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Jhajharia A, Singh S, Chaudhary M, Ameta M, Ashdhir P, Nijhawan S. Efficacy and Rationale of Endoscopic Ultrasound-Guided Thrombin Injection in Visceral Artery Pseudoaneurysm Not Amenable to Angioembolization. Pancreas 2024; 53:e330-e337. [PMID: 38345925 DOI: 10.1097/mpa.0000000000002303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
BACKGROUND Pseudoaneurysm usually occurs after vascular injuries or erosions such as in trauma or inflammation like pancreatitis and is associated with high morbidity and mortality. AIM The aim of study is to assess efficacy and safety of EUS-guided thrombin injection in pseudoaneurysm. MATERIALS AND METHODS Prospective data collection was done at SMS Hospital, Jaipur, from January 2015 to March 2023. All patients with pseudoaneurysm were consecutively enrolled. RESULTS Twenty patients (M/F, 18:2) with median age of 41 years (25-58 years), were studied. Underlying etiology of pseudoaneurysm was chronic pancreatitis in 75% of the patients, blunt trauma abdomen in 15% of the patients, recurrent acute pancreatitis in 5%, and idiopathic in 5% of the patients. At the time of admission, mean hemoglobin was 6.7 g/dL (3.4-8.2), with median blood transfusion requirement was 2 units (0-6 units). Hemoglobin values after 4-6 weeks showed a significant improvement ( t = 9.21, P < 0.05).Mean dose of human thrombin required for complete obliteration of pseudoaneurysm was 520 ± 188.6 IU per patient (300-800 IU). Amount of thrombin (IU) dose needed to achieve complete obliteration correlated well significantly with the dimension of pseudoaneurysm, P value less than 0.05 ( R = 0.80). Median follow-up duration in this study was 44 months (3-84 months), which was the longest follow-up period by far. CONCLUSIONS Endoscopic ultrasound-guided thrombin injection in visceral artery pseudoaneurysm is a safe and effective alternative for patients not amenable for digital subtraction angiography-guided angioembolization.
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Affiliation(s)
- Ashok Jhajharia
- From the Department of Gastroenterology, SMS Medical College and Hospital
| | - Shashank Singh
- From the Department of Gastroenterology, SMS Medical College and Hospital
| | - Monika Chaudhary
- Department of Radiology, Santokba Durlabhji Memorial Hospital, Jaipur, India
| | - Mayank Ameta
- From the Department of Gastroenterology, SMS Medical College and Hospital
| | - Prachis Ashdhir
- From the Department of Gastroenterology, SMS Medical College and Hospital
| | - Sandeep Nijhawan
- From the Department of Gastroenterology, SMS Medical College and Hospital
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Chowdary PB, Maheshwari G, Haynes M, Amaechi I, Dickson-Lowe R. Intraperitoneal Haemorrhage Secondary to Rupture of Right Colic Artery Pseudoaneurysm: A Case Report and Literature Review. Cureus 2023; 15:e44634. [PMID: 37799213 PMCID: PMC10548298 DOI: 10.7759/cureus.44634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 10/07/2023] Open
Abstract
This article presents the case of a 58-year-old woman who presented feeling unwell with pain in the right upper abdomen for three days. She had a history of splenic infarcts, was on lifelong warfarin and had recently returned from a trip to Gambia. She was admitted to the hospital under suspicion of sepsis of unknown origin, and a CT scan later revealed haemoperitoneum along with a pseudoaneurysm of the right colic artery. After initially responding to resuscitation, the patient deteriorated haemodynamically, and a decision was made to perform a laparotomy, revealing a ruptured right colic artery pseudoaneurysm. In this article, the authors highlight the challenges of managing a complex unwell patient with a ruptured right colic artery pseudoaneurysm, emphasising the importance of a multi-disciplinary team approach and shared decision-making and reviewing the available literature.
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Affiliation(s)
| | - Gaurav Maheshwari
- General and Colorectal Surgery, Medway NHS Foundation Trust, Gillingham, GBR
| | - Maria Haynes
- Pathology, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, GBR
| | - Iheoma Amaechi
- Interventional Radiology, Medway NHS Foundation Trust, Gillingham, GBR
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Zhu F, Zhang L, Shang D. The management of spontaneous isolated celiac artery dissection: A case report and literature review. Vascular 2023:17085381231197931. [PMID: 37604155 DOI: 10.1177/17085381231197931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Spontaneous isolated celiac artery dissection (SICAD) without associated aortic dissection is a rare disease. Complications are ischemia, aneurysm formation, and rupture. Different treatment options have been reported for managing SICAD, including conservative management, endovascular intervention, and open surgery. Despite the increased recognition of this disease, there are no consensus guidelines on management of this condition. To improve the knowledge and treatment of this disease, a case of SICAD was reported. METHODS AND RESULTS We describe the case of a 57-year-old woman with SICAD whose symptoms improved after endovascular treatment when conservative treatment failed and systematically analyze the management strategy for patients with SICAD. CONCLUSIONS SICAD is a rare disease and has no universally agreed upon guidelines for treatment. Most patients can be first treated conservatively for dissection with strict blood pressure control, antithrombotic therapy, and intensive surveillance. For SICAD patients with aneurysms located in the celiac trunk, stent grafts can be used in such patients without affecting the branch blood supply.
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Affiliation(s)
- Feng Zhu
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liqiang Zhang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Shang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Salehi MG, Golezar MH, Goudarzi M. Spontaneous rupture of a gastroduodenal artery side branch immediately following endovascular treatment of gastroepiploic artery aneurysm or pseudoaneurysm. Clin Case Rep 2023; 11:e7835. [PMID: 37621723 PMCID: PMC10444941 DOI: 10.1002/ccr3.7835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/01/2023] [Accepted: 05/25/2023] [Indexed: 08/26/2023] Open
Abstract
Key clinical massage Pseudoaneurysms and aneurysms of the visceral arteries are rare entities. To the best of our knowledge, rupture of a proximal parental artery during endovascular treatment of a visceral aneurism/pseudoaneurysm has not been reported and should be kept in mind as a tragic possibility immediately following an apparently successful management of them. Abstract A 55-year-old woman with a history of coronary artery disease was referred to our hospital with abdominal pain as her primary complaint. Early works revealed anemia, a small amount of free peritoneal fluid, and a possible large aneurysm or pseudoaneurysm by the greater curvature of the stomach. She underwent emergency angiography that showed a large aneurism/pseudoaneurysm of the gastroepiploic artery. Successful embolization of the lesion was performed using the isolation technique. Perforation of a side branch of the gastroduodenal artery was observed on the immediate postembolization control angiography. Therefore, parent artery coiling was done immediately with good results. She was symptom-free and stable hemodynamically after the procedure, during the hospital course, and in the follow-ups.
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Affiliation(s)
| | | | - Mahmoud Goudarzi
- Department of RadiologyShahid Beheshti University of Medical SciencesTehranIran
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Khairallah MK, Morgan RA, Das R. Technical considerations of endovascular management of true visceral artery aneurysms. CVIR Endovasc 2023; 6:31. [PMID: 37284993 DOI: 10.1186/s42155-023-00368-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/18/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND True visceral artery aneurysms are potentially complex to treat but with advances in technology and increasing interventional radiology expertise over the past decade are now increasingly the domain of the interventional radiologist. BODY: The interventional approach is based on localization of the aneurysm and identification of the anatomical determinants to treat these lesions to prevent aneurysm rupture. Several different endovascular techniques are available and should be selected carefully, dependent on the aneurysm morphology. Standard endovascular treatment options include stent-graft placement and trans-arterial embolisation. Different strategies are divided into parent artery preservation and parent artery sacrifice techniques. Endovascular device innovations now include multilayer flow-diverting stents, double-layer micromesh stents, double-lumen balloons and microvascular plugs and are also associated with high rates of technical success. CONCLUSION Complex techniques such as stent-assisted coiling and balloon-remodeling techniques are useful techniques and require advanced embolisation skills and are further described.
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Affiliation(s)
- M K Khairallah
- Department of Radiology, St.George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
- Assiut University Hospital, Assiut, Egypt
| | - R A Morgan
- Department of Radiology, St.George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
| | - R Das
- Department of Radiology, St.George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK.
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Znaniecki Ł, Tarnawski J, Żegleń B, Dymecki M, Gniedziejko M, Wojciechowski J. Surgical repair of a symptomatic celiac artery aneurysm with resection and end-to-end anastomosis. J Vasc Surg Cases Innov Tech 2023; 9:101197. [PMID: 37305359 PMCID: PMC10250160 DOI: 10.1016/j.jvscit.2023.101197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/30/2023] [Indexed: 06/13/2023] Open
Abstract
A true aneurysm of the celiac artery is a rare form of a visceral aneurysm, constituting ∼4% of visceral aneurysms. Mortality in ruptured cases is high; thus, early recognition and treatment are crucial. Recent guidelines suggest endovascular therapy; however, numerous complications are associated with endoluminal treatment. Open repair in select cases, using an individualized strategy fit for the patient's anatomy still provides excellent early and long-term results. Our patient was treated with open surgical resection and end-to-end anastomosis of the celiac and common hepatic arteries. A 43-month follow-up computed tomography angiogram revealed excellent hepatic artery patency and no pseudoaneurysm formation.
