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Viszeral Arterielle Aneurysmen
2016
Dr. Abidin Geles
Welche Arterien sind betroffen:
oo Truncus coeliacus
oo A. lienalis
oo A. hepatica communis
oo A. gastrica sinister
oo A. mesenterica superior et inferior
oo A. renalis
History
oo 1809: first reported hepatic artery aneurysm as a post-mortem finding after ruptur(1)
oo 1903: first successful operative repair by ligating(2)
oo 1951, first successful VAA treatment by ligation and revascularization (3)
(11)
Wie gefährlich ist VAA?
oo High incidence of rupture and hemorrhage (6)
oo distribution of aneurysms among the visceral vessels : splenic artery (60%), hepatic artery (20%), superior mesenteric artery (5.5%), celiac artery (4%), gastric and gastroepiploic arteries (4%), jejunal, ileal, colic (3%), pancreaticoduodenal and pancreatic arteries (2%), gastroduodenal artery (1.5%), and inferior mesenteric artery (<1%) (7)
oo The real incidence is unknown because most cases are asymptomatic (10) 1-2% of all vascular aneurysms (9) Visceral artery aneurysms are rare, with an incidence of just 0.01% to 0.2%
oo Renal and splanchnic artery aneurysms 0.01% - 0.09% and 0.1% - 2% (4)
oo 22% of reported visceral artery aneurysms are with rupture, resulting in 8.5% mortality rate (7,5)
oo Mortality 21 % for hepatic artery aneurysms to 100% for celiac artery ones. (10)
oo hepatic artery aneurysms with a high rupture risk of 80% (6)
oo patients with hepatic aneurysms have also multiple aneurysms visceral (31%) and non-visceral circulation (42%)(6)
oo splenic artery aneurysm rupture risk of 20% (6)
oo mortality rate : 20% to 70% with the rupture of a VAA depending on the location and size (12)
oo Ätiologie: Atherosclerosis (32% of cases), Medial degeneration/dysplasia (24%), Abdominal trauma (22%), Infection and inflammatory disease (10%), Connective tissue disorders (Marfan syndrome, Ehlers-Danlos syndrome, Osler-Weber-Rendu disease, fibromuscular dysplasia, Kawasaki, hereditary hemorrhagic telangiectasia, And hyperflow conditions (portal hypertension, pregnancy)
indications for intervention: diameter => 1.5-2 cm, rapid growth of the aneurysm, symptomatic aneurysm, and the childbearing age (8)
(6)
Diagnosis
oo Computed tomography
oo Magnetic resonance
oo Ultrasonography
oo Arteriography
Einteilung nach Symptomatik
oo Asymptomatisch
oo Symptomatisch
oo Ruptur
(6)
(6)
(6)
(6)
(6)
Marone EM, Mascia D, Kahlberg A, et al. Is open repair still the gold standard in visceral artery aneurysm management? Ann Vasc Surg 2011; 25: 936-46.
oo 94 patients with VAA/VAPA between 1988 and 2010, 74 patients managed with open traditional surgical technique, 20 with an endoluminal technique
oo 100 % success with the open approach, 1 mortality (1,3%), and morbidity of 9.4%
oo endovascular group had no perioperative mortality but a 10% peri-operative morbidity
oo Conclusion: endovascular treatment is safe and feasible in selected patients, but incomplete exclusion may be observed, requiring late surgical conversion in a significant number of patients. Long-term results (high survival, low complication rate) confirm the durability of the surgical approach that in our experience remains the gold standard with satisfactory results, especially for aneurysms involving the visceral hilum.
References
oo 1-) Andreassen M, Lindenberg J, Winkler K.Peripheral ligation of the hepatic artery during surgery in non-cirrhotic patients. Gut 1962; 3: 167-71 [PMC free article][PubMed]
oo 2-) Kibbler CC, Cohen DL, Cruicshank JK, et al. Use of CAT scanning in the diagnosis and management of hepatic artery aneurysm. Gut 1985; 26: 752-6 [PMC free article][PubMed]
oo 3-) Paul M.A large traumatic aneurysm of the hepatic artery. Br J Surg 1951; 39: 278-80 [PubMed]
oo 4-) Pulli R, Dorigo W, Troisi N, et al. Surgical treatment of visceral artery aneurysms: a 25-year experience. J Vasc Surg 2008; 48: 334-42 [PubMed]
oo 5-) Ferrero E, Ferri M, Viazzo A, et al. Visceral artery aneurysms, an experience on 32 cases in a single center: treatment from surgery to multilayer stent. Ann Vasc Surg 2011; 25: 923-35 [PubMed]
oo 6-) Visceral Artery Aneurysms and Pseudoaneurysms -- Should They All be Managed by Endovascular Techniques? Alfredo C. Cordova, MD[1][,2] and Bauer E. Sumpio, MD, PhD, FACS[2]
oo 7-) VISCERAL ARTERY ANEURYSMS Original Research Article, Surgical Clinics of North America, Volume 77, Issue 2, 1 April 1997, Pages 425-442, Louis M. Messina, Charles J. Shanley
oo 8-) E. Ferrero, A. Gaggiano, M. Ferri, A. Viazzo, G. Berardi, S. Piazza, P. Cumbo, V. Lamorgese, F. Nessi, Visceral artery aneurysms: series of 17 cases treated in a single center, Int Angiol, 29 (2010), pp. 30 - 36
oo 9-) Asymptomatic aneurysm of the superior mesenteric artery: a time bomb., Paolo Spontoni, Massimo Venturini, Francesco De Sanctis, Chrysanthos Grigoratos, Marco Nuti, Giovanni Coppi, Lorenzo Faggioni, Roberto Chiesa, Alberto Balbarini , Journal of Cardiovascular Medicine (Impact Factor: 2.66). 05/2011; 12(8):589-91.
oo 10-) R. Chiesa, D. Astore, G. Guzzo et al., Visceral artery aneurysms', Ann Vasc Surg, 19 (2005), pp. 42 - 48
oo 11-) Visceral Artery Aneurysm: Risk Factor Analysis and Therapeutic Opinion, Y.-K. Huang,1 H.-C. Hsieh,1* F.-C. Tsai,1 S.-H. Chang,2 M.-S. Lu1 and P.-J. Ko1, Eur J Vasc Endovasc Surg, 33 (2007), pp. 293 - 301
oo 12-) Schweigert M, Adamus R, Stadlhuber RJ, Stein HJ. Endovascular stent -- graft repair of a symptomatic, superior mesenteric artery aneurysm. Ann Vasc Surg 2011; 25: 841. e5-8.
oo 13-) Marone EM, Mascia D, Kahlberg A, et al. Is open repair still the gold standard in visceral artery aneurysm management? Ann Vasc Surg 2011; 25: 936-46.
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