151
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Patlas MN, Alabousi A, Scaglione M, Romano L, Soto JA. Cross-sectional imaging of nontraumatic peritoneal and mesenteric emergencies. Can Assoc Radiol J 2013; 64:148-53. [PMID: 23528385 DOI: 10.1016/j.carj.2013.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 02/14/2013] [Indexed: 12/28/2022] Open
Abstract
Multiple nontraumatic peritoneal and mesenteric emergencies are encountered at imaging of patients in the emergency department. Peritoneal and mesenteric emergencies are usually detected in patients in the emergency department during evaluation of nonspecific abdominal pain. A high index of suspicion is required for the establishment of early diagnosis and aversion of life-threatening complications in cases of peritoneal carcinomatosis, nontraumatic hemoperitoneum, and peritonitis. A correct diagnosis of omental infarction, mesenteric adenitis, and mesenteric panniculitis helps patients primarily by avoiding unnecessary surgery. In this review article, we illustrate the cross-sectional imaging appearance of various nontraumatic peritoneal and mesenteric emergencies by emphasizing the role of the emergency radiologist in detecting and managing these entities.
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Affiliation(s)
- Michael N Patlas
- Division of Emergency/Trauma Radiology, Department of Radiology, McMaster University, Hamilton, Ontario, Canada.
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152
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Retroperitoneal follicular lymphoma presenting with gastric varices and splenic artery pseudoaneurysm. Ann Hematol 2013; 92:1283-4. [PMID: 23435843 DOI: 10.1007/s00277-013-1704-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 02/05/2013] [Indexed: 12/16/2022]
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153
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Taori K, Rathod J, Disawal A, Mundhada R, Rewatkar A, Bakare V, Wavare P, Puria RP. Endovascular Embolization of Pseudoaneurysms Complicating Pancreatitis Using Microcoils: Case Series. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojrad.2013.31005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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154
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Taslakian B, Khalife M, Faraj W, Mukherji D, Haydar A. Pancreatitis-associated pseudoaneurysm of the splenic artery presenting as lower gastrointestinal bleeding: treatment with transcatheter embolisation. BMJ Case Rep 2012. [PMID: 23208811 DOI: 10.1136/bcr-2012-007403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Pancreatitis is a known cause of pseudoaneurysms of the peripancreatic arteries, which can rarely rupture into various adjacent structures and become a source of life-threatening bleeding. The management is challenging and requires an individualised approach and multidisciplinary care. Herein, we present the case of a 24-year-old man in whom a splenic pseudoaneurysm ruptured into the adjacent infected pseudocyst, communicating with the colon by a fistulous tract, causing massive lower gastrointestinal bleeding. This was successfully managed by transcatheter arterial embolisation (TAE).
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Affiliation(s)
- Bedros Taslakian
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
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155
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Spiliopoulos S, Sabharwal T, Karnabatidis D, Brountzos E, Katsanos K, Krokidis M, Gkoutzios P, Siablis D, Adam A. Endovascular treatment of visceral aneurysms and pseudoaneurysms: long-term outcomes from a multicenter European study. Cardiovasc Intervent Radiol 2012; 35:1315-25. [PMID: 22146976 DOI: 10.1007/s00270-011-0312-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 11/03/2011] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the percutaneous endovascular management of visceral aneurysms (VA) and visceral pseudoaneurysms (VPA) treated in three European interventional radiology departments. METHODS Patient archives from the department's databases were examined and retrospectively analyzed. Patients diagnosed between 2000 and 2010 with VA and/or VPA, confirmed by computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography and treated exclusively with percutaneous endovascular methods, were included in the study. The study's primary end points were procedural technical success, target lesion reintervention rate, and periprocedural mortality rate. Secondary end points included major and minor complications rates. RESULTS The medical records of 54 patients (41 male, mean age 55 ± 18.1 years) with 58 VAs or VPAs and treated with various percutaneous endovascular therapeutic modalities were analyzed. In total, 21 VAs (mean diameter 49.4 ± 21 mm, range 20-100 mm) and 37 VPAs (mean diameter 25.1 ± 14.6 mm, range 8-60 mm) were treated. Procedural technical success was achieved in 100% of the cases, while target lesion reintervention rate was 6.1% (2 of 33) and 14.2% (3 of 21) in the VPA and VA groups, respectively. Mean clinical follow-up period was 19.1 ± 21.4 months. Overall periprocedural mortality rate was 3% (1 of 33) in the VPA group and 0% (0 of 21) in the VA group. CONCLUSION Percutaneous endovascular treatment of VAs and VPAs is safe and effective with low morbidity and mortality. There is a small but significant reintervention rate, particularly for true aneurysms; dedicated follow-up imaging is recommended. Successful aneurysm exclusion was achieved in all cases with a second procedure.
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Affiliation(s)
- Stavros Spiliopoulos
- Department of Interventional Radiology, Guy's and St Thomas' Hospitals NHS Trust, 1st Floor Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
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156
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Wang J, Wang B, Chen DF. An unusual cause of recurrent massive upper gastrointestinal bleeding. Gastroenterology 2012; 143:542-872. [PMID: 22819502 DOI: 10.1053/j.gastro.2012.03.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 03/13/2012] [Indexed: 12/02/2022]
Affiliation(s)
- Jun Wang
- Department of Gastroenterology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Bin Wang
- Department of Gastroenterology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Dong-Feng Chen
- Department of Gastroenterology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
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157
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Yadav S, Sharma P, Singh PK, Punia S, Desai P, Anjan AK, Jain S. Giant splenic artery aneurysm: A rare but potentially catastrophic surgical challenge. Int J Surg Case Rep 2012; 3:533-6. [PMID: 22902799 DOI: 10.1016/j.ijscr.2012.06.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 05/30/2012] [Accepted: 06/15/2012] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Splenic artery aneurysms are rare but clinically important entities because of their potential for life threatening rupture. They seldom exceed 3cms in size and only a few cases of giant splenic artery aneurysms (more than 10cm size) have been reported until now. PRESENTATION OF CASE A 58yr old female presented with painless pulsatile progressively enlarging lump in left upper abdomen. Contrast enhanced computed tomography revealed a 10.6×10.38cm aneurysm arising from distal splenic artery along with a normal pancreas. Surgical treatment in form of complete excision of the aneurysm along with spleen and distal pancreas was performed. Gross examination showed an unruptured 12.7×11.8cm true aneurysm of distal splenic artery. Postoperative course was uneventful. DISCUSSION Splenic artery aneurysms are discovered incidentally and the life time risk of rupture is 28% for giant aneurysms. Even with availability of less invasive procedures such as laproscopy or endovascular treatment, open surgery is mostly preferred. CONCLUSION Giant splenic artery aneurysms, although rare, should be considered in patients presenting with left upper abdomen pulsatile masses. Clinical suspicion followed by emergent management is necessary to prevent potentially life threatening complications.
