Aneurysmen an viszeralen Arterien

Abstract

Visceral artery aneurysms (VAA) are relatively rare disease patterns. With regard to the aetiology two different entities of VAA can be distinguished: (i) real VAA, where arteriosclerosis plays an important role, particular in elderly patients, and (ii) pseudo-aneurysms. Here, previous abdominal trauma or former inflammatory processes are considered to be the responsible factors for their occurrence. Most frequently, VAA are located in the splenic (60%) and common hepatic artery (20-50%). The common hepatic artery (80%) and the pancreatico-duodenal artery (75%) feature the highest rupture rates. Generally all VAA with a diameter exceeding 2 cm should be treated. Special attention has to be paid to young pregnant women (particularly multipara) who bear the highest risk of VAA rupture, especially during the third trimenon. Early therapy is essential to avoid fatal consequences for mother and foetus. Basically, interventional, endovascular (embolisation, stent) or surgical (resection with direct vessel anastomosis, graft interposition, aneurysmorraphy, ligature) therapy options exist. The choice of the intervention should be adapted to the patient's individual risk profile. In our own series of VAA (n=19; 1996-2007), we evaluated both interventional and surgical procedures as valid therapy regimens with regard to the patients clinical condition.

Operative management of hepatic artery aneurysms

“…[4][5][6] Despite their rarity, they remain a difficult clinical problem because of the desire to preserve hepatic artery flow and the variability of aneurysm location. In the current report, we present the Overall mortality 3 (14) Rupture mortality 2 (40) Elective mortality 1 (6) In-hospital complications Any complications 6 (29) Reoperation due to hemorrhage 3 (15) Reoperation due to saphenous vein graft thrombosis 1 (5) Reoperation due to duodenal perforation 1 (5) Reoperation due to common bile duct stricture 1 (5) Enterocutaneous fistula 1 (5) Acute kidney injury requiring temporary dialysis 1 (5) Pancreatitis 1 (5) Dacron graft occlusion 1 (5) Liver abscess 1 (5) largest series of degenerative HAAs treated during a 23-year period at Mayo Clinic.…”

“…3 The incidence of HAA is as low as 0.01% in routine autopsy reports. [4][5][6] Repair of HAA is recommended when the aneurysm reaches 2 cm in size because of an elevated rupture risk approaching 25% for larger aneurysms and an associated 70% to 100% mortality with rupture. 7,8 In contemporary practice, >50% of HAAs are pseudoaneurysms from interventional procedures to treat biliary tract disease and blunt abdominal trauma.…”

Visceral artery aneurysms

“…The highest rate of visceral artery aneurysms is seen in young expectant mothers and multiparous women [ 4 ]. Spontaneous rupture of a visceral artery aneurysm is a serious and potentially life-threatening complication during pregnancy, both for the expectant mother and the unborn child.…”

“…The highest rupture rate is seen in hepatic artery aneurysms (ca. 80%) followed by pancreaticoduodenal artery aneurysms (75%) [ 4 ]. Inflammatory visceral artery aneurysms, which are often associated with a nearby infectious process (e. g., pancreatitis, pancreatic fistula), represent a special aneurysm type that poses a particular risk due to its rapid growth [ 5 ].…”

“…Inflammatory visceral artery aneurysms, which are often associated with a nearby infectious process (e. g., pancreatitis, pancreatic fistula), represent a special aneurysm type that poses a particular risk due to its rapid growth [ 5 ]. Traumatic aneurysms following, e. g., traffic accidents, as well as iatrogenic aneurysms following interventional/surgical treatment have also been described [ 4 , 6 – 8 ].…”