1
|
Oishi A, Yamamoto T, Kajimoto K, Amano A. Surgical Treatment of Celiacomesenteric Trunk Aneurysm: Report of 2 Cases. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e927077. [PMID: 33154344 PMCID: PMC7656087 DOI: 10.12659/ajcr.927077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Celiac artery aneurysm is very rare, and even is more uncommon in patients with celiacomesenteric trunks. With recent developments in diagnostic imaging, the detection of asymptomatic abdominal visceral aneurysms has increased. However, some abdominal visceral aneurysms are still first discovered after a rupture. An abdominal visceral aneurysm rupture can occur suddenly and lead to shock due to intraperitoneal hemorrhage. Two cases of celiac artery aneurysms that involved common celiacomesenteric trunks are presented. CASE REPORT Case 1 was a 63-year-old man who was referred to our facility for further study after a routine abdominal ultrasound identified an aneurysm in the superior mesenteric artery. Contrast-enhanced computed tomography (CT) scan revealed a 39-mm aneurysm in the celiacomesenteric trunk and its branches. Case 2 was a 32-year-old man who was referred to our facility after an abdominal ultrasound performed during a physical examination revealed a celiac artery aneurysm. Contrast-enhanced CT revealed a 31-mm aneurysm in the celiacomesenteric trunk and its branches. In both patients, the aneurysms were proximally located, and the distinctive anatomy of the celiacomesenteric trunk made endovascular treatment difficult. Open replacement and reconstructive surgery was performed to repair the aneurysms with grafts from the great saphenous vein. Both patients had uneventful postoperative courses. CONCLUSIONS The optimal treatment for the patients described was open surgical repair because the lower risk of occlusion of the visceral branch made it safer and more reliable than an endovascular approach.
Collapse
Affiliation(s)
- Atsumi Oishi
- Department of Cardiovascular Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Taira Yamamoto
- Department of Cardiovascular Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kan Kajimoto
- Department of Cardiovascular Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University School of Medicine, Tokyo, Japan
| |
Collapse
|
2
|
Pfister K, Kasprzak PM, Jung EM, Müller-Wille R, Wohlgemuth W, Kopp R, Schierling W. Contrast-enhanced ultrasound to evaluate organ microvascularization after operative versus endovascular treatment of visceral artery aneurysms. Clin Hemorheol Microcirc 2017; 64:689-698. [PMID: 27802212 DOI: 10.3233/ch-168003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the organ microvascularization after operative versus endovascular treatment of visceral artery aneurysms (VAAs) by contrast-enhanced ultrasound (CEUS) and colour-coded duplex sonography (CCDS). METHOD AND MATERIALS Between April 1995 to January 2016, 168 patients (78 males, 90 females; median age: 62 years) were diagnosed with VAAs at our hospital site. 60/168 patients (36%) fulfilled treatment criteria and had either open (29/60, 48%) or endovascular (31/60, 52%) aneurysm repair. Patients' characteristics and presentations were consecutively reviewed. Technical success and organ microvascularization were determined by CCDS/CEUS and correlated to computed tomography angiography (CTA) or magnetic resonance imaging (MRI). RESULTS 18/60 patients (30%) presented with acute bleeding. 16/18 emergency patients (89%) were treated by endovascular means. After emergency treatment, two patients showed segmental liver malperfusion by CEUS and CTA. One small bowel resection had to be performed.42/60 patients (70%) were electively treated. 27/42 patients (64%) had open and 15/42 (36%) endovascular aneurysm repair. There were no liver or bowel infarctions after elective treatment of hepatic or mesenteric artery aneurysms (n = 13) in CCDS/CEUS and in CTA. Treatment of patients with splenic or renal artery aneurysms led to partial or complete organ loss in 42% (8/19) after operative and in 50% (5/10) after endovascular treatment (p < 0.05). CONCLUSION The endovascular approach is the preferred therapeutic option in emergency to control bleeding. In contrast to hepatic or mesenteric procedures, patients for elective splenic or renal artery aneurysm repair have to be evaluated very carefully because of a high rate of partial or complete organ loss demonstrated by CEUS - either after open or endovascular aneurysm repair.
Collapse
Affiliation(s)
- Karin Pfister
- Division of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Piotr M Kasprzak
- Division of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Ernst M Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - René Müller-Wille
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Walter Wohlgemuth
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Reinhard Kopp
- Division of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Wilma Schierling
- Division of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| |
Collapse
|
3
|
Sun Y, Zhang G, Yu J, Dong L, Liu W, Liang P. Evaluation of percutaneous microwave coagulation therapy for hepatic artery injury. Heliyon 2016; 1:e00030. [PMID: 27441219 PMCID: PMC4939808 DOI: 10.1016/j.heliyon.2015.e00030] [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] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/17/2015] [Accepted: 09/18/2015] [Indexed: 11/16/2022] Open
Abstract
Objectives To evaluate the in vivo efficacy of 915 MHz percutaneous coagulation in the treatment of hepatic artery injury. Methods After inducing hepatic artery injury, 8 dogs in each group underwent 915 MHz microwave percutaneous coagulation therapy and 8 dogs were injected with batroxobin and α-cyanoacrylate. Results The hemostatic effects of 915 MHz microwave were better than drug injection, and the amount of bleeding was significantly lower (p < 0.05). Pathological examination showed that vessel wall necrosis were greater. Conclusion Contrast ultrasound guided 915 MHz microwave percutaneous coagulation treatment has potent hemostatic effects in the repair of in vivo hepatic artery injury.