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Affiliation(s)
- Siddharth Yadav
- Department of Surgery, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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158
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Patel A, Weintraub JL, Nowakowski FS, Kim E, Fischman AM, Ellozy SH, Faries PL, Vouyouka AG, Marin ML, Lookstein RA. Single-center experience with elective transcatheter coil embolization of splenic artery aneurysms: technique and midterm follow-up. J Vasc Interv Radiol 2012; 23:893-9. [PMID: 22579853 DOI: 10.1016/j.jvir.2012.03.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 03/13/2012] [Accepted: 03/29/2012] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To review a single-center experience with elective coil embolization of splenic artery aneurysm (SAA) and analyze efficacy of the technique at midterm follow-up. MATERIALS AND METHODS From 2002 through 2011, 50 patients (28 women, 22 men; age range, 24-89 y; mean age, 53.5 y ± 13.6) underwent transcatheter coil embolization for treatment of SAAs. Pseudoaneurysms and ruptured aneurysms were excluded. A total of 63 SAAs were treated (size, 13-97 mm; mean, 29 mm). Ninety-eight percent of aneurysms were treated with coils alone. Regular follow-up consisted of an office visit and imaging. Patient medical records were reviewed for aneurysm location, procedural approach, and technical and clinical outcomes. RESULTS Ninety-eight percent of procedures were technically successful at thrombosing the aneurysm at the time of procedure. Repeat intervention was performed in four of 47 patients (9%) because of continued aneurysm perfusion at follow-up. Mean time to repeat intervention was 125 days (range, 42-245 d). All repeat interventions were technically successful. Neither aneurysm growth nor aneurysm rupture was observed in any patient during the follow-up period (mean, 78 weeks; range, 9 d to 7.1 y). There were no major adverse events. Major splenic infarction occurred in three of 33 patients (9%) with no underlying liver disease and normal splenic volume and in seven of 14 patients (50%) with portal hypertension. CONCLUSIONS Percutaneous transcatheter coil embolization is a safe, effective, and minimally invasive treatment for SAAs as evidenced by high rates of technical success and freedom from aneurysm rupture.
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Affiliation(s)
- Amish Patel
- Division of Interventional Radiology, Mount Sinai Medical Center, 1 Gustave L. Levy Place, New York, NY 10029, USA
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159
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Chu KE, Sun CK, Wu CC, Yang KC. Complete remission of pancreatic pseudoaneurysm rupture with arterial embolization in a patient with poor risk for surgery: a case report. Case Rep Gastroenterol 2012; 6:254-9. [PMID: 22679414 PMCID: PMC3369412 DOI: 10.1159/000338845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Pancreatic pseudoaneurysm is a rare vascular complication of chronic pancreatitis resulting from erosion of the pancreatic or peripancreatic artery into a pseudocyst that is identified as a pulsating vascular malformation which may lead to lethal complications if left untreated. Many publications in the literature consider angiography as the first step in the management of pancreatic pseudoaneurysm to stabilize the patient's critical condition; it should be followed by surgical intervention as the definite treatment. We report a rare case of pancreatic pseudoaneurysm rupture with hemodynamic embarrassment in a critical patient with multiple comorbid conditions and poor risk for surgery who responded dramatically to angiographic management as a single therapeutic modality without further surgical intervention. The results observed in our patient suggest that pancreatic pseudoaneurysm may be successfully managed with angiography only and that not all cases require surgical intervention. This is particularly relevant in critically ill patients in whom surgical intervention would be unfeasible.
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Affiliation(s)
- Kuang-En Chu
- Division of Gastroenterology, Department of Internal Medicine, Taipei, Taiwan
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160
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Puri A, Acharya H, Tyagi S, Curian S, Chadha R, Anand R, Choudhary SR. Pseudoaneurysm of the radial branch of the splenic artery with pancreatic pseudocyst in a child with recurrent acute pancreatitis: treatment with endovascular stent graft and cystogastrostomy. J Pediatr Surg 2012; 47:1012-5. [PMID: 22595592 DOI: 10.1016/j.jpedsurg.2012.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 02/03/2012] [Accepted: 02/07/2012] [Indexed: 11/17/2022]
Abstract
Splenic artery pseudoaneurysms (SAPs) are rare in children and usually follow abdominal trauma. Although pancreatitis is a well-known cause for SAP in adults, pancreatitis resulting in SAP has only sporadically been reported in children. Before the refinements of endovascular techniques for management of SAP, surgery used to be the mainstay of treatment, often resulting in splenectomy. Recent technical advancements, including development of smaller delivery systems and microcatheters, have made endovascular treatment feasible in children with SAP and increased chances of splenic preservation. In this article, we report a rare case of SAP associated with a pancreatic pseudocyst in a 5-year-old boy with recurrent acute pancreatitis that was managed by endovascular stent graft and cystogastrostomy.
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Affiliation(s)
- Archana Puri
- The Department of Paediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi-110 001, India.
