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Toyota K, Ishida H, Mori M, Okamoto N, Kuraoka N, Yano R, Kobayashi H, Hashimoto Y, Sakashita Y, Yokoyama Y, Murakami Y, Ishida H, Takahashi S, Miyamoto K. Safe suprapancreatic lymph node dissection for gastric cancer with ectopic common hepatic artery. Asian J Endosc Surg 2024; 17:e13299. [PMID: 38499011 DOI: 10.1111/ases.13299] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 03/20/2024]
Abstract
Suprapancreatic lymph node dissection for patients with gastric cancer in whom the common hepatic artery is located neither at the suprapancreatic margin nor in front of the portal vein is a more difficult procedure than when the common hepatic artery is in a more typical position. There is an increased risk of injury to the vessels that need to be preserved and inadequate lymph node dissection. Measures that have been reported for use in this situation are preoperative diagnosis with three-dimensional computed tomography angiography, dissection using the portal vain as a guide, and safe exposure of the portal vein with dissection to preserve the nerves at the suprapancreatic margin and in front of the portal vein. We review the literature and report our experience with a patient whose common hepatic artery was not located in the suprapancreatic margin who safely underwent suprapancreatic lymph node dissection using these methods.
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Affiliation(s)
- Kazuhiro Toyota
- Department of surgery, Hiroshima Memorial Hospital, Hiroshima, Japan
| | - Hayato Ishida
- Department of surgery, Hiroshima Memorial Hospital, Hiroshima, Japan
| | - Masayuki Mori
- Department of surgery, Hiroshima Memorial Hospital, Hiroshima, Japan
| | - Nobuyuki Okamoto
- Department of surgery, Hiroshima Memorial Hospital, Hiroshima, Japan
| | - Norimasa Kuraoka
- Department of surgery, Hiroshima Memorial Hospital, Hiroshima, Japan
| | - Raita Yano
- Department of surgery, Hiroshima Memorial Hospital, Hiroshima, Japan
| | | | - Yasushi Hashimoto
- Department of surgery, Hiroshima Memorial Hospital, Hiroshima, Japan
| | | | - Yujiro Yokoyama
- Department of surgery, Hiroshima Memorial Hospital, Hiroshima, Japan
| | - Yoshiaki Murakami
- Department of surgery, Hiroshima Memorial Hospital, Hiroshima, Japan
| | - Hiroshi Ishida
- Department of surgery, Hiroshima Memorial Hospital, Hiroshima, Japan
| | - Shinya Takahashi
- Departtment of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Memar SA, Taylor AM, Ahuja S, Daly DT, Tan Y. Rare left colic artery variation of the gut arterial system. Folia Morphol (Warsz) 2021; 82:198-204. [PMID: 34845717 DOI: 10.5603/fm.a2021.0130] [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: 10/06/2021] [Revised: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022]
Abstract
Most variations of the abdominal blood supply are related to branching of the coeliac trunk and superior mesenteric artery. This case details a remarkable variation in the branching pattern of the left colic artery (LCA) observed during routine cadaveric dissection of an 84-year-old male donor. An anomalous common trunk, originating from the common hepatic artery, gave rise to three branches: 1) an accessory posterior pancreaticoduodenal artery to the head of the pancreas and adjacent duodenum, 2) the dorsal pancreatic artery anastomosing with branches of the splenic artery, and 3) the LCA. The LCA descended between the splenic vein and superior mesenteric artery to supply the left colic flexure and form a collateral route with the middle colic artery by contributing to the marginal artery of Drummond. Knowledge of this variation is clinically relevant for surgical and radiological procedures in the abdomen.