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Affiliation(s)
- Łukasz Znaniecki
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Jakub Tarnawski
- Students’ Scientific Circle of Vascular Surgery, Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Bartosz Żegleń
- Students’ Scientific Circle of Vascular Surgery, Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Marta Dymecki
- Students’ Scientific Circle of Vascular Surgery, Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Michał Gniedziejko
- Students’ Scientific Circle of Vascular Surgery, Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Jacek Wojciechowski
- Students’ Scientific Circle of Vascular Surgery, Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
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7
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Treffalls RN, Stonko DP, DeMartino RR, Morrison JJ. Acute management of mesenteric emergencies: Tailoring the solution to the problem. Semin Vasc Surg 2023; 36:234-249. [PMID: 37330237 DOI: 10.1053/j.semvascsurg.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 06/19/2023]
Abstract
Acute mesenteric ischemia (AMI) constitutes a life-threatening problem that can result in death, multiorgan failure, and severe nutritional disability. Although AMI is a rare cause of acute abdominal emergencies, ranging between 1 and 2 individuals per 10,000, the morbidity and mortality rates are high. Arterial embolic etiology composes nearly one-half of AMIs, with a sudden onset of severe abdominal pain considered the most common symptom. Arterial thrombosis is the second most common cause of AMI, which presents similarly to arterial embolic AMI, although often more severe due to anatomic differences. Veno-occlusive causes of AMI are the third most common and are associated with an insidious onset of vague abdominal pain. Each patient is unique, and the treatment plan should be tailored to their individual needs. This may include considering the patient's age, comorbidities, and overall health, as well as their preferences and personal circumstances. A multidisciplinary approach involving specialists from different fields, such as surgeons, interventional radiologists, and intensivists, is recommended for the best possible outcome. Potential challenges in tailoring an optimal treatment plan for AMI may include delayed diagnosis, limited availability of specialized care, or patient factors that make some interventions less feasible. Addressing these challenges requires a proactive and collaborative approach, with regular review and adjustment of the treatment plan as needed to ensure the best possible outcome for each patient.
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Affiliation(s)
- Rebecca N Treffalls
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - David P Stonko
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Randall R DeMartino
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Jonathan J Morrison
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
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Gong C, Sun MS, Leng R, Ren HL, Zheng K, Wang SX, Zhu RM, Li CM. Endovascular embolization of visceral artery aneurysm: a retrospective study. Sci Rep 2023; 13:6936. [PMID: 37117396 PMCID: PMC10147652 DOI: 10.1038/s41598-023-33789-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/19/2023] [Indexed: 04/30/2023] Open
Abstract
To assess the safety and efficacy of endovascular embolization techniques, we compared the short- to medium-term prognosis of coil embolization for symptomatic visceral aneurysms (SVAA) and asymptomatic visceral aneurysms (ASVAA) to identify risk factors associated with 30-day mortality. Explore the symptom profile and intrinsic associations of SVAA. A retrospective study of 66 consecutive patients at two tertiary care hospitals from 2010 to 2020 compared the short- to mid-term outcomes of 22 symptomatic VAAs and 44 asymptomatic VAAs treated with coil embolization. Univariate and log-rank tests were used to analyze the prognostic impact of SVAA and ASVAA. SVAA group had significantly higher 30-day mortality than ASVAA group (2(9.1%) vs 0, P = 0.042), both patients who died had symptomatic pseudoaneurysms. Perioperative complications such as end-organ ischemia (P = 0.293) and reintervention (P = 1) were similar in both groups. No difference in event-free survival was identified between the two groups (P = 0.900), but we found that the majority of pseudoaneurysms were SVAA (4/5) and that they had a much higher event rate than true aneurysms. In addition, dyslipidemia may be an influential factor in the development of VAA (P = 0.010). Coil embolization is a safe and effective method of treatment for VAA. Most pseudoaneurysms have symptoms such as abdominal pain and bleeding, and in view of their risk, more attention should be paid to symptomatic patients and the nature of the aneurysm should be determined as soon as possible to determine the next stage of treatment.
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Affiliation(s)
- Chi Gong
- Department of Vascular Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ming-Sheng Sun
- Department of Vascular Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Rui Leng
- Department of General Surgery, Beijing Huai-Rou Hospital, Beijing, China
| | - Hua-Liang Ren
- Department of Vascular Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Kai Zheng
- Department of Vascular Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Sheng-Xing Wang
- Department of Vascular Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ren-Ming Zhu
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Chun-Min Li
- Department of Vascular Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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9
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Vincenzi P, Gaudenzi D, Mulazzani L, Rebonato A, Patriti A. Crohn's Disease and Jejunal Artery Aneurysms: A Report of the First Case and a Review of the Literature. Medicina (Kaunas) 2022; 58:1344. [PMID: 36295505 PMCID: PMC9611918 DOI: 10.3390/medicina58101344] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/01/2022] [Accepted: 09/21/2022] [Indexed: 12/01/2023]
Abstract
Background and Objectives: Jejunal artery (JA) and ileal artery (IA) aneurysms constitute less than 3% of all visceral artery aneurysms (VAAs), carrying a risk of rupture as high as 30%, and a mortality of 20%. Though many etiologies have been reported in the literature, no mention exists on a causal association between these aneurysms and inflammatory bowel diseases (IBD). We present the first case of a JA aneurysm related to Crohn's Disease (CD) together with a review of the literature. Materials and Methods: A 74-year-old male presenting with CD intestinal relapse and an incidental finding at the computed tomography enterography (CTE) of a 53 × 47 × 25mm apparently intact JA pseudoaneurysm, arising from the first and second jejunal branches, underwent coil embolization followed by small bowel resection, with an uneventful outcome. We also included the review of literature on JA and IA aneurysms, analyzing all reports published in PubMed and Scopus from 1943 to July 2022. Results: 60 manuscripts with 103 cases of JA and IA aneurysms in 100 patients were identified. Among cases with available data, 34 (33.0%) presented acutely with rupture, 45 (43.7%) were described as non-ruptured. 83 (80.6%), and 14 (13.6%) were JA and IA aneurysms, respectively, having a median size of 15 (range:3.5-52) mm. Atherosclerosis (16.5%), infections (10.7%), and vasculitides/connective tissue disorders (9.7%) represented the main causes mentioned. Mean age was 53.6 (±19.2) years, male patients being 59.4%. One third of patients (32.4%) were asymptomatic. Overall, treatment was indicated in 63% of patients, with surgery and endovascular procedures performed in 61.9% and 38.1% cases, respectively. The technical success rate of endovascular treatment (EVT) was 95.8%. The mortality rate was 11.8%, being higher (21.2%) in the rupture group. Conclusions: The prompt treatment accomplished in our case granted a successful outcome. JA and IA aneurysms should be included among local complications of IBD. Considering their high potential for rupture, regardless of size, a low threshold for endovascular or surgical treatment should be applied.
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Affiliation(s)
- Paolo Vincenzi
- Department of Surgery, Ospedali Riuniti Marche Nord, Piazzale Cinelli n 1, 61121 Pesaro, Italy
| | - Diletta Gaudenzi
- Department of Perioperative Services, AOU Ospedali Riuniti di Ancona, Via Conca n 71, 60126 Ancona, Italy
| | - Luca Mulazzani
- Department of Radiology, Division of Interventional Radiology, Ospedali Riuniti Marche Nord, Piazzale Cinelli n 1, 61121 Pesaro, Italy
| | - Alberto Rebonato
- Department of Radiology, Division of Interventional Radiology, Ospedali Riuniti Marche Nord, Piazzale Cinelli n 1, 61121 Pesaro, Italy
| | - Alberto Patriti
- Department of Surgery, Ospedali Riuniti Marche Nord, Piazzale Cinelli n 1, 61121 Pesaro, Italy
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Lee SH, Yang S, Park I, Im YC, Kim GY. Ruptured splenic artery aneurysms in pregnancy and usefulness of endovascular treatment in selective patients: A case report and review of literature. World J Clin Cases 2022; 10:9057-9063. [PMID: 36157677 PMCID: PMC9477030 DOI: 10.12998/wjcc.v10.i25.9057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/25/2022] [Accepted: 07/18/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The rupture of a splenic artery aneurysm (SAA) in pregnancy is an uncommon condition. However, it is associated with high mortality rates in pregnant women and fetuses even after surgical treatment. Though the endovascular treatment of SAAs is currently preferred as it can improve the outcomes even in emergent cases, the endovascular treatment of a ruptured SAA during pregnancy has not been reported until date.
CASE SUMMARY We report a case of a 33-year-old woman with the sudden onset of epigastric pain due to a ruptured SAA at the mid-portion of the splenic artery at 18 wk of pregnancy. After emergent initial resuscitation, the patient was diagnosed with a ruptured SAA through digital angiography. Immediately upon diagnosis, she underwent emergent endovascular embolization of the splenic artery for the rupture on the spot. Next, surgery was performed to remove the hematoma under stable conditions. Although the fetus was found to be dead during resuscitation, the woman recovered without complications and was discharged 15 d postoperatively.
CONCLUSION Endovascular treatment might be a valuable alternative to surgery/lead to safer surgery for selected pregnant patients with ruptured SAAs.