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161
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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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162
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Zarrouki Y, Elhaouatti R, Khallouki M, Boumzebra D, Samkaoui MA. Ruptured splenic artery pseudoaneurysm complicating acute pancreatitis. ACTA ACUST UNITED AC 2011; 30:e77-8. [PMID: 21981847 DOI: 10.1016/j.annfar.2011.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 07/08/2011] [Indexed: 11/27/2022]
MESH Headings
- Aneurysm, False/complications
- Aneurysm, False/pathology
- Aneurysm, False/surgery
- Aneurysm, Ruptured/complications
- Aneurysm, Ruptured/pathology
- Aneurysm, Ruptured/surgery
- Cholecystectomy
- Heart Arrest/complications
- Humans
- Male
- Middle Aged
- Pancreatitis, Acute Necrotizing/complications
- Pancreatitis, Acute Necrotizing/diagnostic imaging
- Pancreatitis, Acute Necrotizing/pathology
- Shock, Hemorrhagic/complications
- Splenic Artery/diagnostic imaging
- Splenic Artery/pathology
- Splenic Artery/surgery
- Tomography, X-Ray Computed
- Vascular Surgical Procedures
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163
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Splenic artery pseudoaneurysm as a complication of pancreatic pseudocyst. VOJNOSANIT PREGL 2011; 68:602-6. [PMID: 21899182 DOI: 10.2298/vsp1107602m] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Pancreatic pseudocyst presented as pseudoaneurysm of the splenic artery is a potential serious complication in patients with chronic pancreatitis. CASE REPORT A 42-year-old male patient with a long-standing evolution of chronic pancreatitis and 8-year long evolution of pancreas pseudocyst was referred to the Military Medical Academy, Belgrade due to worsening of the general condition. At admission, the patient was cachectic, febrile, and had the increased values of amylases in urine and sedimentation (SE). After clinical and diagnostic examination: laboratory assessment, esophagogastroduodenoscopy (EGDS), ultrasonography (US), endoscopic ultrasonography (EUS), multislice computed scanner (MSCT) angiography, pseudoaneurysm was found caused by the conversion of pseudocyst on the basis of chronic pancreatitis. The patient was operated on after founding pancreatic pseudocyst, which caused erosion of the splenic artery and their mutual communication. Postoperative course was duly preceded without complications with one year follow-up. CONCLUSION Angiography is the most reliable and the safest method for diagnosing hemorrhagic pseudocysts when they clinically present as pseudoaneurysms. A potentially dangerous complication in the presented case was treated surgically with excellent postoperative results.
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164
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Endovascular treatment of visceral and renal artery aneurysms. J Vasc Interv Radiol 2011; 22:1246-53. [PMID: 21741856 DOI: 10.1016/j.jvir.2011.05.012] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 05/22/2011] [Accepted: 05/25/2011] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To analyze early and midterm results of endovascular treatment of visceral aneurysms regarding technical considerations, technical success rate, aneurysm rupture, and end-organ ischemia. MATERIALS AND METHODS Endovascular treatment of 41 visceral and renal artery aneurysms (VAAs) in 40 consecutive patients (25 women; mean age, 59.4 y ± 16.2) was retrospectively reviewed. The series included 30 true aneurysms and 11 pseudoaneurysms in renal (n = 17), splenic (n = 13), hepatic (n = 4), celiac (n = 4), gastroduodenal (n = 2), and middle colic (n = 1) arteries. Demographic, clinical, procedural, and follow-up data were analyzed. RESULTS Forty-one aneurysms underwent endovascular treatment. Hypertension (73%) and hyperlipidemia (32%) were the most common associated comorbidities. Nineteen patients presented with symptoms of pain (15%) or rupture (32%) in 10 pseudoaneurysms (91%) and nine true aneurysms (30%; P = .0007). The most commonly used technique (93%) was coil embolization with (15%) or without (78%) other endovascular agents. The rate of technical success (cessation of hemorrhage or blood flow into aneurysm sac) was 98%. There was no periprocedural mortality. Mean hospital stays were 1 and 2 days for asymptomatic and symptomatic patients, respectively. Mean clinical follow-up was 44.5 months; mean imaging follow-up was 11.7 months. The only complication was an intraprocedural thromboembolic event in one case (3%). Follow-up imaging evidence of end-organ partial infarct was detected in six patients (21%), with no clinical evidence of organ insufficiency. CONCLUSIONS Endovascular treatment of VAAs is a safe and highly successful procedure. Associated side effects such as distal embolization and end-organ infarcts were not found to be clinically significant.
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165
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Belli AM, Markose G, Morgan R. The role of interventional radiology in the management of abdominal visceral artery aneurysms. Cardiovasc Intervent Radiol 2011; 35:234-43. [PMID: 21674280 DOI: 10.1007/s00270-011-0201-3] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 05/22/2011] [Indexed: 12/14/2022]
Abstract
Abdominal visceral artery aneurysms (VAA) include true and false aneurysms. The majority are asymptomatic and are discovered on cross-sectional imaging performed for unrelated clinical indications. With the maturation of techniques and devices used for embolization procedures and the treatment of aneurysms in other locations, most VAAs are now suitable for treatment by minimally invasive transcatheter techniques. The choice of technique used greatly depends on the local anatomy of the VAA and the experience of the interventional radiologist in complex vascular interventional techniques.
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166
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Goldberg RF, Maley W, Kennedy EP, Yeo CJ, Lavu H. Giant splenic artery pseudoaneurysm. J Gastrointest Surg 2011; 15:1063-6. [PMID: 21108018 DOI: 10.1007/s11605-010-1388-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 11/12/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Giant splenic artery pseudoaneurysms (≥5 cm in size) are rare entities. We document the successful operative management of one of the largest splenic artery pseudoaneurysms (18 cm) ever reported as well as review the world literature on the subject. METHOD Our literature review identified 160 cases of splenic artery pseudoaneurysm in the last 43 years. These ranged in size from 0.3 to 17 cm, and of these, 18 (11%) were 5 cm or larger. The majority of patients underwent treatment, either endovascularly or with open surgery, and their outcomes were independent of presenting symptoms or size. RESULTS Giant splenic artery pseudoaneurysms are uncommon, most often caused by pancreatitis, trauma, or iatrogenic etiologies and typically present with vague constitutional symptoms, or occasionally with hemorrhage. Most can be treated endovascularly, though in our case this was not possible due to the presence of celiac artery occlusion with retrograde filling of the pseudoaneurysm from superior mesenteric artery collaterals. Ultimately, we opted for an open technique, with supraceliac aortic control prior to manipulation and resection of the pseudoaneurysm. CONCLUSION Our recommendation is that splenic artery pseudoaneurysms should be repaired when encountered, regardless of aneurysm size at presentation.