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Affiliation(s)
- S A Memar
- A.T. Still University Kirksville College of Osteopathic Medicine, Kirksville, MO, United States
| | - A M Taylor
- Centre for Anatomical Science and Education, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - S Ahuja
- Centre for Anatomical Science and Education, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - D T Daly
- Centre for Anatomical Science and Education, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, MO, United States.
| | - Y Tan
- Centre for Anatomical Science and Education, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, MO, United States
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Petzold S, Storsberg SD, Fischer K, Schumann S. Variant Arterial Supply of the Descending Colon by the Coeliac Trunk: A Case Report. ACTA ACUST UNITED AC 2021; 57:medicina57050487. [PMID: 34066117 PMCID: PMC8151744 DOI: 10.3390/medicina57050487] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 12/02/2022]
Abstract
Background and Objectives: Knowledge of arterial variations of the intestines is of great importance in visceral surgery and interventional radiology. Materials and Methods: An unusual variation in the blood supply of the descending colon was observed in a Caucasian female body donor. Results: In this case, the left colic artery that regularly derives from the inferior mesenteric artery supplying the descending colon was instead a branch of the common hepatic artery. Conclusions: Here, we describe the very rare case of an aberrant left colic artery arising from the common hepatic artery in a dissection study.
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Affiliation(s)
- Sandra Petzold
- Institute of Anatomy, Medical Faculty, Otto-von-Guericke-University Magdeburg, 39120 Magdeburg, Germany; (S.P.); (K.F.)
| | - Silke Diana Storsberg
- Institute for Anatomy and Clinical Morphology, School of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany;
| | - Karin Fischer
- Institute of Anatomy, Medical Faculty, Otto-von-Guericke-University Magdeburg, 39120 Magdeburg, Germany; (S.P.); (K.F.)
| | - Sven Schumann
- University Medical Center, Institute for Microscopic Anatomy and Neurobiology, Johannes Gutenberg-University, 55131 Mainz, Germany
- Correspondence:
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Coco D, Leanza S. Common hepatic artery arises from superior mesenteric artery: bipode celiac trunk. Pan Afr Med J 2021; 38:2. [PMID: 33520071 PMCID: PMC7825368 DOI: 10.11604/pamj.2021.38.2.27425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Danilo Coco
- Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Silvana Leanza
- Department of General Surgery, Carlo Urbani Hospital, Jesi, Ancona, Italy
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Ekingen A, Tuncer MC, Ertuğrul Ö. Investigation of proper hepatic artery and gastroduodenal artery variations by multidetector computed tomography angiography method. Acta Chir Belg 2020; 120:102-115. [PMID: 30714485 DOI: 10.1080/00015458.2019.1570744] [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: 10/27/2022]
Abstract
Purpose: The purpose of this study is to evaluate the clinical anatomic variations of the proper hepatic artery (PHA) and the gastroduodenal artery (GDA). For this purpose, angiographic images of patients were evaluated.Materials and methods: We retrospectively reviewed the multiple-detector computed tomography angiography images of 671 patients.Results: In this retrospective study, 35 different types were identified as associated with PHA and GDA. There were 292 patients (43.52%; 175 females and 117 males) included in normal anatomical classification. Different anatomic variations were detected in 300 patients (44.71%; 129 females and 171 males). In 79 patients, arterial branch follow-up failed. These patients were evaluated as an unidentified group.Conclusion: We described different vascular variations in the PHAs and GDAs of our patients.
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Affiliation(s)
- Arzu Ekingen
- Vocational School of Health Services, University of Batman, Batman, Turkey
| | - Mehmet Cudi Tuncer
- Department of Anatomy Faculty of Medicine, University of Dicle, Diyarbakır, Turkey
| | - Özgür Ertuğrul
- Department of Radiology, Memorial Hospital, Diyarbakır, Turkey
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Yaseen S, Wadhwa S, Jeelani K, Mahajan A, Mishra S. Abnormal Persistence of Embryonic Blood Supply of Liver: Anatomist's Delight, Surgeon's Nightmare. Acta Medica (Hradec Kralove) 2019; 62:72-76. [PMID: 31362814 DOI: 10.14712/18059694.2019.106] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The high incidence of hepato-biliary vascular anatomy variations necessitates its evaluation prior to performing liver transplantation, hepatobiliary, pancreatic, gastric and oesophageal surgeries. We report a unique case of persistence of embryonic arteries of the liver, wherein, the liver was supplied by five vessels. In addition to the usual right and left hepatic arteries from the hepatic artery proper, the liver received two accessory right hepatic arteries, one from the gastroduodenal artery, while another arising from superior mesenteric artery and an accessory left hepatic artery, from the left gastric artery. The origin of gastroduodenal artery was found to be unusually high and its abnormal anterior course over the common bile duct further added complexity to the hepatobiliary anatomy. The presence of these aberrant and accessory arteries predisposes to inadvertent injury leading to patient morbidity and sometimes mortality.
