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Mellucci PL, de Marqui BAL, Isper L, Pugas AA, Martelli CAT, Melo RD, Bertanha M, Sobreira ML. Hepatic artery aneurysm with no proximal neck and proper hepatic artery bifurcation involvement. J Vasc Bras 2024; 23:e20230063. [PMID: 39629279 PMCID: PMC11614102 DOI: 10.1590/1677-5449.202300632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/21/2023] [Indexed: 12/07/2024] Open
Abstract
We report the case of a patient with a saccular aneurysm of the hepatic artery with maximum diameter of 2.8 cm, no proximal neck, and involving the bifurcation of the proper hepatic artery, constituting a hostile anatomy for endovascular treatment, which would usually be the first choice for such cases. We performed open surgical treatment with resection and reconstruction using an autologous graft (internal saphenous vein). We illustrate the surgical technique used for adequate vascular exposure of the celiac trunk and hepatic hilum (which is often an area little explored by vascular surgeons) and of structures anatomically close to the hepatic artery. We also illustrate the anastomosis with telescoping technique. We demonstrate the need for vascular surgeons to master the anatomy and classical surgical technique for visceral branches, even in the era of minimally invasive procedures.
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Affiliation(s)
- Pedro Luciano Mellucci
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina – FMB, Botucatu, SP, Brasil.
| | | | - Letícia Isper
- Universidade do Oeste Paulista – UNOESTE, Presidente Prudente, SP, Brasil.
| | | | | | - Rodolfo Dahlem Melo
- Hospital Regional de Presidente Prudente – HRPP, Presidente Prudente, SP, Brasil.
| | - Matheus Bertanha
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina – FMB, Botucatu, SP, Brasil.
| | - Marcone Lima Sobreira
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina – FMB, Botucatu, SP, Brasil.
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Talaie R, Torkian P, Spano A, Mahjoubnia A, Flanagan SM, Rosenberg M, Lin J, Golzarian J, Shrestha P. Comparative Efficacy and Safety of Self-Expandable vs. Balloon-Expandable Stent Grafts in Visceral Artery Aneurysm Management. Diagnostics (Basel) 2024; 14:1695. [PMID: 39125571 PMCID: PMC11311521 DOI: 10.3390/diagnostics14151695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/06/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
PURPOSE This study assesses the efficacy and safety of self-expandable (SE) versus balloon-expandable (BE) stent grafts for managing visceral artery aneurysms (VAAs), focusing on procedural success and complication rates. MATERIALS AND METHODS We conducted a retrospective analysis of VAA patients treated at our institution from April 2006 to September 2021. The study reviewed patient demographics, aneurysm characteristics, treatment details, and outcomes, including endoleaks. RESULTS Among the 23 patients analyzed, splenic artery aneurysms represented 44% of cases. Fifteen patients were treated with balloon-expandable stent grafts (BE SGs), and eight patients were treated with self-expandable stent grafts (SE SGs). For saccular aneurysms, the average neck size was 10.10 ± 8.70 mm in the BE group versus 18.50 ± 3.40 mm in the SE group (p = 0.23), with an average sac size of 20.10 ± 18.9 mm in the BE group versus 15.60 ± 12.7 mm in the SE group (p = 0.16). The average sac-to-neck ratio was 1.69 ± 2.23 in the BE group versus 1.38 ± 0.33 in the SE group (p = 0.63). The BE group exhibited a significantly higher endoleak rate (60%) compared to the SE group (12.5%; p = 0.03). CONCLUSIONS While further investigation is needed to fully assess the outcomes of stent graft treatment for VAAs, initial data show a significantly higher endoleak rate with BE SGs compared to SE SGs. The SE SGs may offer better outcomes due to their superior ability to conform to tortuous and mobile visceral arteries.
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Affiliation(s)
- Reza Talaie
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Pooya Torkian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Anthony Spano
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Alireza Mahjoubnia
- Department of Mechanical and Aerospace Engineering, University of Missouri, Columbia, MO 65211, USA
| | - Siobhan M. Flanagan
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Michael Rosenberg
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jian Lin
- Department of Mechanical and Aerospace Engineering, University of Missouri, Columbia, MO 65211, USA
| | - Jafar Golzarian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Preshant Shrestha
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
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3
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Harada K, Kawamura Y, Nagata K, Fujikawa T. Laparoscopic Splenectomy for Splenic Artery Aneurysms Associated With Infective Endocarditis: A Case Report. Cureus 2024; 16:e66740. [PMID: 39268281 PMCID: PMC11392510 DOI: 10.7759/cureus.66740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2024] [Indexed: 09/15/2024] Open
Abstract
Splenic artery aneurysms (SAAs) are a relatively uncommon but potentially life-threatening disease. In recent years, although there have been an increasing number of reports of interventional radiology (IVR) treatment for SAAs, there are still many cases in which surgical intervention is required. In particular, SAAs associated with infective endocarditis (SAAs-IE) are rare, and the treatment strategies and perspectives for SAAs-IE remain controversial. Herein, we report a successful case of laparoscopic splenectomy for SAAs-IE with a literature review.
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Affiliation(s)
- Kei Harada
- Surgery, Kokura Memorial Hospital, Kitakyushu, JPN
| | | | - Keiji Nagata
- Surgery, Kokura Memorial Hospital, Kitakyushu, JPN
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An TJ, Chen X, Omar OMF, Sutphin PD, Irani Z, Wehrenberg-Klee E, Iqbal S, Kalva SP. The Natural History of Splenic Artery Aneurysms: Factors That Predict Aneurysm Growth. J Vasc Interv Radiol 2024; 35:972-978. [PMID: 38663514 DOI: 10.1016/j.jvir.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 03/12/2024] [Accepted: 04/12/2024] [Indexed: 06/25/2024] Open
Abstract
PURPOSE To examine the natural history of splenic artery aneurysms (SAAs) at a single institution and assess the effect of patient factors and aneurysm characteristics on aneurysm growth. MATERIALS AND METHODS This single-center retrospective study included patients with SAAs who underwent serial imaging over 30 years (1990-2020). Data regarding patient demographics and aneurysm characteristics were collected. The variables contributing to aneurysm growth were assessed using nonparametric tests for continuous variables and chi-square test for categorical variables. Multivariable linear regression was performed using aneurysm growth rate as a continuous dependent variable. RESULTS A total of 132 patients were included in this study. The median maximum diameter of the SAAs was 15.8 mm (range, 4.0-50.0 mm). Growth over time was observed in 39% of the aneurysms, whereas the remaining 61% were stable in size. Of aneurysms that increased in size, the median aneurysm growth rate was 0.60 mm/y (range, 0.03-5.00 mm/y). Maximum aneurysm diameter of >2 cm and the presence of >50% mural thrombus were significant positive predictors for aneurysm growth (P = .020 and P = .022, respectively). Greater than 50% rim calcification was a significant negative predictor for aneurysm growth (P = .009) in multivariate analysis. CONCLUSIONS A larger baseline SAA size, presence of mural thrombus, and lack of rim calcification are associated with increased aneurysm growth rate.