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Affiliation(s)
- Ross Frederick Goldberg
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, 1025 Walnut Street, College Bldg., Suite 605, Philadelphia, PA 19107, USA
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167
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Saba L, Anzidei M, Lucatelli P, Mallarini G. The multidetector computed tomography angiography (MDCTA) in the diagnosis of splenic artery aneurysm and pseudoaneurysm. Acta Radiol 2011; 52:488-98. [PMID: 21498313 DOI: 10.1258/ar.2011.100283] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Splenic artery aneurysm is the most frequent visceral artery aneurysm and rupture of the aneurysm is associated with a high mortality rate. It is important to discriminate between a true aneurysm and a pseudoaneurysm that may be caused by pancreatitis, iatrogenic and postoperative causes, trauma and peptic ulcer disease. Multidetector-row CT angiography (MDCTA) allows detailed visualization of the vascular anatomy and may allow identification of aneurysms and pseudoaneurysms that affect the splenic artery. The objective of this article is to provide a review of the general characteristics of splenic artery aneurysms and pseudoaneurysms and to describe the findings of MDCTA.
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Affiliation(s)
- Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (AOU), Cagliari
| | - Michele Anzidei
- Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy
| | - Pierleone Lucatelli
- Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy
| | - Giorgio Mallarini
- Department of Radiology, Azienda Ospedaliero Universitaria (AOU), Cagliari
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168
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Boufi M, Belmir H, Hartung O, Ramis O, Beyer L, Alimi YS. Emergency stent graft implantation for ruptured visceral artery pseudoaneurysm. J Vasc Surg 2011; 53:1625-31. [PMID: 21530142 DOI: 10.1016/j.jvs.2011.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Revised: 02/09/2011] [Accepted: 02/09/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND Literature series that include visceral artery pseudoaneurysms rarely separate them from true aneurysms, although they address different issues. Guidelines for optimal management of these lesions are lacking. We report our experience of stent graft treatment of these lesions with midterm results. METHODS We retrospectively reviewed all patients with a visceral pseudoaneurysm who were treated with a stent graft in our institution. Patient history, clinical characteristics, procedure details, and outcome were recorded and analyzed. RESULTS From March 2004 to June 2009, 10 consecutive patients (9 men), who were a mean age of 59 years, were treated for symptomatic visceral artery pseudoaneurysm, with hemorrhagic shock in 8 patients (80%), after pancreaticoduodenectomy in 8, gastrectomy in 1, and abdominal trauma in 1. A mean of 24 days (range, 7-60 days) passed between the initial surgery or trauma and pseudoaneurysm diagnosis. Septic complications were associated in six patients (60%). The pseudoaneurysm was in the hepatic artery in 8 patients, the splenic artery in 1, and the superior mesenteric artery in 1. Technical and clinical success was achieved in 80% of patients. Two failures of catheterization were followed by redo surgery and death (20%). No patients died postoperatively, and no complications among the patients who were treated successfully. Mean follow-up was 37 months (range, 10-63 months). All stent grafts were patent, with no signs of infection. Two patients died secondary to neoplasm. No rebleeding or recurrent aneurysms were noted. CONCLUSION Stent graft exclusion of visceral artery pseudoaneurysm seems to be a valid therapeutic approach regardless of the patient's septic or hemodynamic status.
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Affiliation(s)
- Mourad Boufi
- Department of Vascular Surgery, University Hospital Nord, Marseille, France.
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169
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A visceral pseudoaneurysm: management by EUS-guided thrombin injection. Gastrointest Endosc 2011; 73:392-5. [PMID: 20630509 DOI: 10.1016/j.gie.2010.05.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 05/08/2010] [Indexed: 01/11/2023]
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170
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Pappy R, Sech C, Hennebry TA. Giant splenic artery aneurysm: managed in the cardiovascular catheterization laboratory using the modified neck remodeling technique. Catheter Cardiovasc Interv 2011; 76:590-4. [PMID: 20506550 DOI: 10.1002/ccd.22584] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report the first case of coil embolization using the "modified neck remodeling technique" in the management of a splenic artery aneurysm. This technique was feasible due to the unique and complex anatomy of the aneurysm. This condition has been largely treated by vascular surgeons and interventional radiologists; however, this patient was referred to the interventional cardiologists for endovascular coiling.
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Affiliation(s)
- Reji Pappy
- Department of Medicine, Section of Cardiovascular Medicine, University of Oklahoma Health Sciences Center, Oklahoma, USA.
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171
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Lakin RO, Bena JF, Sarac TP, Shah S, Krajewski LP, Srivastava SD, Clair DG, Kashyap VS. The contemporary management of splenic artery aneurysms. J Vasc Surg 2011; 53:958-64; discussion 965. [PMID: 21215563 DOI: 10.1016/j.jvs.2010.10.055] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 10/04/2010] [Accepted: 10/04/2010] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The management of patients with splenic artery aneurysms (SAAs) is variable since the natural history of these aneurysms is poorly delineated. The objective of this study was to review our experience with open repair, endovascular therapy, and observation of SAAs over a 14-year interval. METHODS Between January 1, 1996 and December 31, 2009, 128 patients with SAAs were evaluated. Sixty-two patients underwent surgical repair (n = 13) or endovascular coil/glue ablation (n = 49), while 66 patients underwent serial observation. The original medical records and computed tomography (CT) imaging were reviewed. Statistical analyses were performed using χ(2) or Fisher's exact test for categorical patient characteristics and t-test for continuous variables. Kaplan-Meier estimates for survival were calculated. Mortality was verified via the Social Security Death Index. RESULTS Patients (61 ± 11 years, 69% female) were investigated for abdominal symptoms (49%) or had the incidental finding of SAA (mean size, 2.4 ± 1.4 cm). Seven patients (5.5%) presented with rupture and were treated emergently with two perioperative mortalities (29%). Patients requiring surgical or endovascular treatment were more likely male (40% vs 21%, P = .031), younger (58 vs 64 years; P = .004), and current smokers (18% vs 5%; P = .035). Increased aneurysm calcification was associated with decreased SAA size (P = .013). The mean aneurysm size at initial diagnosis was 1.67 cm for patients undergoing observation and 3.13 cm for the treated group (P < .001). Endovascular repair was safe and durable with a mean 1.5-mm regression in SAA size over 2 years. The mean rate of growth for observed SAA was 0.2 mm/y. Ten-year survival was 89.4% (95% confidence interval: 82.0, 97.4) for all patients (observed group, 94.9%; treated group, 85.1%; P = .18). No late aneurysm-related mortality was identified. CONCLUSIONS Ruptured SAAs are lethal. Large SAAs can undergo endovascular ablation safely with durable SAA regression. Smaller SAAs (<2 cm) grow slowly and carry a negligible rupture risk.
