The role of emergency presentation and revascularization in aneurysms of the peripancreatic arteries secondary to celiac trunk or superior mesenteric artery occlusion

Autor: Benedetta Spampinato, Barbara Paro, Nazario Portolani, Raffaele Cuomo, Franco Nodari, Iacopo Barbetta, Camilla Zanotti, Marco Ravanelli, Stefano Bonardelli
Rok vydání: 2019
Předmět:
Male
medicine.medical_treatment
Celiac plexus
030204 cardiovascular system & hematology
Visceral pseudoaneurysm
0302 clinical medicine
Celiac Artery
Risk Factors
Occlusion
Mesenteric Vascular Occlusion
Celiac axis stenosis
030212 general & internal medicine
Superior mesenteric artery
Embolization
Splanchnic Circulation
Aged
80 and over
Surgical treatment
Endovascular Procedures
Middle Aged
Collateral circulation
Embolization
Therapeutic
medicine.anatomical_structure
Treatment Outcome
Female
Cardiology and Cardiovascular Medicine
Visceral aneurysm
Aneurysm
False
Adult
medicine.medical_specialty
Collateral Circulation
Revascularization
03 medical and health sciences
Blood Vessel Prosthesis Implantation
Aneurysm
Mesenteric Artery
Superior
medicine.artery
medicine
Humans
Endovascular treatment
cardiovascular diseases
Aged
Retrospective Studies
business.industry
Median arcuate ligament
medicine.disease
Surgery
Gastroduodenal arteries
Mesenteric Ischemia
Emergencies
business
Zdroj: Journal of vascular surgery. 72(1S)
ISSN: 1097-6809
Popis: Objective The goal of this study was to analyze our 10-year experience in the treatment of aneurysms of the collateral circulation secondary to steno-occlusions of the celiac trunk (CT) or superior mesenteric artery (SMA). Methods In the last 10 years, 32 celiac-mesenteric aneurysms were detected (25 true aneurysms and seven pseudoaneurysms) in 25 patients with steno-occlusion of the CT or SMA. All cases were diagnosed and treated at our center, with either surgical or endovascular approach. As open surgery, we performed aneurysmectomy and revascularization; as endovascular treatment we performed both the embolization (or graft exclusion) of the aneurysm sac, and embolization of afferent and efferent arteries. Results Sixteen patients (64%) underwent endovascular treatment, accounting for 66% of aneurysms (21/32). Six patients (24%) and seven associated aneurysms (22%) underwent open surgery. Three asymptomatic patients (12%), representing a total of four aneurysms (12%), were not treated. For endovascular procedures, the technical success rate was 90%, with a 56% clinical success rate. For open surgery, clinical and technical success were achieved in five patients (83%) and six procedures (86%), respectively. Sixty-eight percent of patients (17/25) were treated in an emergency setting, using either endovascular (88%) or open (12%) approaches. Although technical success was achieved in more than 85% of these procedures for both approaches, clinical success was reached less frequently among patients with an acute presentation (P = .041). Regardless of the type of treatment, CT or SMA revascularization during the first procedure did not show an increased rate of clinical success (P = .531). However, we reported four cases of visceral ischemia after an endovascular approach without revascularization, with three open surgical corrections required. The mean follow-up was 41 months (range, 0-136 months). Conclusions Neither of the approaches described qualifies as a standard optimal choice. We suggest a tailored therapeutic approach based on the clinical condition at the time of diagnosis and specific vascular anatomy.
Databáze: OpenAIRE
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