's medical records and endovascular database. Patient demographics, history, clinical presentation, aneurysm characteristics, treatments, and follow-up outcome were retrospectively recorded. Significant differences between patients treated by surgical or endovascular therapy were determined by using Student's t test and chi2 analysis. RESULTS Between January 1, 1991, and July 1, 2005, 59 patients with 61 aneurysms were treated at a single institution. Twenty-four patients had surgical repair, and 35 underwent endovascular treatment, which included coil embolization and stent-graft therapy. Splenic (28) and hepatic (22) artery aneurysms predominated. Eighty-nine percent of splenic artery aneurysms were true aneurysms and were treated by endovascular and surgical procedures in near equal numbers (14 and 11, respectively). Pseudoaneurysms were significantly more likely to be treated by endovascular means (P < .01). The technical success rate of endovascular treatment for aneurysms was 89%, and failures were successfully treated by repeat coil embolization in all patients who presented for retreatment. Patients treated by endovascular techniques had a significantly higher incidence of malignancy than patients treated with open surgical techniques (P = .03). Furthermore, patients treated by endovascular means had a shorter in-hospital length of stay (2.4 vs 6.6 days, P < .001). CONCLUSION Endovascular management of visceral aneurysms is an effective means of treating aneurysms involving branches of the celiac and superior mesenteric arteries and is particularly useful in patients with comorbidities, including cancer. It is associated with a decreased length of stay in the elective setting, and failure of primary treatment can often be successfully managed percutaneously.
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Affiliation(s)
- Ulka Sachdev
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Medical Center, New York, NY 10029, USA.
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89
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Battula N, Malireddy K, Madanur M, Srinivasan P, Karani J, Rela M. True giant aneurysm of gastroduodenal artery. Int J Surg 2006; 6:459-61. [PMID: 19059144 DOI: 10.1016/j.ijsu.2006.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Revised: 05/08/2006] [Accepted: 05/10/2006] [Indexed: 11/19/2022]
Affiliation(s)
- Narendra Battula
- Institute of Liver Studies, Kings College Hospital, Denmark Hill, London SE5 9RS, UK
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90
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Turaga KK, Amirlak B, Davis RE, Yousef K, Richards A, Fitzgibbons RJ. Cholangitis after coil embolization of an iatrogenic hepatic artery pseudoaneurysm: an unusual case report. Surg Laparosc Endosc Percutan Tech 2006; 16:36-8. [PMID: 16552377 DOI: 10.1097/01.sle.0000202189.65160.ef] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pseudoaneurysm involving the hepatic arterial system is a recognized complication of biliary surgery. The standard nonsurgical treatment is coil embolization. We present a case of a patient who underwent coil embolization of a pseudoaneurysm and subsequently presented with ascending cholangitis due to migration of coils into the common bile duct.
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Affiliation(s)
- Kiran K Turaga
- Department of Surgery, Creighton University Medical Center, Omaha, NE 68131, USA
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91
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Harvey J, Dardik H, Impeduglia T, Woo D, DeBernardis F. Endovascular management of hepatic artery pseudoaneurysm hemorrhage complicating pancreaticoduodenectomy. J Vasc Surg 2006; 43:613-7. [PMID: 16520182 DOI: 10.1016/j.jvs.2005.11.031] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2005] [Accepted: 11/12/2005] [Indexed: 12/19/2022]
Abstract
Gastrointestinal bleeding is a morbid complication of pancreaticoduodenectomy. Determining its etiology is often a daunting challenge in that both common and unusual mechanisms may be operative. Visceral artery pseudoaneurysms, although rare, must be considered in that minimally invasive means are available for effective therapy. Our recent experience with two cases highlights the importance for both general and vascular surgeons to be aware of the diagnostic and therapeutic role for early angiography and deployment of endovascular techniques to achieve a successful outcome.
