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Rebelo A, Ronellenfitsch U, Partsakhashvili J, Kleeff J, John E, Ukkat J. Visceral Aneurysms: Systematic Review and Meta-analysis of Endovascular Versus Open Repair. Angiology 2024; 75:546-555. [PMID: 36915266 DOI: 10.1177/00033197231164286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
SYSTEMATIC REVIEW REGISTRATION PROSPERO ID 348699.
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Affiliation(s)
- Artur Rebelo
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Ulrich Ronellenfitsch
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Jumber Partsakhashvili
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Jörg Kleeff
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Endres John
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Jörg Ukkat
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Asokan G, Barbaro A, Trochsler M, Maddern GJ, Kuan LL. Pancreaticoduodenectomy in a Patient With Marfan Syndrome. Pancreas 2022; 51:e29-e30. [PMID: 35404909 DOI: 10.1097/mpa.0000000000001994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Gayatri Asokan
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, Australia
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Vani K, Calligaro KD, Maloni K, Madden N, Troutman DA, Dougherty MJ. Management of Pancreaticoduodenal Artery Aneurysms Based on a Single-Institution Experience. Vasc Endovascular Surg 2021; 55:684-688. [PMID: 34008440 DOI: 10.1177/15385744211017112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Pancreaticoduodenal artery aneurysms (PDAAs) are rare and have a high propensity for rupture. Historically, management of PDAAs included surgical reconstruction but has evolved with advances in endovascular therapy. We report our experience with management of PDAAs during the last 30 years. METHODS We retrospectively reviewed our prospectively maintained registry between January 1, 1992 - March 30, 2020. RESULTS We identified 8 patients with PDAAs: 4 with associated celiac artery occlusive disease and 4 without identifiable etiologies. Four patients were treated with surgical resection of the PDAAs: 2 intact aneurysms underwent concomitant revascularization (superior mesenteric artery-to-hepatic artery Dacron bypass; supra celiac aorta-to-hepatic artery Dacron bypass) and 2 (1 intact, 1 rupture) underwent ligation alone. Four patients were treated with coil embolization of the PDAA: 2 with concomitant stent-graft exclusion of the aneurysm (1 non-rupture, 1 rupture) and 2 without adjunctive measures (intact). There were no deaths nor any significant procedure-related morbidity. CONCLUSION Our large single-center experience shows that PDAAs can be successfully treated by open or endovascular intervention with selective revascularization.
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Affiliation(s)
- Kunal Vani
- Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Keith D Calligaro
- Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Krystal Maloni
- Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Nicholas Madden
- Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Douglas A Troutman
- Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA, USA
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Sex Differences in the Exocrine Pancreas and Associated Diseases. Cell Mol Gastroenterol Hepatol 2021; 12:427-441. [PMID: 33895424 PMCID: PMC8255941 DOI: 10.1016/j.jcmgh.2021.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 12/12/2022]
Abstract
Differences in pancreatic anatomy, size, and function exist in men and women. The anatomical differences could contribute to the increase in complications associated with pancreatic surgery in women. Although diagnostic criteria for pancreatitis are the same in men and women, major sex differences in etiology are reported. Alcohol and tobacco predominate in men, whereas idiopathic and obstructive etiologies predominate in women. Circulating levels of estrogens, progesterone, and androgens contribute significantly to overall health outcomes; premenopausal women have lower prevalence of cardiovascular and pancreatic diseases suggesting protective effects of estrogens, whereas androgens promote growth of normal and cancerous cells. Sex chromosomes and gonadal and nongonadal hormones together determine an individual's sex, which is distinct from gender or gender identity. Human pancreatic disease etiology, outcomes, and sex-specific mechanisms are largely unknown. In rodents of both sexes, glucocorticoids and estrogens from the adrenal glands influence pancreatic secretion and acinar cell zymogen granule numbers. Lack of corticotropin-releasing factor receptor 2 function, a G protein-coupled receptor whose expression is regulated by both estrogens and glucocorticoids, causes sex-specific changes in pancreatic histopathology, zymogen granule numbers, and endoplasmic reticulum ultrastructure changes in acute pancreatitis model. Here, we review existing literature on sex differences in the normal exocrine pancreas and mechanisms that operate at homeostasis and diseased states in both sexes. Finally, we review pregnancy-related pancreatic diseases and discuss the effects of sex differences on proposed treatments in pancreatic disease.
