Rupture Risk and Etiology of Visceral Artery Aneurysms and Pseudoaneurysms

Regus, Susanne; Lang, Werner

doi:10.1177/1538574415627868

Cited by 52 publications

(54 citation statements)

References 26 publications

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“…False aneurysms or pseudoaneurysms are defined as missing complete arterial walls lined by adventitia or perivascular tissue and arises from the weakening of the arterial wall caused by trauma, including surgical trauma [9], or by proteolytic action as occurs in pancreatitis cases. Because of that, almost all cases of pseudoaneurysms are symptomatic and display greater risk of rupturing than true aneurysms [1,2].…”

Section: Discussionmentioning

confidence: 99%

“…In the last 20 years, due to advances in endovascular techniques, a new modality of treatment has arisen, as an alternative for open surgery, providing the advantage of reducing inherent morbidity and mortality of the procedure [1].…”

Section: Discussionmentioning

confidence: 99%

“…Visceral Artery Aneurysms (VAAs) are rare with an estimated incidence ranging from 0.01% to 2% in autopsies and angiographic series [1]. Aneurysms can affect any of the abdominal aorta branches, although hepatic and splenic aneurysms represent 80% of the reported cases.…”

Section: Introductionmentioning

confidence: 99%

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Pseudoaneurysm Endovascular Treatment of a Middle Colic Arterial Branch in a Patient with an Intermittent Digestive Hemorrhage from an Obscure Source: Case Report

Júnior¹,

Beck²,

Perotoni³

et al. 2017

Vasc Med Surg

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Aneurysms of the middle colic arterial branches are extremely rare, the main manifestation occurs due to the rupture and intraabdominal bleeding making death possible in up to 70% of cases. Herein, we report a case of a male patient, who is 50 years old and displays intermittent, recurrent, and self-limited episodes of a digestive hemorrhage that has been symptomatic during the course of a three-month investigation. After an extensive investigation, the patient was submitted to angiography detecting a pseudoaneurysm in the middle colic branch, being treated by embolization using micro-coils. Intermittent digestive hemorrhages from an obscure source can represent a diagnostic challenge, due to the high degree of clinical suspicion for performing the correct differential diagnosis. Arteriography must not be delayed whenever a pseudoaneurysm with active bleeding is suspected, as this exam is selected for diagnosis and the preferred method for conclusive treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pseudoaneurysm Endovascular Treatment of a Middle Colic Arterial Branch in a Patient with an Intermittent Digestive Hemorrhage from an Obscure Source: Case Report

Júnior¹,

Beck²,

Perotoni³

et al. 2017

Vasc Med Surg

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“…Vis dėlto daugėja publikacijų, pastaraisiais metais pateikiančių beveik iki 0 proc. sumažėjusį mirtingumą po planinių VA operacijų ir endovaskulinio gydymo, todėl atsiranda siūlymų šią ≥ 2 cm ribą pažeminti [36,37].…”

Section: Indikacijos Invaziniam Gydymuiunclassified

“…Bet kokio dydžio aneurizmos šalintinos, jei neaterosklerotinės kilmės, retų lokalizacijų, daugybinės arba greitai didėjančios, taip pat pseudoaneurizmos, nes nustatyta, kad šių aneurizmų plyšimo rizika didesnė ir nepriklauso nuo aneurizmos maišo dydžio [11,35,37,39]. Aneurizmos po organų transplantacijos taip pat linkusios didėti ir greičiau plyšti [8].…”

