Regression of Abdominal Visceral Aneurysms in Polyarteritis Nodosa: CT Findings

Tarhan, Nefise Çağla; Coşkun, Mehmet; Kayahan, E. M.; Yıldırım, Erkan; Yücel, Eftal

doi:10.2214/ajr.180.6.1801617

Cited by 20 publications

(12 citation statements)

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“…The indication to treat has been expanded to include asymptomatic aneurysms regardless of size in affected women who wish to become pregnant [8]. In addition, all symptomatic aneurysms in patients with vasculitis should be treated immediately, while incidental aneurysms in such patients should be treated during an inflammation-free interval if they do not significantly reduce in size under immunosuppressive therapy [9]. In addition, all aneurysms with an increase in size of more than 0.5 cm/year should be treated [10].…”

Section: Discussionmentioning

confidence: 99%

Visceral Artery Aneurysms and Pseudoaneurysms: Retrospective Analysis of Interventional Endovascular Therapy of 43 Aneurysms

Ruhnke¹,

Kröncke²

2017

Fortschr Röntgenstr

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ABSTR AC TPurpose To evaluate the results of interventional endovascular therapy of incidental and symptomatic visceral artery aneurysms in the elective and emergency situation.Materials and Methods 43 aneurysms in 38 patients (19 female, 19 male, mean age: 57 ± 16 years [18 -82]) were treated between 2011 and 2015. The characteristics of the aneurysms (true vs. false aneurysm, size, etiology, location, symptoms) were considered. Furthermore, we evaluated the intervention with respect to technical success, embolic/occlusive agents used, therapy-associated complications and postinterventional follow-up.Results 23 true aneurysms (maximum diameter: 22 ± 18 mm [11 -67 mm]) and 20 false aneurysms (maximum diameter: 9 ± 33 mm [3 -150 mm]) were evaluated. The splenic (n = 14) and renal arteries (n = 18) were most frequently affected. The etiology was most commonly degenerative-atherosclerotic (47 %) or iatrogenic post-operative (19 %). 18/48 interventions were performed due to active bleeding. False aneurysms were associated significantly more often with active bleeding (63 vs. 25 %, p = 0.012). 41/48 treatments were technically successful. Re-intervention was necessary 6 times. In 2 cases the endovascular approach did not succeed. There was a complication rate of 10 %, whereby only 4 minor and 1 major complications occurred. No patient suffered from permanent sequelae. Aneurysms were primarily treated by using coils and if necessary additional embolic agents (liquid embolic agent or vascular plugs) (75 %). In the follow-up period, reperfusion of treated aneurysms occurred at a rate of 7 % (n = 3). ConclusionInterventional endovascular therapy of visceral artery aneurysms is safe and effective in the elective treatment of incidental aneurysms as well as in significantly more frequent hemorrhaging false aneurysms in the emergency situation. Key points▪ Interventional endovascular therapy of visceral artery aneurysms is safe and effective. ▪ In more than 60 % of cases visceral artery pseudoaneurysms are associated significantly more often with a history of bleeding or acute bleeding. Hence, there is a need for (interventional) therapy even in small pseudoaneurysms. ▪ Follow-up seems to be useful to detect reperfusion as manifestation of treatment failure. This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.tischen Aneurysmen der viszeralen Gefäße in der elektiven sowie der Notfallsituation. Material und Methoden

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Section: Discussionmentioning

confidence: 99%

Visceral Artery Aneurysms and Pseudoaneurysms: Retrospective Analysis of Interventional Endovascular Therapy of 43 Aneurysms

Ruhnke¹,

Kröncke²

2017

Fortschr Röntgenstr

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“…Aneurysms as small as 3 mm in diameter can be identified by CT scan, an effective noninvasive way to follow-up patients with PAN. 11 Steroids have been used to treat PAN since 1951 and have increased survival rates for patients with PAN. 12 Some reports documented regression of associated aneurysms after combined medical treatment with steroids and immunosuppressant drugs.…”

Section: Discussionmentioning

confidence: 99%

Polyarteritis Nodosa-Induced Pancreaticoduodenal Artery Aneurysmal Rupture

et al. 2013

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Polyarteritis nodosa (PAN) is a systemic, necrotizing vasculitis of small- and medium-sized arteries typically with multiorgan involvement. Most cases of PAN are idiopathic, although hepatitis B or C virus infections and hairy cell leukemia are important in the pathogenesis of some cases. PAN is characterized as segmental transmural inflammation of muscular arteries. Diagnosis is based on clinical suspicion, a negative immunofluorescence test for antineutrophil cytoplasmic antibodies, and whenever possible, biopsy conformation. Angiographic images may reveal microaneurysms affecting the renal, hepatic, or mesenteric vasculature. Aneurysmal formation and rupture are important complications that can be fatal. Treatment may warrant immunosuppression with steroids and cyclophosphamide. If left untreated, PAN can be fatal. To our knowledge, we report the second documented case of PAN-induced ruptured inferior pancreaticoduodenal artery aneurysm.

