Das Viszeralarterienaneurysma

Abstract

The purpose of this article is to review the etiology, clinical presentation and treatment options of visceral artery aneurysms (VAA) on the basis of our experiences. Visceral artery aneurysms are uncommon lesions with a frequency of 0,1-0,2 % in autopsy statistics. In fact many visceral artery aneurysms still present first with a rupture (22 %) and despite emergency laparotomies the mortality rate is about 8,5 %. The course of disease often is disastrous due to rupture of the aneurysms or thromboembolic complications, emphasizing the importance to be aware of this differential diagnosis of abdominal pain. This article covers 9 patients with VAA. 3 patients each revealed an a. lienalis aneurysm and a. gastrica aneurysm, resp. In the other 3 patients an aneurysm of the a. gastroepiploica, the a. pancreatico-duodenalis and the a. mesenterica superior resp. was proven. In 8 of 9 patients a surgical therapy of the VAA took place. Only 2 patients (22 %) were interventionally treated. 1 patient deceased due to postoperative hemorrhage. Both the surgical and the radiological intervention therapy are available for treatment of the VAA. The decision on the choice of the therapeutic procedure should be made on an individual basis.

Visceral artery aneurysms—follow-up of 23 patients with 31 aneurysms after surgical or interventional therapy

“…The highest incidence of rupture is in young pregnant woman. More than 95% of SA detected during pregnancy undergo rupture, associated with a maternal mortality rate of 75% [1,4,[6][7][8]24]. The rupture rate in our patients was 17.4% involving the gastroduodenal artery, SA, a collateral of SMA, and CT.…”

“…The timely diagnosis of VAAs is still demanding, as these aneurysms are either found accidentally or as a cause of bleeding in an abdominal surgery emergency situation. In general, visceral artery aneurysms (VAA) are rare forms of vascular pathology, with an incidence of 0.1% to 0.2% in routine autopsies [1][2][3][4][5][13][14][15][16].…”

“…VAAs are diagnosed in the condition of rupture in 22% and resulting in a mortality of 8.5 to 75% [1,4,[6][7][8]. The clinical occurrence of VAAs is between the fifth and sixth decade of life.…”

“…

Purpose Visceral artery aneurysms (VAA) are rare forms of vascular pathology, with an incidence of 0.1% to 0.2% in routine autopsies [1][2][3][4]. They frequently present as a lifethreatening, often fatal, emergency, if associated with rupture and intra-or retroperitoneal bleeding.

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Differenzielles gefäßmedizinisches Management des Viszeralarterienaneurysmas anhand einer unizentrischen konsekutiven Patientenkohorte im Rahmen einer laufenden krankheitsspezifischen, klinisch-systematischen, prospektiven Observationsstudie

“…Bei Dissektion von Viszeralarterien stehen die Behandlung mit " offenem gefäßchirurgischen Herangehen, " endovaskulärer Stentimplantation oder " Antikoagulationstherapie zur Debatte, es besteht jedoch kein Konsensus hinsichtlich des optimalen Therapieansatzes [25]. Nach Literaturangaben wurde die Mehrzahl der Patienten mit Viszeralarterienaneurysmata offen-chirurgisch behandelt oder aber einer Verlaufsbeobachtung unterzogen [14,15,17,21,22,[26][27][28][29], wenn es die Größe erlaubte (< 2 cm), außer in der Studie von Piffaretti et al [15], in der 71,4 % der Patienten endovaskulär und nur 28,6 % chirurgisch behandelt wurden. Eine ausschließliche Verlaufsbeobachtung wurde hier gar nicht favorisiert.…”