Visceral Artery Aneurysms and Pseudoaneurysms—Should They All be Managed by Endovascular Techniques?

Córdova, Alfredo; Sumpio, Bauer E.

doi:10.3400/avd.ra.13-00045

Cited by 135 publications

(157 citation statements)

References 19 publications

Supporting

Mentioning

142

Contrasting

Unclassified

Order By: Relevance

“…However, the risk of rupture depends not only on the size but also on the location of the aneurysm. Therefore, hepatic artery aneurysms have a greater risk of rupture than splenic artery aneurysms [7]. 6 of the 15 asymptomatic true aneurysms had a diameter of less than 20 mm.…”

Section: Discussionmentioning

confidence: 99%

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

Ruhnke¹,

Kröncke²

2017

Fortschr Röntgenstr

View full text Add to dashboard Cite

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

show abstract

Section: Discussionmentioning

confidence: 99%

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

Ruhnke¹,

Kröncke²

2017

Fortschr Röntgenstr

View full text Add to dashboard Cite

show abstract

“…8) Elective treatments are usually tailored to the patient's individual presentation and vary with respect to the presence of symptoms, the relative risk of rupture, the anatomic location and the size of the particular lesion.…”

Section: Discussionmentioning

confidence: 99%

Operative Management of Hilar Renal Artery Aneurysm in a Pregnant Patient

Schulte

Rodríguez-Dávalos

Lujic

et al. 2015

Annals of Vascular Diseases

View full text Add to dashboard Cite

Complications of renal artery aneurysms (RAAs) can be life threatening and include the spontaneous rupture which may lead to severe retroperitoneal hemorrhage, loss of the kidney, or death. As the incidence and diagnosis of RAAs is expected to rise, it is becoming increasingly important to enhance our awareness and knowledge of this rare clinical entity. Here, we present the case of a hilar right RAA and the surgical approach for primary repair during the postpartum period. Additionally, we discuss current pathophysiologic mechanisms, associated symptoms as well as current treatment modalities for RAAs.Keywords: renal artery aneurysm (RAA), pregnancy, primary repair to have a higher incidence of RAAs, the cardiovascular changes associated with pregnancy increase the risk of rupture and subsequent fetal and/or maternal death. For this reason, the repair of RAAs with a maximum diameter of >2 cm is usually recommended in pregnant women and women of reproductive age. 1) Case ReportA 29-year-old woman, gravida 4 para 3, at 26 weeks and two days of gestation presented to the obstetric/gynecology clinic with worsening right flank pain. She had a history of a right RAA, which was diagnosed in her third pregnancy three years ago during the diagnostic workup for flank pain. At that time, Doppler ultrasound had shown a RAA in the right renal hilum with a diameter of 1.7 cm. Her family history was positive for a cousin with a ruptured RAA.Diagnostic studies were initiated at her current presentation. A MRI angiogram examination without intravenous contrast demonstrated a right RAA measuring 2.4 cm × 1.6 cm (Fig. 1). It was located at the bifurcation of the right main renal artery approximately 2.5 cm from the right lateral edge of the aorta. A segmental branch arising from the superior aspect of the aneurysm was noted. A Doppler ultrasound examination confirmed the above measurements and showed no evidence of active bleeding. Therefore, the patient's flank pain was controlled with minimal narcotics. In light of the increased risk of rupture of the aneurysm during pregnancy, especially during the imminent third trimester, the patient had close obstetric monitoring. The Maternal-Fetal Medicine team, together with our group, decided to plan the surgical repair of the right RAA for the postpartum period. At 37 weeks of gestation, the patient underwent a scheduled cesarean section without complications and delivered a healthy child.Fifty days postpartum the patient was admitted to the hospital for the elective surgical repair of a right RAA. A surgical repair was chosen over an endovascular approach due to the hilar location of the RAA, which would not

show abstract

“…Literatūroje sutariama, kad endovaskuliniam gydymui reikia teikti pirmenybę, jei paciento bendra būklė sunki, operacijos rizika didelė, taip pat gydant pseudoaneurizmas, kai kuriais atvejais -atsižvelgus į intervenciją galinčių atlikti specialistų patyrimą [35,40,41]. Pavienėse studijose nurodoma, kad endovaskulinis gydymas pasižymi trumpesne procedūros trukme, mažesniu kraujo praradimu (ir hemotransfuzijų skaičiumi), trumpesne hospitalizacijos trukme, mažesniu peri-procedūriniu mirtingumu [3,42].…”

Section: Invazinio Gydymo Pasirinkimasunclassified

Visceralinės Aneurizmos: Literatūros Apžvalga

Kvietkauskas¹

2017

Medicinos Teorija Ir Praktika

View full text Add to dashboard Cite

Reikšminiai žodžiai: visceralinių arterijų aneurizmos, visceralinės aneurizmos, aneurizmos plyšimas. Straipsnyje pateikiama visceralinių aneurizmų literatūros apžvalga. Iki šiol literatūroje apie šią patologiją publikuota per 4 000 straipsnių. Pirmasis visceralinę aneurizmą aprašė prancūzas Beaussiers 1770 metais. Visceralinėmis aneurizmomis vadinamos pilvinio kamieno, viršutinės ir apatinės pasaito, inkstų arterijų ir jų šakų aneurizmos. Jų sutinkama ne daugiau kaip 2 proc. populiacijos. Visceralinės aneurizmos skirstomos į tikras visceralines aneurizmas ir pseudoaneurizmas. Pastarosios aptinkamos dvigubai dažniau nei tikros visceralinės aneurizmos. Dažniausiai tikrosios aneurizmos susiformuoja dėl aterosklerozės, fibromuskulinės displazijos arba traumos, o pseudoaneurizmas dažniausiai sukelia pankreatitai. Pagal klinikinę stadiją skiriamos asimptominės, simptominės ir plyšusios visceralinės aneurizmos. Pastarosios pasižymi ypač dideliu mirtingumu. Visceralinės aneurizmos dažniausiai pažeidžia blužnies arterijas, rečiau – kepenų, inkstų, ypač retai – kitas visceralines arterijas. Pagrindiniai diagnostikos iššūkiai – labai įvairi ir nespecifinė visceralinių aneurizmų klinika. Pagrindinės diagnostikos naujovės – didesnės raiškos ir erdvinės vaizdinių tyrimų atmainos. Planinis invazinis gydymas taikytinas, jei visceralinių aneurizmų diametras ≥ 2 cm, taip pat kai kurių išimčių atvejais – nepriklausomai nuo aneurizmos dydžio. Esant simptominėms aneurizmoms, intervencija turi būti atliekama neatidėliotinai, o plyšusių atvejais – skubiai. Minimaliai invaziniai gydymo metodai pamažu tampa pagrindiniai gydant visceralines aneurizmas. Ypač gerų rezultatų ateityje tikimasi gydant aneurizmas srovę nukreipiančiais stentais, kai jie taps prieinamesni.

show abstract

Visceral Artery Aneurysms and Pseudoaneurysms—Should They All be Managed by Endovascular Techniques?

Cited by 135 publications

References 19 publications

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

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

Operative Management of Hilar Renal Artery Aneurysm in a Pregnant Patient

Visceralinės Aneurizmos: Literatūros Apžvalga

Contact Info

Product

Resources

About