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“…Zudem sollten alle Aneurysmen vaskulitischer Genese, die symptomatisch sind, unmittelbar therapiert werden. Inzidentelle vaskulitische Aneurysmen, die unter immunsuppressiver Therapie keine signifikante Größenreduktion zeigen, sollten im entzündungsfreien Intervall behandelt werden [9]. Zudem sollten alle Aneurysmen mit einer Größenzunahme von mehr als 0,5 cm/Jahr behandelt werden [10].…”

Section: Cme-fortbildungunclassified

“…Sowohl bei Morbidität als auch bei Mortalität müssen jedoch insbesondere die begrenzte Vergleichbarkeit aufgrund unterschiedlicher Klassifikation der Komplikationen und die geringe Fallzahl sowohl in der vorliegenden Studie als auch in den bisherigen Veröffentlichungen beachtet werden. Bei einer interventionsbedingten Gesamtmorbidität von 10 % (8 % therapiebedürftig) im Rahmen aller Interventionen des untersuchten Kollektivs zeigt sich eine gute Vergleichbarkeit mit anderen Untersuchungen (3 -8 %) [9,22,23]. Die perioperative Morbidität der konventionellen chirurgischen Therapie im Sinne operationsassoziierter Komplikationen ist in einem Zeitraum von bis zu 30 Tagen nach der Operation mit 7 -13 % ebenfalls vergleichbar [15,24,25].…”

Section: Komplikationsrateunclassified

Aneurysmen und Pseudoaneurysmen viszeraler Arterien – interventionelle Therapie

Ruhnke¹,

Kröncke²

2018

Gefäßmedizin Scan

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Purpose To evaluate the results of interventional endovascular therapy of incidental and symptomatic visceral artery aneurysms in the elective and emergency situation. Materials and Methods 43 aneurysms in 38 patients (19 female, 19 male, mean age: 57???16 years [18???82]) were treated between 2011 and 2015.?The characteristics of the aneurysms (true vs. false aneurysm, size, etiology, location, symptoms) were considered. Furthermore, we evaluated the intervention with respect to technical success, embolic/occlusive agents used, therapy-associated complications and postinterventional follow-up. Results 23 true aneurysms (maximum diameter: 22???18?mm [11???67?mm]) and 20 false aneurysms (maximum diameter: 9???33?mm [3???150?mm]) were evaluated. The splenic (n?=?14) and renal arteries (n?=?18) were most frequently affected. The etiology was most commonly degenerative-atherosclerotic (47?%) or iatrogenic post-operative (19?%). 18/48 interventions were performed due to active bleeding. False aneurysms were associated significantly more often with active bleeding (63 vs. 25?%, p?=?0.012). 41/48 treatments were technically successful. Re-intervention was necessary 6 times. In 2 cases the endovascular approach did not succeed. There was a complication rate of 10?%, whereby only 4 minor and 1 major complications occurred. No patient suffered from permanent sequelae. Aneurysms were primarily treated by using coils and if necessary additional embolic agents (liquid embolic agent or vascular plugs) (75?%). In the follow-up period, reperfusion of treated aneurysms occurred at a rate of 7?% (n?=?3). Conclusion Interventional endovascular therapy of visceral artery aneurysms is safe and effective in the elective treatment of incidental aneurysms as well as in significantly more frequent hemorrhaging false aneurysms in the emergency situation.

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Regression of Abdominal Visceral Aneurysms in Polyarteritis Nodosa: CT Findings

Cited by 20 publications

References 5 publications

Visceral Artery Aneurysms and Pseudoaneurysms: Retrospective Analysis of Interventional Endovascular Therapy of 43 Aneurysms

Visceral Artery Aneurysms and Pseudoaneurysms: Retrospective Analysis of Interventional Endovascular Therapy of 43 Aneurysms

Polyarteritis Nodosa-Induced Pancreaticoduodenal Artery Aneurysmal Rupture

Aneurysmen und Pseudoaneurysmen viszeraler Arterien – interventionelle Therapie

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