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Kayashima H, Minagawa R, Inokuchi S, Koga T, Miura N, Kajiyama K. Laparoscopic treatment of median arcuate ligament syndrome without ganglionectomy of the celiac plexus in the hybrid operating room: Report of a case. Int J Surg Case Rep 2021; 81:105840. [PMID: 33887859 PMCID: PMC8044698 DOI: 10.1016/j.ijscr.2021.105840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 11/23/2022] Open
Abstract
The treatment of median arcuate ligament syndrome is the surgical release of the ligament. Symptomatic patients need the ligament release with wide excision of the celiac plexus. However, the majority of the patients with celiac artery compression remains asymptomatic. It might be enough to just release the ligament without ganglionectomy for asymptomatic patients. Hybrid operating room could allow for adequate ligament release without ganglionectomy.
Introduction Median arcuate ligament syndrome (MALS) is a rare condition in which the median arcuate ligament (MAL) causes compression of the celiac artery (CA) and plexus. Although 13–50 % of healthy population exhibit radiologic evidence of the CA compression, the majority remains asymptomatic. With or without symptoms, MALS have a risk of developing collateral circulation that leads to pancreaticoduodenal artery (PDA) aneurysms that have high risk of rupture. The treatment of MALS is the surgical release of the MAL. However, the necessity of ganglionectomy of the celiac plexus is still unclear. Presentation of case A 60-year-old man with a ruptured PDA aneurysm caused by MALS was admitted to our hospital for an emergency. After treatment for the ruptured PDA aneurysm by transcatheter arterial coil embolization, he underwent elective laparoscopic MAL release in the hybrid operation room to check blood flow of the CA intraoperatively. The angiography of the CA immediately after MAL release without ganglionectomy of the celiac plexus showed the antegrade blood flow to the proper hepatic artery instead of the retrograde flow via the pancreaticoduodenal arcade. The postoperative course was uneventful and the follow-up computed tomography revealed no residual CA stenosis. Discussion Unlike symptomatic MALS, it might be enough to just release the MAL without ganglionectomy of the celiac plexus for asymptomatic MALS, especially that with the treated PDA aneurysm. Conclusion Laparoscopic treatment of MALS in hybrid operating room could allow for adequate MAL release without ganglionectomy of the celiac plexus using the intraoperative angiography of the CA.
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Affiliation(s)
- Hiroto Kayashima
- Department of Surgery, Iizuka Hospital, 3-83 Yoshio-machi, Iizuka, Fukuoka, 820-8505, Japan.
| | - Ryosuke Minagawa
- Department of Surgery, Iizuka Hospital, 3-83 Yoshio-machi, Iizuka, Fukuoka, 820-8505, Japan
| | - Shoichi Inokuchi
- Department of Surgery, Iizuka Hospital, 3-83 Yoshio-machi, Iizuka, Fukuoka, 820-8505, Japan
| | - Tadashi Koga
- Department of Surgery, Iizuka Hospital, 3-83 Yoshio-machi, Iizuka, Fukuoka, 820-8505, Japan
| | - Nobutoshi Miura
- Department of Radiology, Iizuka Hospital, 3-83 Yoshio-machi, Iizuka, Fukuoka, 820-8505, Japan
| | - Kiyoshi Kajiyama
- Department of Surgery, Iizuka Hospital, 3-83 Yoshio-machi, Iizuka, Fukuoka, 820-8505, Japan
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Spontaneous Retroperitoneal Hemorrhage Secondary to Chronic Celiac Axis Compression Treated with Embolization Utilizing Cone Beam CT. Case Rep Radiol 2020; 2020:2636495. [PMID: 32832185 PMCID: PMC7422076 DOI: 10.1155/2020/2636495] [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] [Received: 01/23/2020] [Revised: 04/16/2020] [Accepted: 07/25/2020] [Indexed: 11/17/2022] Open
Abstract
Median arcuate ligament syndrome (MALS) is a rare and often misdiagnosed vascular pathology. In this paper, we discuss a 51-year-old female with MALS presenting with hypotension due to retroperitoneal hemorrhage. Currently, there is no consensus regarding the optimal treatment approach for such patients. This case report demonstrates the utility of conventional mesenteric angiography, cone beam CT with 3D reconstruction, and selective mesenteric transarterial embolization as an effective treatment approach for patients with spontaneous aneurysm rupture in MALS.
