Celiac Aneurysm Research Articles

Aortic aneurysm in Behcet’s disease, endovascular management options

This study aims to review contemporary lines of endovasular management of Aortic aneurysm in bechet’s disease illustrating the pros and cons of each treatment modality. This is a retrospective cohort study of all consecutive Aortic aneurysms in patients diagnosed bechet’s disease treated between 2018-2021. The aim of this study is to evaluate efficacy &outcome of endovascular stent graft implantation for the treatment of Aortic aneurysm in Bechet’s disease. From feb 2018 to august 2021, 11 Aortic aneurysms were diagnosed in 10 patients with Bechet’s disease. All patients were male. The patients ranged in age from 33 to 66 years (median ,41 years). There were three infrarenal abdominal aortic aneurysm, two supra celiac aneurysm, three descending thoracic, one Aortic arch aneurysm, and one patient had both pararenal &descending thoracic aneurysm. All patients received immunosuppressive therapy before intervention to induce remission. After hospital discharge, all patients were followed up regularly at 3 months intervals. The mean duration of follow-up was 22.6 months (range ,1-39 months). A straight tube graft was implanted in nine patients and a bifurcated graft in one patient. Two stage procedures (debranching before endovascular therapy) were performed in three patients.

Celiac Aneurysm With the Arc of Buhler Treated by a Sutureless Anastomotic Device and the Integration of Cinematic Rendering into Surgical Planning

In this video, we present the management of a celiac aneurysm, a rare condition, that had also presented as an anatomic variant. We used a novel three-dimensional imaging technique for preoperative planning. During open management of this case, we used a sutureless anastomotic device to avoid aortic cross-clamping.

Celiac trunk aneurysm in a patient with Adamantiades-Behçet disease

Major artery involvement in Adamantiades-Behcet disease (ABD) ranges from 5% to 18% and mainly manifests as arterial stenosis and/or aneurysm formation.1 Celiac artery involvement is considered rare; celiac aneurysms have been reported in isolated cases.2,3 We present computed tomography (CT) angiography of a 70-year-old male, suffering from ABD for 40 years (initial symptoms included recurrent oral and genital ulcerations and bilateral anterior uveitis). Treatment, over time, included methylprednisolone, cyclosporine and azathioprine. He was admitted for severe upper abdominal pain, accompanied by nausea and abdominal distension. Laboratory investigation showed elevated erythrocyte sedimentation rate and C-reactive protein. Abdominal CT angiography revealed a celiac artery aneurysm starting 2 mm from the aorta measuring 32 mm in length and with a maximum diameter of 16.7 mm (Panel A) with thrombus attached in the arterial wall. Additionally, the common hepatic artery was totally occluded; hepatic perfusion was sustained via the superior mesenteric and pancreatoduodenal arteries (Panel B). Intravenous methylprednisolone pulses (1000 mg/day for 5 consecutive days) were administered with satisfactory response. Maintenance treatment included methylprednisolone and mycophenolate mofetil, along with antiplatelet therapy (aspirin plus clopidogrel). After 12 months, repeated abdominal CT angiography revealed stabilization of the celiac artery aneurysm (maximum diameter 16.3 mm). During this period, the patient remained asymptomatic. Celiac artery aneurysm in ABD represents a rare entity and may require combined medical and surgical intervention. Urgent surgery, either by open or endovascular repair, is mandatory in case of enlarging or ruptured aneurysms or due to organ-threatening ischemia.3,4 Equally significant is the implementation of postoperative immunosuppressive therapy, to prevent relapse and common complications after arterial bypass surgery, such as graft occlusion and new aneurysm formation at the site of anastomoses. Remission induction with immunosuppressive drugs represents the first goal in uncomplicated cases of ABD, while Images in Vascular Medicine

Two-Stage Hybrid Repair of a Complex Symptomatic Celiac Aneurysm

We report the case of a novel 2-stage hybrid repair of a complex celiac artery aneurysm. The patient was a 42-year-old man with a proximal celiac artery aneurysm giving rise to distinct right and left hepatic arterial branches. Repair was performed using a staged approach. First, a bifurcated aortohepatic bypass was constructed to the common and left hepatic arteries. After recovering from surgery, he underwent percutaneous embolization of the aneurysm. Completion angiograms demonstrated flow into all celiac branches with successful thrombosis of the aneurysm. At 12-month follow-up, the patient had remained symptom-free with patent bypass grafts and complete aneurysm exclusion. We describe the treatment option we used, which involves repair of a complex celiac aneurysm using a 2-stage, open, endovascular approach.