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Affiliation(s)
- Sang Hun Lee
- Department of Obstetrics and Gynecology, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
| | - Songsoo Yang
- Department of Surgery, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
| | - Inkyu Park
- Department of Surgery, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
| | - Yeong Cheol Im
- Department of Surgery, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
| | - Gyu Yeol Kim
- Department of Surgery, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
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Corvino F, Giurazza F, Ierardi AM, Lucatelli P, Basile A, Corvino A, Niola R. Splenic Artery Pseudoaneurysms: The Role of ce-CT for Diagnosis and Treatment Planning. Diagnostics (Basel) 2022; 12:1012. [PMID: 35454060 DOI: 10.3390/diagnostics12041012] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/07/2022] [Accepted: 04/13/2022] [Indexed: 01/19/2023] Open
Abstract
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.
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12
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Peacock T, Liu L. Superior mesenteric artery aneurysm with rupture: an atypical cause of abdominal pain. J Surg Case Rep 2022; 2022:rjab604. [PMID: 35070264 PMCID: PMC8776401 DOI: 10.1093/jscr/rjab604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022] Open
Abstract
Superior mesenteric artery aneurysm management has evolved in the last 20 years with a greater emphasis on interventional radiological intervention. This case reviews a 60-year-old lady who had a ruptured superior mesenteric aneurysm resulting in a large mesenteric haematoma.
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Affiliation(s)
- Timothy Peacock
- Correspondence address. Department of General Surgery, Liverpool Hospital, Liverpool, NSW 2170, Australia. E-mail:
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13
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Bramucci A, Miceli F, Fontana A, Tusini N, Sereni G, Sassatelli R. Successful Endovascular and Endoscopic Treatment of a Symptomatic Celiac Artery Aneurysm for Obstructive Jaundice: A Clinical Case Report. Ann Vasc Surg 2021; 80:395.e1-395.e7. [PMID: 34808263 DOI: 10.1016/j.avsg.2021.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 10/04/2021] [Accepted: 10/27/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Celiac artery aneurysm (CAA) is an infrequent aneurysm of the celiac visceral branch and is potentially life-threatening, mainly due to the risk of rupture. CAA is often diagnosed following rupture and rarely diagnosed secondary to a primary manifestation; obstructive jaundice is extremely rare and poorly described. This clinical case report reports a combined endovascular and endoscopic noninvasive treatment. METHODS A 51-year old male was admitted to the emergency department at the Arcispedale Santa Maria Nuova in Reggio Emilia following several days of jaundice. The patient did not have any history of abdominal trauma, chronic pancreatitis, bile duct calculus or alcohol abuse. Cholestatic impairment was demonstrated by blood analyses and abdominal ultrasound revealed a large cephalo-pancreatic mass. Contrast-enhanced computed tomography (CT) showed a 40 mm CAA, causing a common bile duct (CBD) compression and dilatation of the hepatic bile ducts. After a multidisciplinary team consultation, a noninvasive, combined endovascular and endoscopic approach was programmed in a hybrid room. RESULTS Immediate results confirmed successful exclusion of the CAA, stent graft patency and the absence of endoleak with correct positioning of a plastic stent in the CBD. At 1 month, an abdominal CT-angiography (CTA) evidenced a type II endoleak, successfully treated with an endovascular secondary procedure and an asymptomatic, partial downward dislodgement of the plastic stent in the CBD was correct with the positioning of 2 plastic stents. At 3-months cholangiography showed no dilation of intraepatic biliary ducts. CONCLUSIONS Symptomatic CAA with common bile duct compression could be amenable to a combined endovascular and endoscopic noninvasive treatment.
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Affiliation(s)
- Alberto Bramucci
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Francesca Miceli
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL-IRCCS Reggio nell' Emilia, Reggio Emilia, Italy
| | - Antonio Fontana
- Vascular Surgery, AO Reggio Emilia, Arcispedale S.Maria Nuova, Reggio Emilia, Italy
| | - Nicola Tusini
- Vascular Surgery, AO Reggio Emilia, Arcispedale S.Maria Nuova, Reggio Emilia, Italy
| | - Giuliana Sereni
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL-IRCCS Reggio nell' Emilia, Reggio Emilia, Italy
| | - Romano Sassatelli
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL-IRCCS Reggio nell' Emilia, Reggio Emilia, Italy
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Mascia D, Salvatii S, Carta N, Andrea A, Santoro A, Melissano G, Chiesa R. Endovascular Oriented Classification and Treatment of Celiac Trunk Aneurysms: 10 Years Experience. Ann Vasc Surg 2021:S0890-5096(21)00657-9. [PMID: 34644646 DOI: 10.1016/j.avsg.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/07/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To propose an endovascular-oriented classification of celiac trunk aneurysms (CTa) and discuss single center results of this rare pathology. METHODS Data of all patients admitted to our institution for CTa from 2011 to 2021 were prospectively collected. Of them, those who underwent endovascular treatment were retrospectively analyzed. All preoperative CT scans were reviewed and CTa were classified in 4 different configurations based on progressive distal landing zone. We excluded from the classification all cases with median arcuate ligament syndrome (MALS), patients with coexistent aortic dilation or no endovascular proximal neck. Preoperative demographics, intraoperative data and post-operative complications were recorded. All-cause late mortality and complications were identified through a review of office charts and telephone assessment. RESULTS During the study period 19 patients were referred to our Institution for CTa. Ten patients underwent endovascular treatment (ET). In 6 cases a watchful waiting strategy was adopted, 2 (10.5 %) patients refused ET and one patient without suitable proximal landing zone (< 10 mm) was not proposed to open surgical repair for surgical contraindication but is followed by strict instrumental and clinical evaluation. Six (60%) patients presented type 2 CTa; all of them underwent ET requiring positioning of covered stent-graft and SA embolization. Three (30%) patients presented type 3 CTa; all of them underwent ET with covered stent-graft deployment over the GDA with preliminary embolization. One (10%) patient presented type 4 CTa that was treated by means of covered stent-graft deployment along the right hepatic artery with left hepatic artery embolization. Overall, no major complications and perioperative mortality was observed. CONCLUSION Celiac trunk aneurysms are rare, and no classifications have still been presented. Stent-graft exclusion provides excellent short-term outcome with no significant morbidity and mortality rate when technically feasible.
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O'Connell JL, Faria LAO, de Souza MG, Meneses GA, Carrijo AMM. Endovascular treatment of an asymptomatic hepatic artery aneurism: case report. J Vasc Bras 2021; 20:e20200123. [PMID: 34456983 PMCID: PMC8366405 DOI: 10.1590/1677-5449.200123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 01/10/2021] [Indexed: 11/24/2022] Open
Abstract
We report a case of an asymptomatic, 77-year-old, male patient with arterial hypertension and no other comorbidities or risk factors for coronary disease. During a routine abdominal ultrasound examination, he was diagnosed with a hepatic vascular mass with an approximate diameter of 5 cm. Abdominal computed angiotomography was requested, showing an aneurysm of the hepatic artery, with maximum diameter of up to 5.2 cm, longest longitudinal axis of 7.2 cm, and a maximum true lumen caliber of 3.0 cm. We opted for endovascular aneurysm repair with implantation of three sequential Lifestream covered vascular stents (7x58mm, 8x58mm, and 8x37mm), successfully diverting the flow through the stents and excluding the aneurysm. The patient remains asymptomatic and free from clinical complications 2 years after the procedure. Control examinations with arterial duplex ultrasound 6 and 12 months after the procedure showed good flow through the stents with no leakage into the aneurysmal sac.
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Affiliation(s)
- João Lucas O'Connell
- Universidade Federal de Uberlândia - UFU, Faculdade de Medicina - FAMED, Uberlândia, MG, Brasil
| | | | - Marcela Gomes de Souza
- Universidade Federal de Uberlândia - UFU, Faculdade de Medicina - FAMED, Uberlândia, MG, Brasil
| | - Gabriel Alves Meneses
- Universidade Federal de Uberlândia - UFU, Faculdade de Medicina - FAMED, Uberlândia, MG, Brasil
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Sant’Anna CV, Kuhl FG, Leite AM, Oliveira Raymundo SRD, Miquelin AR, Acar V, Fachini VB, Canuti MR. Pseudoaneurisma roto de artéria ileocólica: relato de caso. J Vasc Bras 2021; 20:e20210163. [PMID: 35096034 PMCID: PMC8759586 DOI: 10.1590/1677-5449.210163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/10/2021] [Indexed: 12/02/2022] Open
Abstract
Visceral artery aneurysms (VAAs) and visceral artery pseudoaneurysms (VAPAs) are rare conditions and are potentially lethal when they rupture. They are usually found as incidental findings on computed tomography (CT) scans of asymptomatic patients. Although conventional open surgery is currently considered the gold standard treatment, the endovascular approach has gained prominence as a minimally invasive procedure with lower surgical risk. In this approach, use of coil embolization in saccular VAAs and VAPAs and implantation of flow-modulating stents constitute alternative treatments for fusiform aneurysms. We present the case of a 51-year-old female patient complaining of acute abdominal pain, tachycardia, and hypotension, with evidence of abdominal bleeding on CT angiography, who was diagnosed with a ruptured ileocolic artery (ICA) pseudoaneurysm. She underwent early endovascular treatment for ICA embolization, which was successful and achieved clinical improvement.
