Interdisciplinary Management of Visceral Artery Aneurysms and Visceral Artery Pseudoaneurysms

Abstract

The paper presents the results of treating 14 patients, namely eight patients with visceral artery aneurysms and six patients with visceral artery pseudoaneurysms. In 64.3% of the patients, the initial diagnosis was made based on the ultrasound examination. All the patients (100%) underwent CT angiography, while angiography was performed in 71.4% of the cases. Five (35.7%) patients with visceral artery pseudoaneurysms were emergently hospitalized; among them, the signs of bleeding were observed in 2 patients. In 9 patients, pathology was detected during tests for other conditions. Five (35.7%) patients underwent endovascular treatment, while 9 (64.3%) patients received surgical treatment. Endovascular interventions and open surgery demonstrated a nil mortality rate. After endovascular treatment, stent thrombosis was found in 1 patient. In the case of surgical treatment, visceral artery aneurysm was observed in 1 patient who underwent the resection of superior mesenteric artery pseudoaneurysm. Conclusions. The choice of the method of treating visceral artery aneurysms and visceral artery pseudoaneurysms depends on the location, size, anatomic features of the visceral arteries and the clinical course of the disease. Both endovascular and surgical treatment demonstrate good postoperative outcomes. Visceral ischemia is one of the most serious complications in the postoperative period, which can complicate both the diagnosis and the choice of treatment tactics.

Experience of managing superior mesenteric artery aneurysm and its midterm follow-up results with 18 cases

“…Debate remains for years on the consensus for the first-line therapy for lesions that are both suitable for open and endovascular surgery. We summarized publications of SMAA with at least three cases in recent 10 years 11 , 30–32 (Table 5), and found that first-line therapy and reporting standard varies between different centers, which, to some degree, indicate the lack of a powerful guideline and also the complex and individual nature of SMAA. However, a trend toward endovascular surgery is emerging.…”

Post-traumatic Pseudoaneurysm of Hepatic Artery (Case Report and Literature Review)

“…Большинство ПА протекают бессимптомно и выявляются при динамическом наблюдении за пациентом с травмой или при обследовании по поводу других заболеваний [2,4,8]. Разрыв внепеченочной аневризмы сопровождается внутрибрюшным кровотечением [5].…”

“…Симптомы, характерные для кровотечения из верхних отделов ЖКТ, -тошнота, рвота кровью или «кофейной гущей», мелена, при обильном кровотечении -выделение алой крови из прямой кишки, гемодинамическая нестабильность. Они могут встречаться изолированно у 42 % больных [5,8,12].…”

“…Данные о повреждении ПА в литературе вариабельны -разрыв происходит от 21 до 80 % случаев, смертность при этом достигает 9-100 % [2,[5][6][7][8].…”

“…Ультразвуковое исследование (УЗИ) может демонстрировать ПА как образование с током крови внутри, но чувствительность метода низкая, 37-50 %, хотя специфичность высока -100 % [8,12].…”