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Affiliation(s)
- Thomas J An
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Xiaomin Chen
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Patrick D Sutphin
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Zubin Irani
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Eric Wehrenberg-Klee
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Shams Iqbal
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sanjeeva P Kalva
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
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Borghese O, Pisani A, Luparelli A, Sica S, Minelli F, Donati T, Tshomba Y. Endovascular Stent-Graft Repair of True and False Aneurysms of the Splenic Artery. J Clin Med 2024; 13:2802. [PMID: 38792344 PMCID: PMC11122477 DOI: 10.3390/jcm13102802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/29/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVE In treatment of aneurysms (SAAs) and pseudoaneurysms (SAPs) of the splenic artery, endovascular coil embolization is the approach most commonly used as it is minimally invasive and safe. However, it carries a significant rate of primary failure (up to 30%) and might be complicated by splenic infarction. The use of stent grafts might represent a valuable alternative when specific anatomical criteria are respected. We report a comprehensive review on technical and clinical outcomes achieved in this setting. Methods: We performed a comprehensive review of the literature through the MedLine and Cochrane databases (from January 2000 to December 2023) on reported cases of stenting for SAAs and SAPs. Outcomes of interest were clinical and technical success and related complications. The durability of the procedure in the long-term was also investigated. Results: Eighteen papers were included in the analysis, totalling 41 patients (n = 20 male 48.8%, mean age 55.5, range 32-82 years; n = 31, 75.6% SAAs). Mean aneurysm diameter in non-ruptured cases was 35 mm (range 20-67 mm), and most lesions were detected at the proximal third of the splenic artery. Stent grafting was performed in an emergent setting in n = 10 (24.3%) cases, achieving immediate clinical and technical success rate in 90.2% (n = 37) of patients regardless of the type of stent-graft used. There were no procedure-related deaths, but one patient died in-hospital from septic shock and n = 2 (4.9%) patients experienced splenic infarction. At the last available follow-up, the complete exclusion of the aneurysm was confirmed in 87.8% of cases (n = 36/41), while no cases of aneurysm growing nor endoleak were reported. None of the patients required re-intervention during follow-up. Conclusions: When specific anatomical criteria are respected, endovascular repair of SAAs and SAAPs using stent grafts appears to be safe and effective, and seems to display a potential advantage in respect to simple coil embolization, preserving the patient from the risk of end-organ ischemia.
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Affiliation(s)
- Ottavia Borghese
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Rome, Italy; (A.L.); (S.S.); (F.M.); (T.D.)
| | - Angelo Pisani
- Post Doctoral School Angio-Cardio-Thoracic Pathophysiology and Imaging, Sapienza University, 00185 Rome, Italy;
| | - Antonio Luparelli
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Rome, Italy; (A.L.); (S.S.); (F.M.); (T.D.)
- Unit of Vascular Surgery, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Gemelli IRCCS-Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Rome, Italy
| | - Simona Sica
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Rome, Italy; (A.L.); (S.S.); (F.M.); (T.D.)
- Unit of Vascular Surgery, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Gemelli IRCCS-Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Rome, Italy
| | - Fabrizio Minelli
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Rome, Italy; (A.L.); (S.S.); (F.M.); (T.D.)
- Unit of Vascular Surgery, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Gemelli IRCCS-Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Rome, Italy
| | - Tommaso Donati
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Rome, Italy; (A.L.); (S.S.); (F.M.); (T.D.)
| | - Yamume Tshomba
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Rome, Italy; (A.L.); (S.S.); (F.M.); (T.D.)
- Unit of Vascular Surgery, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Gemelli IRCCS-Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Rome, Italy
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Pratesi C, Esposito D, Martini R, Novali C, Zaninelli A, Annese AL, Baggi P, Bellosta R, Bianchini Massoni C, Bonardelli S, Carriero S, Cervelli R, Chisci E, Cioni R, Corvino F, DE Cobelli F, Fanelli F, Fargion AT, Femia M, Freyrie A, Gaggiano A, Gallitto E, Gennai S, Giampalma E, Giurazza F, Grego F, Guazzarotti G, Ierardi AM, Kahlberg AL, Mascia D, Mezzetto L, Michelagnoli S, Nardelli F, Niola R, Lenti M, Perrone O, Piacentino F, Piffaretti G, Pulli R, Puntel G, Puppini G, Rossato D, Rossi M, Silingardi R, Sirignano P, Squizzato F, Tipaldi MA, Venturini M, Veraldi GF, Vizzuso A, Allievi S, Attisani L, Fino G, Ghirardini F, Manzo P, Migliari M, Steidler S, Miele V, Taurino M, Orso M, Cariati M. 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 JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:49-63. [PMID: 38037721 DOI: 10.23736/s0021-9509.23.12809-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
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.
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Affiliation(s)
- Carlo Pratesi
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Davide Esposito
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy -
| | - Romeo Martini
- Department of Angiology, San Martino Hospital, Belluno, Italy
| | - Claudio Novali
- Department of Vascular Surgery, GVM Maria Pia Hospital, Turin, Italy
| | | | - Antonio L Annese
- Department of Diagnostic and Interventional Radiology, Careggi University Hospital, Florence, Italy
| | - Paolo Baggi
- Department of Vascular Surgery, ASST Spedali Civili, Brescia, Italy
| | - Raffaello Bellosta
- Department of Vascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | | | | | - Serena Carriero
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosa Cervelli
- Department of Diagnostic and Interventional Radiology, A.O.U. Pisana, Pisa, Italy
| | - Emiliano Chisci
- Department of Vascular Surgery, S. Giovanni di Dio Hospital, Florence, Italy
| | - Roberto Cioni
- Department of Diagnostic and Interventional Radiology, A.O.U. Pisana, Pisa, Italy
| | - Fabio Corvino
- Department of Diagnostic and Interventional Radiology, AORN Cardarelli, Naples, Italy
| | - Francesco DE Cobelli
- Department of Diagnostic and Interventional Radiology, San Raffaele Hospital, Milan, Italy
| | - Fabrizio Fanelli
- Department of Diagnostic and Interventional Radiology, Careggi University Hospital, Florence, Italy
| | - Aaron T Fargion
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Marco Femia
- Department of Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Antonio Freyrie
- Department of Vascular Surgery, University Hospital of Parma, Parma, Italy
| | - Andrea Gaggiano
- Department of Vascular Surgery, Umberto I Mauriziano Hospital, Turin, Italy
| | - Enrico Gallitto
- Department of Vascular Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Stefano Gennai
- Department of Vascular Surgery, Baggiovara Hospital, Modena, Italy
| | - Emanuela Giampalma
- Department of Diagnostic and Interventional Radiology, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Francesco Giurazza
- Department of Diagnostic and Interventional Radiology, AORN Cardarelli, Naples, Italy
| | - Franco Grego
- Department of Vascular Surgery, University Hospital of Padua, Padua, Italy
| | - Giorgia Guazzarotti
- Department of Diagnostic and Interventional Radiology, San Raffaele Hospital, Milan, Italy
| | - Anna M Ierardi
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Daniele Mascia
- Department of Vascular Surgery, San Raffaele Hospital, Milan, Italy
| | - Luca Mezzetto
- Department of Vascular Surgery, University Hospital of Verona, Verona, Italy
| | | | - Floriana Nardelli
- Department of Diagnostic and Interventional Radiology, Città della Salute e della Scienza, Turin, Italy
| | - Raffaella Niola
- Department of Diagnostic and Interventional Radiology, AORN Cardarelli, Naples, Italy
| | - Massimo Lenti
- Department of Vascular Surgery, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Orsola Perrone
- Department of Diagnostic and Interventional Radiology, A.O.U. Pisana, Pisa, Italy
| | - Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Varese, Italy
| | | | - Raffaele Pulli
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Gino Puntel
- Department of Diagnostic and Interventional Radiology, University Hospital of Verona, Verona, Italy
| | - Giovanni Puppini
- Department of Diagnostic and Interventional Radiology, University Hospital of Verona, Verona, Italy
| | - Denis Rossato
- Department of Diagnostic and Interventional Radiology, Città della Salute e della Scienza, Turin, Italy
| | - Michele Rossi
- Department of Diagnostic and Interventional Radiology, Sant'Andrea University Hospital, Rome, Italy
| | | | | | | | - Marcello A Tipaldi
- Department of Diagnostic and Interventional Radiology, Sant'Andrea University Hospital, Rome, Italy
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Varese, Italy
| | - Gian F Veraldi
- Department of Vascular Surgery, University Hospital of Verona, Verona, Italy
| | - Antonio Vizzuso
- Department of Diagnostic and Interventional Radiology, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Sara Allievi
- Department of Vascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Luca Attisani
- Department of Vascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Gianluigi Fino
- Department of Vascular Surgery, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | - Paola Manzo
