Endovascular management of giant visceral artery aneurysms

Abstract

Endovascular management of small visceral artery aneurysms is an established treatment with satisfactory outcomes. However, when size exceeds 5 cm visceral aneurysms are considered as “giant” (giant visceral artery aneurysms or GVAAs) and management is significantly more complex. Between August 2007 and June 2019 eleven cases of GVAAs that were endovascularly treated were retrospectively reviewed and included in this single center study. Mean size was 80 mm (± 26.3 mm) x 46 mm (+ \-11.8 mm). Nine of the lesions were true aneurysms, and two were pseudoaneurysms. In 8 patients, the lesion was causing compression symptoms in the surrounding organs, one patient developed a contained rupture while 2 patients were completely asymptomatic. However, all patients were hemodynamically stable at the time of treatment. Technical success was defined as immediate complete exclusion of the aneurysmal sac, and clinical success as complete relief from clinical symptoms. Follow-up was performed with CT angiography, ultrasound and clinical examination. Mean follow-up was 45 months (range 6–84). Technical and clinical success were both 91%. Complications were one lack of control of contained rupture that was subsequently operated, one case of self-limiting non-target spleen embolization and one case of splenic abscess. Three patients died, one due to the contained rupture 15 days after procedure, the other two for other causes and occurred during the long-term follow-up. This series suggests that endovascular treatment of giant visceral artery aneurysms and pseudoaneuryms is a valid minimally invasive solution with very satisfactory immediate and long-term outcomes unless the aneurysm is already ruptured. A variety of endovascular tools may be required for successful treatment.

Crohn’s Disease and Jejunal Artery Aneurysms: A Report of the First Case and a Review of the Literature

“…Technical success rate of EVT defined as immediate complete exclusion of the aneurysmal sac without the need to perform other procedures [ 71 ], regardless of endovascular or surgical, was reported in 95.8% of patients (23/24), as displayed in Table 5 .…”

Management of a Giant Renal Artery Aneurysm in a Patient with Severe Hemophilia A

“…In diagnostic imaging, CTA or MRA are the criterion standard for final diagnosis of a pseudo-aneurism or true aneurysm of this size. DSA should be reserved for ambiguous findings and for cases when mini-invasive treatment is intended [ 11 , 18 , 19 , 22 ]. Our patient underwent abdominal US and showing suspicious changes; afterwards, CT, CTA, and DSA were performed and the diagnosis was confirmed.…”

“…Renal artery aneurysms (RAA) are rare and are defined as a focal dilatation of the renal artery that exceeds 1.5 cm in diameter [ 6 , 7 ]. If the size of the RAA is more than 5 cm, it is defined as giant [ 8 – 11 ]. Most documented giant RAAs are 5–12 cm, with only a few severe hemophiliac patient case reports in the literature [ 7 , 12 – 17 ].…”

Late development of giant hepatic artery pseudoaneurysm following abdominal trauma due to tire blast: case report and literature review

“…It can be recognized from intrahepatic hematoma as it continues to communicate with the artery, causing a high-pressure cavity with the risk of rupture [ 5 ]. Giant visceral pseudoaneurysms are aneurysmal lesions of the splanchnic vessels that are >5 cm in diameter [ 6 ]. Post-traumatic hepatic artery pseudoaneurysm is uncommon, appearing in ~1–4% of hepatic trauma cases; 80% of the cases are extrahepatic [ 7 ].…”