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Affiliation(s)
- Ryan O Lakin
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA
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172
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Sileikis A, Beisa V, Rutkauskaite D, Misonis N, Strupas K. Management of Bleeding Pseudoaneurysms in Complicated Pancreatitis. VISZERALMEDIZIN 2011. [DOI: 10.1159/000332931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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173
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Anévrisme de l’artère splénique : diagnostic et thérapeutique endovasculaire. ACTA ACUST UNITED AC 2010; 91:1103-11. [DOI: 10.1016/s0221-0363(10)70155-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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174
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Imaging of acute pancreatitis: prognostic value of computed tomographic findings. J Comput Assist Tomogr 2010; 34:485-95. [PMID: 20657214 DOI: 10.1097/rct.0b013e3181d344ca] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although most cases of acute pancreatitis are uncomplicated and resolve spontaneously, the presence of complications has significant prognostic importance. Necrosis, hemorrhage, and infection convey up to 25%, 52%, and 80% mortality, respectively. Other complications such as pseudocyst formation, pseudoaneurysm formation, or venous thrombosis increase morbidity and mortality to a lesser degree.We review the computed tomographic findings of complications associated with acute pancreatitis with emphasis on their prognostic significance and impact on clinical management.
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175
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He MX, Zheng JM, Zhang SH, Wang JJ, Liu WQ, Zhu MH. Rupture of splenic artery aneurysm in pregnancy: a review of the literature and report of two cases. Am J Forensic Med Pathol 2010; 31:92-4. [PMID: 20032776 DOI: 10.1097/paf.0b013e3181c65da2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Splenic artery aneurysms are an uncommon form of vascular disease, which have a significant potential for rupture, most commonly associated with pregnancy, typically presents as sudden, unexpected death. As a consequence, the initial recognition and diagnosis of splenic artery aneurysm rupture take place only at autopsy. CLINICAL CASES This report presents 2 cases of sudden death resulting from splenic artery aneurysm in a pregnant woman and a postpartum woman, respectively. The former splenic artery aneurysm were measuring 1 cm in diameter and the latter splenic artery aneurysm 5.5 x 5 x 2 cm in size. Histologic examination of the both vessels wall showed severe morphologic changes of degeneration together with an attenuation of arterial internal elastica. CONCLUSIONS To our knowledge, splenic artery aneurysm in pregnant woman is unusual vital disease. It is essential that obstetricians are alert to the prodromal and catastrophic symptoms of splenic artery aneurysm. Early recognition and prompt management, including early resected electively, are vital to the survival of both mother and fetus.
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Affiliation(s)
- Miao-Xia He
- Department of Pathology, Changhai Hospital, Second Military Medical University, Shanghai, China
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176
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177
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Machado ADT, Procópio RJ, Neves FAC, Santos GM, Girundi MG, Afonso CT, Navarro TP. Tratamento endovascular de hemorragia secundária a lesão da artéria esplênica na pancreatite aguda: relato de caso. J Vasc Bras 2010. [DOI: 10.1590/s1677-54492010005000003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A lesão arterial esplênica é uma rara complicação relacionada a situações como trauma, lesão iatrogênica e pancreatite. Hemostasia pode ser feita por identificação do foco do sangramento através de cateterismo seletivo seguido por embolização do ramo sangrante. Relata-se caso clínico de um paciente portador de pancreatite biliar que apresentou, durante procedimento de necrosectomia, hemorragia decorrente da ruptura da artéria esplênica, sendo, então, tratado com sucesso por embolização supersseletiva.
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178
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Abstract
Splenic artery aneurysm is the third most common intra-abdominal aneurysm with a prevalence as high as 10% in some studies. Widespread use of abdominal imaging has resulted in the increasing detection of asymptomatic incidental aneurysms. In this manuscript we review the changing incidence, risk factors and evolving therapeutic options in the era of minimally invasive therapy and have developed a treatment algorithm for practical use. Aneurysms with a low risk of rupture may be treated conservatively but require regular imaging to ascertain progress. Available evidence suggests that splenic artery aneurysms that are symptomatic, enlarging, more than 2 cm in diameter or those detected in pregnancy, childbearing age or following liver transplantation are at high risk of rupture and should undergo active treatment. Prophylactic screening should be reserved for those with multiple risk factors, such as pregnancy in liver transplant recipients. All false aneurysms should also be treated. The primary therapeutic approach should be endovascular therapy by either embolization or stent grafting.
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179
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Percutaneous transcatheter arterial embolization in haemodynamically stable patients with blunt splenic injury. Radiol Oncol 2010; 44:30-3. [PMID: 22933888 PMCID: PMC3423673 DOI: 10.2478/v10019-010-0011-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Accepted: 01/10/2010] [Indexed: 01/18/2023] Open
Abstract
Background The nonoperative management of the blunt splenic injury in haemodynamically stable patients has become an accepted treatment in recent years. We present a case of the blunt splenic injury successfully treated by supraselective embolization with microspheres. Case report. A young hockey player was brought to the Emergency Department with the history of blunt abdominal trauma 2 h earlier. A Grade III splenic injury with haemoperitoneum was diagnosed on sonographic evaluation and the patient was treated with the selective distal splenic artery embolization with microspheres. Postprocedural ultrasound and computed tomography follow-up a year later revealed only a small area of parenchymal irregularity. Conclusions The percutaneous splenic arterial embolization has a major role in the management of traumatic splenic injuries. Embolization is particularly beneficial in injuries of grade III or higher.