- Department of Vascular Surgery, Umberto I Mauriziano Hospital, Turin, Italy
| | - Mattia Migliari
- Department of Vascular Surgery, Baggiovara Hospital, Modena, Italy
| | - Stephanie Steidler
- Department of Diagnostic and Interventional Radiology, San Raffaele Hospital, Milan, Italy
| | - Vittorio Miele
- Department of Diagnostic and Interventional Radiology, Careggi University Hospital, Florence, Italy
| | - Maurizio Taurino
- Department of Vascular Surgery, Sant'Andrea University Hospital, Rome, Italy
| | - Massimiliano Orso
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
| | - Maurizio Cariati
- Department of Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, Milan, Italy
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Wang S, Huang W, Liu J, Liu Q, Wang Z, Wang Q, Shan Q, Li W, Ding X, Wu Z, Wang Z. Selection of endovascular treatment strategies and analysis of the efficacy of different locations and types of splenic artery aneurysms. CVIR Endovasc 2024; 7:16. [PMID: 38294662 PMCID: PMC10831027 DOI: 10.1186/s42155-024-00427-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/18/2024] [Indexed: 02/01/2024] Open
Abstract
PURPOSE To analyze the selection of endovascular treatment strategies and the efficacy of various locations and types of splenic artery aneurysms (SAAs). METHODS Sixty-three cases of patients diagnosed with SAA from January 2016 to October 2021 were collected, and their clinical data and follow-up results were analyzed. RESULTS Among the 63 patients, 55 had true SAAs, and 8 had false SAAs. The average diameter of the true SAAs was 2.0 ± 0.8 cm. There were 10 cases of intra-aneurysm embolization, 24 cases of intra-aneurysm and aneurysm-bearing artery embolization, 10 cases of bare stent-assisted coil embolization, and 11 cases of stent grafts. The false SAAs had an average diameter of 2.3 ± 1.1 cm. Aneurysm-bearing artery embolization was applied in 5 cases, and stent grafts were applied in 3 cases. The incidence of complications after embolization of the aneurysm-bearing artery was higher (P < 0.01). Postembolization syndrome occurred in 10 patients; 7 patients developed splenic infarction to varying degrees, 1 patient had mildly elevated blood amylase, and 1 patient developed splenic necrosis with abscess formation, all of which improved after active treatment. The average length of hospital stay was 5.5 ± 3.2 days. The average follow-up time was 17.2 ± 16.1 months, and the aneurysm cavity of all patients was completely thrombotic. CONCLUSION Endovascular treatments of SAAs are safe and effective. For various locations and types of SAAs, adequate selection of treatment is necessary. Stent grafts are recommended for their safety, economy, practicality, and preservation of the physiological functions of the human body.
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Affiliation(s)
- Shenjie Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Wei Huang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Jingjing Liu
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Qin Liu
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Ziyin Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Qingbing Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Qungang Shan
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Wenchang Li
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Xiaoyi Ding
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Zhiyuan Wu
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China.
| | - Zhongmin Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China.
- College of Health Science and Technology, Shanghai JiaoTong University School of Medicine, Shanghai, China.
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8
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Khan A, Fosby B, Labori KJ, Lanari J, Dorenberg E, Line PD. Management of Coeliac and Hepatic Artery Aneurysms: An Experience of 84 Cases. Eur J Vasc Endovasc Surg 2023; 66:814-820. [PMID: 37722651 DOI: 10.1016/j.ejvs.2023.09.032] [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] [Received: 01/08/2023] [Revised: 08/22/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To report outcomes following open or endovascular treatment of true hepatic and coeliac artery aneurysms at a single referral centre. METHODS This was a retrospective cohort study of consecutive patients treated for true hepatic and coeliac artery aneurysms between May 2002 and December 2021. Outcome measures included complications, graft patency, and survival rate. RESULTS Overall, 84 patients were included with a median age of 63 years (interquartile range 55, 79). The majority (76%) of the patients were men. Frequent comorbidities included a history of tobacco (69%), hypertension (65%), hyperlipidaemia (32%), and diabetes (15%). Multiple synchronous aneurysms were detected in 22 patients (26%). There were 33 (39%) symptomatic aneurysms (abdominal pain without rupture [n = 18], rupture [n = 10], and sepsis [n = 5]). Seventeen patients (20%) had mycotic aetiology. Fifty patients (60%) underwent endovascular treatment with either covered stent placement (n = 29) or coil embolisation (n = 21), and 34 patients (40%) were treated with open surgery using allogenic iliac artery (n = 15), autologous saphenous vein (n = 15), GoreTex graft (n = 2), or ligation (n = 2). The complication rate was 32% in the open group and 18% in the endovascular group (p = .048). The overall 90 day post-operative mortality rate was 1.2%, five year primary patency was 90.0%, five year survival rate was 81.2%, and mean follow up was 6.9 ± 4.2 years. CONCLUSION Endovascular treatment is the preferred approach whenever technically possible. Despite higher post-operative morbidity, an open approach with vascular reconstruction using autologous or allogenic vascular grafts yields acceptable long term results.
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Affiliation(s)
- Ammar Khan
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Bjarte Fosby
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Knut J Labori
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Jacopo Lanari
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Eric Dorenberg
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Pål-Dag Line
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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9
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Soliński DG, Celer M, Dyś K, Witkiewicz W, Wiewióra M. 3D printing in the endovascular treatment of visceral artery aneurysms. Medicine (Baltimore) 2023; 102:e35844. [PMID: 37960732 PMCID: PMC10637494 DOI: 10.1097/md.0000000000035844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/06/2023] [Indexed: 11/15/2023] Open
Abstract
Visceral artery aneurysms (VAAs) are vascular pathologies that are difficult to treat. The variable geometry of the vessels and the location of aneurysms render difficult their evaluation in radiological imaging studies. Less invasive endovascular procedures are increasingly used in common practice. Our aim was to test the feasibility of using 3D printing technology in the preparation of preoperative spatial models of visceral artery aneurysms and their impact on interventional treatment. In our observational study, we examined a group of patients with true aneurysms of the visceral arteries who were followed and who underwent endovascular procedures with the use of 3D prints for better imaging of vascular lesions. We analyzed the fused filament fabrication method of 3D printing and printable materials in the preparation of spatial vascular models. We confirmed that more accurate visualization and analysis of vascular anatomy could assist operators in attempting minimally invasive treatment with good results. Extending imaging studies using 3D printing models that allow for the assessment of the position, morphology and geometry of the aneurysm sac, particularly of vessel branches, could encourage surgeons to perform endovascular procedures.
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Affiliation(s)
| | - Marcin Celer
- Regional Specialist Hospital in Wroclaw, Research and Development Center, Wroclaw, Poland
| | - Krzysztof Dyś
- Regional Specialist Hospital in Wroclaw, Research and Development Center, Wroclaw, Poland
| | - Wojciech Witkiewicz
- Regional Specialist Hospital in Wroclaw, Research and Development Center, Wroclaw, Poland
| | - Maciej Wiewióra
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
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10
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Khreisat A, Bateman J, Kozyk M, Strubchevska K. Spontaneous Celiac Artery Pseudoaneurysm in a Patient With Viral Myocarditis: Coincidence or Consequence? Cureus 2023; 15:e48970. [PMID: 38106727 PMCID: PMC10725737 DOI: 10.7759/cureus.48970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/19/2023] Open
Abstract
Spontaneous pseudoaneurysm formation in the celiac artery is a very infrequent occurrence in the absence of trauma or descending aortic dissection. If it continues to progress, it can lead to visceral organ infarction or life-threatening hemoperitoneum. Management is conservative in select cases; however, most patients require an endovascular or surgical approach. The definitive etiology of spontaneous celiac artery pseudoaneurysm remains unclear. We present an intriguing case of a 67-year-old female who presented to the hospital with sudden chest pain preceded by viral prodromal symptoms. She was discharged as a case of viral myocarditis and was re-admitted the same day with acute abdominal pain. Computed tomography with intravenous contrast showed an enlarging eight-millimeter celiac artery pseudoaneurysm managed with endovascular coil embolization. This case report demonstrates spontaneous celiac artery pseudoaneurysm workup and management. We are also investigating whether a unifying diagnosis exists to explain both viral myocarditis and celiac artery pseudoaneurysm or if both conditions are sporadic occurrences.