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Affiliation(s)
| | | | | | | | | | - Vitória Acar
- Faculdade de Medicina de São José do Rio Preto, Brasil
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Sagar S, Soundarajan R, Gupta P, Praveen Kumar M, Samanta J, Sharma V, Kochhar R. Efficacy of endovascular embolization of arterial pseudoaneurysms in pancreatitis: A systematic review and meta-analysis. Pancreatology 2021; 21:46-58. [PMID: 33303372 DOI: 10.1016/j.pan.2020.11.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/16/2020] [Accepted: 11/22/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is a significant variability in the reported outcomes following endovascular embolization of arterial pseudoaneurysms in pancreatitis. The objective of this systematic review and meta-analysis is to evaluate the efficacy of endovascular embolization of pancreatitis-related pseudoaneurysms. METHODS Searches of MEDLINE, EMBASE, and SCOPUS databases were performed through July 1, 2019 in accordance with PRISMA guidelines. All studies with ≥10 patients reporting technical success, clinical success, complications, and mortality were included. Generalized linear mixed method with random effects model was used for assessing pooled incidence rates and corresponding 95% confidence intervals (CIs). RESULTS A total of 29 studies (n = 840 with 638 pseudoaneurysms) were included. The pooled incidence rates of pseudoaneurysms in acute and chronic pancreatitis were 0.05% and 0.03%, respectively (odds ratio, 0.91, 95% CI-0.24-3.43). The most common site of pseudoaneurysm was splenic artery (37.7%). The most common embolization agent was coil (n = 415). The follow up period was 54.7 months (range, 21 days to 40.5 months). Pooled technical success rate was 97% (95% CI-92-99%, I2 83%). Clinical success rates at ≤3 months, 3-12 months, and >12 months were 82% (95% CI-70-90%, I2 42%), 86% (95% CI-75-92%, I2 44%), and 88% (95% CI-83-91%, I2 0%), respectively. There was no significant difference in the technical or clinical success between acute and chronic pancreatitis on subgroup analysis. Mortality was lower in chronic pancreatitis (OR 4.27 (95% CI 1.35-13.53, I2 0%)). Splenic infarction was the most common complication (n = 47). CONCLUSION Endovascular embolization is associated with a high technical and clinical success.
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Affiliation(s)
- Sathya Sagar
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Raghuraman Soundarajan
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Pankaj Gupta
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - M Praveen Kumar
- Department of Pharmacology, Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Xu H, Jing C, Zhou J, Min X, Zhao J, Yang L, Ren Y. Application of interventional embolization in the treatment of iatrogenic pseudoaneurysms. Exp Ther Med 2020; 20:248. [PMID: 33178346 PMCID: PMC7651869 DOI: 10.3892/etm.2020.9378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 09/04/2020] [Indexed: 02/05/2023] Open
Abstract
The present study aimed to investigate the clinical effectiveness and safety of endovascular embolization for the treatment of pseudoaneurysm secondary to previous abdominal and pelvic surgery or radiological percutaneous abdominal procedure. A retrospective review was performed on all patients with abdominal and pelvic pseudoaneurysm confirmed by CT angiography or digital subtraction angiography and treated with endovascular embolization. Different techniques of embolization with coils were applied and the outcomes, including clinical effectiveness and safety, were assessed. A total of 31 patients with a total of 32 pseudoaneurysms were included in the present study. Of these pseudoaneurysms, 23 were from the main trunks and branches of the gastroduodenal artery, 5 were from the splenic artery, 2 were from the common hepatic artery, 1 was from the right hepatic artery and 1 was from the right internal iliac artery. There were no serious complications observed and there was no occurrence of re-bleeding following embolization. The embolization of the pseudoaneurysms was successful in all patients. In conclusion, endovascular embolization is a safe and effective method for the treatment of secondary iatrogenic pseudoaneurysm in the abdomen and pelvis.
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Affiliation(s)
- Hao Xu
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Cong Jing
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Jie Zhou
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Xuli Min
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Jing Zhao
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Lin Yang
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Yongjun Ren
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
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Xu H, Jing C, Zhou J, Min X, Zhao J, Yang L, Ren Y. Clinical efficacy of coil embolization in treating pseudoaneurysm post-Whipple operation. Exp Ther Med 2020; 20:37. [PMID: 32952628 PMCID: PMC7480126 DOI: 10.3892/etm.2020.9164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 06/24/2020] [Indexed: 02/05/2023] Open
Abstract
The present study aimed to evaluate the clinical efficacy and safety of angiography and coil embolization for pseudoaneurysm post-pancreatoduodenectomy (PD). A total of 17 patients with gastrointestinal or abdominal hemorrhage after PD were included in the present study. Angiography was performed on the celiac artery, common hepatic artery, splenic artery, gastroduodenal artery and superior mesenteric artery to determine the size of the pseudoaneurysm, the parent artery and its collateral branches. A variety of embolization techniques have been applied to embolize pseudoaneurysm, including the sac packing technique, proximal embolization, exclusion technique and sandwich technique. Different techniques with coils were used for embolization and the clinical effects of embolization were analyzed. A total of 18 pseudoaneurysms were identified in 17 patients. In 2 patients, severe technical complications occurred, including migration of the coil and rupture of pseudoaneurysm, and one of them died, which may have been associated with this complication. No serious clinical complications were observed in the other patients. A total of 7 patients had mild clinical complications, including mild abdominal and dorsal pain, which were alleviated after symptomatic management. A total of 15 patients with definite pseudoaneurysm were successfully embolized without re-bleeding and complications. The clinical success rate was 94.1% (16/17). In conclusion, a variety of embolization techniques may be applied for the treatment of pseudoaneurysm after PD, which have high technical and clinical success rates and small trauma. It is recommended in emergency situations, but care should be taken to avoid serious technical complications.
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Affiliation(s)
- Hao Xu
- Sichuan Key Laboratory of Medical Imaging, Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Cong Jing
- Sichuan Key Laboratory of Medical Imaging, Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Jie Zhou
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Xuli Min
- Sichuan Key Laboratory of Medical Imaging, Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Jing Zhao
- Sichuan Key Laboratory of Medical Imaging, Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Lin Yang
- Sichuan Key Laboratory of Medical Imaging, Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Yongjun Ren
- Sichuan Key Laboratory of Medical Imaging, Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
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21
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Sandelis-Pérez JE, Córdova-Toro A, García-Santiago S, Otero-Cárdenas EG, de Rubio-Cruz PG, Márquez-Márquez S, Rodríguez-Malavé MJ, Febles-Negrón A, Colon-Márquez JA, Hidalgo-Ríos A. Life-Threatening Rupture of an Idiopathic Left Hepatic Artery Pseudoaneurysm Successfully Treated with Endovascular Coil Embolization. Case Rep Vasc Med 2020; 2020:8835573. [PMID: 32963879 DOI: 10.1155/2020/8835573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/03/2020] [Indexed: 12/20/2022] Open
Abstract
Hepatic artery pseudoaneurysm is a rare condition; they are multifactorial, most of them locating in the extrahepatic vasculature and the mortality associated to its rupture may reach up to 70%. We report a 77 years old female who was admitted due to headache and uncontrolled hypertension and that on her second hospital day developed sudden hemodynamic instability, abdominal pain, fatigue, skin-mucosa pallor, and anemia. Abdominal CT scan with contrast showed a left hepatic artery pseudoaneurysm associated with extensive hemoperitoneum. Patient required emergent hemodynamic stabilization and finally was treated successfully with a superselective endovascular coil embolization. Our patient represents an atypical case of a spontaneous rupture of an idiopathic hepatic artery pseudoaneurysm. Hence, the importance of having a high index of clinical suspicion. Endovascular coil embolization has become the first-line treatment.
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Nagarajan K, Sunilkumar D, Ramakrishnaiah VPN, Amuthabarathi M. Left Gastric Pseudoaneurysm in a Case of Chronic Pancreatitis: A Case Report With Review of Literature. Vasc Endovascular Surg 2020; 55:73-76. [PMID: 32869730 DOI: 10.1177/1538574420954309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Visceral artery pseudoaneurysms are common complications of pancreatitis that carry a high mortality rate. Early detection and treatment of the pseudoaneurysms should be done as they carry high mortality following rupture. The splenic artery is the commonest artery involved followed by gastroduodenal and pancreaticoduodenal arteries. Gastric artery pseudoaneurysms are less common with less than 50 cases reported in the literature till now. We describe a case of gastric artery pseudoaneurysm secondary to chronic pancreatitis in a patient who presented with intermittent GI bleeding and also describe the role of endovascular management in the treatment of the same.
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Affiliation(s)
- Krishnan Nagarajan
- Department of Radio-Diagnosis, 29988Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | - Devaraj Sunilkumar
- Department of Radio-Diagnosis, 29988Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | | | - Mohan Amuthabarathi
- Department of Radio-Diagnosis, 29988Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
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23
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Can Y, Kocayiğit İ. A novel technique for treating visceral artery pseudoaneurysm: Selective arterial embolization with cut-inflateddeflated balloon. Anatol J Cardiol 2020; 24:56-9. [PMID: 32628140 DOI: 10.14744/AnatolJCardiol.2020.59507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Abstract
True splenic artery aneurysms (SAA) are a rare, but potentially fatal, pathology. They are the third most common type of abdominal aneurysm, after aneurysms of the aorta and of the iliac artery, and account for almost the all aneurysms of visceral arteries. True aneurysms account for 60% of SAA and affect four times as many women as men, generally related to increased incidental or symptomatic findings that coincide with use of ultrasonography in pregnancy. Among pregnant patients, mortality after rupture is 65-75%, with fetal mortality exceeding 90%. There are multiple etiologies and it is believed that hormonal influences and changes in portal flow during gestation play an important role in development of SAA. This review discusses their history, epidemiology, pathophysiology, and diagnosis and current treatment techniques.
