Successful endovascular treatment of a recurrent giant celiac artery aneurysm

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.

Successful endovascular embolization of a giant splenic artery pseudoaneurysm secondary to a huge pancreatic pseudocyst with concomitant spleen invasion

“…Doppler US is the first choice for pregnant patients, and it can be effective and sufficient, depicting precisely the location and the morphology of the false aneurysm in superficial anatomical districts, but it has a lower accuracy in abdomen, because of intestinal bloating, and has many limitations in emergency settings if the patient is not collaborating, while CEUS was recently proven to be a powerful new tool to detect false aneurysms, both for the first diagnosis, in patients with a clinical suspicion, and for follow-up after treatment, allowing a faster, easier, cheaper, repeatable, and above all, valid and effective radiation-free imaging. CT angiography, however, represents the gold standard for diagnosis, showing the typical aneurysm body in the arterial phase, as demonstrated in our case [8,10,17,[20][21][22][23][24][25]. MRI proved to be more sensitive and specific, but it is contraindicated for patients with pacemakers and metal prostheses, it is unsuitable for claustrophobic and respiratory distressed patients, especially considering the prolonged time of execution, and above all, its availability is still limited in emergency settings [8,10].…”

“…MRI proved to be more sensitive and specific, but it is contraindicated for patients with pacemakers and metal prostheses, it is unsuitable for claustrophobic and respiratory distressed patients, especially considering the prolonged time of execution, and above all, its availability is still limited in emergency settings [8,10]. Treatment is recommended for all symptomatic splenic artery aneurysms, regardless of the diameter, and for all asymptomatic patients in whom the aneurysmal sac diameter is > 2 cm, due to their high risk of rupture associated with high morbidity and mortality rates, and for those who are pregnant or fertile, who are affected by portal vein hypertension or are candidates for liver transplantation [8][9][10]25,26]. In contrast, the rupture risk for pseudoaneurysms is not related to their diameter, and all pseudoaneurysms should be treated [8,[27][28][29].…”

“…However, this approach is characterized by high incidence of rebleeding and reoperation, and surgically it would be better to identify the involved vessel and to ligate it proximally and distally to the pseudoaneurysm [4,19]. However, in the last few years, surgery has been replaced by transcatheter endovascular embolization due to its low morbidity and mortality and high success rate [25,30]. In fact, in recent years transcatheter endovascular embolization has been preferred for the treatment of peripancreatic bleeding pseudoaneurysms because of the high risk, ineffectiveness, and high mortality during surgery, and it represents a safe alternative to surgery [4,6].…”

Successful Endovascular Embolisation of an Unusual Giant Pseudoaneurysm of the Middle Colic Artery

“…True aneurysms involve all three layers of vessels, and most are asymptomatic, while false aneurysms or pseudoaneurysms are defined as a lack of treatment of choice for visceral artery aneurysms, but in recent years, with the improvement and development of interventional vascular techniques, surgery has been replaced by transcatheter endovascular embolisation due to its low morbidity and mortality and high success rate. In this way, an endovascular approach can be considered a safe alternative therapy to surgery [1,3,7,17,18,29,[31][32][33][34][35]. These reasons informed our decision to perform endovascular embolisation to treat our patient.…”

Successful Endovascular Management of a Massive Hemoptysis due to a Rare Oncological Giant Pulmonary Artery Pseudoaneurysm

“…In the reported case, the giant pseudoaneurysm originated from a high-flow main division branch of the right pulmonary artery and had no out-flow vessels, but just a single in-flow tract, represented by its neck, which was, however, wide. The packing of the sac only is not enough as an endovascular approach, since it is necessary to seal its in-flow tract too, to avoid a later reperfusion of the sac due to the dislocation of the coils, already released, under the blood pressure of the main pulmonary artery [34]. Liquid agents in our patient were not indicated, as they could not have allowed a safe embolisation, due to the high-flow and wide-necked PAP, exposing the risk of a non-target embolisation [5,24,27].…”