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Chaer RA, Abularrage CJ, Coleman DM, Eslami MH, Kashyap VS, Rockman C, Murad MH. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg 2020; 72:3S-39S. [DOI: 10.1016/j.jvs.2020.01.039] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/18/2022]
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Sakugawa T, Ishigami K, Nakamata A, Toguchi M, Arakaki K, Murayama S. Thromboaspiration for Iatrogenic Thrombotic Occlusion of the Superior Mesenteric Artery during Endovascular Treatment of Pancreaticoduodenal Artery Aneurysm and Celiac Artery Occlusion. INTERVENTIONAL RADIOLOGY 2020; 5:27-31. [PMID: 36284833 PMCID: PMC9550388 DOI: 10.22575/interventionalradiology.2019-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 01/07/2020] [Indexed: 02/07/2023]
Abstract
Herein, we present a case of superior mesenteric artery (SMA) thrombus as a complication of stent placement for celiac stenosis and coil packing of a pancreaticoduodenal artery aneurysm. The SMA thrombus was likely caused by thromboembolism from the guiding sheath in the SMA without a continuous heparin flush. It was promptly treated with aspiration thrombectomy, and there was no mesenteric ischemia. To avoid thromboembolic complications, periprocedural prophylactic antithrombotic therapy should also have been performed because a complex procedure involving the pull-through technique was performed.
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Affiliation(s)
- Takayuki Sakugawa
- Department of Radiology, University of the Ryukyus Hospital
- Department of Radiology, Urasoe General Hospital
| | | | | | | | - Katsuya Arakaki
- Department of Cardiovascular Surgery, Urasoe General Hospital
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Toriumi T, Shirasu T, Akai A, Ohashi Y, Furuya T, Nomura Y. Hemodynamic benefits of celiac artery release for ruptured right gastric artery aneurysm associated with median arcuate ligament syndrome: a case report. BMC Surg 2017; 17:116. [PMID: 29183305 PMCID: PMC5706422 DOI: 10.1186/s12893-017-0320-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 11/20/2017] [Indexed: 12/18/2022] Open
Abstract
Background It has been reported that median arcuate ligament syndrome is closely associated with gastric or pancreaticoduodenal artery aneurysms. Hemodynamic state plays an important role in the formation of the aneurysms. These aneurysms are treated with open resection or endovascular exclusion. However, whether revascularization of the celiac artery can prevent the aneurysm formation is unknown. This report indicated a possibility that prophylactic revascularization for celiac artery stenosis resulted in decreased shear stress on the collaterals, which may otherwise be susceptible to new aneurysms. Case presentation This report describes a 51-year-old man who presented with epigastric pain at our hospital. According to contrast enhanced computed tomography (CT), he was diagnosed with a ruptured right gastric artery aneurysm and celiac artery stenosis caused by the median arcuate ligament (MAL). He had a vascular anomaly of the common hepatic artery arising from the superior mesenteric artery (SMA). His vital signs were stable. We informed him of the situation and he chose open surgery rather than endovascular treatment. Following, we resected the aneurysm and transected the MAL. Intraoperative angiography after transection of the MAL showed the antegrade blood flow to the splenic artery instead of the retrograde flow via the prominent collaterals. Follow-up CT confirmed narrowed collateral vessels between the SMA and the celiac artery without de-novo aneurysms. Conclusion While the necessity of celiac artery release could be questioned, the present case supports the hemodynamic benefits of MAL transection in terms of de-novo aneurysm prevention.
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Affiliation(s)
- Tetsuro Toriumi
- Department of Surgery, Asahi General Hospital, 1326, I, Asahi-shi, Chiba, 289-2511, Japan
| | - Takuro Shirasu
- Department of Surgery, Asahi General Hospital, 1326, I, Asahi-shi, Chiba, 289-2511, Japan.
| | - Atsushi Akai
- Division of Vascular Surgery, Department of Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuichi Ohashi
- Division of Vascular Surgery, Department of Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takatoshi Furuya
- Department of Surgery, Asahi General Hospital, 1326, I, Asahi-shi, Chiba, 289-2511, Japan
| | - Yukihiro Nomura
- Department of Surgery, Asahi General Hospital, 1326, I, Asahi-shi, Chiba, 289-2511, Japan
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