Features of localization and type of surgical treatment of aneurysms of unpaired visceral aortal branches

Abstract

In most cases, the aneurysm unpaired visceral branches of the aorta diagnosed by accident during examination for the purpose of other diseases of the abdominal cavity, or in case of rupture of the aneurysm. Last years, due to frequent use of the sonography, MSCT and MRI for various diseases of the abdominal cavity the asymptomatic aneurysm is more often diagnosed. So far, due to the rare cases of aneurysm in unpaired visceral branches of the aorta in the literature there is no clearly based approach to indications and choice of treatment.Purpose: to examine the localization of unpaired visceral aneurysms of the aorta and branches based on the analysis of results of surgical treatment to determine the optimal treatment option.Methods.The analysis of the survey data and the results of surgical treatment of 30 patients of unpaired visceral aneurysms of the aorta were conducted . Mean age was 52,2±15,2 years , ranging from 23 years to 76. Prevailed male patients - 20 (66.7 %). All the patients underwent angiography or spiral computed tomography multicut. Angiography performed on the unit «SiemensAxiomArtis MP» (Germany, 2005) and «Siemens MS Plus» (Germany, 2000). MSCT was performed according to standard procedures on 4 detection apparatus ToshibaAsteion and 64x the detection - GE Optima 660, equipped with an automatic injector.RESULTSOn the basis of MSCT and angiography anatomical localization of unpaired visceral aneurysms of the aorta levels are defined. Localization of lesions in the pool of celiac trunk was following (n=22) directly in the celiac trunk was revealed 5 (16.7%) aneurysms in the splenic artery - 13 (43.3 %), gastric artery 2 (6.7 %), top pancreatoduodenal artery - 1 (3.3 %), the right hepatic artery - 1 (3.3 %). Localization of lesions Superior mesenteric artery (n = 7) in 5 (16.6 %) cases were in the bottom pancreaticoduodenal artery (of which 3 patients was revealed occlusion of the celiac trunk ). In the other 2 (6.7 %) cases, the aneurysm was located in the third-order branches of the Superior mesenteric artery. Localization inferior mesenteric artery aneurysm (3.3 %) was in the initial section of the artery. Surgical treatment of patients was performed for 22 patients. Open surgery is performed within 10 patients (45.4 %), endovascular - 12 patients (54.5 %).Open surgery (10/100 %) concluded in most cases: artery ligation and resection of the aneurysm 8 (80 %), resection of the aneurysm and prosthetics - 2 (20 %). All endovascular interventions in the analyzed group of patients consisted of embolization of the aneurysm cavity. This is done by selective angiography-related artery aneurysms, aneurysms were introduced into the cavity of the helix. Later control angiography was performed or MSCT to monitor clotting aneurysm cavity.To determine the surgical treatment is necessary to consider the localization of the aneurysm diameter, the presence of collateral circulation, to determine the need to maintain blood flow in the aneurysm dependent artery. Given the frequent localization in the pool of unpaired visceral aneurysms emergencies and Superior mesenteric artery preferably endovascular intervention, given the high risk of intraoperative bleeding and rupture. Given the analysis treatment strategy should be in cases of endovascular localization of unpaired visceral aneurysms branches in the 2nd and 3rd order visceral branches and the absence of complications off this artery from the bloodstream. With the localization of the main trunk artery required open surgical correction - resection and prosthetics.