Endovascular Oriented Classification and Treatment of Celiac Trunk Aneurysms: 10 Years Experience

Guidelines on the diagnosis, treatment and management of visceral and renal arteries aneurysms: a joint assessment by the Italian Societies of Vascular and Endovascular Surgery (SICVE) and Medical and Interventional Radiology (SIRM)

The objective of these Guidelines is to provide recommendations for the classification, indication, treatment and management of patients suffering from aneurysmal pathology of the visceral and renal arteries. The methodology applied was the GRADE-SIGN version, and followed the instructions of the AGREE quality of reporting checklist. Clinical questions, structured according to the PICO (Population, Intervention, Comparator, Outcome) model, were formulated, and systematic literature reviews were carried out according to them. Selected articles were evaluated through specific methodological checklists. Considered Judgments were compiled for each clinical question in which the characteristics of the body of available evidence were evaluated in order to establish recommendations. Overall, 79 clinical practice recommendations were proposed. Indications for treatment and therapeutic options were discussed for each arterial district, as well as follow-up and medical management, in both candidate patients for conservative therapy and patients who underwent treatment. The recommendations provided by these guidelines simplify and improve decision-making processes and diagnostic-therapeutic pathways of patients with visceral and renal arteries aneurysms. Their widespread use is recommended.

Massive upper gastrointestinal bleeding caused by splenic artery pseudoaneurysm rupture: A case report

BACKGROUND

Upper gastrointestinal (UGI) bleeding secondary to a ruptured splenic artery pseudoaneurysm (SAP) is a rare but life-threatening condition. Owing to the low prevalence, it remains a diagnostic and therapeutic challenge. When patients are admitted to the hospital with UGI bleeding, it is easy to overlook the cause of SAP rupture.

CASE SUMMARY

We report the case of a 65-year-old man who was admitted to our hospital with hematemesis. By endoscopic inspection and imaging examination, he was diagnosed with a ruptured SAP that caused UGI bleeding. He underwent surgery and was discharged 20 d after surgery. Now, he has good quality of life, with no incidents of hematemesis or melena.

CONCLUSION

We have documented a case of SAP rupture of unknown etiology, in which the ruptured SAP caused a gastric fistula that eventually resulted in massive UGI bleeding. Through timely diagnosis and treatment, the patient's life was saved. Therefore, even if patients with acute UGI bleeding have no previous history of pancreatic disease, abdominal trauma, etc., it is still suggested that SAP be considered as a differential diagnosis. Once SAP is found, a prompt diagnosis and urgent treatment strategy should be employed to achieve good results.

Splenic Artery Pseudoaneurysms: The Role of ce-CT for Diagnosis and Treatment Planning

Splenic artery pseudoaneurysm (PSA) is a contained vascular wall lesion associated with a high mortality rate, generally related to pancreatitis, trauma, malignancy, iatrogenic injury, and segmental arterial mediolysis. Computed tomography angiography allows us to visualize the vascular anatomy, differentiate a PSA from an aneurysm, and provide adequate information for endovascular/surgical treatment. The present review reports on the main state-of-the-art splenic artery PSA diagnosis, differentiating between the pros and cons of the imaging methods and about the endovascular treatment.