Visceral artery aneurysms: review on indications and current treatment strategies

Sousa, Joel; Costa, Diogo; Mansilha, Armando

doi:10.23736/s0392-9590.19.04194-4

Cited by 26 publications

(28 citation statements)

References 89 publications

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“…Stent disconnection has also been reported 21 . Coiling technique (coil embolization of native artery, stent‐assisted coiling of the aneurysm sac) offers another alternative to exclude PAA/VAAs, but it carries a significant risk of coil migration (8–29%) and distal organ infarction 23,24 . In selected cases, the grafted stent could provide effective exclusion of an aneurysm while maintaining the patency of the parent vessel.…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta‐analysis of the performance of flow‐diverting stents in the treatment of peripheral and visceral artery aneurysms

Zhang

Xiang

et al. 2020

Cathet Cardio Intervent

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Objective This meta‐analysis aims to evaluate the safety and efficacy of flow‐diverting stents (FDS) in treating peripheral and visceral artery aneurysms (PAA/VAAs). Background Though rare, PAA/VAAs can represent a life‐threatening condition due to their propensity of rupture. The FDS emerges as a new solution to exclude these aneurysms while maintaining collateral branches, but convincing evidence is lacking on its clinical effectiveness. Methods A systematic literature search was performed to identify studies related to FDS in treating PAA/VAAs. The preferred reporting items for systematic reviews and meta‐analyses (PRISMA) statement was applied to guide the data extraction, quality assessment, and synthesis of outcomes of interest. Random effect models were applied to calculate the event rates of major endpoints. OpenMeta[Analyst] software was used for statistical analysis. Results Of 130 records screened, 10 cohort studies (including 220 patients, average age: 66.0 years, 78.4% male) were enrolled in the meta‐analysis. Pooled data suggested a technical success rate of 98.5% (95% CI: 97.0–100%). During a mean follow‐up period of 14.1 months, 93.6% (95% CI: 88.6–98.5%) side branches remained patent, 89.8% (95% CI: 84.3–95.3%) aneurysms were totally thrombosed, whereas shrinkage/stabilization of the aneurysm was documented in 93.4% (95% CI: 88.4–98.4%) cases. The primary stent patency rate was estimated to be 87.9% (95% CI: 81.0–94.8%). Overall clinical success was achieved in 83.2% (95% CI: 74.4–92.0%) patients. Conclusions The FDS features a potential advantage of preserving side branches while inducing sac thrombosis and aneurysm shrinkage/stabilization. Further prospective, comparative studies in larger patient cohorts are anticipated to draw a robust conclusion.

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Section: Discussionmentioning

confidence: 99%

A systematic review and meta‐analysis of the performance of flow‐diverting stents in the treatment of peripheral and visceral artery aneurysms

Zhang

Xiang

et al. 2020

Cathet Cardio Intervent

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“…Metallic coils can be used alone or with other embolic agents/devices. Coils can determine mechanical obstruction and secondary thrombosis both by their thrombogenic fibers and induced inflammatory reaction [ 39 ]. Fibered coils are considered more thrombogenic than non-fibered coils [ 40 ].…”

Section: Embolization: Techniques and Materialsmentioning

confidence: 99%

“…VAA exclusion can be obtained via total occlusion or with preservation of the target artery. In the case of fusiform VAAs, which cover the entire circumference of the vessel, a sacrifice of the target artery is usually necessary, while in case of saccular VAAs which involve only one side of the vessel, the preservation of the target artery is usually possible [ 39 , 45 ], provided that the VAA neck is sufficiently narrow. The angiographic procedure is generally performed via a transfemoral approach and involves the catheterization of the main trunk of the target artery with a standard angiographic catheter (4–5 French).…”

Section: Embolization: Techniques and Materialsmentioning

confidence: 99%

Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives

Venturini

Piacentino

Coppola

et al. 2021

JCM

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Visceral artery aneurysms (VAAs) are rare, usually asymptomatic and incidentally discovered during a routine radiological examination. Shared guidelines suggest their treatment in the following conditions: VAAs with diameter larger than 2 cm, or 3 times exceeding the target artery; VAAs with a progressive growth of at least 0.5 cm per year; symptomatic or ruptured VAAs. Endovascular treatment, less burdened by morbidity and mortality than surgery, is generally the preferred option. Selection of the best strategy depends on the visceral artery involved, aneurysm characteristics, the clinical scenario and the operator’s experience. Tortuosity of VAAs almost always makes embolization the only technically feasible option. The present narrative review reports state of the art and new perspectives on the main endovascular and other interventional options in the treatment of VAAs. Embolization techniques and materials, use of covered and flow-diverting stents and percutaneous approaches are accurately analyzed based on the current literature. Visceral artery-related considerations and targeted approaches are also provided and discussed.

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“…Visceral arterial aneurysms and pseudoaneurysms are very rare entities but have high mortality because of their risk for rupture. Recently the prevalence of visceral artery aneurysm was reported from a structured review of the literature [8]. The most common location are aneurysms of the splenic or hepatic arteries.…”

Section: Epidemiologymentioning

confidence: 99%

“…Current postprocedure surveillance recommendations by manufacturers are a 1-month CTA followed by a 12-month CTA in most circumstances. The objective of the study by Soult et al was to determine the utility of the 1-month CTA following elective EVAR and determine if initial surveillance at 6-month CTA is appropriate [8]. A singlecenter retrospective chart review of all elective EVARs at a tertiary medical center over a 12-year period was conducted comprising 363 pts.…”

Section: Angiography Computed Tomography and Computed Tomography Angiographymentioning

confidence: 99%

Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review

Nikol

Mathias²,

Olinic

et al. 2020

Vasa

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Visceral artery aneurysms: review on indications and current treatment strategies

Cited by 26 publications

References 89 publications

A systematic review and meta‐analysis of the performance of flow‐diverting stents in the treatment of peripheral and visceral artery aneurysms

A systematic review and meta‐analysis of the performance of flow‐diverting stents in the treatment of peripheral and visceral artery aneurysms

Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives

Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review

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