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Martinelli O, Giglio A, Irace L, Di Girolamo A, Gossetti B, Gattuso R. Single-Center Experience in the Treatment of Visceral Artery Aneurysms. Ann Vasc Surg 2019; 60:447-454. [DOI: 10.1016/j.avsg.2019.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/05/2019] [Accepted: 01/13/2019] [Indexed: 02/09/2023]
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Wang W, Chang H, Liu B, Wang W, Yu Z, Chen C, Li Y, Wang Z, Wang Y. Long-term outcomes of elective transcatheter dense coil embolization for splenic artery aneurysms: a two-center experience. J Int Med Res 2019; 48:300060519873256. [PMID: 31510827 PMCID: PMC7262844 DOI: 10.1177/0300060519873256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objective This study was performed to analyze the long-term follow-up safety and efficacy of transcatheter dense coil embolization for splenic artery aneurysms. Methods Thirty-two patients (18 women, 14 men; age range, 23–56 years; mean age, 43.1 ± 13.6 years) who underwent dense coil embolization for treatment of splenic artery aneurysms from August 2010 to January 2018 were retrospectively reviewed. The size and location of the splenic artery aneurysms, the technical and clinical outcomes of the procedure, and the complications related to the procedure were reviewed. Results The technical success rate of embolization was 100% (mean aneurysm size, 29.4 ± 6.9 mm; range, 20–43 mm). Two (6.3%) patients underwent a successful repeat intervention procedure for recurrent aneurysm perfusion during follow-up (mean, 36 months; range, 6–72 months). No aneurysm ruptured during follow-up. Splenic infarction was observed in 8 of 32 (25%) patients. No patients developed major adverse events related to the procedure, such as splenic abscess or pancreatitis. Conclusions Percutaneous elective transcatheter dense coil embolization is safe and effective to prevent aneurysm rupture and overcome aneurysm recanalization during long-term follow-up.
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Affiliation(s)
- Wujie Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Haiyang Chang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Bin Liu
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Wei Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Zhe Yu
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Chao Chen
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Zhenting Wang
- Medical Imaging Institute of Shandong Province, Jinan City, Shandong Province, China
| | - Yongzheng Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
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Borzelli A, Amodio F, Paladini A, de Magistris G, Giurazza F, Silvestre M, Corvino F, Corvino A, Frauenfelder G, Pane F, Coppola M, Zobel DB, Paladini L, Amodeo E, Cavaglià E, Niola R. Successful endovascular treatment of a recurrent giant celiac artery aneurysm. Radiol Case Rep 2019; 14:723-728. [PMID: 30988864 PMCID: PMC6447743 DOI: 10.1016/j.radcr.2019.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 03/19/2019] [Accepted: 03/24/2019] [Indexed: 12/05/2022] Open
Abstract
Visceral artery aneurysms are very rare and aneurysms of the celiac trunk are the rarest ones: they are in most cases asymptomatic and their detection is frequently incidental. In this article we report the case of a man affected by severe abdominal pain with a huge aneurysm of the celiac trunk, first successfully treated with coil embolization, but, after 10 months, another endovascular embolization was required for deployment of the metallic coils previously released, ahead into the fund of the sac with recanalization of the aneurysm. A second endovascular treatment was performed with other coils and Amplatzer-Plug. The high risk of rupture makes treatment of such aneurysms mandatory and surgery is still considered the gold standard therapy of VAA, but, due to its high morbidity and mortality risks, in the last years, it has been widely replaced by endovascular embolization. An effective endovascular embolization requires not only the complete filling of the aneurysmal sac, but also the complete vascular exclusion of its in-flow and out-flow tracts, to reduce the risk of its anterograde or retrograde reperfusion.
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Affiliation(s)
- A. Borzelli
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
- Corresponding author.
| | - F. Amodio
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
| | - A. Paladini
- Department of Services Diagnosis and Therapies, Radiology Institute, Maggiore della Carità Hospital, University of Eastern Piedmont - UPO University, Corso G. Mazzini 18, 28100 Novara, Italy
| | - G. de Magistris
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
| | - F. Giurazza
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
| | - M. Silvestre
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
| | - F. Corvino
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
| | - A. Corvino
- Dipartimento di scienze biomediche avanzate, Università degli studi di Napoli “Federico II”, Via S.Pansini, 80131 Naples, Italy
| | - G. Frauenfelder
- Department of Radiology, Campus Bio-medico University, Via Alvaro del Portillo, 200, 00100 Rome, Italy
| | - F. Pane
- Dipartimento di scienze biomediche avanzate, Università degli studi di Napoli “Federico II”, Via S.Pansini, 80131 Naples, Italy
| | - M. Coppola
- Dipartimento di scienze biomediche avanzate, Università degli studi di Napoli “Federico II”, Via S.Pansini, 80131 Naples, Italy
| | - D. Beomonte Zobel
- Division of Interventional Radiology, IFO Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144 Rome, Italy
| | - L. Paladini
- Università Cattolica del Sacro Cuore, Rome- Fondazione Gemelli, Rome, Italy
| | - E.M. Amodeo
- Università Cattolica del Sacro Cuore, Rome- Fondazione Gemelli, Rome, Italy
| | - E. Cavaglià
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
| | - R. Niola
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
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Shiu SI, Yong SA, Lai KL, Tseng CW, Wang CY, Lee BJ, Chen YH. Ruptured Multifocal Hepatic Aneurysms in a Woman with Systemic Lupus Erythematosus Successfully Treated with Transcatheter Arterial Embolization: A Case Report and Literature Review. Case Reports Hepatol 2019; 2019:6272419. [PMID: 30937200 DOI: 10.1155/2019/6272419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 02/13/2019] [Indexed: 11/17/2022] Open
Abstract
To present a first reported case of ruptured multifocal hepatic aneurysms in a woman with systemic lupus erythematosus (SLE) who was treated successfully with transcatheter arterial embolization (TAE) in literature, similar cases in the previous English literature were also reviewed and analyzed to summarize the clinical manifestations, management, and outcome in these patients. The data were gathered from the medical record and literature reviews were searched from PudMed. In our review, patients with SLE-related hepatic aneurysms were often middle-aged females. Most of them presented with acute abdominal pain and hypotension. The overall mortality rate was 50%, but it was lower (12.5%) in patients who received TAE. Both TAE and surgical intervention are used to treat SLE-related hepatic aneurysms. Our review raised concerns about early detection, diagnosis, and prompt intervention of possible hepatic aneurysm rupture in patients with SLE.
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Piasek E, Sojka M, Kuczyńska M, Światłowski Ł, Drelich-Zbroja A, Furmaga O, Jargiełło T. Visceral artery aneurysms - classification, diagnosis and treatment. J Ultrason 2018; 18:148-151. [PMID: 30451408 PMCID: PMC6440504 DOI: 10.15557/jou.2018.0021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2018] [Indexed: 12/05/2022] Open
Abstract
Although visceral artery aneurysms are rare, mortality due to their rupture is high, estimated at even 25–75%. That is why it is significant to detect each such lesion. Visceral artery aneurysms are usually asymptomatic and found incidentally during examinations performed for other indications. Autopsy results suggest that most asymptomatic aneurysms remain undiagnosed during lifetime. Their prevalence in the population is therefore higher. The manifestation of a ruptured aneurysm depends on its location and may involve intraperitoneal hemorrhage, gastrointestinal and portal system bleeding with concomitant portal hypertension and bleeding from esophageal varices. Wide access to diagnostic tests, for example ultrasound, computed tomography or magnetic resonance imaging, helps establish the correct diagnosis and a therapeutic plan as well as select appropriate treatment. After a procedure, the same diagnostic tools enable assessment of treatment efficacy, or are used for the monitoring of aneurysm size and detection of potential complications in cases that are ineligible for treatment. The type of treatment depends on the size of an aneurysm, the course of the disease, risk of rupture and risk associated with surgery or endovascular procedure. Endovascular treatment is preferred in most cases. Aneurysms are excluded from the circulation using embolization coils, ethylene vinyl alcohol, stents, multilayer stents, stent grafts and histoacryl glue (or a combination of these methods).
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Affiliation(s)
- Ewa Piasek
- Student Study Group, Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Michał Sojka
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Maryla Kuczyńska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Łukasz Światłowski
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Anna Drelich-Zbroja
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Olga Furmaga
- Department of Radiology, 424 General Military Hospital, Thessaloniki, Greece
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
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Santos FS, Sousa KMDS, de Castro TAC, Coelho F, de Oliveira RG, de Araujo WJB, Dos Santos LCP, de Souza RCA. Endovascular treatment of pseudoaneurysms secondary to chronic pancreatitis: reports of two cases. J Vasc Bras 2018; 17:71-75. [PMID: 29930685 PMCID: PMC5990257 DOI: 10.1590/1677-5449.012517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pseudoaneurysm secondary to chronic pancreatitis is a rare complication, but one with a high mortality rate. It is etiologically associated with chronic pancreatitis, and most diagnoses are made after rupture, which manifests with clinical signs of acute hemorrhage. Computed tomography plays an important role in diagnosis, but digital subtraction angiography remains the gold-standard method for diagnostic confirmation and for treatment planning. This article describes two cases of pseudoaneurysm in patients with chronic alcoholic pancreatitis; one involving the splenic artery and the other the gastroduodenal artery, complicated by thoracic and abdominal bleeding respectively. Both were successfully treated, using minimally invasive endovascular methods to implant coils and stent-grafts.