Section: Indikacijos Invaziniam Gydymuiunclassified

Visceralinės Aneurizmos: Literatūros Apžvalga

Kvietkauskas¹

2017

Medicinos Teorija Ir Praktika

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Reikšminiai žodžiai: visceralinių arterijų aneurizmos, visceralinės aneurizmos, aneurizmos plyšimas. Straipsnyje pateikiama visceralinių aneurizmų literatūros apžvalga. Iki šiol literatūroje apie šią patologiją publikuota per 4 000 straipsnių. Pirmasis visceralinę aneurizmą aprašė prancūzas Beaussiers 1770 metais. Visceralinėmis aneurizmomis vadinamos pilvinio kamieno, viršutinės ir apatinės pasaito, inkstų arterijų ir jų šakų aneurizmos. Jų sutinkama ne daugiau kaip 2 proc. populiacijos. Visceralinės aneurizmos skirstomos į tikras visceralines aneurizmas ir pseudoaneurizmas. Pastarosios aptinkamos dvigubai dažniau nei tikros visceralinės aneurizmos. Dažniausiai tikrosios aneurizmos susiformuoja dėl aterosklerozės, fibromuskulinės displazijos arba traumos, o pseudoaneurizmas dažniausiai sukelia pankreatitai. Pagal klinikinę stadiją skiriamos asimptominės, simptominės ir plyšusios visceralinės aneurizmos. Pastarosios pasižymi ypač dideliu mirtingumu. Visceralinės aneurizmos dažniausiai pažeidžia blužnies arterijas, rečiau – kepenų, inkstų, ypač retai – kitas visceralines arterijas. Pagrindiniai diagnostikos iššūkiai – labai įvairi ir nespecifinė visceralinių aneurizmų klinika. Pagrindinės diagnostikos naujovės – didesnės raiškos ir erdvinės vaizdinių tyrimų atmainos. Planinis invazinis gydymas taikytinas, jei visceralinių aneurizmų diametras ≥ 2 cm, taip pat kai kurių išimčių atvejais – nepriklausomai nuo aneurizmos dydžio. Esant simptominėms aneurizmoms, intervencija turi būti atliekama neatidėliotinai, o plyšusių atvejais – skubiai. Minimaliai invaziniai gydymo metodai pamažu tampa pagrindiniai gydant visceralines aneurizmas. Ypač gerų rezultatų ateityje tikimasi gydant aneurizmas srovę nukreipiančiais stentais, kai jie taps prieinamesni.

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Aneurysms of pancreaticoduodenal arcade: Clinical profile and endovascular strategies

et al. 2020

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Background and Aim: Pancreaticoduodenal arcade aneurysms (PDAAs) are uncommon lesions associated with a significant risk of rupture and mortality. This study describes the etiology, clinical presentation, and endovascular management strategies of PDAAs across a spectrum of indications. Methods: The clinical records of patients with PDAAs referred for endovascular management from January 2018 till November 2019 were retrospectively reviewed. Data on presenting symptoms, associated etiologies, and outcomes after endovascular treatment were collected and studied. Results: We found 15 patients with false and 1 patient with true aneurysm of pancreatoduodenal arcade (PDA). The associated conditions were coeliac artery stenosis, severe necrotizing pancreatitis, and chronic pancreatitis or iatrogenic (postendoscopic papillotomy and percutaneous metallic biliary stenting). The main presenting feature was gastrointestinal bleed, while 2 patients had abdominal pain and 1 had gastric outlet obstruction. A multiphase computed tomography scan demonstrated the ruptured aneurysm in all patients. Site of origin of PDAA influenced the choice of transarterial endovascular strategy (coiling for aneurysms of main trunk of arteries and glue injection for those arising from small arterial branches). This was carried out in an emergency setting for 12 patients and as an elective procedure in 4 patients. Technical success was demonstrated in all patients and clinical success in 14. The two patients who had rebleed were salvaged by repeat endovascular procedure. Postembolization syndrome was seen in three patients. Conclusions: With advancing technology, endovascular strategies continue to evolve. Careful attention to ensure hemodynamic resuscitation and stability, correction of preexisting coagulopathy and attention to technique can lead to the possibility of endovascular approaches as a dependable option in the management of ruptured PDAAs.

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Rupture Risk and Etiology of Visceral Artery Aneurysms and Pseudoaneurysms

Abstract: Chronic pancreatitis seems to be a prominent risk factor for the development of VAPA in this single-center experience. Modern endovascular techniques with promising short- and long-term results could broaden indications to treat asymptomatic VAA and VAPA.

Cited by 52 publications

References 26 publications

Pseudoaneurysm Endovascular Treatment of a Middle Colic Arterial Branch in a Patient with an Intermittent Digestive Hemorrhage from an Obscure Source: Case Report

Pseudoaneurysm Endovascular Treatment of a Middle Colic Arterial Branch in a Patient with an Intermittent Digestive Hemorrhage from an Obscure Source: Case Report

Visceralinės Aneurizmos: Literatūros Apžvalga

Aneurysms of pancreaticoduodenal arcade: Clinical profile and endovascular strategies

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