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Affiliation(s)
- John Harvey
- Vascular Surgery Service, Englewood Hospital and Medical Center, Englewood, NJ 07631, USA
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92
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Chen F, Kriegshauser JS, Huettl EA, Roberts CC. Percutaneous Thrombin Injection for Treatment of a Splenic Artery Aneurysm. Radiol Case Rep 2006. [DOI: 10.1016/s1930-0433(15)30350-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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93
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94
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Pescarus R, Montreuil B, Bendavid Y. Giant splenic artery aneurysms: case report and review of the literature. J Vasc Surg 2005; 42:344-7. [PMID: 16102637 DOI: 10.1016/j.jvs.2005.04.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2004] [Accepted: 04/19/2005] [Indexed: 12/13/2022]
Abstract
Although splenic artery aneurysms (SAAs) are the most common visceral aneurysms, giant SAAs >10 cm in diameter have rarely been reported. We present the case of a 67-year-old asymptomatic man who was diagnosed with a 15-cm SAA in the absence of a clear etiologic factor. The patient underwent open surgical repair. A medial visceral rotation was performed to gain good vascular control and subsequently the aneurysm was ligated from within. A systematic review was carried out, allowing us to analyze 12 cases of giant SAAs >10 cm published to date. The difference in terms of demographics, clinical presentation, and arterial location between the giant SAA group and usual SAAs may indicate a different underlying physiopathology that remains unclear at this time.
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Affiliation(s)
- Radu Pescarus
- Faculty of Medicine, Université de Montréal, Québec, Canada
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95
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Saltzberg SS, Maldonado TS, Lamparello PJ, Cayne NS, Nalbandian MM, Rosen RJ, Jacobowitz GR, Adelman MA, Gagne PJ, Riles TS, Rockman CB. Is Endovascular Therapy the Preferred Treatment for All Visceral Artery Aneurysms? Ann Vasc Surg 2005; 19:507-15. [PMID: 15986089 DOI: 10.1007/s10016-005-4725-3] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Endovascular intervention can provide an alternative method of treatment for visceral artery aneurysms. We conducted a retrospective review of all patients with visceral artery aneurysms at a single university medical center from 1990 to 2003, focusing on the outcome of endovascular therapy. Sixty-five patients with visceral artery aneurysms were identified: 39 splenic (SAA), 13 renal, seven celiac, three superior mesenteric (SMA), and three hepatic. Eleven patients (16.9%) had symptoms attributable to their aneurysms, which included a total of four ruptures (6.2%): three splenic and one hepatic. Management consisted of 18 (27.7%) endovascular interventions, nine (13.9%) open surgical repairs, and 38 (58.5%) observations. Mean aneurysm diameter for patients treated expectantly was significantly less than for those who underwent intervention (p = 0.001). Endovascular interventions included 15 (83.3%) embolizations (11 SAA, three renal, one hepatic) and three (16.7%) stent grafts (two SMA, one renal). The initial technical success rate of the endovascular procedures was 94.4% (17/18). However, there were four patients (22.2%) with major endovascular procedure-related complications: one late recurrence requiring open surgical repair, two large symptomatic splenic infarcts, and one episode of severe pancreatitis. These four patients had distal splenic artery aneurysms at or adjacent to the splenic hilum. There were no endovascular procedure-related deaths. Reasons for performing open surgical repair included three SAA ruptures diagnosed at laparotomy and complex anatomy not amenable to endovascular intervention (six patients). One surgical patient had a postoperative small bowel obstruction treated nonoperatively; and there was one perioperative death in a patient operated on emergently for rupture. Endovascular management of visceral artery aneurysms is a reasonable alternative to open surgical repair in carefully selected patients. Individual anatomic considerations play an important role in determining the best treatment strategy if intervention is warranted. However, four of 11 (36.4%) patients with distal splenic artery aneurysms treated with endovascular embolization developed major complications. Based on our experience, traditional surgical treatment of SAA with repair or ligation and concomitant splenectomy when necessary may be preferred in these cases.
