Splanchnic Artery Aneurysms Research Articles

Rapid progression of multiple splanchnic artery aneurysms

A 62-year-old man with a complex medical history that included long-standing muscular dystrophy presented with moderate-to-severe epigastric and mid-back pain. Family history was noncontributory. The patient worked as a full-time computer instructor. He was a social drinker and denied a history of cigarette smoking or illicit drug use. At initial presentation, vital signs were normal except for a blood pressure of 148/105 mm Hg. Physical examination revealed moderate epigastric tenderness without rebound or guarding. Laboratory findings were unremarkable, and the hemoglobin was 12.4 g/dL (hematocrit, 37%). A computed tomography of the abdomen and pelvis demonstrated a retroperitoneal hemorrhage that involved the mesenteric circulation. A mesenteric arteriogram (Fig 1) was performed that revealed high-grade stenosis of the celiac artery origin with retrograde filling via superior mesenteric artery (SMA) collaterals as well as aneurysms of the celiac artery trifurcation and inferior pancreaticoduodenal artery (IPDA) without evidence of active bleeding. No therapeutic intervention was undertaken, and the patient was stabilized and discharged home. Three weeks later, he was admitted with recurrent abdominal pain, and a repeat arteriogram (Fig 2) showed significant increase in the size and number (13 in total) of splanchnic artery aneurysms that involved the celiac trunk, branches of the SMA that included the anterior and posterior branches of IPDA and gastroepiploic arteries, and splenic and right renal arteries. No risk for splanchnic artery aneurysms was identified, and evaluation for vasculitis or mycotic etiology was negative. Also, we could not identify any reports of an association between our patient's muscular dystrophy and the development of splanchnic artery aneurysms. Therapeutic intervention was neither feasible nor attempted given the patient's vascular anatomy and overall health. At follow-up, 4 months since the last arteriogram, the patient remains hemodynamically stable in his usual state of health. Fig 2Follow-up mesenteric arteriogram performed 3 weeks after the initial study (as observed in Fig 1), which revealed splanchnic artery aneurysms that involve the celiac trunk, branches of the SMA that include the anterior and posterior branches of IPDA, and gastroepiploic arteries, as well as splenic and right renal arteries. View Large Image Figure Viewer Download Hi-res image This section features outstanding photographs of clinical materials selected for their educational value or message, or possibly their rarity. The images are accompanied by brief case reports (limit 2 typed pages, 4 references). Our readers are invited to sumit items for consideration.

MDCT and 3D CT Angiography of Splanchnic Artery Aneurysms

The purpose of this article is to review our experience with the use of MDCT and 3D imaging in the detection and management of patients with both symptomatic and asymptomatic splanchnic artery aneurysms. Although splanchnic artery aneurysms are relatively rare, they are being diagnosed with increased frequency given the widespread availability of MDCT and 3D imaging capabilities. It is important that these aneurysms be diagnosed accurately because they can carry a high morbidity and mortality, even in asymptomatic patients.

Successful Surgical Management of a Ruptured True Pancreaticoduodenal Artery Aneurysm following Failed Transcatheter Embolization

A ruptured splanchnic artery aneurysm is a rare clinical entity. Its diagnosis requires a high index of clinical suspicion, and management usually requires a multidisciplinary approach. We present a case of ruptured true pancreaticoduodenal artery aneurysm in an 83-year-old woman who was initially treated with transcatheter embolization, but it failed to arrest the bleeding, and she subsequently required laparotomy and surgical ligation. The clinical course and management are discussed with a review of the literature.

Analysis of five cases of splanchnic artery aneurysm associated with coeliac artery stenosis due to compression by the median arcuate ligament

To elucidate the mechanism of occurrence of splanchnic artery aneurysm associated with coeliac artery stenosis due to compression by the median arcuate ligament, and also to discuss the management for this relatively rare condition. Five consecutive cases of splanchnic artery aneurysm associated with coeliac axis stenosis due to compression by the median arcuate ligament, including four cases of pancreaticoduodenal artery aneurysm and one case of epiploic artery aneurysm, were investigated. These cases were collected over a 5-year period in our local and affiliated hospitals. Among these five cases, three were discovered because of rupture of the aneurysm, and two were found incidentally in annual medical check-ups. In all cases, conspicuously developed collateral arteries, which were of the dilated pancreaticoduodenal arcade and its branches, were conspicuously found on digital subtraction angiography of the superior mesenteric artery. The findings suggested that haemodynamic changes in the splanchnic arterial networks (an increase in blood flow mainly through the pancreaticoduodenal arcade), were the possible cause of the corresponding aneurysms. Compression by the median arcuate ligament might be a frequent cause of splanchnic aneurysm, which, on rupture of the aneurysm, could be life-threatening.