TEVAR with SVG Bypass to SMA for Mycotic Celiac Aneurysm due to Catheter Infection

TEVAR with SVG Bypass to SMA for Mycotic Celiac Aneurysm due to Catheter Infection

The Role of Duplex Ultrasound in the Detection of Celiac Aneurysm

Celiac trunk aneurysms are a rare and unusual pathology, accounting for roughly 4% of all splanchnic aneurysms; fewer than 180 cases have been reported since 1745. Early recognition of splanchnic aneurysms is crucial because of the operative mortality rate associated with ruptured splanchnic aneurysms. Duplex ultrasound in this case study has proven to be sensitive and specific in the detection of celiac aneurysms.

Selective use of extended criteria deceased liver donors with anatomic variations

An ongoing shortage of organs for liver transplantation has led surgeons to continually modify criteria for organ acceptance, which are now defined as extended criteria. The organ shortage becomes more problematic in retransplantation, in which the use of a limited resource such as a liver graft with anatomic variation must be weighed against the risk of a more difficult operation. We report 2 peculiar anatomic variations discovered in deceased donors for whole liver transplantation and confirmed at the back table: 1 with a huge biliary enlargement of the common hepatic duct and 1 with a celiac trunk aneurysm. In the first variation, any potential biliary reconstruction was thought to be at high risk of difficult outflow. The vascular anomaly did not preclude successful performance of a liver retransplantation. We briefly report the use of 2 liver grafts from deceased donors with rare anatomic variations, which is relevant to increasing the liver donor pool. To the best of our knowledge this is the first report of this biliary anomaly. In certain specific settings, strategies based on the appropriate donor-recipient match have allowed the use of grafts that otherwise would have been discarded due to celiac aneurysm.

Celiac Artery Aneurysm

Coeliac artery aneurysms are rare and frequently detected incidentally. It is usually with associated aneurysms. Herein we present accidentally detected, asymptomatic coeliac aneurysm in a patient with acute myocardial infarction. Multi-slice tomography and invasive angiography images are provided along with brief discussion on clinical presentation, diagnostic tools and treatment options.

Two-Stage Repair of a Complex Symptomatic Celiac Aneurysm

Two-Stage Repair of a Complex Symptomatic Celiac Aneurysm

Coil embolization of a celiac artery aneurysm using the neck remodeling technique

Aneurysms of the celiac trunk are rare. Untreated lesions enlarge progressively and may rupture spontaneously. We report the case of a 56-year-old man whose wide neck celiac aneurysm was successfully packed with coils with preservation of the native arterial circulation by percutaneous transcatheter embolization using the neck remodeling technique.

Nonoperative Management of Isolated Celiac and Superior Mesenteric Artery Dissection: Case Report and Review of the Literature

Isolated dissection of the origin of both celiac and superior mesenteric arteries is a rare vascular pathology with limited management guidelines. The presentation is generally nonspecific, most often manifesting with epigastric pain radiating to the back. A high diagnostic index of suspicion and stepwise management are essential for a successful outcome. This case report details the clinical course of a 57-year-male who presented with a 2-week history of epigastric discomfort with back pain and was found to have focal celiac artery dissection with aneurysmal dilation of 1.2 cm. His vital signs were stable, and the physical examination was unremarkable. At this time, he was placed on antiplatelet medication and was scheduled for endovascular repair of his celiac aneurysm with a covered stent graft. Two weeks later, recurrent abdominal pain prompted a repeat computed tomographic scan that revealed sequential superior mesenteric artery (SMA) dissection. The patient was admitted and anticoagulated. A complete workup ruled out underlying collagen vascular and autoimmune pathology. He remained stable, with significant symptomatic improvement. After 6 months, anticoagulation was discontinued and antiplatelet therapy was instituted for long-term management. Subsequent operative or endovascular intervention was not required. The patient was continuing to do well on his 18-month clinical follow-up. There are 71 cases of SMA and 12 cases of celiac artery dissection in the literature. This report outlines this rare presentation of isolated, proximal sequential celiac artery and SMA dissection. This case illustrates that conservative management may be warranted in uncomplicated, isolated visceral arterial dissection.