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Affiliation(s)
- Stephanie S Saltzberg
- Division of Vascular Surgery, New York University Medical Center, New York, NY, USA.
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96
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Ballard JL, Reiss J, Abou-Zamzam AM, Teruya TH, Bianchi C. Two-Graft Repair of Very Proximal Superior Mesenteric Artery Aneurysms: A Technical Note. Ann Vasc Surg 2005; 19:465-9. [PMID: 15981123 DOI: 10.1007/s10016-005-4655-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Visceral artery aneurysms are found in only 0.2% of the general population. Among these, aneurysms of the superior mesenteric artery (SMA) are very unusual and account for only 5.5 % to 8 %. Risk of rupture or embolization is the impetus for their definitive treatment and this should be performed in acceptable candidates. These aneurysms are typically located distal to the origin of the SMA and this situation lends itself to interposition grafting as a means of both aneurysm repair and reestablishment of prograde SMA blood flow. However, SMA origin aneurysms that arise directly from the abdominal aorta add a degree of complexity because the vascular reconstruction must include the diseased visceral aorta as well as the SMA. In this article we report successful operative treatment of large aneurysms at the origin of the superior mesenteric artery using a two-graft technique in two elderly patients.
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Affiliation(s)
- Jeffrey L Ballard
- Department of Surgery, University of California, Irvine, Orange, CA, USA.
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97
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Hung RK, Loh C, Goldstein L. Selective use of electrolytic detachable and fibered coils to embolize a wide-neck giant splenic artery pseudoaneurysm. J Vasc Surg 2005; 41:889-92. [PMID: 15886676 DOI: 10.1016/j.jvs.2005.02.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report on a 55-year-old woman with recurrent chronic pancreatitis complicated by a 7-cm splenic artery pseudoaneurysm. A therapeutic endovascular treatment was chosen because of the patient's high surgical risk. Initial embolization with fibered coils succeeded in thrombosing the aneurysm lumen, but the aneurysm neck remained patent. Further embolization was achieved with two detachable Gugliemi Detachable Coils (GDCs) deployed across the aneurysm neck, successfully thrombosing the residual aneurysm. GDCs complement the more thrombogenic traditional fibered coils and should be used advantageously in critical locations to embolize difficult splenic artery pseudoaneurysms.
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Affiliation(s)
- Raymond K Hung
- Santa Clara Valley Medical Center, San Jose, CA 95128, USA.
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98
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Sessa C, Tinelli G, Porcu P, Aubert A, Thony F, Magne JL. Treatment of visceral artery aneurysms: description of a retrospective series of 42 aneurysms in 34 patients. Ann Vasc Surg 2005; 18:695-703. [PMID: 15599627 DOI: 10.1007/s10016-004-0112-8] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Visceral artery aneurysms (VAA) can be treated by revascularization, ligation, or, most often, endovascular techniques depending on clinical presentation, hemodynamic status, and location. From 1975 to 2002 a total of 42 VAA in 34 patients were treated. The lesion involved the splenic artery (SA; 19), pancreaticoduodenal artery (PDA; 6), celiac trunk (CT; 5), superior mesenteric artery (SNA; 4), common hepatic artery (CHA; 3), gastroduodenal artery (GDA; 2), left hepatic artery (LHA; 1), a branch of the inferior mesenteric artery (BIMA; 1), and a branch of the SMA (BSMA; 1). Twenty-seven VAA in 21 patients (64%) were uncomplicated (group I) and 15 VAA in 13 patients (36%) had ruptured (group II) (PDA; 6; CT, 3; SA, 1; CHA, 1; LHA, 1; BSMA, 1; BIMA, 1). In group I VAA were treated by embolization (n = 11), splenectomy (n = 6), bypass (n = 7), ligation (n = 2), and aneurysmorraphy (n = 1). No deaths were observed. The morbidity rate associated with surgical treatment was 12% including hepatic bypass thrombosis without ischemic complications in two cases. The morbidity rate associated with endovascular treatment was 18% including cholecystitis in one case and bile duct stenosis in one case. The VAA recanalization rate following embolization was 9%. In group II, 