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Affiliation(s)
- Ali Khreisat
- Internal Medicine, Beaumont Health, Royal Oak, USA
| | | | - Marko Kozyk
- Internal Medicine, Beaumont Hospital, Royal Oak, USA
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11
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Tsuchida K, Kokaguchi K, Akamatsu D, Namiki K. Open surgical repair of a giant common hepatic artery pseudoaneurysm that perforated into the duodenum and common bile duct. J Vasc Surg Cases Innov Tech 2023; 9:101226. [PMID: 37363143 PMCID: PMC10285279 DOI: 10.1016/j.jvscit.2023.101226] [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: 03/03/2023] [Accepted: 05/08/2023] [Indexed: 06/28/2023] Open
Abstract
This is a case of 60-year-old male patient with a history of heavy alcohol consumption and liver dysfunction who presented with a giant hepatic aneurysm. The incidence of giant hepatic aneurysms exceeding 10 cm in diameter is rare, particularly in the context of pseudoaneurysms. Furthermore, simultaneous perforation into the bile duct and duodenum is highly unusual. This case report elucidates the successful surgical management of a large pseudoaneurysm of the common hepatic artery that concurrently perforated the bile duct and duodenum, without any complications or deterioration of liver function.
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Affiliation(s)
- Ken Tsuchida
- Division of Vascular Surgery, Osaki Citizen Hospital, Osaki, Japan
| | | | - Daijirou Akamatsu
- Division of Vascular Surgery, Department of Surgery, Tohoku University Hospital, Sendai, Japan
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12
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Lerut AV, Pirenne J, Sainz-Barriga M, Blondeel J, Maleux G, Monbaliu D. Case report: Immediate revascularization for symptomatic hepatic artery pseudoaneurysm after orthotopic liver transplantation? A case series and literature review. Front Surg 2023; 10:1169556. [PMID: 37440926 PMCID: PMC10333477 DOI: 10.3389/fsurg.2023.1169556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/06/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Hepatic artery pseudoaneurysm (HAPA), a rare vascular complication that can develop after liver transplantation, is associated with a high mortality rate and graft loss. To salvage the liver graft, immediate revascularization, either through surgical or endovascular intervention, is required. However, currently there is no consensus on the optimal strategy. Here, we report three cases of liver transplant recipients diagnosed with HAPA and treated with immediate revascularization. In addition, we present an overview of HAPA cases described in the literature and make recommendations on how to treat this rare complication. Methods All adults transplanted in our center between 2005 and 2021 were retrospectively reviewed. Literature search was done in PubMed for original studies between 1980 and 2021 reporting early hepatic artery (pseudo) aneurysm after liver transplantation requiring either surgical or endovascular intervention. Results From a total of 1,172, 3 liver transplant patients were identified with a symptomatic HAPA and treated with immediate revascularization. HAPA occurred 73, 27, and 8 days after liver transplantation and was treated with immediate revascularization (two surgical and one endovascular intervention). Literature review identified 127 cases of HAPA. HAPA was managed with endovascular therapy in 20 cases and by surgical intervention in 89 cases. Overall reported mortality rate was 39.6%, whereas overall graft survival was 45.2%. Conclusion Immediate surgical or radiological interventional excision and prompt revascularization to salvage liver grafts is feasible but still associated with a high mortality.
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Affiliation(s)
- An Verena Lerut
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jacques Pirenne
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Abdominal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Mauricio Sainz-Barriga
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Joris Blondeel
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Abdominal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Diethard Monbaliu
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Abdominal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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13
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Takata Y, Katayama K, Shimizu H, Inoue R, Takasaki T, Takahashi S. Treatment of celiac artery rupture with a hybrid procedure involving aortic stent grafting and open surgery in a patient with neurofibromatosis type 1. J Vasc Surg Cases Innov Tech 2022; 8:625-628. [PMID: 36248389 PMCID: PMC9556580 DOI: 10.1016/j.jvscit.2022.07.020] [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: 02/09/2022] [Accepted: 07/27/2022] [Indexed: 11/25/2022] Open
Abstract
Neurofibromatosis type 1 is associated with vascular fragility, and vascular disease is the second leading cause of death in these patients. A 42-year-old woman with neurofibromatosis type 1 was transferred to our hospital owing to shock. A computed tomography scan revealed a ruptured celiac artery aneurysm, which had expanded from 14 to 26 mm in 1 day. The survival rate of patients with celiac artery rupture is extremely low, and there is no consensus on treatment. Here, we successfully performed a hybrid procedure with emergent implantation of aortic stent grafts for life-saving treatment and subsequent laparotomy for complete hemostasis.
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14
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Schroeder G, Edalati M, Tom G, Kuntjoro N, Gutin M, Gurian M, Cuniberto E, Hirth E, Martiri A, Sposato MT, Aminzadeh S, Eichenbaum J, Alizadeh P, Baidya A, Haghniaz R, Nasiri R, Kaneko N, Mansouri A, Khademhosseini A, Sheikhi A. Assessing the aneurysm occlusion efficacy of a shear-thinning biomaterial in a 3D-printed model. J Mech Behav Biomed Mater 2022; 130:105156. [PMID: 35397405 PMCID: PMC9060636 DOI: 10.1016/j.jmbbm.2022.105156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 02/13/2022] [Accepted: 02/27/2022] [Indexed: 12/26/2022]
Abstract
Metallic coil embolization is a common method for the endovascular treatment of visceral artery aneurysms (VAA) and visceral artery pseudoaneurysms (VAPA); however, this treatment is suboptimal due to the high cost of coils, incomplete volume occlusion, poor reendothelialization, aneurysm puncture, and coil migration. Several alternative treatment strategies are available, including stent flow diverters, glue embolics, gelfoam slurries, and vascular mesh plugs-each of which have their own disadvantages. Here, we investigated the in vitro capability of a shear-thinning biomaterial (STB), a nanocomposite hydrogel composed of gelatin and silicate nanoplatelets, for the minimally-invasive occlusion of simple necked aneurysm models. We demonstrated the injectability of STB through various clinical catheters, engineered an in vitro testing apparatus to independently manipulate aneurysm neck diameter, fluid flow rate, and flow waveform, and tested the stability of STB within the models under various conditions. Our experiments show that STB is able to withstand at least 1.89 Pa of wall shear stress, as estimated by computational fluid dynamics. STB is also able to withstand up to 10 mL s-1 pulsatile flow with a waveform mimicking blood flow in the human femoral artery and tolerate greater pressure changes than those in the human aorta. We ultimately found that our in vitro system was limited by supraphysiologic pressure changes caused by aneurysm models with low compliance.
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Affiliation(s)
- Grant Schroeder
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Masoud Edalati
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA; Department of Mechanical Engineering Rowan University, Rowan Hall 201 Mullica Hill Rd. Glassboro, NJ, 08028, USA
| | - Gregory Tom
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Nicole Kuntjoro
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Mark Gutin
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA; Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Melvin Gurian
- Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Edoardo Cuniberto
- Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Elisabeth Hirth
- Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Alessia Martiri
- Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Maria Teresa Sposato
- Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Selda Aminzadeh
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - James Eichenbaum
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Parvin Alizadeh
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA; Department of Materials Science & Engineering, Faculty of Engineering & Technology, Tarbiat Modares University, Tehran, Iran
| | - Avijit Baidya
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Reihaneh Haghniaz
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA; Terasaki Institute for Biomedical Innovation (TIBI), Los Angeles, CA, 90024, USA
| | - Rohollah Nasiri
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Naoki Kaneko
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Abraham Mansouri
- Department of Mechanical Engineering, Higher College of Technology, Dubai, 15825, United Arab Emirates
| | - Ali Khademhosseini
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA; Terasaki Institute for Biomedical Innovation (TIBI), Los Angeles, CA, 90024, USA.
| | - Amir Sheikhi
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, USA; California NanoSystems Institute (CNSI), University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA; Department of Chemical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA; Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA.