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180
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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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181
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Busel D, Yanez A, Jimenez E, Johansen CK. Multiple splenic artery aneurysms in a patient with idiopathic thrombocytopenic purpura: A case report, brief literature review and discussion. Artery Res 2010. [DOI: 10.1016/j.artres.2009.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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182
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Sweetser SR, Wong Kee Song LM. An unusual cause of hematochezia. Gastroenterology 2009; 137:1895, 2183. [PMID: 19879208 DOI: 10.1053/j.gastro.2009.06.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 06/26/2009] [Indexed: 12/02/2022]
Affiliation(s)
- Seth R Sweetser
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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183
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Huang YC, Xie ZY, Tseng HS, Yang CF, Hsiao LT. Splenic artery pseudoaneurysm with rupture by transformed splenic marginal zone B cell lymphoma. Ann Hematol 2009; 89:639-40. [PMID: 19888578 DOI: 10.1007/s00277-009-0851-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 10/05/2009] [Indexed: 10/20/2022]
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184
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Kapoor BS, Haddad HL, Saddekni S, Lockhart ME. Diagnosis and management of pseudoaneurysms: an update. Curr Probl Diagn Radiol 2009; 38:170-88. [PMID: 19464587 DOI: 10.1067/j.cpradiol.2008.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
"Pseudoaneurysm" is a term that describes disruption of an artery with patent flow in a defined space beyond the confines of the vessels. A pseudoaneurysm can involve any vascular bed and is usually associated with direct arterial injury or erosion of an artery by an adjacent tumor or inflammation. In this article, we discuss different clinical settings and various imaging modalities such as ultrasound, computerized tomography, magnetic resonance imaging, as well as conventional angiography used for the diagnosis of pseudoaneurysms. We also describe the role of newer endovascular, percutaneous, and traditional surgical approaches for the treatment of visceral and peripheral pseudoaneurysms in different clinical circumstances.
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Affiliation(s)
- Baljendra S Kapoor
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35249-6830, USA.
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185
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Sbihi L, Dafiri R. [Unusual cause of hematemesis in a child: rupture of a splenic artery aneurysm]. JOURNAL DE RADIOLOGIE 2009; 90:315-317. [PMID: 19421117 DOI: 10.1016/s0221-0363(09)72511-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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186
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Lee CH, Lan CC, Wang CC, Chan CY, Wu YK. Spontaneous rupture of gastroduodenal artery pseudoaneurysm following vigorous cough. Am J Gastroenterol 2009; 104:529-30. [PMID: 19190616 DOI: 10.1038/ajg.2008.52] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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187
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Jung H, Choi SH, Shin SH, An JY, Choi MG, Noh JH, Sohn TS, Bae JM, Kim S. Proximal Splenic Artery Pseudoaneurysm after Radical Subtotal Gastrectomy. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.77.1.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hun Jung
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Hee Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk Hee Shin
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Yeong An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Gew Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyung Noh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Sung Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Moon Bae
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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188
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Pasklinsky G, Gasparis AP, Labropoulos N, Pagan J, Tassiopoulos AK, Ferretti J, Ricotta JJ. Endovascular covered stenting for visceral artery pseudoaneurysm rupture: report of 2 cases and a summary of the disease process and treatment options. Vasc Endovascular Surg 2008; 42:601-6. [PMID: 18583306 DOI: 10.1177/1538574408318478] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present 2 cases of hemorrhage from a visceral artery pseudoaneurysm, managed successfully with endovascular covered stent placement. The first case was a 59-year-old man, 3 months after a laparoscopic distal pancreatectomy for adenoma, presenting with diffuse abdominal pain. The patient was evaluated with a computed tomography scan revealing a splenic artery pseudoaneurysm (PA) bleeding into a pancreatic pseudocyst. He was emergently taken to the angiography suite where a covered stent was deployed at the level of splenic artery PA. The second case was a 52-year-old woman with recurrent left retroperitoneal mass 5 years after distal pancreatectomy and splenectomy for a nonfunctional neuroendocrine tumor. She underwent resection of the mass in the left upper quadrant. Postoperative course was complicated by hematoma, abscess formation, reexploration, and repair of the duodenotomy and the portal vein. Subsequently, she was noted to have intermittent gastrointestinal hemorrhage, which prompted an angiogram revealing a hepatic artery PA that was repaired with a covered balloon-expandable stent. A completion angiogram was obtained in each case demonstrating exclusion of the PA. Our experience with these 2 cases supports the notion that endovascular covered stenting is a safe and effective therapy for exclusion of visceral artery aneurysm.
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Affiliation(s)
- Garri Pasklinsky
- Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, New York 11794-8191, USA
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189
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Upadhyaya PK, Chava S, Bin-Sangheer S, Sudan R, Mittal SK, Cemaj S. Delayed rupture of a splenic artery pseudoaneurysm after biliopancreatic diversion. Obes Surg 2008; 18:890-2. [PMID: 18484144 DOI: 10.1007/s11695-007-9411-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2007] [Accepted: 06/30/2007] [Indexed: 11/26/2022]
Abstract
Splenic artery pseudoaneurysm (SAP) is a known but rare complication of pancreatitis and blunt abdominal trauma. SAP caused by operative trauma has been rarely reported. We present a patient who presented with massive upper gastrointestinal (GI) bleed in shock. On exploratory laparotomy, a SAP was diagnosed. He must have sustained injury to his splenic artery while undergoing reinforcement of sleeve gastrectomy during an open biliary pancreatic diversion procedure 2 years back. Alternatively, the prolene suture might have eroded into the splenic artery to cause the SAP. Literature on iatrogenic SAP is reviewed. SAP should be considered in patients with history of foregut surgery with GI bleed and equivocal endoscopic findings.