12 VAA (80%) were treated by ligation in association with splenectomy in two cases and left hepatectomy in one case. Only one bypass procedure was performed and embolization was used to treat two VAA (1 SMA and 1 PDA). The mortality rate was 20% (3/15). The morbidity rate associated with surgical treatment was 46% (6/13) including bile duct stenosis in one case, ischemic cholecystitis in one case, duodenal fistula in one case, pancreatic fistula in one case, bile tract fistula in one case, and colonic ischemia in one case. No patient died after endovascular treatment and the morbidity rate was 50% (1/2) with duodenal stenosis occurring in one case. In sum, VAA can rupture. Emergency cases can be treated by ligation in most cases or by embolization if the hemodynamic status of the patient allows. Regardless of treatment technique, the morbidity and mortality rate remains high after rupture, especially in cases involving PDA. Embolization can be proposed as a first-line treatment for most VAA. Because of the risk of rupture, endovascular or open repair is warranted for VAA and has a favorable prognosis.
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Affiliation(s)
- Carmine Sessa
- Department of Vascular Surgery, Grenoble University Hospital, Grenoble, France.
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99
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Abstract
Visceral artery aneurysms are an uncommon form of vascular disease, yet are important to the practicing vascular surgeon because of the potential for rupture or erosion into an adjacent viscus, resulting in life-threatening hemorrhage. Many visceral artery aneurysms still present with rupture, which often results in the death of the patient. An aggressive approach to the diagnosis and management of these aneurysms is warranted. The treatment of visceral artery aneurysms has significantly evolved over the past decade. Open surgical repair has been the standard method of treatment, usually by aneurysm resection or simple ligation. Open surgical repair is durable with excellent long-term results, but is accompanied by the morbidity and mortality of a major abdominal operation. Over the past decade, catheter-based treatments with coil embolization and placement of stent grafts have emerged as promising therapies to treat visceral artery aneurysms. These have provided safe and effective short-term results and should be preferentially used in selected patients at high surgical risk.
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Affiliation(s)
- Jade S Hiramoto
- University of California, 400 Parnassus Avenue, A-581, Box 0222, San Francisco, CA 94143-0222, USA.
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100
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Gebauer T, Schulz HU, Tautenhahn J, Halloul Z, Effenberger O, Lippert H, Bürger T. [Interventional and vascular surgical management for inflammatory arrosion hemorrhage from visceral arteries following pancreatic surgery]. Chirurg 2005; 75:1021-8. [PMID: 15138659 DOI: 10.1007/s00104-004-0834-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Spontaneous or postoperative hemorrhage into the abdominal cavity due to inflammatory vessel arrosion represents an uncommon but menacing situation. According to the literature, such hemorrhage is associated with a lethality of nearly 2%. Therapeutical options include reoperation and interventional radiological techniques such as endovascular catheter techniques with stent graft implantation or the embolization of vessels. We report on the management of seven cases with hemorrhage either from the gastroduodenal artery ( n=5) following pancreatic surgery for pancreatic carcinoma, liposarcoma, and chronic pancreatitis or from the common hepatic artery ( n=1) and the superior mesenteric artery ( n=1) following chronic pancreatitis. The present article describes our experiences with stent graft implantation (hemobahn prosthesis) in four cases. Based on these experiences, we see the advantages of stent grafts in primary hemostasis without any contact to infected tissue and the preservation of regular perfusion. However, further clinical data are required focussing on indication, technical success rates, stent-related complications, and long-term outcome.
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Affiliation(s)
- T Gebauer
- Klinik für Allgemein-, Viszeral- und Gefässchirurgie, Otto-von-Guericke-Universität Magdeburg.
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