The Minimally Invasive Management of Visceral Artery Aneurysms and Pseudoaneurysms

Abstract

years) and 125 women (mean age, 70.0 Ϯ 11.2 years; P ϭ NS). Women were more likely to undergo treatment for critical limb ischemia (87.7% vs 77.7%; P ϭ .028) and less likely to have treatment for claudication (12.3% vs 22.3%; P ϭ NS). Women were also more likely to undergo balloon angioplasty (57.5% vs 68.9%; P ϭ .043). However, men were more likely to have coronary disease, history of coronary bypass grafting, and chronic renal insufficiency. TransAtlantic Intersociety Consensus distribution, incidence of smoking, and diabetes were equivalent in both sexes. When adjusted for comorbidities, women had higher 24-month primary patency rates (46.0% Ϯ 6.1% vs 30.4% Ϯ 5.9%; P ϭ .016) and limb salvage rates (87.5% Ϯ 4.1% vs 82.9% Ϯ 5.4%; P ϭ .041) than men for tibial lesions with concurrent proximal disease. The difference in 24-month patency between women and men was more pronounced for isolated tibial lesions (50.1% Ϯ10.1% vs 28.8% Ϯ 10.4%; P ϭ .002). Although the overall complication rates were similar, women had comparatively higher rates of postoperative access site thrombosis than men (8.9% vs 0.6%, P ϭ .001).Conclusions: Overall, endovascular interventions below the knee are safe and effective in women and should be considered the first-line modality for the management of critical tibial occlusive disease. However, further investigation and development of technique to better fit the female anatomy is necessary to improve the gender-related disparity in access site-related complications.

Endovascular Management of Visceral Arterial Aneurysms

“…While the natural history of these aneurysms is not well known as many are found incidentally on studies performed for other reasons, a definite risk of rupture has been demonstrated. [5][6][7][8][9] Depending on size and location, mortality from rupture ranges from 25-100%. 1,6 Treatment recommendations are based on the specific artery affected.…”

Endovascular Management of Anastomotic Blowout of Proper Hepatic to Common Hepatic Artery Saphenous Vein Bypass With Coil Embolization and Hepatic Artery Stent Placement

“…Surgical intervention is one option for the treatment of pseudoaneurysms of the visceral arteries; however, the risk of post-operative complications in this patient population can increase the chance of a poor surgical outcome. 8 This is the first reported case describing the endovascular management of a common hepatic to proper hepatic artery saphenous vein interposition graft anastomotic blowout. Transcatheter embolization or stent placement offers a viable treatment alternative to traditional surgery.…”

Gastroepiploic artery pseudoaneurysm: a rare cause of abdominal pain

“…A century later, in 1871, German surgeon Heinrich Quincke described the clinical signs of haemobilia caused by the rupture of a hepatic artery aneurysm . Today, visceral artery aneurysms (VAAs) are still considered rare, with an incidence of between 0.01% and 2% of all autopsies and angiographic series . The term encompasses both true and false aneurysms of the coeliac axis, superior mesenteric artery, inferior mesenteric artery and their branches.…”

“…As the pseudoaneurysm was noted to be fairly superficial, it was initially injected with thrombin percutaneously, and an abdominal Doppler USS performed immediately after revealed adequate pseudoaneurysm occlusion . However, a follow‐up abdominal Doppler USS performed 2 days later revealed a small area of patency through the initially occluded pseudoaneurysm, with blood flow into the patent area.…”

“…It is believed that 28% of splenic artery aneurysms and up to 50% of hepatic artery aneurysms are pseudoaneurysms . No similar figures currently exist for other VAAs due to their rarity but a retrospective analysis conducted by Fankhauser et al . of patients presenting with VAAs over a 10‐year period found that 50% of the detected gastroepiploic artery aneurysms were in fact pseudoaneurysms.…”