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Affiliation(s)
- Fabiana Seifert Santos
- Pontifícia Universidade Católica do Paraná - PUCPR, Curso de Medicina, Londrina, PR, Brasil
| | | | | | - Felipe Coelho
- Universidade de Brasília - UnB, Programa de Pós-graduação em Ciências Médicas, Brasília, DF, Brasil.,Pontifícia Universidade Católica do Paraná - PUCPR, Londrina, PR, Brasil
| | | | - Walter Jr Boim de Araujo
- Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Serviço de Angiorradiologia e Cirurgia Endovascular, Curitiba, PR, Brasil
| | | | - Raquel Canzi Almada de Souza
- Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Serviço de Endoscopia Digestiva, Departamento de Medicina Interna, Curitiba, PR, Brasil
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31
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Kaihara M, Ono S, Shibutani S, Funabiki T, Egawa T. A Rare Surgical Case of Giant Jejunal Artery Aneurysm in a Young Patient. Ann Vasc Surg 2018. [PMID: 29518521 DOI: 10.1016/j.avsg.2017.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Aneurysms of the abdominal visceral arteries are infrequently encountered. Jejunal artery aneurysm (JAA) is one of the rarest visceral aneurysms, especially in young patients. Endovascular surgery tends to be an effective treatment for visceral artery aneurysms. Here, we report a case of symptomatic JAA with a peripheral dilated vessel in a young patient. However, in consideration of the patient's anatomic suitability and young age, we chose open surgical intervention with intraoperative angiography. Thus, we could resect the aneurysm and the peripheral dilated vessel, preserve the bowel, and leave no devices that could cause further complication. The choice of the most appropriate treatment should depend on aneurysm characteristics and the background of the patient.
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Affiliation(s)
- Masaki Kaihara
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Shigeshi Ono
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan; Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba, Japan.
| | - Shintaro Shibutani
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Tomohiro Funabiki
- Department of Radiology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Tomohisa Egawa
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
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Björck M, Koelemay M, Acosta S, Bastos Goncalves F, Kölbel T, Kolkman JJ, Lees T, Lefevre JH, Menyhei G, Oderich G, Kolh P, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Sanddal Lindholt J, Vega de Ceniga M, Vermassen F, Verzini F, Geelkerken B, Gloviczki P, Huber T, Naylor R. Editor's Choice - Management of the Diseases of Mesenteric Arteries and Veins: Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 53:460-510. [PMID: 28359440 DOI: 10.1016/j.ejvs.2017.01.010] [Citation(s) in RCA: 329] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Song C, Dong J, Yu G, Zhou J, Xiang F, Pei Y, Lu Q, Jing Z. Comparison of open surgery and endovascular procedures as a therapeutic choice for visceral artery aneurysms. Vascular 2017; 26:387-392. [PMID: 29228875 DOI: 10.1177/1708538117744102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objectives Visceral arterial aneurysms may be treated using open surgery or endovascular repair, but the best approach remains controversial. This was a retrospective study aiming to compare open surgery and endovascular treatment strategies for visceral arterial aneurysms. Methods The study included all 93 patients who were admitted with visceral artery aneurysms between January 2001 and January 2011 at the Department of Vascular Surgery, Changhai Hospital, Shanghai, China. All cases underwent either open or endovascular procedures. Overall survival and adverse events were compared between the groups. Success rate, blood loss, length of surgery, and length of hospital stay were also compared. The patients were followed up at three, six, and 12 months then every year until April 2014. Results Open surgery was performed on 34 patients and endovascular procedures on 59. There were no differences in characteristics of the patients between the open surgery and endovascular groups. The perioperative complication rate was 52.9 and 13.6% in the open surgery and endovascular groups, respectively. Mean follow-up was 36.8 months (range: 11 months to 10 years). The one- and five-year survival rates were 100 and 60.6%, respectively, in the open surgery group, compared to 100 and 84.5% in the endovascular group. Multivariate analysis for factors related to overall survival showed that there was a significant relationship with the treatment approach (HR = 0.479, 95%CI: 0.278-0.825; P = 0.008) and the presence of false aneurysm (HR = 2.929, 95%CI: 1.388-6.180, P = 0.005). Conclusions Endovascular repair could be considered as an effective method for visceral artery aneurysm. Endovascular repair showed lower perioperative complication rates and better long-term survival.
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Affiliation(s)
- Chao Song
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Jian Dong
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Guanyu Yu
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Feng Xiang
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Yifei Pei
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
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Abstract
An 86-year-old woman presented to hospital with melaena. This was her third presentation with the same symptom. There was no obvious source of bleeding on her oesophagogastroduodenoscopy; however, it did show a previously clipped Dieulafoy lesion. CT angiography showed an aneurysm arising from the hepatic artery. Selective coeliac artery angiogram showed aneurysmal dilatation of the distal part of the coeliac trunk and confirmed the presence of the common hepatic artery aneurysm. The aneurysm was coiled by the interventional radiologist. Final angiogram showed good flow through the hepatic artery with obliteration of the inferior patch. The procedure was uncomplicated and the patient was discharged shortly afterwards.
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Affiliation(s)
- Madeleine Frank
- Department of Gastroenterology, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Rosemary Phillips
- Department of Gastroenterology, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Zaid Aldin
- Department of Radiology, The Princess Alexandra Hospital, Essex, UK
| | - Deb Ghosh
- Department of Gastroenterology, Princess Alexandra Hospital NHS Trust, Harlow, UK
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Kingma KD, van der Linden AN, Roumen RM. Rebleeding of a Splenic Artery Aneurysm after Coil Embolisation. Case Rep Surg 2016; 2016:1858461. [PMID: 27872785 DOI: 10.1155/2016/1858461] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/11/2016] [Indexed: 01/17/2023] Open
Abstract
Background. Splenic artery aneurysm (SAA) is an uncommon and difficult diagnosis. SAA is more common in females. Only 20% of SAA is symptomatic and may present as a rupture. A ruptured SAA is associated with a 25% mortality rate. Case Presentation. We present a case of a male patient with a bleeding SAA that rapidly increased in size. Distal coiling was technically impossible and despite proximal coil embolisation the SAA continued to bleed. A laparotomy including splenectomy and partial pancreatectomy was performed with an uneventful patient recovery. Discussion. Endovascular management is currently considered the optimal treatment of SAA. However, careful monitoring and follow-up is needed after embolisation as rapid recanalization of the SAA may possibly occur, especially when distal coiling of the aneurysm is unsuccessful. Conclusion. Endovascular treatment of an SAA is not necessarily effective. Surgeons must be prepared to perform open procedures to further reduce mortality rates.
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Abstract
Presented is a patient with an iatrogenic hepatic artery pseudoaneurysm that was treated by endovascular stent grafting. Endovascular stent grafting of a hepatic artery pseudoaneurysm offers a safe and potentially less morbid alternative to an open repair. The report stresses the necessity of careful preoperative evaluation with angiography to determine the feasibility of the procedure. An aggressive approach to treating hepatic artery pseudoaneurysms is advocated because of the poor correlation between size and their tendency to rupture. With an increasing rate of diagnosis of visceral artery aneurysms in elderly, debilitated patients, endovascular repair is anticipated to have an increasing role and should be considered a first-line therapy in anatomically suitable candidates.
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Affiliation(s)
- Dorian deFreitas
- Section of Vascular and Endovascular Surgery, East Carolina University, Greenville, North Carolina 27834, USA
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Abstract
Mycotic aneurysm formation in a visceral artery carries a significant risk of mortality and morbidity. The authors present a case of a symptomatic superior mesenteric artery aneurysm secondary to a septic embolus in a patient who had undergone aortic valve replacement. The patient initially presented with evidence of acute intestinal ischemia from a presumed embolic source. Although an extensive bowel resection was performed, an adequate search for the embolus was not carried out. Prompt diagnosis and removal of suspected septic emboli must be performed to avoid the formation of delayed mycotic aneurysms.
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Affiliation(s)
- Patrick J Javid
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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38
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Guo B, Guo D, Xu X, Chen B, Shi Z, Luo J, Jiang J, Fu W. Early and intermediate results of endovascular treatment of symptomatic and asymptomatic visceral artery aneurysms. J Vasc Surg 2016; 64:140-8. [DOI: 10.1016/j.jvs.2016.02.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
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Abstract
Visceral artery aneurysm is a rare but clinically important form of vascular pathology, showing a high mortality rate in emergency surgery. Most often these aneurysms cause no symptoms and are therefore incidental findings. Reports on ileocolic artery aneurysms are rare and often anecdotal. Therapeutic procedures can be performed either surgically or by interventional therapeutic techniques. This article presents a case of ruptured ileocolic artery aneurysm and reviews the literature on this topic.