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15
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Two Cases of Duodenal Ulcers That Developed after Transcatheter Procedures for Unruptured Visceral Artery Aneurysms. Case Rep Gastrointest Med 2022; 2022:9988216. [PMID: 35433061 PMCID: PMC9010178 DOI: 10.1155/2022/9988216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/29/2022] [Indexed: 12/17/2022] Open
Abstract
Herein, we report two cases of duodenal ulcers that developed after transcatheter procedures for the treatment of unruptured artery aneurysms. Both patients recovered after the administration of nothing by mouth, intravenous fluids, and proton-pump inhibitors. Notably, the duodenal ulcer was unchanged in one patient six days after endovascular treatment and improved in the other patient 13 days after angiography. These cases suggest that conservative treatment is acceptable in patients with duodenal ischemia that develops as an adverse effect of endovascular procedures. The usefulness of esophagogastroduodenoscopy in such patients has also been highlighted.
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16
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Soliński DG, Celer M, Dyś K, Wiewióra M. 3D printing in the preoperative planning and endovascular treatment of splenic artery aneurysm. Own clinical experience and literature review. Wideochir Inne Tech Maloinwazyjne 2022; 17:110-115. [PMID: 35251395 PMCID: PMC8886478 DOI: 10.5114/wiitm.2021.107765] [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: 02/02/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022] Open
Abstract
Splenic artery aneurysms (SAAs) are the most common visceral aneurysms. Endovascular treatment of SAAs is increasingly used. Appropriate preoperative imaging of aneurysms is crucial to treatment planning. The case of a patient with accidentally detected SAA on angio-CT examination was the basis for implementation of 3D printing to prepare an artery model. The 3D model made it easier to qualify for endovascular treatment of the SAA and helped to visualize its morphology. An excellent treatment effect was achieved. 3D printing provides an opportunity for better visualization of SAA anatomy, which has a direct impact on the choice of minimally invasive treatment method.
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Affiliation(s)
- Daniel G Soliński
- Regional Specialist Hospital, Research and Development Center, Wroclaw, Poland
| | - Marcin Celer
- Regional Specialist Hospital, Research and Development Center, Wroclaw, Poland
| | - Krzysztof Dyś
- Regional Specialist Hospital, Research and Development Center, Wroclaw, Poland
| | - Maciej Wiewióra
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
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17
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Dubois AS, Mathew JM, Makris SA, Renwick B. Surgical Excision of a Contained Rupture of an Inferior Mesenteric Aneurysm. Vasc Endovascular Surg 2022; 56:321-324. [PMID: 34983268 DOI: 10.1177/15385744211069746] [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
Inferior mesenteric artery (IMA) aneurysms represent the minority of visceral aneurysm presentations. A 57-year-old female was admitted with a symptomatic IMA aneurysm secondary to atherosclerotic disease. She was treated with open excision which revealed a contained ruptured of a true aneurysm. This case highlights the challenges of an accurate preoperative diagnosis of IMA aneurysm and the correct position of the recent guidelines on visceral aneurysms issued by the Society of Vascular Surgery (SVS).
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Affiliation(s)
- Andre S Dubois
- Department of Vascular Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Joyce M Mathew
- Department of Histopathology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Sotirios A Makris
- Department of Vascular Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Bryce Renwick
- Department of Vascular Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
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18
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Santini G, Quassone P, Arienzo F, Sarti G. Complex endovascular treatment of a celiac trunk artery aneurysm with splenic artery rescue: Santini et al.: Celiac trunk artery aneurysm treatment - endovascular approach. Radiol Case Rep 2021; 16:3359-3362. [PMID: 34484545 PMCID: PMC8408551 DOI: 10.1016/j.radcr.2021.08.008] [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: 04/17/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022] Open
Abstract
Visceral arterial aneurysms are uncommon pathologies, with an uncertain ethology and no clear treatment guidelines. As in our case, where we treated a 70 y.o. male patient, who came to us for un unspecific abdominal pain. So, he practiced a CT total body with contrast, presenting a celiac trunk aneurysm with involvement of the hepatic and splenic artery and therefore the team decided for an endovascular treatment, successfully obtained. Our experience is about the description of a case in its most practical and technical aspect, especially in complicated or rare conditions.
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Affiliation(s)
- Gianpaolo Santini
- Vascular and Interventional Unit-P.O. Ospedale del Mare, ASL NA1 Centro, viale delle Metamorfosi
| | - Pasquale Quassone
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Via Luciano Armanni, 14-20, Naples, Italy
| | - Francesco Arienzo
- Vascular and Interventional Unit-P.O. Ospedale del Mare, ASL NA1 Centro, viale delle Metamorfosi
| | - Giuseppe Sarti
- Vascular and Interventional Unit-P.O. Ospedale del Mare, ASL NA1 Centro, viale delle Metamorfosi
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19
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Shelton J, Raviraj S. A Case Report: Hepatic artery pseudoaneurysm causing life-threatening haemobilia. Int J Surg Case Rep 2021; 86:106350. [PMID: 34482204 PMCID: PMC8426515 DOI: 10.1016/j.ijscr.2021.106350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/22/2021] [Accepted: 08/22/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction & importance Hepatic artery aneurysms (HAA) are rare and it accounts 20% of all visceral artery aneurysms. Commonly HAAs are autopsy findings, but rupture and bleeding carrying significant morbidity and can manifest as haemobilia. Case presentation A 63-year-old Sri Lankan male presented with severe melaena upper abdominal pain and features of obstructive jaundice was found to have a giant pseudoaneurysm at the right hepatic artery with the possible arterio-biliary fistula. The etiology for the pseudoaneurysm was not identified. Despite massive transfusion, the patient died before the endovascular intervention. Clinical discussion Atherosclerosis is the leading cause of HAA formation but can be associated with connective tissue disorders and arteritis. Most of the HAA are asymptomatic. Aneurysms can be managed with surgical or endovascular interventions. Conclusion Life-threatening haemobilia is a notorious complication of the rapture of HAA into the biliary system. The incidents of hepatic artery aneurysms and pseudoaneurysms due to percutaneous transhepatic interventions and minimal invasive hepatobiliary surgeries are in the rising trend. Nonleaking VAA can be best treated with endovascular treatment. The knowledge on this topic is important for the early detection and intervention of this rare entity. Massive Gastrointestinal bleeding can be haemobilia. Rupture of vascular aneurysms into the biliary system can cause severe haemobilia. Incidents of Hepatic artery aneurysms due to minimal invasive transhepatic procedures are in a rising trend. Non-leaking Visceral artery aneurysms can be managed best with Endovascular treatment.
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Affiliation(s)
- J Shelton
- General Surgery, Teaching Hospital Jaffna, Sri Lanka.
| | - S Raviraj
- University Surgical Unit, Teaching Hospital Jaffna, Sri Lanka
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20
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Law NL, Villada FA, Kruse MJ. Rupture of splenic artery aneurysm in a man with polycythemia vera and acquired von Willebrand syndrome. BMJ Case Rep 2021; 14:14/6/e243316. [PMID: 34167989 DOI: 10.1136/bcr-2021-243316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Nathan L Law
- Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Fabio A Villada
- Radiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Matthew J Kruse
- Radiology, Creighton University School of Medicine, Omaha, Nebraska, USA
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21
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Graham I, Kanitra J, Berg R, Haouilou J. Management of a common and proper hepatic artery aneurysm. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:283-285. [PMID: 33997574 PMCID: PMC8095111 DOI: 10.1016/j.jvscit.2021.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/20/2021] [Indexed: 12/28/2022]
Abstract
First-line management of hepatic artery aneurysms is via an endovascular approach. However, unfavorable anatomy may preclude this. We present a patient with an aneurysm involving most of the common hepatic artery and the entire proper hepatic artery including the emergence of the right and left hepatic artery and the gastroduodenal artery. The endovascular approach was not feasible due to unfavorable anatomy. The patient was successfully treated with an open bifurcated Dacron graft.
