Surgical treatment of visceral artery aneurysms: A 25-year experience

Pulli, Raffaele; Dorigo, Walter; Troisi, Nicola; Pratesi, Giovanni; Innocenti, Alessandro; Pratesi, Carlo

doi:10.1016/j.jvs.2008.03.043

Cited by 311 publications

(249 citation statements)

References 34 publications

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“…It shows extended loss of arterial perfusion in the parenchyma distal to the coiled artery consistent with partial splenic infarction. or only partial primary success of 12.5 % in this study are not significantly greater than the results of other studies with re-intervention rates of 3 -11 % [12 -14] and comparable results of surgical therapy with re-operation rates of 0 -12 % [13,15,16]. The mortality rate of the elective surgical therapy of visceral aneurysms is approximately 5 % [15,17].…”

Section: Discussionsupporting

confidence: 41%

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: Discussionsupporting

confidence: 41%

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

Ruhnke¹,

Kröncke²

2017

Fortschr Röntgenstr

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“…6 In a study conducted by Pulli et al, only one out of 55 patients showed right gastroepiploic aneurysm, and this case was diagnosed incidentally during abdominal ultrasound. 7 As in the case presented here, right gastroepiploic artery aneurysm is among the rarest forms.…”

Section: Discussionmentioning

confidence: 53%

Spontaneous rupture of right gastroepiploic artery aneurysm: a rare cause of hemorrhagic shock. case report

Sarıgöz¹,

Carkit

Topuz

et al. 2017

Sao Paulo Med. J.

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CONTEXT: Aneurysms of the gastroepiploic arteries are seen only rarely. They are usually diagnosed during autopsy or laparotomy in patients with hemodynamic instability. Although the operation to treat this condition is relatively easy, delay in making the diagnosis affects the course of the disease. CASE REPORT: A 57-year-old woman was admitted to the emergency department with abdominal pain and unconsciousness. A computed tomography scan showed extravasation of contrast agent at the headcorpus junction of the pancreas, and the patient underwent exploratory laparotomy under general anesthesia. During laparotomy, aneurysmatic rupture of the right gastroepiploic artery was detected. Control over bleeding was achieved by ligating the right gastroepiploic artery at its origin. The aneurysm was also resected and sent for pathological examination. CONCLUSION: Especially in cases of unidentified shock, splanchnic artery aneurysms should be kept in mind. Moreover, in the light of the data in the literature, the possibility of death should be taken into account seriously and, if feasible, prophylactic aneurysmectomy should be performed.

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“…3,4 Although a laparoscopic approach is reported to be feasible, especially for splenic artery aneurysm, 2,16,17 the incision to extract the specimen is essential. In this case, the aneurysm was 4.5 cm in diameter, and intracorporeal mobilization was unnecessary because the lesion was located in the distal part of the SMA.…”

Section: Discussionmentioning

confidence: 99%

Mini-Laparotomy for Superior Mesenteric Artery Aneurysm Due to Takayasu's Arteritis

Matsumoto

Ishizuka

Iso

et al. 2015

International Surgery

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Superior mesenteric artery aneurysm (SMAA) is reported to be the third-most common type of visceral aneurysm (VA), accounting for 5% of all VAs. The etiology of SMAA is commonly thought to be infection, and it usually exists in the proximal part of the superior mesenteric artery, which is suitable for endovascular treatment. We herein report an extremely rare case of the distal part of SMAA caused by Takayasu's arteritis (TA), which was successfully resected using a mini-laparotomy method without impairing the intestinal blood supply. A 51-year-old woman was admitted to our hospital with sustained fever and lower back pain. Physical examination showed that she had a discrepancies in blood pressure between both arms. Contrast-enhanced wholebody computed tomography showed stenosis of the thoracic aorta and an aneurysm located in the distal part of the superior mesenteric artery. The diameter of the aneurysm was 4.5 cm. The aneurysm was resected via 4-cm mini-laparotomy, and the vascularity of the intestine was successfully preserved. The postoperative course was uneventful, and the patient was diagnosed as having TA based on both clinical and pathologic findings. Additional corticosteroid therapy was started to treat the arteritis, and at 3-month followup she was without critical incidents. Mini-laparotomy is a safe and less-invasive approach to treat SMAA, especially when the lesion is located in the distal part of the artery.

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Surgical treatment of visceral artery aneurysms: A 25-year experience

Abstract: In the era of minimally invasive therapeutic approaches, elective open surgical treatment of visceral artery aneurysms is safe and effective, and offers satisfactory early and long-term results.

Cited by 311 publications

References 34 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

Spontaneous rupture of right gastroepiploic artery aneurysm: a rare cause of hemorrhagic shock. case report

Mini-Laparotomy for Superior Mesenteric Artery Aneurysm Due to Takayasu's Arteritis

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