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Affiliation(s)
- Graham Roche-Nagle
- Department of Vascular Surgery, St Vincent's University Hospital, Dublin, Ireland.
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40
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Batagini NC, El-Arousy H, Clair DG, Kirksey L. Open versus Endovascular Treatment of Visceral Artery Aneurysms and Pseudoaneurysms. Ann Vasc Surg 2016; 35:1-8. [PMID: 27238989 DOI: 10.1016/j.avsg.2016.01.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 01/18/2016] [Accepted: 01/18/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Visceral artery aneurysms and pseudoaneurysms (VAAP) represent a rare and potential life-threatening disease with a documented incidence of 0.1-2.0%. Treatment options for VAAP vary from open approach with aneurysm excision, exclusion and revascularization to endovascular techniques. Aneurysm anatomy and pathogenesis dictate treatment choice. The purpose of this study was to compare the perioperative, short- and mid-term outcomes of open and endovascular approaches. METHODS Between January 2007 to April 2015, patients with VAAP who underwent surgical treatment, either by endovascular technique (endovascular surgery [EV] group) or by open surgery (OS group), were selected for analysis. Aneurysm's anatomy and pathogenesis dictated treatment choice. Demographic variables, surgical data, and postoperative follow-up were retrospectively analyzed. Preoperative computed tomography scans were evaluated for aneurysm characteristics. RESULTS A total of 296 consecutive patients were identified with VAAP. Surveillance without intervention occurred in 183 patients, and 113 underwent surgical treatment: 57 by EV technique and 56 by OS. The VAAP sites were: splenic (50.9/5.4%), renal (7.0/50%), superior mesenteric (7.0/7.1%), celiac (12.3/17.9%), hepatic (14.0/5.4%), gastroduodenal (7.0/7.1%), and pancreaticoduodenal (1.8/7.1%). Eight urgent surgeries occurred in EV and 5 in OS group (P = 0.39). Operative time and estimated blood loss were 122 ± 54 vs. 312 ± 157 min (P < 0.001) and 5 (interquartile range [IR], 0-50) vs. 550 (IR, 200-980) mL (P < 0.001) in groups EV and OS, respectively. The intraoperative and postoperative major complications, including end-organ infarction, and reinterventions were comparable between the groups. Transfusion of blood products was necessary in 12.3% (EV) and 42.9% (OS; P < 0.001). Median hospital length of stay was 1 (IR, 1-3) and 6 (IR, 4-9) days in groups EV and OS, respectively (P < 0.001). Short-term technical success was achieved in 98.2% (EV) and 96.4% (OS). During the median follow-up period of 16 (IR, 7.1-43.9) months, the clinical success was 91.2% and 92.9% (P = 0.74), and the overall survival was 94.7% and 96.4% (P = 1.0) in groups EV and OS, respectively. CONCLUSIONS Open and endovascular approaches have similar rates of technical and clinical success, as well as mortality during follow-up. However, periprocedural morbidity was significantly higher in cases treated by OS. Although longer-term follow-up is needed to access the durability of the endovascular treatment, initial successful outcomes and low reintervention rates make it a safe and feasible approach.
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Affiliation(s)
| | - Hazem El-Arousy
- Vascular Surgery Department, The Cleveland Clinic, Cleveland, OH
| | - Daniel G Clair
- Vascular Surgery Department, The Cleveland Clinic, Cleveland, OH
| | - Lee Kirksey
- Vascular Surgery Department, The Cleveland Clinic, Cleveland, OH
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Madhusudhan KS, Venkatesh HA, Gamanagatti S, Garg P, Srivastava DN. Interventional Radiology in the Management of Visceral Artery Pseudoaneurysms: A Review of Techniques and Embolic Materials. Korean J Radiol 2016; 17:351-63. [PMID: 27134524 PMCID: PMC4842855 DOI: 10.3348/kjr.2016.17.3.351] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 01/25/2016] [Indexed: 12/15/2022] Open
Abstract
Visceral artery pseudoaneurysms occur mostly as a result of inflammation and trauma. Owing to high risk of rupture, they require early treatment to prevent lethal complications. Knowledge of the various approaches of embolization of pseudoaneurysms and different embolic materials used in the management of visceral artery pseudoaneurysms is essential for successful and safe embolization. We review and illustrate the endovascular, percutaneous and endoscopic ultrasound techniques used in the treatment of visceral artery pseudoaneurysm and briefly discuss the embolic materials and their benefits and risks.
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Affiliation(s)
| | | | - Shivanand Gamanagatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Pramod Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
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Zhang X, Li X. Successful Embolization of a Huge Hepatic Artery Pseudoaneurysm after Blunt Abdominal Trauma. J Pediatr 2016; 168:252-252.e1. [PMID: 26490131 DOI: 10.1016/j.jpeds.2015.09.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 09/17/2015] [Indexed: 02/05/2023]
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Hemmati H, Karimian M, Moradi H, Farid Marandi K, Haghdoost A. Endovascular Treatment of a Huge Hepatic Artery Aneurysm by Coil Embolization Method: A Case Report. Iran J Radiol 2015; 12:e5200. [PMID: 26528386 PMCID: PMC4623773 DOI: 10.5812/iranjradiol.5200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/23/2013] [Accepted: 11/30/2013] [Indexed: 11/16/2022]
Abstract
Hepatic artery aneurysms are rare but potentially life threatening. We describe a novel case of a successful endovascular coil embolization of a huge hepatic artery aneurysm. A 67-year-old woman presented with recent abdominal pain that had begun from 2 weeks before referring to our hospital. Sonographic and computerized tomographic (CT) findings revealed a huge hepatic artery aneurysm with 95 mm × 83 mm diameter. The patient underwent an endovascular technique. In aortic angiography, the celiac artery orifice and superior mesenteric artery were so narrow, so sonography was used in order to determine the exact position of the catheter in the celiac artery orifice. The aneurysm was thrombosed using coil embolization. Pulsation of the aneurysm immediately disappeared. Huge hepatic artery aneurysm can be safely treated using coil embolization.
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Affiliation(s)
- Hossein Hemmati
- Respiratory Diseases and TB Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding author: Hossein Hemmati, Respiratory Diseases and TB Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran. Tel: +98-9133045924, Fax: +98-1333542460, E-mail:
| | - Mehdi Karimian
- Respiratory Diseases and TB Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Habibollah Moradi
- Respiratory Diseases and TB Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Kambiz Farid Marandi
- Respiratory Diseases and TB Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Afrooz Haghdoost
- Student Research Committee, Department of Research and Technology, Guilan University of Medical Sciences, Rasht, Iran
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Tétreau R, Beji H, Henry L, Valette PJ, Pilleul F. Arterial splanchnic aneurysms: Presentation, treatment and outcome in 112 patients. Diagn Interv Imaging 2015; 97:81-90. [PMID: 26292616 DOI: 10.1016/j.diii.2015.06.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 06/08/2015] [Accepted: 06/30/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study was to identify subgroups with different risks of progression and their appropriate management among the heterogeneous group of 112 patients diagnosed with splanchnic aneurysm. METHODS Using radiology databases and medical records of our institution (Hospital Édouard-Hérriot, Lyon, France), we undertook a retrospective review of all patients diagnosed with splanchnic artery aneurysms from 1995 to 2011. Cases were analyzed by aneurysm location, etiology and a distinction was also made between true and false aneurysms. RESULTS False aneurysms were more likely than true aneurysms to be diagnosed as symptomatic and/or ruptured (TA: 50/66 patients asymptomatic vs. FA: 16/46 asymptomatic, P<0.05) with a rupture rate of 59% (27/46) which was unrelated to the size of aneurysms. Percutaneous treatment was carried in the majority of patients with a final success rate of 91%. Peripancreatic true aneurysms were associated in 75% of cases with celiac occlusive disease and diagnosed mostly in symptomatic patients (7/9: 78%) with a rupture rate of 44% unrelated to their size. Radiologic treatment has faced problems due to failure of catheterization and incomplete embolization, although there have been cases in which delayed occlusion was achieved. Common true aneurysms were incidental findings in 87% (57/66) of patients with 3 ruptured aneurysms which were larger than 2 cm. Observation in that group was safe: significant growth was seen only in one patient and the embolization required was successful. Splanchnic false aneurysms and peripancreatic true aneurysms carried a high and an unpredictable risk of rupture that warranted prompt endovascular treatment as soon as possible. CONCLUSIONS Stratification by localization and by the true or false appearance of the aneurysm was an effective (means of identifying) way to identify subgroups with different risks of progression. False aneurysms and peripancreatic true aneurysms carried a high and unpredictable risk of rupture. The splanchnic aneurysms should have been treated in the case of patients of childbearing age, size ≥ 20 mm, and in the case of liver transplantation. Other splanchnic aneurysms should either have been observed, if smaller than 2 cm. In the absence of rigorous published comparisons, surgical and endovascular methods should have been considered equally suitable in the elective treatment of these patients.