Fatal Coil Migration into the Stomach 10 Years after Endovascular Celiac Aneurysm Repair

Celiac trunk aneurysms are rare and can be treated with coil embolization. Migration of the coil with erosion of the arterial wall and further perforation to an extravascular structure, although infrequent, can occur. The authors describe a lethal aortogastric fistula in a patient who had undergone embolization of a celiac trunk aneurysm with tungsten coils and alcohol prolamine solution 10 years earlier. Gastroscopy, performed due to acute hematemesis, showed the coil placed 10 years previously inside the stomach without active bleeding. Two days later, the patient died of a recurrent gastrointestinal bleeding. Autopsy showed abscess formation at the celiac trunk resulting in an aortogastric fistula. The authors discuss the possible cause of this remote complication of the embolotherapy.

Mycotic Aneurysm of the Celiac Trunk: From Early CT Sign to Rupture

We present a case of the rapid development and rupture of a mycotic celiac trunk aneurysm. Initially on multislice computed tomography (ms-CT) there was a normal celiac trunk with minimal haziness of the surrounding fat. Only 2 weeks later the patient went into hypovolemic shock due to a ruptured celiac aneurysm. Although aneurysms of the visceral arteries are rare, they are of major clinical importance as they carry a life-threatening risk of rupture. This case illustrates the use of ms-CT in detecting and evaluating visceral aneurysms, in order to prevent emergency operation.

Axillary artery access for interventional procedures.

To evaluate axillary artery access for the interventional treatment of carotid or splanchnic arteries that have angulated takeoff or complex anatomy when larger catheters (up to 9 F) are needed. The axillary artery approach was used to treat the left internal carotid artery (ICA) in 3 patients (2 angulated takeoffs and 1 bovine arch) and a celiac axis aneurysm. An 8-F, 45-cm-long introducer sheath was inserted for the carotid procedures, whereas a 9-F, 90-cm sheath was chosen for the celiac aneurysm. Cerebral protection and stenting were successfully performed in all carotid patients; an 8x40-mm stent-graft was implanted to exclude the celiac artery aneurysm. An 8-F vascular closure device was used in the axillary arteries; hemostasis was immediate, and no hematoma or other complications were recorded in follow-up. This preliminary experience revisits the axillary approach as an alternative access route for interventional procedures. In association with a vascular closure device, this approach should be considered as a useful and safe option for those interventional procedures in which larger sheaths or catheters are required to cope with difficult arterial anatomies.

Experimental cerebral aneurysms in the female heterozygous Blotchy mouse.

The Blotchy mouse is characterized by an X-linked inherited disorder of connective tissue synthesis. The susceptibility to aneurysm formation in the cerebral arteries of the circle of Willis was compared in female heterozygous 'Blotchy' and control mice subjected to unilateral carotid artery ligation either alone or associated with hypertension. Cerebral aneurysms developed only in hypertensive Blotchy mice (6/31 vs. 0/30 in hypertensive controls). Aneurysms of the aorta and its major branches occurred in normotensive mice only in the Blotchy group in which hypertension increased the incidence of mesenteric and coeliac aneurysms. A light microscopic study of interruptions of the internal elastic lamina (IIEL) showed that they developed in arteries of both Blotchy and control mice but to a greater extent in the Blotchy group where hypertension further increased their incidence. The IIEL incidence in the aortic arch varied in parallel to the occurrence of aneurysms in all the different arterial sites. Thus, in an apparently normally viable animal, the presence of a mutated gene which indirectly leads to defective elastin and collagen fibre synthesis, favours the formation of both peripheral and cerebral aneurysms. However, the development of cerebral aneurysms requires the addition of an increase in haemodynamic stress.

A case of celiac aneurysm exposed to the ulcer base of the remnant stomach : an usefulness of miniature ultrasonic probe

A case of celiac aneurysm exposed to the ulcer base of the remnant stomach : an usefulness of miniature ultrasonic probe