Visceral artery aneurysms: evolving interdisciplinary management and future role of the abdominal surgeon

Abstract

Background Visceral artery aneurysms (VAA) are rare vascular lesions. Clinically silent VAA are increasingly detected by cross-sectional imaging but some lesions are at risk for rupture with severe bleeding. The aim of the present study was to evaluate the trends in the interdisciplinary management at a tertiary center. Methods Patients who underwent treatment for VAA at University Hospital of Bonn between 2005 and 2018 were enrolled in this retrospective study. Demographic, clinical, VAA-specific data as well as information on therapy, early and long-term outcome were collected and statistically analyzed. Results Forty-two consecutive patients, 19 females and 23 males with a median age of 59 years (range 30–91 years), were diagnosed with 56 VAA. The majority were true aneurysms ( N = 32; 57%), whereas 43% ( N = 24) were pseudoaneurysms. The most common localization was the splenic artery ( N = 18; 32%) and the average diameter was 3 cm (range 1–5 cm). Twenty-five patients (59.5%) had VAA-related symptoms such as chronic abdominal pain and hemorrhage at primary diagnosis, while the diagnosis was incidental in 17 patients (40.5%). Eleven patients (26%) underwent open surgery whereas 29 patients (69%) received an endovascular treatment. Patients with pseudoaneurysms were significantly older ( P = 0.003), suffered more often from associated symptoms ( P < 0.001) and required more emergency interventions ( P < 0.0001) compared to those with true VAA. In the last years, the number and proportion of true VAA increased significantly ( P < 0.001) while a significantly larger proportion could be managed interventionally ( P = 0.017). Conclusions VAA are increasingly detected on imaging with lesions presenting very heterogeneously. Due to the risk of lethal rupture and in the absence of reliable prognostic markers, all the patients with VAA should be offered definite treatment. Localization, anatomy and the end-organ perfusion after intervention or operation are the most important aspects to consider when planning a treatment for VAA. For this reason, a multidisciplinary evaluation of every individual patient is necessary for an optimized outcome.

Surgical Treatment of Visceral Pseudoaneurysms

“…Однако, по мнению Vittorio Branchi et al [13], лечение висцеральных ПА должно быть индивидуализированным и основываться на решении мультидисциплинарной команды с участием абдоминального, сосудистого хирурга, анестезиолога и специалиста по рентгенэндоваскулярным вмешательствам. При этом эндоваскулярные вмешательства и традиционные хирургические операций не должны противопоставляться друг другу, а должны дополнять друг друга.…”

Application of interventional embolization in the treatment of iatrogenic pseudoaneurysms

“…Pseudoaneurysm is usually caused by the disruption of arterial wall continuity. Such a disruption may be secondary to direct injury during an abdominal procedure or surgery or various endovascular treatments, or an indirect injury from post-operative peri-vascular inflammation or infections (18)(19)(20), resulting in the formation of pseudoaneurysm.…”

Clinical Profile and the Management of Mycotic Superior Mesenteric Artery (SMA) Aneurysm in Infective Endocarditis: A Potential Tsunami

“…Apart from anatomical and technical challenges, insertion of a foreign body into a hostile (infected) tissue can aid in further bacterial colonization leading to relapse of infection [11]. Currently, endovascular procedures are indicated only in high-risk individuals who cannot tolerate general anaesthesia or open surgery [12]. Aneurysms can also be treated using embolization coils, ethylene-vinyl alcohol copolymer (EVOH) stents, multilayer stents, stent grafts and histoacryl glue or a combination of these methods [13][14][15].…”