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Affiliation(s)
- R Tétreau
- Centre d'Imagerie Médicale, Institut du Cancer, 3, rue Croix-Verte, 34000 Montpellier, France
| | - H Beji
- Radiologie, CLCC Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - L Henry
- Radiologie, Hôpital Édouard-Hérriot, 69003 Lyon, France
| | - P-J Valette
- Radiologie, Hôpital Édouard-Hérriot, 69003 Lyon, France
| | - F Pilleul
- Centre d'Imagerie, CLCC Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
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Tuncel SA, Gülcü A, Yılmaz E, Çiftçi T, Göktay AY. Endovascular Stent-Graft Treatment of Giant Celiac Artery Pseudoaneurysm. Pol J Radiol 2015; 80:356-9. [PMID: 26236417 PMCID: PMC4505756 DOI: 10.12659/pjr.894377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/05/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Visceral artery aneurysms (VAAs) comprise an uncommon but life-threatening vascular disease. When rupture is the first clinical presentation, mortality rate reaches 70%. Increased use of cross-sectional imaging has led to a greater rate of diagnosis (40-80%) of asymptomatic VAAs. In the past, surgery was the treatment of choice for VAAs carrying high risk of mortality and morbidity. CASE REPORT A 22-year-old man, who had undergone gastric, pancreatic and aortic surgery 2.5 years earlier, presented with progressive abdominal pain. Multidetector computed tomography scan revealed an 8-cm celiac pseudoaneurysm. We report a giant celiac pseudoaneurysm treated with stent-graft implantation. CONCLUSIONS Endovascular treatment of VAA is a safe and effective method alternative to surgery.
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Affiliation(s)
| | - Aytaç Gülcü
- Department of Radiology, Dokuz Eylül University, İzmir, Turkey
| | - Erdem Yılmaz
- Department of Radiology, Trakya University, Edirne, Turkey
| | - Taner Çiftçi
- Department of Anesthesiology, Trakya University, Edirne, Turkey
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Chiaradia M, Novelli L, Deux JF, Tacher V, Mayer J, You K, Djabbari M, Luciani A, Rahmouni A, Kobeiter H. Ruptured visceral artery aneurysms. Diagn Interv Imaging 2015; 96:797-806. [DOI: 10.1016/j.diii.2015.03.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
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Roberts K, Mcculloch N, Forde C, Mahon B, Mangat K, Olliff S, Jones R. Emergency Treatment of Haemorrhaging Coeliac or Mesenteric Artery Aneurysms and Pseudoaneurysms in the Era of Endovascular Management. Eur J Vasc Endovasc Surg 2015; 49:382-9. [DOI: 10.1016/j.ejvs.2014.12.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 12/13/2014] [Indexed: 11/23/2022]
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Pitton MB, Dappa E, Jungmann F, Kloeckner R, Schotten S, Wirth GM, Mittler J, Lang H, Mildenberger P, Kreitner KF, Oberholzer K, Dueber C. Visceral artery aneurysms: Incidence, management, and outcome analysis in a tertiary care center over one decade. Eur Radiol. 2015;25:2004-2014. [PMID: 25693662 PMCID: PMC4457909 DOI: 10.1007/s00330-015-3599-1] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 11/10/2014] [Accepted: 01/13/2015] [Indexed: 12/13/2022]
Abstract
Objectives To evaluate the incidence, management, and outcome of visceral artery aneurysms (VAA) over one decade. Methods 233 patients with 253 VAA were analyzed according to location, diameter, aneurysm type, aetiology, rupture, management, and outcome. Results VAA were localized at the splenic artery, coeliac trunk, renal artery, hepatic artery, superior mesenteric artery, and other locations. The aetiology was degenerative, iatrogenic after medical procedures, connective tissue disease, and others. The rate of rupture was much higher in pseudoaneurysms than true aneurysms (76.3 % vs.3.1 %). Fifty-nine VAA were treated by intervention (n = 45) or surgery (n = 14). Interventions included embolization with coils or glue, covered stents, or combinations of these. Thirty-five cases with ruptured VAA were treated on an emergency basis. There was no difference in size between ruptured and non-ruptured VAA. After interventional treatment, the 30-day mortality was 6.7 % in ruptured VAA compared to no mortality in non-ruptured cases. Follow-up included CT and/or MRI after a mean period of 18.0 ± 26.8 months. The current status of the patient was obtained by a structured telephone survey. Conclusions Pseudoaneurysms of visceral arteries have a high risk for rupture. Aneurysm size seems to be no reliable predictor for rupture. Interventional treatment is safe and effective for management of VAA. Key Points • Diagnosis of visceral artery aneurysms is increasing due to CT and MRI. • Diameter of visceral arterial aneurysms is no reliable predictor for rupture. • False aneurysms/pseudoaneurysms and symptomatic cases need emergency treatment. • Interventional treatment is safe and effective.
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Hogendoorn W, Lavida A, Hunink MGM, Moll FL, Geroulakos G, Muhs BE, Sumpio BE. Open repair, endovascular repair, and conservative management of true splenic artery aneurysms. J Vasc Surg 2014; 60:1667-76.e1. [PMID: 25264364 DOI: 10.1016/j.jvs.2014.08.067] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 08/11/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE True splenic artery aneurysms (SAAs) are a rare but potentially fatal pathology. For many years, open repair (OPEN) and conservative management (CONS) were the treatments of choice, but throughout the last decade endovascular repair (EV) has become increasingly used. The purpose of the present study was to perform a systematic review and meta-analysis evaluating the outcomes of the three major treatment modalities (OPEN, EV, and CONS) for the management of SAAs. METHODS A systematic review of all studies describing the outcomes of SAAs treated with OPEN, EV, or CONS was performed using seven large medical databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to ensure a high-quality review. All articles were subject to critical appraisal for relevance, validity, and availability of data regarding characteristics and outcomes. All data were systematically pooled, and meta-analyses were performed on several outcomes, including early and late mortality, complications, and number of reinterventions. RESULTS Original data of 1321 patients with true SAAs were identified in 47 articles. OPEN contained 511 patients (38.7%) in 31 articles, followed by 425 patients (32.2%) in CONS in 16 articles and 385 patients (29.1%) in EV in 33 articles. The CONS group had fewer symptomatic patients (9.5% vs 28.7% in OPEN and 28.8% in EV; P < .001) and fewer ruptured aneurysms (0.2% vs 18.4% in OPEN and 8.8% in EV; P < .001), but no significant differences were found in existing comorbidities. CONS patients were usually older and had smaller-sized aneurysms than patients in the OPEN and EV groups. The only identified difference in baseline characteristics between OPEN and EV was the number of ruptured aneurysms (18.4% vs 8.8%; P < .001). OPEN had a higher 30-day mortality than EV (5.1% vs 0.6%; P < .001), whereas minor complications occurred in a larger number of the EV patients. EV required more reinterventions per year (3.2%) compared with OPEN (0.5%) and CONS (1.2%; P < .001). The late mortality rate was higher in patients treated with CONS (4.9% vs 2.1% in OPEN and 1.4% in EV; P = .04). CONCLUSIONS EV of SAA has better short-term results compared with OPEN, including significantly lower perioperative mortality. OPEN is associated with fewer late complications and fewer reinterventions during follow-up. Patients treated with CONS showed a higher late mortality rate. Ruptured SAAs are predictors of a significantly higher perioperative mortality compared with nonruptured SAAs in the OPEN and EV groups.
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Affiliation(s)
- Wouter Hogendoorn
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn; Section of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
| | - Anthi Lavida
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn; Department of Vascular Surgery, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - M G Myriam Hunink
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Health Policy & Management, Harvard School of Public Health, Boston, Mass
| | - Frans L Moll
- Section of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
| | - George Geroulakos
- Department of Vascular Surgery, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - Bart E Muhs
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn
| | - Bauer E Sumpio
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn.
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Maignien C, Marcellin L, Anselem O, Silvera S, Dousset B, Grangé G, Goffinet F. [Embolization of a ruptured pseudo-aneurysm of the uterine artery at 26weeks of gestation: Materno-fetal consequences; a case-report]. ACTA ACUST UNITED AC 2014; 44:665-9. [PMID: 25201019 DOI: 10.1016/j.jgyn.2014.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 06/27/2014] [Accepted: 07/08/2014] [Indexed: 11/28/2022]
Abstract
Rupture of a uterine artery pseudo-aneurysm during pregnancy is a rare condition with potential life-threatening complications, and management should take into account the fetal impact of the therapeutic choice. We report the case of a 2cm left uterine artery pseudo-aneurysm revealed by pelvic pain, in a 30-year-old pregnant woman at 26(+0)weeks of gestation (WG). Diagnosis was suspected at ultrasound scan, and confirmed with Magnetic Resonance angiography that showed signs of pre-rupture. An emergency selective embolization attempted in utero allowed the complete exclusion of the aneurysmal sac. The patient gave birth one month later to a girl at 31(+1)WG, initially managed by neonatologists, who is currently in good health.
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Affiliation(s)
- C Maignien
- Maternité Port-Royal, hôpital Cochin Broca, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, université Paris Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France.
| | - L Marcellin
- Maternité Port-Royal, hôpital Cochin Broca, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, université Paris Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - O Anselem
- Maternité Port-Royal, hôpital Cochin Broca, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, université Paris Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - S Silvera
- Service de radiologie, hôpital Cochin Broca, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; DHU risques et grossesse, université Paris Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - B Dousset
- Service de chirurgie digestive, hépatobiliaire et endocrinienne, hôpital Cochin Broca, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - G Grangé
- Maternité Port-Royal, hôpital Cochin Broca, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, université Paris Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - F Goffinet
- Maternité Port-Royal, hôpital Cochin Broca, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, université Paris Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France
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