False aneurisms of visceral arteries: radiology methods in diagnostics and treatment

Abstract

Purpose: To define the possibilities of radiology in diagnostics and treatment tactics definition of patients with the false aneurisms (FA) of visceral arteries. Materials and methods: 46 patients with FA passed inspection and treatment (men-54.3%, middle age – 48 ± 2.27 years) during 1995–2015. Duration of the chronic pancreatitis (CP): 6 months–15 years. Preoperative inspection: ultrasonography, MSCT, MRI/MRCP. FA arteries-sources: lienalis – 30 (65.2%); pancreaticooduodenalis – 5 (10.9%); gastroduodenalis – 6 (13.0%); left gastric – 1 (2.2%); mesenterica superior – 2 (4.3%); right hepatic artery departing from mesenterica superior – 1 (2.2%); gastroduodenalis artery and mesenterica superior vein with formation of an arteriovenous fistula through FA cavity – 1 (2.2%). Results: FA arose because of the arrosion of vessel wall were divided into two groups: 1st (in pseudocyst cavity, possible communication with main pancreatic duct (MPD) – 33(71.7%); 2nd (in the pancreas (P) parenchyma, without communication with MPD) – 13(28.3%). At diagnostics of FA, and treatment tactics definition it is necessary to consider the following: aneurism sizes; communication of aneurism's cavity with P duct system; existence of complications of CP current (pancreatic duct hypertension, P parenchyma calcinosis, portal hypertension). Endovascular surgery f FA is expedient and effective, in the absence of contraindications. In the presence of indications to the surgical treatment directed on elimination of FA and other complications of CP, it is possible to carry out endovascular intervention as the Ist stage, the IInd stage – open surgery. Conclusion: Radiology methods allows to:1.diagnose FA and the complications accompanying it;2.directly influence a choice of treatment tactics.