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Affiliation(s)
- Sabah Yaseen
- Department of Anatomy, Maulana Azad Medical College, New Delhi, India
| | - Surbhi Wadhwa
- Department of Anatomy, Maulana Azad Medical College, New Delhi, India.
| | - Kahkashan Jeelani
- Department of Anatomy, Maulana Azad Medical College, New Delhi, India
| | - Anita Mahajan
- Department of Anatomy, Maulana Azad Medical College, New Delhi, India
| | - Sabita Mishra
- Department of Anatomy, Maulana Azad Medical College, New Delhi, India
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Chentanez V, Nateniyom N, Huanmanop T, Agthong S. Co-existence of the double inferior vena cava with complex interiliac venous communication and aberrant common hepatic artery arising from superior mesenteric artery: a case report. Folia Morphol (Warsz) 2017; 77:151-155. [PMID: 28832091 DOI: 10.5603/fm.a2017.0074] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 11/25/2022]
Abstract
Variations of the arterial and venous system of the abdomen and pelvis have important clinical significance in hepatobiliary surgery, abdominal laparoscopy, and radiological intervention. A case of double inferior vena cava (IVC) with complex interiliac communication and variation of the common hepatic artery (CHA) arising from superior mesenteric artery (SMA) in a 79-year-old male cadaver is presented. Both IVCs ascended on either side of the abdominal aorta. The left-sided IVC crossed anterior to the aorta at the level of the left renal vein. The union of both IVCs was at the level just above the right renal vein. The diameter of right-sided IVC, left-sided IVC and the common IVC were 16.73 mm, 21.57 mm and 28.75 mm, respectively. In the pelvic cavity, the right common iliac vein was formed by a union of right external and internal iliac veins while the formation of left common iliac vein was from the external iliac vein and two internal iliac veins. An interiliac vein ran from right internal iliac vein to left common iliac vein with an additional communicating vein running from the middle of this interiliac vein to the right common iliac vein. Another co-existence variation in this case was the origin of the CHA arising from the SMA with a suprapancreatic retroportal course. Clinical importance of double IVC are observed in retroperitoneal surgery, whole organ transplantation or radical nephrectomy, surgical ligation of the IVC or the placement of an IVC filter for thromboembolic disease. The variation of CHA has an important clinical significance in liver transplantation, abdominal laparoscopy and radiological abdominal intervention. (Folia Morphol 2018; 77, 1: 151-155).
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Affiliation(s)
- V Chentanez
- Department of Anatomy, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Rama 4 Road, 10330 Bangkok, Thailand.
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Abstract
Anatomical variations of the celiac trunk and its branches are particularly important from a surgical perspective due to their relationships with surrounding structures. We report here a particularly rare variant involving absence of the celiac trunk in association with trifurcation of the common hepatic artery. These variations were found in an adult male cadaver. We perform a review of the literature and discuss the clinical and embryological significance of these variations. Recognition of celiac trunk and hepatic artery variations is of utmost importance to surgeons and radiologists because multiple variations can lead to undue complications.