Collapse
Affiliation(s)
- Yuanyuan Sun
- Department of Ultrasound, The General Hospital of Jinan Military Region, Jinan 250031, China
| | - Guoming Zhang
- Department of Cardiology, The General Hospital of Jinan Military Region, Jinan 250031, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| | - Lei Dong
- Department of Ultrasound, The General Hospital of Jinan Military Region, Jinan 250031, China
| | - Wei Liu
- The Nanjing Kangyou Institute of Microwave Energy, Nanjing 210000, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| |
Collapse
|
4
|
Recommendation of treatment strategy for postpancreatectomy hemorrhage: Lessons from a single-center experience in 35 patients. Pancreatology 2016; 16:454-63. [PMID: 26935829 DOI: 10.1016/j.pan.2016.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 02/07/2016] [Accepted: 02/08/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Postpancreatectomy hemorrhage (PPH) is a life-threatening complication of pancreatic surgery. The shift from surgical to radiological intervention was recently reported in retrospective cohort studies, but it has remained controversial as to which emergent intervention provides optimal management. METHODS All 553 patients who underwent standard pancreatic resection at Kobe University Hospital between January 2003 and December 2013 were included. Patient data and complication data were identified from a prospective database. RESULTS The overall incidence of PPH was 6% (35 of 553 patients). Ten patients underwent endoscopic intervention or observation monitoring, or suffered hemorrhagic sudden death. Among the remaining 25 PPH patients, primary surgical intervention was successful in the 6 hemodynamically unstable PPH patients. Primary radiological intervention could successfully stop the bleeding in 15 of the 17 patients with late-PPH. Nine patients who had bleeding from the hepatic artery after pancreaticoduodenectomy were rescued by endovascular embolization of the artery-trunk. The in-hospital mortality of PPH was 20% (7 of 35). Four of the 5 PPH patients who died following any intervention eventually died due to the other complications associated with prolonged pancreatic fistula. CONCLUSIONS The leading treatment has been radiological intervention. Endovascular embolization of the hepatic artery-trunk can be securely performed only if blood flow to the liver by an alternate route is confirmed. To reduce mortality of PPH patients, it is necessary to prevent other complications associated with pancreatic fistula following hemostasis. Proactive surgical intervention such as abscess drainage or remnant pancreatectomy is a key consideration.
Collapse
|
5
|
Bellemann N, Sommer CM, Mokry T, Kortes N, Gnutzmann D, Gockner T, Schmitz A, Weitz J, Kauczor HU, Radeleff B, Stampfl U. Hepatic artery stent-grafts for the emergency treatment of acute bleeding. Eur J Radiol 2014; 83:1799-803. [DOI: 10.1016/j.ejrad.2014.06.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 06/03/2014] [Accepted: 06/26/2014] [Indexed: 02/07/2023]
|
6
|
Cavalcante RN, Couto VAP, da Fonseca AV, de Miranda RB, Costa AJV, Correa JA. Endovascular treatment of a giant hepatic artery aneurysm with Amplatzer vascular plug. J Vasc Surg 2014; 60:500-2. [DOI: 10.1016/j.jvs.2013.06.077] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 06/27/2013] [Accepted: 06/27/2013] [Indexed: 10/26/2022]
|
7
|
Lü PH, Zhang XC, Wang LF, Chen ZL, Shi HB. Stent graft in the treatment of pseudoaneurysms of the hepatic arteries. Vasc Endovascular Surg 2014; 47:551-4. [PMID: 24052448 DOI: 10.1177/1538574413488460] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of our study was to evaluate the technical feasibility, procedural complications, clinical follow-up, and computed tomography (CT) scan outcomes of hepatic artery pseudoaneurysms (HAPs) treated with stent graft. METHODS Between October 2004 and October 2009, we treated 8 patients with HAPs with stent graft. RESULTS Stent graft deployment was technically successful in all the patients. Complete exclusion of the pseudoaneurysm preserving patency of the hepatic artery was achieved in 6 patients. Total occlusion of the common hepatic artery was observed in 1 patient, and vasospasm of proper hepatic artery and endoleak from distal stent margin were observed in another patient. The 2 patient were controlled through occlusion parent artery with coils. After these procedures, symptoms of bleeding and abdominal pain disappeared. Follow-up enhanced CT scan was performed at an average of 14 months (range, 6-26 months), which showed complete disappearance of the HAP and patency of the stent without intrastent stenosis in 6 patients who had successful deployment of the stent. CONCLUSIONS Endovascular treatment of HAPs using stent graft can maintain the hepatic artery blood flow and could be considered as an alternative to embolization.
