Endovascular Treatment of a Dissected Celiac Trunk Aneurysm Complicated with Consequent Pseudoaneurysm: Primary Treatment and Treatment Relapse after 5 Years.

Francesco Giurazza,Amedeo Cervo,Mattia Silvestre,Franco Maglione

doi:10.1155/2015/291953

Abstract

We report on an asymptomatic 56-year-old male with incidental diagnosis of celiac trunk aneurysm, diagnosed during an ultrasound scan performed to control polycystic kidney disease. The CT scan revealed a 3.8 cm saccular aneurysm of the celiac artery dissected in the superior wall with a consequent 4.3 cm pseudoaneurysm; we adopted an endovascular approach to exclude the lesion by catheterizing the celiac trunk and positioning a vascular plug in the common hepatic artery and a covered stent in the splenic artery; finally we fulfilled the aneurysm sac with Onyx. 30-day control CT scan revealed procedural success. Five years later he came back to our department for an aneurysm relapse in the common hepatic artery. We performed a second endovascular approach with a superselective catheterization of the pancreaticoduodenal arcade in order to exclude the lesion with Onyx and microcoils. Nowadays the patient is in good clinical conditions. Endovascular approach is a valuable method to treat visceral aneurysms; however, long-term imaging follow-up is essential to monitor the risk of relapse.

Highlights

The computed tomography (CT) scan revealed a 3.8 cm saccular aneurysm of the celiac artery dissected in the superior wall with a consequent 4.3 cm pseudoaneurysm; we adopted an endovascular approach to exclude the lesion by catheterizing the celiac trunk and positioning a vascular plug in the common hepatic artery and a covered stent in the splenic artery; we fulfilled the aneurysm sac with Onyx. 30-day control CT scan revealed procedural success
Spontaneous dissection of these lesions is even more rare and, in presence of a consequent pseudoaneurysm, there is the indication for immediate treating because of the significant risk of hemorrhage
We report here on a 56-year-old patient affected by a dissected saccular aneurysm of the celiac trunk with a consequent pseudoaneurysm treated by endovascular technique

Summary

Introduction

Aneurysms of celiac trunk are uncommon and represent only 4% of all the visceral aneurysms [1] To avoid their rupture, treatment is indicated in patients with aneurysms >20 mm [2]. Treatment is indicated in patients with aneurysms >20 mm [2] Spontaneous dissection of these lesions is even more rare and, in presence of a consequent pseudoaneurysm, there is the indication for immediate treating because of the significant risk of hemorrhage. The endovascular approach reduces the postoperative complications and the duration of the hospital stay and is replacing open surgery as the preferred surgical option, at least in selected cases [4]. We report here on a 56-year-old patient affected by a dissected saccular aneurysm of the celiac trunk with a consequent pseudoaneurysm treated by endovascular technique

Case Presentation

Findings

Discussion

Conclusion