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Affiliation(s)
| | - Ashwini Aithal Padur
- Manipal University, Melaka Manipal Medical College, Department of Anatomy, Manipal, Karnataka, India
| | - Naveen Kumar
- Manipal University, Melaka Manipal Medical College, Department of Anatomy, Manipal, Karnataka, India
| | - Deepthinath Reghunathan
- Manipal University, Melaka Manipal Medical College, Department of Anatomy, Manipal, Karnataka, India
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Prasanna LC, Alva R, Sneha GK, Bhat KMR. Rare variations in the Origin, Branching Pattern and Course of the Celiac Trunk: Report of Two Cases. Malays J Med Sci 2016; 23:77-81. [PMID: 27540329 PMCID: PMC4975580] [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: 07/10/2014] [Accepted: 08/23/2014] [Indexed: 06/06/2023] Open
Abstract
Multiple anomalies in the celiac arterial system presents as rare vascular malformations, depicting deviations of the normal vascular developmental pattern. We found a common left gastro-phrenic trunk and a hepato-spleno-mesenteric trunk arising separately from the abdominal aorta in one cadaver. We also found a common hepatic artery and a gastro-splenic trunk arising individually from the abdominal aorta in another cadaver. Even though many variations in the celiac trunk have been described earlier, the complex variations described here are not mentioned and classified by earlier literature. Knowledge of such variations has significance in the surgical and invasive arterial radiological procedures in the upper abdomen.
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Affiliation(s)
| | | | | | - Kumar M R Bhat
- Correspondence: Dr Kumar MR Bhat, PhD (Kasturba Medical College, Manipal University), Department of Anatomy, Kasturba Medical Collage, Manipal University, Manipal-576104, India, Tel:+91-820-292 2327, Fax: +91-820-257 0061,
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Abstract
Vascular variations are significant for liver transplantations, radiological procedures, laparoscopic method of operation and for the healing of penetrating injuries, including the space close to the hepatic area. These variants are very common in the abdominal region, and their description will be useful. During a routine dissection of a 73 year old female cadaver, we found in the subhepatic region that the blood supply of the liver differed from a normal one. The difference was found in the absence of the right liver branch and the cystic artery, which normally arises from the common hepatic artery. After a detailed dissection of the superior mesenteric artery we distinguished a branchthat was routed to the right lobe of the liver. The diameter of this vessel was 3.7 mm and the length 8.2 cm. In the artery pathway, three consecutive branches were observed. The first branch was found about 2.02 cm before the portal region of the liver. The second one became visible after another millimeter and finally the artery made one little curve and became a cystic artery.
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Affiliation(s)
- Ivan Maslarski
- Department of Anatomy, Histology and Pathology, Medical Faculty at the University of Sofia, Bulgaria
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Al-Hawary MM, Francis IR, Chari ST, Fishman EK, Hough DM, Lu DS, Macari M, Megibow AJ, Miller FH, Mortele KJ, Merchant NB, Minter RM, Tamm EP, Sahani DV, Simeone DM. Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the society of abdominal radiology and the american pancreatic association. Gastroenterology 2014; 146:291-304.e1. [PMID: 24355035 DOI: 10.1053/j.gastro.2013.11.004] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/05/2013] [Indexed: 12/11/2022]
Abstract
Pancreatic ductal adenocarcinoma is an aggressive malignancy with a high mortality rate. Proper determination of the extent of disease on imaging studies at the time of staging is one of the most important steps in optimal patient management. Given the variability in expertise and definition of disease extent among different practitioners as well as frequent lack of complete reporting of pertinent imaging findings at radiologic examinations, adoption of a standardized template for radiology reporting, using universally accepted and agreed on terminology for solid pancreatic neoplasms, is needed. A consensus statement describing a standardized reporting template authored by a multi-institutional group of experts in pancreatic ductal adenocarcinoma that included radiologists, gastroenterologists, and hepatopancreatobiliary surgeons was developed under the joint sponsorship of the Society of Abdominal Radiologists and the American Pancreatic Association. Adoption of this standardized imaging reporting template should improve the decision-making process for the management of patients with pancreatic ductal adenocarcinoma by providing a complete, pertinent, and accurate reporting of disease staging to optimize treatment recommendations that can be offered to the patient. Standardization can also help to facilitate research and clinical trial design by using appropriate and consistent staging by means of resectability status, thus allowing for comparison of results among different institutions.
