Visceral artery aneurysms are relatively rare clinical entities, although their detection is rising due to an increased use of cross-sectional imaging. Rupture is the most devastating complication, and is associated with a high morbidity and mortality. For this reason, elective repair is preferable in the appropriately chosen patient. In general, splenic artery aneurysms measuring 2 cm or larger and those found in women of childbearing age and in persons undergoing liver transplantation should be treated. Hepatic artery aneurysms 2 cm or larger and those that are multiple or nonatherosclerotic in nature should be repaired in the appropriate patient due to a higher risk of rupture. Endovascular coil embolization has excellent success rates and is the first-line treatment for anatomically suitable splenic artery aneurysms and intrahepatic hepatic artery aneurysms. However, reperfusion is an important complication of endovascular management. Aneurysms involving the celiac, superior mesenteric, pancreaticoduodenal, gastroduodenal, and inferior mesenteric arteries, as well as visceral artery pseudoaneurysms, are unpredictable and should be repaired in the appropriate medical patient. These aneurysms are often amenable to ligation due to the presence of collateral circulation. Endovascular management is particularly useful in the treatment of pseudoaneurysms where comorbidities and previous surgery make open surgical repair less desirable. Mt Sinai J Med 77:296-303, 2010. (c) 2010 Mount Sinai School of Medicine.
maturation. If all three were met, the AVF was 10 times more likely to be mature compared with an AVF meeting no criteria. The BMI correlated strongly with vein depth (P < .001); however, both characteristics independently predicted for maturation. The chance of maturation was highest if the flow and depth criteria were met (positive predictive value, 93), marginally better than if all three criteria were met (positive predictive value, 92; Table II). The receiver operating characteristic area under curve for meeting the flow volume and vein depth criteria together were slightly greater than if all three Ro6 criteria were met (also true for each AVF type; data not shown).Conclusions: The Ro6 predicts for AVF maturation but only a small minority of mature AVFs will meet all three criteria. Flow volume and vein depth together predicted for maturation equally as well as meeting all three criteria. Meeting the vein diameter criterion seems less important. A higher BMI was associated with AVF failure, independent of vein depth.
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