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Affiliation(s)
- Isabella Graham
- Department of Pathology, St. George's University School of Medicine, West Indies, Grenada
| | - John Kanitra
- Department of Surgery, Ascension St. John Hospital, Detroit, Mich
| | - Richard Berg
- Department of Surgery, Ascension St. John Hospital, Detroit, Mich
| | - Jimmy Haouilou
- Department of Surgery, Ascension St. John Hospital, Detroit, Mich
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22
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Yuan FK, Xi HL, Qin RH, Tian ZL, Li C, Lu F. Endovascular treatment with stenting of celiac artery aneurysms. Medicine (Baltimore) 2020; 99:e23448. [PMID: 33235130 PMCID: PMC7710262 DOI: 10.1097/md.0000000000023448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/20/2020] [Accepted: 10/23/2020] [Indexed: 10/29/2022] Open
Abstract
This study aimed to detail the clinical outcomes of patients suffering from celiac arterial aneurysm (CAA) that underwent treatment via stent occlusion.This is a single-center, retrospective study. A total of 8 consecutive CAA patients were treated via stent occlusion from March 2014 to September 2018 at our hospital. Follow-up computed tomography was conducted after stenting at 1, 3, 6, and 12-month time points and every year thereafter. Both short- and long-term outcomes were assessed.In total, 8 stents were inserted into these 8 patients, with 2 being uncovered and 6 being covered stents. In 2 patients, stents were positioned in the celiac artery, while in the remaining 6 patients they were placed in the celiac and common hepatic arteries. The median operative duration was 66 minutes. No patients exhibited procedure-associated complications, and the median follow-up duration was 39 months (range: 18-72). Abdominal contrast-enhanced CT analyses of these patients exhibited stent and distal artery patency in 100% of patients, together with CAA obliteration. Visceral necrosis did not occur in any patients over the follow-up period.Stent occlusion can be safely and effectively used to treat CAA patients.
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Affiliation(s)
- Fu-Kang Yuan
- Xuzhou Institute of Cardiovascular disease; Department of Vascular Surgery, Xuzhou Clinical School of Xuzhou Medical University, 199 Jiefang Road
| | - Hai-Lin Xi
- Xuzhou Institute of Cardiovascular disease; Department of Vascular Surgery, Xuzhou Clinical School of Xuzhou Medical University, 199 Jiefang Road
| | - Rui-Hao Qin
- Xuzhou Institute of Cardiovascular disease; Department of Vascular Surgery, Xuzhou Clinical School of Xuzhou Medical University, 199 Jiefang Road
| | - Zhi-Long Tian
- Xuzhou Institute of Cardiovascular disease; Department of Vascular Surgery, Xuzhou Clinical School of Xuzhou Medical University, 199 Jiefang Road
| | - Cui Li
- Physiology Department of Basic Medical College, Xuzhou Medical University
| | - Fei Lu
- Xuzhou Central Hospital; Department of Critical Care Medicine, The Xuzhou School Of Clinical Medicine Of Nanjing Medical University, 199 Jiefang Road, Xuzhou, Jiangsu, China
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Ahmed G, Abid M, Hosmane S, Mathew S. Unusual case of upper gastrointestinal haemorrhage secondary to a ruptured gastroduodenal artery pseudoaneurysm: case presentation and literature review. BMJ Case Rep 2020; 13:13/11/e236463. [PMID: 33229478 DOI: 10.1136/bcr-2020-236463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Pseudoaneurysm rupture of the gastroduodenal artery (GDA) is life-threatening and can present as an acute upper gastrointestinal haemorrhage. Here, we present a case of upper gastrointestinal haemorrhage arising from a ruptured GDA pseudoaneurysm. A 56-year-old woman presented acutely with haematemesis. She reported ongoing upper epigastric pain for a few weeks. Laboratory evaluation revealed severe microcytic hypochromic anaemia (haemoglobin, 69 g/L; normal, 120-140 g/L) and a mildly raised serum amylase level. Upper gastrointestinal endoscopy revealed dark blood collection between the rugae of the distal stomach. An abdominal CT scan detected a homogeneously enhancing rounded lesion arising from the GDA adjacent to the second part of the duodenum. The median arcuate ligament was causing stenosis of the coeliac axis origin. The diagnosis of haematemesis secondary to a ruptured GDA pseudoaneurysm was confirmed by mesenteric angiography, and aneurysmal embolisation was done. The haemoglobin level stabilised after aneurysmal embolisation.
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Affiliation(s)
- Gasim Ahmed
- Radiology Department, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Mehsim Abid
- Radiology Department, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Sharath Hosmane
- Radiology Department, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Smitha Mathew
- Radiology Department, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
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Wang L, Shu C, Li Q, Jiang X, Li X, He H, Li M. Experience of managing superior mesenteric artery aneurysm and its midterm follow-up results with 18 cases. Vascular 2020; 29:516-526. [PMID: 33115377 DOI: 10.1177/1708538120962884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To characterize the clinical features, treatment, and prognosis of superior mesenteric artery aneurysms and provide evidence for clinical decision-making. METHODS We retrospectively reviewed the diagnosis and treatment of 18 cases of superior mesenteric artery aneurysm admitted to our center from 2003 to 2020, including demographic data, risk factors, clinical manifestations, diagnosis, treatment strategies, and follow-up results. RESULTS The average age of the patients was 49.1 years, and males accounted 83.3%. The development of the disease was associated with infection, hypertension, pancreatitis, and trauma, but no significant associations with atherosclerosis were noted by our results. Nine patients were diagnosed with true aneurysm, seven patients with pseudoaneurysm, and two patients with dissecting aneurysm. Rupture of aneurysm occurred in three patients (16.7%), and one of them died before surgery. The surgery success rate was 94.1%, and open surgery was performed on nine patients, endovascular surgery on three patients, and conservative treatment on three patients. The follow-up rate was 77.8% (14/18), and the average follow-up time was 48.2 months. The mortality and reintervention rate during follow-up was 0. The two-year patency rate of artificial vessels and covered stents was 50%. CONCLUSION The clinical manifestations and features of superior mesenteric artery aneurysms vary between patients. Careful evaluation of vascular anatomy and personalized treatment strategy are critical in the management of superior mesenteric artery aneurysms. Midterm follow-up results of superior mesenteric artery aneurysms are satisfactory.
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Affiliation(s)
- Lunchang Wang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Chang Shu
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China.,Department of Vascular Surgery, Fuwai Hospital, Beijing, China
| | - Quanming Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Xiaohua Jiang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Xin Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Hao He
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
| | - Ming Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Vascular Disease Institute of Central South University, Changsha, China
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25
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Sharma S, Prasad R, Gupta A, Dwivedi P, Mohindra S, Yadav RR. Aneurysms of pancreaticoduodenal arcade: Clinical profile and endovascular strategies. JGH Open 2020; 4:923-928. [PMID: 33102765 PMCID: PMC7578292 DOI: 10.1002/jgh3.12365] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 01/09/2023]
Abstract
Background and Aim Pancreaticoduodenal arcade aneurysms (PDAAs) are uncommon lesions associated with a significant risk of rupture and mortality. This study describes the etiology, clinical presentation, and endovascular management strategies of PDAAs across a spectrum of indications. Methods The clinical records of patients with PDAAs referred for endovascular management from January 2018 till November 2019 were retrospectively reviewed. Data on presenting symptoms, associated etiologies, and outcomes after endovascular treatment were collected and studied. Results We found 15 patients with false and 1 patient with true aneurysm of pancreatoduodenal arcade (PDA). The associated conditions were coeliac artery stenosis, severe necrotizing pancreatitis, and chronic pancreatitis or iatrogenic (postendoscopic papillotomy and percutaneous metallic biliary stenting). The main presenting feature was gastrointestinal bleed, while 2 patients had abdominal pain and 1 had gastric outlet obstruction. A multiphase computed tomography scan demonstrated the ruptured aneurysm in all patients. Site of origin of PDAA influenced the choice of transarterial endovascular strategy (coiling for aneurysms of main trunk of arteries and glue injection for those arising from small arterial branches). This was carried out in an emergency setting for 12 patients and as an elective procedure in 4 patients. Technical success was demonstrated in all patients and clinical success in 14. The two patients who had rebleed were salvaged by repeat endovascular procedure. Postembolization syndrome was seen in three patients. Conclusions With advancing technology, endovascular strategies continue to evolve. Careful attention to ensure hemodynamic resuscitation and stability, correction of pre‐existing coagulopathy and attention to technique can lead to the possibility of endovascular approaches as a dependable option in the management of ruptured PDAAs.