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Sureka B, Mittal MK, Mittal A, Sinha M, Bhambri NK, Thukral BB. Variations of celiac axis, common hepatic artery and its branches in 600 patients. Indian J Radiol Imaging 2013; 23:223-33. [PMID: 24347852 PMCID: PMC3843330 DOI: 10.4103/0971-3026.120273] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [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: 12/03/2022] Open
Abstract
Purpose: To evaluate the spectrum of celiac axis, common hepatic artery (CHA), right, left, middle hepatic artery and gastroduodenal artery variations by using spiral computed tomography (CT). Materials and Methods: A retrospective review of Multidetector CT (MDCT) abdominal angiography scans was performed in patients sent for various liver and other abdominal pathologies between January 2012 and February 2013. A total of 600 patients were evaluated. Definitions of CHA, ambiguous celiac axis, course and division patterns of CHA, replaced hepatic artery, accessory hepatic artery and middle hepatic artery were used as proposed by Song et al., Covey et al., and Wang et al. The pattern of the aortic origin of branches of celiac axis, common hepatic artery and its branches was analyzed. Results: Six types of celiac axis anatomic variations were identified in our study. A total of 546 of the 600 patients had a normal celiac axis anatomy. Anatomic variations were seen in 5.5% of patients. Ambiguous anatomy was seen in 3.5% of the patients. CHA originated from celiac axis in 95.83% of the patients. Variations in anatomic origin of CHA were seen in 8 patients. Ambiguous dual pathway was seen in 4 patients. Normal Sp-preportal course of CHA was identified in 97.78% of cases, Sp-retroportal course in 7 patients, Tp-preportal course in 2, Tp-retroportal in 1, Ip-preportal in 1 and through Ligamentum venosum in 2 patients. Normal origin of RHA from HAP was seen in 79.6% patients. Replaced origin of RHA was seen in 15.16% cases and Accessory origin of RHA was seen in 5.16% cases. LHA originated from HAP in 81.5% patients. Replaced LHA origin was seen in 10.8% cases and Accessory LHA origin seen in 7.6% cases. MHA originated from RHA in 41.3% patients, LHA in 27.83% and from CHA in 4.5% cases. Origin of MHA could not be defined in 26.3% of patients. GDA originated from CHA in 97.6% of patients, from celiac axis in 1.6%, from RHA in 0.33% in patients. Trifurcation of CHA was seen in 7.16% and quadrifurcation of CHA in 2.16%. Conclusion: CT Angiography is a safe and highly sensitive and accurate modality for evaluation of arterial anatomy and its variants.
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Affiliation(s)
- Binit Sureka
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Mahesh Kumar Mittal
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Aliza Mittal
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Mukul Sinha
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Narendra Kumar Bhambri
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Brij Bhushan Thukral
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Abstract
Peripheral arterial aneurysms are uncommon; for some aneurysm types, data are limited to case reports and small case series. There is no Level A evidence in most cases to determine the choice between open or endovascular intervention. The evolution of endovascular technology has vastly improved the armamentarium available to the vascular surgeon and interventionalists in the management of these rare and unusual aneurysms. The choice of operative approach will ultimately be determined on an individual basis, dependent on the patient risk factors, and aneurysm anatomy. After consideration, some aneurysms (femoral, subclavian, carotid and ECAA) fare better with an open first approach; renal, splenic and some visceral artery aneurysms do better with an endovascular first approach. In our practice PAAs are treated with an endovascular first approach. For these rare conditions, both open and endovascular therapy will continue to work in harmony to enhance and extend the capabilities of modern surgical management.
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Affiliation(s)
- Irwin V Mohan
- Westmead Hospital, University of Sydney Medical School, Sydney, NSW 2145, Australia.
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