Visceral Artery Aneurysms and Pseudoaneurysms: Retrospective Analysis of Interventional Endovascular Therapy of 43 Aneurysms

Abstract

ABSTR AC TPurpose To evaluate the results of interventional endovascular therapy of incidental and symptomatic visceral artery aneurysms in the elective and emergency situation.Materials and Methods 43 aneurysms in 38 patients (19 female, 19 male, mean age: 57 ± 16 years [18 -82]) were treated between 2011 and 2015. The characteristics of the aneurysms (true vs. false aneurysm, size, etiology, location, symptoms) were considered. Furthermore, we evaluated the intervention with respect to technical success, embolic/occlusive agents used, therapy-associated complications and postinterventional follow-up.Results 23 true aneurysms (maximum diameter: 22 ± 18 mm [11 -67 mm]) and 20 false aneurysms (maximum diameter: 9 ± 33 mm [3 -150 mm]) were evaluated. The splenic (n = 14) and renal arteries (n = 18) were most frequently affected. The etiology was most commonly degenerative-atherosclerotic (47 %) or iatrogenic post-operative (19 %). 18/48 interventions were performed due to active bleeding. False aneurysms were associated significantly more often with active bleeding (63 vs. 25 %, p = 0.012). 41/48 treatments were technically successful. Re-intervention was necessary 6 times. In 2 cases the endovascular approach did not succeed. There was a complication rate of 10 %, whereby only 4 minor and 1 major complications occurred. No patient suffered from permanent sequelae. Aneurysms were primarily treated by using coils and if necessary additional embolic agents (liquid embolic agent or vascular plugs) (75 %). In the follow-up period, reperfusion of treated aneurysms occurred at a rate of 7 % (n = 3). ConclusionInterventional endovascular therapy of visceral artery aneurysms is safe and effective in the elective treatment of incidental aneurysms as well as in significantly more frequent hemorrhaging false aneurysms in the emergency situation. Key points▪ Interventional endovascular therapy of visceral artery aneurysms is safe and effective. ▪ In more than 60 % of cases visceral artery pseudoaneurysms are associated significantly more often with a history of bleeding or acute bleeding. Hence, there is a need for (interventional) therapy even in small pseudoaneurysms. ▪ Follow-up seems to be useful to detect reperfusion as manifestation of treatment failure. This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.tischen Aneurysmen der viszeralen Gefäße in der elektiven sowie der Notfallsituation. Material und Methoden

Splenic trauma: endovascular treatment approach

“…Small pseudoaneurysms of distal splenic artery branches may be effectively treated with embolization of the feeding branch or the proximal main splenic artery. In the setting of a pseudoaneurysm involving the main splenic artery or a large branch artery, embolization across the site of injury can prevent retrograde perfusion of the injury site from collaterals (60)(61)(62)(63). A combination of distal and proximal embolization may be effectively utilized to address the primary site of extravasation, but also to reduce overall splenic artery pressure to minimize risk of delayed rupture (64) (Figure 8).…”

Splenic Trauma: Technical Considerations and Management of Complications

“…24 25 Care must be taken to exclude the entire site of injury, as retrograde perfusion could otherwise be a source of rebleeding. 26 27…”

Visceral Artery Aneurysms: Decision Making and Treatment Options in the New Era of Minimally Invasive and Endovascular Surgery

“…Major complications occur in 24% of cases and include graft or stent occlusion, arterial dissection, liver failure, abscess formation, cholecystitis, and hemorrhage. 17,31 For open reconstructions, primary patency rates are reported to be 86% at 5 years. 32…”

“…Although long-term follow-up data are lacking, several published case series show endovascular therapy for SMAAs to be safe and effective provided that the aneurysm is sufficiently distal to the origin of the artery so that there is an adequate proximal seal zone or room to place coils safely in the artery. 3,31 Inferior Mesenteric Artery Aneurysms These are very rare and are usually asymptomatic. They make up 1% of VAAs.…”