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Affiliation(s)
- Supriya Sharma
- Department of Surgical Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Raghunanadan Prasad
- Department of Radiology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Archna Gupta
- Department of Radiology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Pranav Dwivedi
- Department of Radiology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Samir Mohindra
- Department of Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Rajanikant R Yadav
- Department of Radiology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
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26
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Laparoscopic and Robotic Surgery for Splenic Artery Aneurysm: A Systematic Review. Ann Vasc Surg 2020; 68:527-535. [PMID: 32479877 DOI: 10.1016/j.avsg.2020.05.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 01/27/2023]
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Jacobs CR, Fatima J, Scali ST, Hodges ZH, Back MR, Arnaoutakis DJ, Shah SK, Huber TS. Surgical Treatment of True Superior Mesenteric Artery Aneurysms. Ann Vasc Surg 2020; 71:74-83. [PMID: 32941966 DOI: 10.1016/j.avsg.2020.08.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Superior mesenteric artery aneurysms (SMAAs) are a rare clinical problem that can be associated with significant morbidity and mortality. The optimal surgical approach for both mycotic and degenerative SMAAs remains poorly defined. The study was designed to review our institutional experience and develop a treatment algorithm. METHODS A single-institution, retrospective review was performed to document presentation, treatment, and outcomes of patients undergoing surgical repair of SMAAs from 2003 to 2020. The primary end-point was 30-day mortality, and secondary end-points included complications, patency, freedom from reinfection, freedom from reintervention, and survival. RESULTS Eighteen patients (mean age: 46 ± 16 yrs; 50% male; mean diameter 2.4 ± 2.0 cm) underwent treatment of mycotic (50%) or degenerative (50%) SMAAs. Abdominal pain (66%) was the most common presenting symptom, and the diagnosis was confirmed with CT arteriography. Endocarditis secondary to intravenous drug abuse was responsible for most (88%) of the mycotic SMAAs, with a majority (66%) having positive cultures and Streptococcus being the most common organism. The majority (61%) of patients underwent urgent or emergent repair with aneurysmectomy and interposition saphenous vein bypass being the most common treatment of mycotic SMAAs while aneurysmectomy and prosthetic bypass were used most frequently for degenerative aneurysms. The operative mortality rate was 6% with a major complication rate of 17% (n = 3 patients: respiratory failure/reintubation-1, pulmonary embolism-1, necrotizing pancreatitis/graft disruption and death-1). The single death occurred in a patient with a degenerative aneurysm that developed postoperative pancreatitis and multiple organ dysfunction. The mean clinical follow-up time was 25 ± 48 (95% CI 1-48) months. The estimated primary patency, freedom from reinfection, and freedom from reintervention were 93 ± 7 %, 94 ± 5%, and 94 ± 5%, respectively, at 1 year. The overall mean survival was 55 ± 51 (95% CI 30-80) months with an estimated survival at 3 years of 77 ± 10%. CONCLUSIONS SMAAs associated with both degenerative and mycotic etiologies can be treated using a variety of surgical approaches with acceptable morbidity and mortality. Mycotic SMAAs should likely be repaired, regardless of size, while the indications for asymptomatic, degenerative aneurysms remain to be defined by further natural history studies.
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Affiliation(s)
- Christopher R Jacobs
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL
| | - Javairiah Fatima
- Division of Vascular Surgery and Endovascular Therapy, Georgetown University Hospital-Medstar, Washington, D.C
| | - Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL.
| | - Zachary H Hodges
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL
| | - Martin R Back
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL
| | - Dean J Arnaoutakis
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL
| | - Samir K Shah
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL
| | - Thomas S Huber
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL
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Warchol-Celinska E, Prejbisz A, Dobrowolski P, Klisiewicz A, Kadziela J, Florczak E, Michalowska I, Jozwik-Plebanek K, Kabat M, Kwiatek P, Nazarewski S, Madej K, Rowinski O, Swiatlowski L, Peczkowska M, Hanus K, Talarowska P, Smolski M, Kowalczyk K, Kurkowska-Jastrzebska I, Stefanczyk L, Wiecek A, Widecka K, Tykarski A, Stryczynski L, Litwin M, Hoffman P, Witkowski A, Szczerbo-Trojanowska M, Januszewicz M, Januszewicz A. Systematic and Multidisciplinary Evaluation of Fibromuscular Dysplasia Patients Reveals High Prevalence of Previously Undetected Fibromuscular Dysplasia Lesions and Affects Clinical Decisions: The ARCADIA-POL Study. Hypertension 2020; 75:1102-1109. [PMID: 32148126 DOI: 10.1161/hypertensionaha.119.13239] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Fibromuscular dysplasia (FMD), regarded as a generalized vascular disease, may affect all vascular beds and may result in arterial stenosis, occlusion, aneurysm, or dissection. It has been proposed to systematically evaluate all vascular beds in patients with FMD, regardless of initial FMD involvement. However, the impact of this approach on clinical decisions and on management is unknown. Within the prospective ARCADIA-POL study (Assessment of Renal and Cervical Artery Dysplasia-Poland), we evaluated 232 patients with FMD lesions confirmed in at least one vascular bed, out of 343 patients included in the registry. All patients underwent a detailed clinical evaluation including computed tomography angiography of intracranial and cervical arteries, as well as computed tomography angiography of the abdominal aorta, its branches, and upper and lower extremity arteries. In the study group, FMD lesions were most frequently found in renal arteries (87.5%). FMD was also found in cerebrovascular (24.6%), mesenteric (13.8%), and upper (3.0%) and lower extremity (9.9 %) arteries. Newly diagnosed FMD lesions were found in 34.1% of the patients, and previously undetected vascular complications were found in 25% of the patients. Among all FMD patients included in the study, one out of every 4 evaluated patients qualified for interventional treatment due to newly diagnosed FMD lesions or vascular complications. The ARCADIA-POL study shows for the first time that the systematic and multidisciplinary evaluation of patients with FMD based on a whole-body computed tomography angiography scan has an impact on their clinical management. This proved the necessity of the systematic evaluation of all vascular beds in patients with FMD, regardless of initial FMD involvement.