Hemorrhagic shock secondary to rupture of a right gastroepiploic artery aneurysm: Case report and brief review of splanchnic artery aneurysms

A case of a 78-year-old woman who presented with hemorrhagic shock and abdominal pain, and who was subsequently found to have a ruptured aneurysm of the right gastroepiploic artery, is presented. She underwent open surgical resection of the aneurysm without any significant postoperative complication. A brief review of splanchnic artery aneurysms with regard to their incidence, presentation and approaches for repair is also presented.

Inferences for odds ratio with dependent pairs

Splanchnic artery aneurysms are localized vascular dilatations having a progressive evolution and leading towards severe complications (depletive rupture, distal emboli, organ ischemia). Treatment can be efficient when the condition is detected in time. The imaging techniques are highly efficient when it comes to detecting and locating splanchnic aneurysms. Each method has its own features. By knowing them, there is a better chance to track down the disease at an early stage.

Gastroduodenal Artery Aneurysm Presenting as Jaundice and Abdominal Pain

Visceral artery aneurysm is a very rare and potentially serious vascular anomaly. The mortality rate from bleeding is 40–60%. Aneurysms of the gastroduodenal artery rank among the rarest splanchnic artery aneurysms, comprising fewer than 2 per cent of all such lesions. We report a case of a 41 year old male with history of pancreatitis admitted with jaundice and vague right upper quadrant pain. Laboratory findings suggested a cholestatic picture and ultrasound of the abdomen revealed a mass of the head of the pancreas causing compression of the common bile duct. Further imaging with a CT scan revealed a 5.6 cm aneurysm of the gastroduodenal artery with surrounding hematoma. Mesenteric angiogram showed aneurysm arising from the proximal gastroduodenal artery and occlusion of the celiac axis with multiple collaterals from superior mesenteric artery to the hepatic and splenic arteries. Coil embolisation could result in hepatic ischemia in the setting of celiac axis occlusion, and was not attempted. Patient underwent ERCP and stenting of the common bile duct with successful decompression of the biliary system. Operative exploration with intraoperative visceral angiogram showed celiac axis compression within the medial arcuate ligament of the diaphragm. The medial arcuate ligament was divided leading to restoration of blood flow to the liver. The inflow and outflow vessels of the aneurysms were ligated without the risk of hepatic ischemia. Patient recovered uneventfully. This case illustrates an uncommon cause of obstructive jaundice caused by bleeding aneurysm of the gastroduodenal artery in the settings of prior pancreatitis and celiac axis occlusion.

True giant aneurysm of gastroduodenal artery

Aneurysms affecting the splanchnic arteries are very rare, while the commonest location is splenic artery (10.4%); the gastroduodenal artery (GDA) remains the rarest site representing only 1.5% of more than 3000 reported splanchnic artery aneurysms (SAA) in literature since 1960. Though aneurysms of visceral arteries are rare, awareness and early treatment are important because the common presentation of aneurysmal rupture is associated with a high mortality rate. Majority of the GDA aneurysms documented in the literature are pseudoaneurysms associated with complications of acute or chronic pancreatitis. True giant GDA aneurysms are extremely rare, although there is no standard size criteria to define a giant GDA aneurysm, the term has been used in literature to describe aneurysms above 5 cm in size as shown in Table 1. Several cases of successful coil embolization of GDA pseudoaneurysms were already reported but we

Traitement des anévrismes du tronc cœliaque : expérience personnelle et revue de la littérature