Collapse
Affiliation(s)
- Peng-Hua Lü
- 1Department of Radiology, First Hospital Affiliated to Nanjing University, Nanjing, China
| | | | | | | | | |
Collapse
|
8
|
Endograft-assisted Coil Embolization of a Celiac Trunk Aneurysm. Ann Vasc Surg 2014; 28:263.e1-5. [DOI: 10.1016/j.avsg.2013.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 02/05/2013] [Accepted: 02/06/2013] [Indexed: 11/17/2022]
|
9
|
Nishibe M, Nishibe T, Koizumi J, Kondo Y, Dardik A, Sato K, Ogino H. Surgical Treatment of a Dissecting Aneurysm of the Proper Hepatic Artery: Report of a Case. Ann Thorac Cardiovasc Surg 2013; 19:326-9. [DOI: 10.5761/atcs.cr.12.01927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
10
|
Stampfl U, Hackert T, Sommer CM, Klauss M, Bellemann N, Siebert S, Werner J, Richter GM, Kauczor HU, Radeleff B. Superselective Embolization for the Management of Postpancreatectomy Hemorrhage: A Single-Center Experience in 25 Patients. J Vasc Interv Radiol 2012; 23:504-10. [DOI: 10.1016/j.jvir.2011.12.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Revised: 12/11/2011] [Accepted: 12/12/2011] [Indexed: 12/14/2022] Open
|
11
|
Stampfl U, Sommer CM, Bellemann N, Weitz J, Böckler D, Richter GM, Kauczor HU, Radeleff B. The use of balloon-expandable stent grafts for the management of acute arterial bleeding. J Vasc Interv Radiol 2012; 23:331-7. [PMID: 22289473 DOI: 10.1016/j.jvir.2011.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Revised: 12/05/2011] [Accepted: 12/08/2011] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of balloon-expandable stent grafts in the emergency treatment of acute arterial hemorrhage. MATERIALS AND METHODS Between July 2008 and December 2009, 15 patients with acute arterial hemorrhage from inflammatory vessel erosion or pseudoaneurysms (n = 9), noninflammatory pseudoaneurysms (n = 3), or iatrogenic vessel injury (n = 3) were treated with emergency stent graft implants. The primary study endpoints to determine treatment efficacy and safety were survival, complication rates, and freedom from recurrent hemorrhaging or reintervention. The secondary study endpoints were technical and clinical success. RESULTS The survival rate was 73% with a mean follow-up of 119 days ± 220. The complication rate was 20%. The procedure was technically successful in 13 of 15 (87%) patients. One endoleak persisted and led to a reintervention rate of 7%. The bleeding ceased immediately after stent graft implantation in 14 patients. CONCLUSIONS Implantation of balloon-expandable stent grafts is a safe and effective emergency treatment for acute arterial hemorrhage from visceral and peripheral vessels.
Collapse
Affiliation(s)
- Ulrike Stampfl
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Huisman M, van den Bosch MAAJ, Mooiweer E, Molenaar IQ, van Herwaarden JA. Endovascular treatment of a patient with an aneurysm of the proper hepatic artery and a duodenal fistula. J Vasc Surg 2011; 53:814-7. [PMID: 21211935 DOI: 10.1016/j.jvs.2010.10.089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 10/14/2010] [Accepted: 10/15/2010] [Indexed: 10/18/2022]
Abstract
Aneurysms of the proper hepatic artery comprise a rare but potentially dangerous entity for which treatment is performed both surgically and endovascularly. Covered stents are generally used for endovascular treatment of such aneurysms. When the aneurysm is contaminated due to an enteric fistula, however, use of a covered stent is considered inappropriate. This case report describes the endovascular repair of a proper hepatic artery aneurysm using overlapping bare metal stents after the patient was surgically treated for duodenal hemorrhage.
Collapse
Affiliation(s)
- Merel Huisman
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | | |
Collapse
|
13
|
Hashim A, Allaqaband S, Bajwa T. Leaking hepatic artery aneurysm successfully treated with covered stent. Catheter Cardiovasc Interv 2009; 74:500-5. [DOI: 10.1002/ccd.22012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
14
|
Late Recurrence of a Hepatic Artery Aneurysm After Treatment Using an Endovascular Stent. Cardiovasc Intervent Radiol 2008; 31:1236-8. [DOI: 10.1007/s00270-008-9368-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 05/05/2008] [Accepted: 05/07/2008] [Indexed: 11/26/2022]
|