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190
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Brugère C, Arvieux C, Dubuisson V, Guillon F, Sengel C, Bricault I, Regimbeau JM, Pilleul F, Menegaux F, Letoublon C. L’embolisationprécoce dans le traitement non opératoire destraumatismes fermés de la rate. Étude rétrospectivemulticentrique. ACTA ACUST UNITED AC 2008; 145:126-32. [DOI: 10.1016/s0021-7697(08)73721-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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191
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Abstract
Partial splenic embolization (PSE) is a non-surgical procedure developed to treat hypersplenism as a result of hepatic disease and thus avoid the disadvantages of splenectomy. A femoral artery approach is used for selective catheterization of the splenic artery. Generally, the catheter tip is placed as distally as possible in an intrasplenic artery. After an injection of antibiotics and steroids, embolization is achieved by injecting 2-mm gelatin sponge cubes suspended in a saline solution containing antibiotics. PSE can benefit patients with thrombocytopenia, esophagogastric varices, portal hypertensive gastropathy, encephalopathy, liver dysfunction, splenic aneurysm, and splenic trauma. The contraindications of PSE include secondary splenomegaly and hypersplenism in patients with terminal-stage underlying disease; pyrexia or severe infections are associated with a high risk of splenic abscess after PSE. Complications of PSE include daily intermittent fever, abdominal pain, nausea and vomiting, abdominal fullness, appetite loss, and postembolization syndrome. Decreased portal-vein flow and a rapid increase in the platelet count after excessive embolization may cause portal-vein or splenic-vein thrombosis.
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192
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Minimally Invasive Therapy of Pseudoaneurysms of the Trunk: Application of Thrombin. Cardiovasc Intervent Radiol 2008; 31:535-41. [DOI: 10.1007/s00270-007-9272-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 11/05/2007] [Accepted: 11/28/2007] [Indexed: 10/22/2022]
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193
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Geoghegan T, McAuley G, Snow A, Torreggiani WC. Emergency embolization of multiple splenic artery pseudoaneurysms associated with portal hypertension complicating cystic fibrosis. AUSTRALASIAN RADIOLOGY 2007; 51 Suppl:B337-B339. [PMID: 17991101 DOI: 10.1111/j.1440-1673.2007.01726.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Cystic fibrosis (CF) is the most common potentially lethal genetic disease in the white population. Improvements in life expectancy have led to an increasing recognition of hepatobiliary complications from CF. Splenic artery aneurysms are a rare complication of portal hypertension with a high mortality due to their significant potential for rupture, resulting in life-threatening i.p. haemorrhage. The optimum treatment of ruptured splenic artery aneurysms is controversial. This case describes the successful emergency embolization of multiple splenic artery pseudoaneurysms associated with portal hypertension complicating cystic fibrosis.
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Affiliation(s)
- T Geoghegan
- Department of Radiology, Tallaght Hospital, Dublin, Ireland
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194
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Pearson J, Alvi A, Hashemi M. Splenic rupture as an unusual cause of massive hematemesis. THE JOURNAL OF TRAUMA 2007; 63:E88-E89. [PMID: 18089995 DOI: 10.1097/01.ta.0000195508.27907.df] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Judith Pearson
- University College London, Department of Surgery, Whittington Hospital, London, United Kingdom
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195
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Shah NA, Akingboye A, Haldipur N, Mackinlay JY, Jacob G. Embolization Coils Migrating and Being Passed per Rectum After Embolization of a Splenic Artery Pseudoaneurysm, “The Migrating Coil”: A Case Report. Cardiovasc Intervent Radiol 2007; 30:1259-62. [PMID: 17882482 DOI: 10.1007/s00270-007-9166-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Revised: 08/02/2007] [Accepted: 08/28/2007] [Indexed: 10/22/2022]
Abstract
Acute or chronic blood loss from pseudoaneurysms of the splanchnic artery in chronic pancreatitis poses diagnostic and management challenges. Arteriographic examination offers both diagnostic and therapeutic options, with success rates of 76%-100% for both modalities. In cases of failure of embolization, repeat embolization is also an option. Surgical intervention is advocated for rebleeding and failure of embolization. Evidence-based guidelines regarding the optimal treatment modality for this condition are lacking. There has been a reported case of dislodgement of coil into the stomach through a gastropseudocystic fistula. We report the case of a migrating steel-wire coil through the gastrointestinal tract and splenic artery pseudoaneurysm. We highlight the potential complications of pseudoaneurysm and other available therapeutic management options.
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Affiliation(s)
- Numan A Shah
- Doncaster and Bassetlaw NHS Trust, Doncaster Royal Infirmary, Thorne Road, Doncaster, South Yorkshire DN2 5LT, UK
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196
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Horton KM, Smith C, Fishman EK. MDCT and 3D CT angiography of splanchnic artery aneurysms. AJR Am J Roentgenol 2007; 189:641-7. [PMID: 17715112 DOI: 10.2214/ajr.07.2210] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The purpose of this article is to review our experience with the use of MDCT and 3D imaging in the detection and management of patients with both symptomatic and asymptomatic splanchnic artery aneurysms. CONCLUSION Although splanchnic artery aneurysms are relatively rare, they are being diagnosed with increased frequency given the widespread availability of MDCT and 3D imaging capabilities. It is important that these aneurysms be diagnosed accurately because they can carry a high morbidity and mortality, even in asymptomatic patients.
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Affiliation(s)
- Karen M Horton
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N Caroline St., Rm. 3253, Baltimore, MD 21287, USA
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197
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Pasha SF, Blair JE, Garvey PB, Gray RJ, Mulligan DC, Collins JM, Heigh RI. Hemosuccus Pancreaticus in the Era of Capsule Endoscopy and Double Balloon Enteroscopy Complicated by Multifocal Mycobacterium chelonae/abscessus Infection. Case Rep Gastroenterol 2007; 1:38-47. [PMID: 21487470 PMCID: PMC3073786 DOI: 10.1159/000104977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Hemosuccus pancreaticus is a rare etiology of obscure gastrointestinal bleeding characterized by bleeding into the pancreatic duct. The diagnosis may be delayed for months to years, due to the episodic nature of bleeding and failure to consider the diagnosis. Patients often undergo multiple endoscopies and radiologic evaluations prior to diagnosis. Incidental gastrointestinal findings may lead to unnecessary endoscopic and surgical interventions. This report describes a patient with hemosuccus pancreaticus diagnosed in the era of video capsule endoscopy and double balloon enteroscopy, whose management was complicated by multifocal Mycobacteria chelonae/abscessus infection.