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Affiliation(s)
- Ewa Warchol-Celinska
- From the Departments of Hypertension (E.W.-C., A.P., P.D., E.F., K.J.-P., M.K., M.P., K.H., P.T., M.S., K.K., A.J.), Institute of Cardiology, Warsaw, Poland
| | - Aleksander Prejbisz
- From the Departments of Hypertension (E.W.-C., A.P., P.D., E.F., K.J.-P., M.K., M.P., K.H., P.T., M.S., K.K., A.J.), Institute of Cardiology, Warsaw, Poland
| | - Piotr Dobrowolski
- From the Departments of Hypertension (E.W.-C., A.P., P.D., E.F., K.J.-P., M.K., M.P., K.H., P.T., M.S., K.K., A.J.), Institute of Cardiology, Warsaw, Poland
| | - Anna Klisiewicz
- Congenital Heart Diseases (A.K., P.H.), Institute of Cardiology, Warsaw, Poland
| | - Jacek Kadziela
- Interventional Cardiology and Angiology (J.K., A.W.), Institute of Cardiology, Warsaw, Poland
| | - Elzbieta Florczak
- From the Departments of Hypertension (E.W.-C., A.P., P.D., E.F., K.J.-P., M.K., M.P., K.H., P.T., M.S., K.K., A.J.), Institute of Cardiology, Warsaw, Poland
| | | | - Katarzyna Jozwik-Plebanek
- From the Departments of Hypertension (E.W.-C., A.P., P.D., E.F., K.J.-P., M.K., M.P., K.H., P.T., M.S., K.K., A.J.), Institute of Cardiology, Warsaw, Poland
| | - Marek Kabat
- From the Departments of Hypertension (E.W.-C., A.P., P.D., E.F., K.J.-P., M.K., M.P., K.H., P.T., M.S., K.K., A.J.), Institute of Cardiology, Warsaw, Poland
| | - Pawel Kwiatek
- Radiology (I.M., P.K.), Institute of Cardiology, Warsaw, Poland
| | - Slawomir Nazarewski
- Department of General, Vascular and Transplant Surgery (S.N., K.M.), Medical University of Warsaw, Poland
| | - Krzysztof Madej
- Department of General, Vascular and Transplant Surgery (S.N., K.M.), Medical University of Warsaw, Poland
| | - Olgierd Rowinski
- 2nd Department of Radiology (O.R., M.J.), Medical University of Warsaw, Poland
| | - Lukasz Swiatlowski
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Poland (L.S., M.S.-T.)
| | - Mariola Peczkowska
- From the Departments of Hypertension (E.W.-C., A.P., P.D., E.F., K.J.-P., M.K., M.P., K.H., P.T., M.S., K.K., A.J.), Institute of Cardiology, Warsaw, Poland
| | - Katarzyna Hanus
- From the Departments of Hypertension (E.W.-C., A.P., P.D., E.F., K.J.-P., M.K., M.P., K.H., P.T., M.S., K.K., A.J.), Institute of Cardiology, Warsaw, Poland
| | - Paulina Talarowska
- From the Departments of Hypertension (E.W.-C., A.P., P.D., E.F., K.J.-P., M.K., M.P., K.H., P.T., M.S., K.K., A.J.), Institute of Cardiology, Warsaw, Poland
| | - Mikołaj Smolski
- From the Departments of Hypertension (E.W.-C., A.P., P.D., E.F., K.J.-P., M.K., M.P., K.H., P.T., M.S., K.K., A.J.), Institute of Cardiology, Warsaw, Poland
| | - Katarzyna Kowalczyk
- From the Departments of Hypertension (E.W.-C., A.P., P.D., E.F., K.J.-P., M.K., M.P., K.H., P.T., M.S., K.K., A.J.), Institute of Cardiology, Warsaw, Poland
| | | | - Ludomir Stefanczyk
- Department of Radiology and Imaging Diagnostics, Medical University of Lodz, Poland (L.S.)
| | - Andrzej Wiecek
- Interventional Cardiology and Angiology (J.K., A.W.), Institute of Cardiology, Warsaw, Poland
| | - Krystyna Widecka
- Department of Hypertensiology and Internal Medicine, Pomeranian Medical University in Szczecin, Poland (K.W.)
| | - Andrzej Tykarski
- Department of Internal Medicine Metabolic Disorders and Hypertension, Poznan University of Medical Science, Poland (A.T., L.S.)
| | - Lukasz Stryczynski
- Department of Internal Medicine Metabolic Disorders and Hypertension, Poznan University of Medical Science, Poland (A.T., L.S.)
| | - Mieczyslaw Litwin
- Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute in Warsaw, Poland (M.L.)
| | - Piotr Hoffman
- Congenital Heart Diseases (A.K., P.H.), Institute of Cardiology, Warsaw, Poland
| | - Adam Witkowski
- Department of Nephrology, Tranplantology and Internal Medecine, Medical University of Silesia, Katowice, Poland (A.W.)
| | | | | | - Andrzej Januszewicz
- From the Departments of Hypertension (E.W.-C., A.P., P.D., E.F., K.J.-P., M.K., M.P., K.H., P.T., M.S., K.K., A.J.), Institute of Cardiology, Warsaw, Poland
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Inoue A, Ohta S, Imai Y, Murakami Y, Tomozawa Y, Sonoda A, Nitta N. Naturally shrunk visceral artery aneurysms by stenting for the superior mesenteric artery occlusion. MINIM INVASIV THER 2020; 30:245-249. [PMID: 32100596 DOI: 10.1080/13645706.2020.1732426] [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: 10/24/2022]
Abstract
A 77-year-old woman who had experienced postprandial abdominal pain for four years was admitted to our institution presenting sudden and severe abdominal pain. Contrast-enhanced computed tomography (CECT) demonstrated complete short-segmented occlusion in the orifice of the superior mesenteric artery (SMA), and saccular aneurysms in the right hepatic artery and the anterior superior pancreaticoduodenal artery. She was diagnosed with abdominal angina due to occlusion of the SMA. The SMA was recanalized by stenting, and a CECT scan confirmed naturally shrunk aneurysms after eight months. The patency of the SMA was maintained at five years after endovascular treatment.
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Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Shinichi Ohta
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Yugo Imai
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Yoko Murakami
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Yuki Tomozawa
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Akinaga Sonoda
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Norihisa Nitta
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
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Abstract
The aim of this study was to evaluate the safety and clinical effectiveness of endovascular stent repair of celiac arterial aneurysm (CAA).From January 2015 to December 2018, 11 patients (7 males, 4 females with a mean age of 52.2 ± 7.9 years) underwent endovascular stent repair of CAA in our center. A covered stent was used to occlude the CAA neck. Follow-up was performed 2 weeks and 1, 3, 6, and 12 months following surgery and yearly thereafter. Rates of technical success, treatment-related complications, and long-term outcome were analyzed.Each patient was placed with 1 stent for repair of CAA. Stent was placed in the celiac and common hepatic arteries for 10 patients and was placed in the celiac artery for 1 patient. The duration of the procedure ranged from 50 to 75 minutes (mean 63.2 ± 7.2 minutes). The rate of technical success of the endovascular stent repair was 100%. No patient experienced CAA rupture or instant endoleak during or after stent insertion. Abdominal pain was relieved progressively after stent insertion. All patients were followed-up for 6 to 48 months (mean 22.4 ± 10.8 months). All patients were alive during the follow-up. No endoleaks were experienced during follow-up with 100% stent patency rate. No patient suffered splenic, hepatic, or bowel infarction during follow-up.Endovascular stent repair is a safe, simple, and effective treatment for patients with CAA.
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Affiliation(s)
| | | | - Xiao-Bing Huo
- Department of Radiology, Binzhou People's Hospital, Binzhou
| | - Yu-Fei Fu
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
| | - Yuan-Shun Xu
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
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31
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Current management strategies for visceral artery aneurysms: an overview. Surg Today 2019; 50:38-49. [PMID: 31620866 PMCID: PMC6949316 DOI: 10.1007/s00595-019-01898-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 09/28/2019] [Indexed: 12/16/2022]
Abstract
Visceral artery aneurysms (VAAs) are rare and affect the celiac artery, superior mesenteric artery, and inferior mesenteric artery, and their branches. The natural history of VAAs is not well understood as they are often asymptomatic and found incidentally; however, they carry a risk of rupture that can result in death from hemorrhage in the peritoneal cavity, retroperitoneal space, or gastrointestinal tract. Recent advances in imaging technology and its availability allow us to diagnose all types of VAA. VAAs can be treated by open surgery, laparoscopic surgery, endovascular therapy, or a hybrid approach. However, there are still no specific indications for the treatment of VAAs, and the best strategy depends on the anatomical location of the aneurysm as well as the clinical presentation of the patient. This article reviews the literature on the etiology, clinical features, diagnosis, and anatomic characteristics of each type of VAA and discusses the current options for their treatment and management.
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