Systematic Review and Single-Center Experience for Endovascular Management of Visceral and Renal Artery Aneurysms

Kok, Hong Kuan; Asadi, Hamed; Sheehan, Mark; Given, Mark F.; Lee, Michael J.

doi:10.1016/j.jvir.2016.07.030

Cited by 55 publications

(51 citation statements)

References 33 publications

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“…Traditionally VRAA and pseudoaneurysm treatment has involved open surgical approaches, including aneurysm ligation, aneurysm resection and subsequent parent artery reunion, and resection of the end organ, but is associated with a significant morbidity in up to 18% of patients . In comparison, endovascular approaches to treatment are now considered first‐line, associated with 3.7% morbidity, 1.5% mortality at 30 days and 4.4% reintervention rates with a 93.6% technical success rate and preserved visceral perfusion in 99.1% . Endovascular treatment algorithms involve exclusion of the aneurysm with flow modulation (flow diverting or covered stents) or embolisation of the aneurysm via coils or liquid embolic agents .…”

Section: Discussionmentioning

confidence: 99%

“…Such aneurysms typically require parent artery sacrifice or adequate exclusion to prevent complications or recurrence of the aneurysm. However, the former requires intact collateral blood supply of the viscera to preserve end‐organ perfusion . This is of particular importance for transplanted viscera in which collateral blood supply may be absent, resulting in visceral ischaemia or infarction …”

Section: Introductionmentioning

confidence: 99%

“…Covered stent grafts permit complete exclusion of an aneurysm or pseudoaneurysm while maintaining parent artery patency, overcoming the ischaemic risk associated with parent artery sacrifice and embolisation of the aneurysm neck . Synthetic stent coverings such as PTFE have been shown to promote thrombosis and slow endothelialisation . Pericardium is a well‐utilised graft material, suitable for use as a stent covering with low immunogenicity and high durability .…”

Section: Introductionmentioning

confidence: 99%

“…However, the former requires intact collateral blood supply of the viscera to preserve end-organ perfusion. 3,9,10 This is of particular importance for transplanted viscera in which collateral blood supply may be absent, resulting in visceral ischaemia or infarction. 11 Covered stent grafts permit complete exclusion of an aneurysm or pseudoaneurysm while maintaining parent artery patency, overcoming the ischaemic risk associated with parent artery sacrifice and embolisation of the aneurysm neck.…”

Section: Introductionmentioning

confidence: 99%

“…12 Synthetic stent coverings such as PTFE have been shown to promote thrombosis and slow endothelialisation. 10,13 Pericardium is a well-utilised graft material, suitable for use as a stent covering with low immunogenicity and high durability. 13,14 In our experience, early institution of dual antiplatelet therapy using 100-mg aspirin and 75-mg clopidogrel is used for many cases, however, the pericardium covering allows for single antiplatelet therapy when dual antiplatelet therapy is not indicated or is inappropriate.…”

Section: Introductionmentioning

confidence: 99%

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Endovascular treatment of a hepatic artery pseudoaneurysm using a novel pericardium covered stent

et al. 2019

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Summary Visceral and renal artery aneurysms (VRAAs) and pseudoaneurysms are rare. Their increasing incidence is largely thought to be due to advances in medical imaging. Twenty percent of VRAAs occur in hepatic arteries, with approximately fifty percent of these represented by pseudoaneurysms, which are prone to spontaneous rupture. Many treatments for VRAAs exist, with the endovascular approach being favoured. Treatment aims to preserve visceral perfusion and exclude the aneurysm; however, complex aneurysms may require parent artery or end‐organ sacrifice. Covered stents allow rapid aneurysm exclusion while preserving parent artery patency, a favourable outcome when parent artery or end‐organ sacrifice is undesirable. The AneuGraft pericardium covered stent (PCS) combines the benefits of a low‐profile covered stent with those of a low immunogenic material. We describe the endovascular treatment of a patient with a hepatic artery pseudoaneurysm, where parent artery sacrifice was considered unacceptable. The AneuGraft PCS was used to provide immediate and complete exclusion, with dual antiplatelet therapy for 1 week, followed by single antiplatelet use. The procedure was a technical success, with preservation of the hepatic arteries and complete exclusion of the pseudoaneurysm. There were no complications immediately following the procedure or on post‐procedural follow‐up. The pseudoaneurysm remained excluded at 6‐week CT angiogram (CTA) follow‐up. This case describes a safe and effective method for completely excluding a complex pseudoaneurysm, utilising the AneuGraft PCS, allowing for the potential management of a wider range of aneurysms with unfavourable morphology.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%