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Affiliation(s)
- Shabana F Pasha
- Division of Gastroenterology & Hepatology, Mayo Clinic Scottsdale, Scottsdale, Ariz., USA
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198
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Abstract
Autopsy studies suggest that splanchnic artery aneurysms may be more frequent than abdominal aortic aneurysms. These aneurysms are important to recognize because up to 25% may be complicated by rupture, and the mortality rate after rupture is between 25% and 70%. However, little is known about the natural history and clinical presentation of splanchnic artery aneurysms. Splenic artery aneurysms are the most common of the splanchnic artery aneurysms; multiple aneurysms are present in approximately one third of patients. Hepatic artery pseudoaneurysms are more common than true aneurysms because of increasing numbers of hepatobiliary interventional procedures. The diagnosis of splanchnic artery aneurysm should be considered in any patient with abdominal pain, a pulsatile mass, or an abdominal bruit with or without associated bleeding. However, most aneurysms are asymptomatic and are detected incidentally on imaging studies. Treatment, which can be either surgical or interventional radiology-based, should be considered in all patients with symptoms related to the aneurysms, if the aneurysm is more than 2 cm in diameter, if the patient is pregnant, or if there is demonstrated growth of the aneurysm.
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Affiliation(s)
- Shabana F Pasha
- Division of General Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN 55905 USA
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Agrawal GA, Johnson PT, Fishman EK. Splenic Artery Aneurysms and Pseudoaneurysms: Clinical Distinctions and CT Appearances. AJR Am J Roentgenol 2007; 188:992-9. [PMID: 17377035 DOI: 10.2214/ajr.06.0794] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Aneurysms of the splenic artery are being diagnosed with greater frequency as incidental findings on cross-sectional imaging. Splenic artery pseudoaneurysms are even more rare than true aneurysms. This article reviews the clinical features and management of splenic artery aneurysms and pseudoaneurysms. A variety of cases are presented to show the range of CT appearances. CONCLUSION Radiologists who identify either type of splenic artery lesion should recognize the clinical and pathophysiologic distinctions between these two forms of splenic vascular pathology and understand the differences in management.
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Affiliation(s)
- Gautam A Agrawal
- Department of Radiology, Johns Hopkins School of Medicine, 601 N Caroline St., Rm. 3251, Baltimore, MD 21287, USA
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Tulsyan N, Kashyap VS, Greenberg RK, Sarac TP, Clair DG, Pierce G, Ouriel K. The endovascular management of visceral artery aneurysms and pseudoaneurysms. J Vasc Surg 2007; 45:276-83; discussion 283. [PMID: 17264002 DOI: 10.1016/j.jvs.2006.10.049] [Citation(s) in RCA: 397] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Accepted: 10/30/2006] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Visceral artery aneurysms may be treated by aneurysm exclusion, excision, revascularization, and endovascular techniques. The purpose of this study was to review the outcomes of the management of visceral artery aneurysms with catheter-based techniques. METHODS Between 1997 and 2005, 90 patients were identified with a diagnosis of visceral artery aneurysm. This was inclusive of aneurysmal disease of the celiac axis, superior mesenteric artery (SMA), inferior mesenteric artery, and their branches. Surveillance without intervention occurred in 23 patients, and 19 patients underwent open aneurysm repair (4 ruptures). The endovascular treatment of 48 consecutive patients (mean age 58, 60% men) with 20 visceral artery aneurysms (VAA) and 28 visceral artery pseudoaneurysms (VAPA) was the basis for this study. Electronic and hardcopy medical records were reviewed for demographic data and clinical variables. Original computed tomography (CT) scans and fluoroscopic imaging were evaluated. RESULTS The endovascular treatment of visceral artery aneurysms was technically successful in 98% of 48 procedures, consisting of 3 celiac axis repairs, 2 left gastric arteries, 1 SMA, 12 hepatic arteries, 20 splenic arteries, 7 gastroduodenal arteries, 1 middle colic artery, and 2 pancreaticoduodenal arteries. Of these, 29 (60%) were performed for symptomatic disease (5 ruptured aneurysms). Procedures were performed in the endovascular suite under local anesthesia with conscious sedation (94%). The femoral artery was used as the preferential access site (90%). Coil embolization was used for aneurysm exclusion in 96%. N-butyl-2-cyanoacrylate (glue) was used selectively (19%) using a triaxial system with a 3F microcatheter for persistent flow or multiple branches. The 30-day mortality was 8.3% (n = 4). One patient died from recurrent gastrointestinal bleeding after gastroduodenal embolization, and the remaining died of unrelated causes. All perioperative deaths occurred in patients requiring urgent or emergent intervention in the setting of hemodynamic instability. No patients undergoing elective intervention died in the periprocedural period. Postprocedural imaging was performed after 77% of interventions at a mean of 16 months. Complete exclusion of flow within the aneurysm sac occurred in 97% interventions with follow-up imaging, but coil and glue artifact complicated CT evaluation. Postembolization syndrome developed in three patients (6%) after splenic artery embolization. There was no evidence of hepatic insufficiency or bowel ischemia after either hepatic or mesenteric artery aneurysm treatment. Three patients required secondary interventions for persistent flow (n = 1) and recurrent bleeding from previously embolized aneurysms (n = 2). CONCLUSION Visceral artery aneurysms and pseudoaneurysms can be successfully treated with endovascular means with low periprocedural morbidity; however, the urgent repair of these lesions is still associated with elevated mortality rates. Aneurysm exclusion can be accomplished with coil embolization and the selective use of N-butyl-2-cyanoacrylate. Current catheter-based techniques extend our ability to exclude visceral artery aneurysms, but imaging artifact hampers postoperative CT surveillance.
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Affiliation(s)
- Nirman Tulsyan
- Department of Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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