Introduction Celiac trunk aneurysms represent 4% of all splanchnic artery aneurysms. These lesions are thus extremely rare but yet have a significant clinical importance. Mortality, mainly related to site characteristics, is a significant risk (14%) in the event of rupture. Patients and methods We put forward our experience in both diagnosis and treatment in three patients, two women and one man (average age 55.3 years, range 35-74), presenting aneurysms involving the celiac trunk. The preoperative diagnosis was established successively with ultrasonography, CT scan and angiography. Two patients were treated via an open surgical approach while endovascular percutaneous treatment was performed for the third patient. Results Mortality was null at 13 days on average from admission for the surgical patients and 4 days for the patient treated endovascularly. Postoperative complications were modest: pulmonary thickening with pleural effusion for the two surgical patients (spontaneous resolution), while for the third patient treated with an endovascular method, the stent migrated to a splanchnic arterial branch, with no consequence for the spleen. The average follow-up was 19 months (range 14-24). Full exclusion of the aneurysm was maintained at four months for the aneurysm treated percutaneously. A patent celiac was also maintained for the patients treated surgically. Conclusions Considering the largely unforeseeable outcome and the high risk of rupture, we suggest that all the patients presenting this type of aneurysmal lesion should be treated. This attitude is widely advocated in the literature. Moreover, we noted null mortality in our small series, with only one percutaneous “re-do” case; resolutive at last control. With the present improvement in stent technology, endovascular treatment should be preferred. Patients should be treated surgically only if a percutaneous procedure would be risky or technically unfeasible due to the size of the aneurysm or its anatomic features. (J Mal Vasc 2006; 31: 72-75).

Angiographie par résonance magnétique dans les anévrismes et pseudoanévrismes des artères splanchniques

Purpose To correlate Magnetic resonance angiography (MRA) with computed tomography for the diagnosis of splanchnic artery aneurysms. Materials-methods We retrospectively reviewed the MRA findings of splanchnic arteries performed in 16 patients with known splanchnic aneurysms. Sixteen patients underwent computed tomography (CT), and MRA. Conventional angiogram was performed to confirm the diagnosis in six cases. This study was conducted on a 1.5T MR Symphony system (Siemens, Erlangen, Germany). CE-MRA was performed by using a 3D RF-spoiled FLASH sequence. Acquisition of source images was performed in the coronal plane and reconstructed by means of maximum-intensity projection (MIP) post-processing. Results Patient population included 7 men and 9 women aged from 31 to 85 years old (mean age 59.5 years old). Splanchnic aneurysms were located as follows: splenic (n=5), hepatic (n=6), celiac trunk (n=4) and gastroduodenal (n=1). In 9 cases, MRA provided results similar to CT. In 3 cases, MRA provided more accurate information on the location of the aneurysm or detected additional aneurysms. In 4 patients, a diagnosis of aneurysm was made first or only made on MRA. Conclusion This small series showed a good correlation between CT and MRA for detection and characterization of splanchnic aneurysms.

Percutaneous treatment of a ruptured superior mesenteric artery aneurysm in a child

Splanchnic artery aneurysms are very rare in children. We report a 10-year-old girl with a large atraumatic ruptured superior mesenteric artery aneurysm that was considered inoperable. She was ultimately treated with two percutaneous US-guided thrombin injections, which led to complete occlusion of the aneurysm. The aetiology of the aneurysm remained unclear, but a family history was suggestive of a congenital connective tissue disease such as Ehlers-Danlos syndrome subtype IV.

Splanchnic artery aneurysms

Splanchnic artery aneurysms are uncommon but important vascular entity because nearly 25% of all cases present as surgical emergency. The purpose of our study was to present nine patients operated on at the Institute of cardiovascular diseases, as well as literature review of clinical presentation of the disease. There were three splenic artery aneurysms, two celiac trunk aneurysms, and one aneurysm of the hepatic, superior mesenteric, inferior mesenteric and gastroduodenal artery. All patients were males, mean aged 67.5 years (60-73). In four patients, splanchnic artery aneurysm was discovered accidentally during routine ultrasonographic and angiographic examinations of the abdominal aorta. At that time, arteriovenous fistula was diagnosed in a patient No 1; it was formed after rupture of the splenic artery aneurysm into the splenic vein. Three aneurysms were manifested by abdominal pain and palpable pulsating abdominal mass. Two patients were admitted as urgent cases in the state of hemorrhagic shock and signs of intraabdominal bleeding due to rupture of the splenic and hepatic arteries. In 7 cases, diagnosis was made preoperatively by means of ultrasonography and angiography; in two patients, accurate diagnosis was confirmed during surgery. Proximal and distal ligation of the artery was performed in a patient with rupture of the splenic aneurysm into the splenic vein that caused arteriovenous fistula. Gastroduodenal artery aneurysm was treated by trans-aneurysmatic ligation of its "entering" and "exiting" branches. Aneurysms of distal part of the superior mesenteric and splenic artery were resected without further reconstruction. Partial resection of the aneurysm and endoaneurysmorrhaphy was carried out in one case of celiac trunk aneurysm, and in another, after aneurysm resection, the restoration of blood flow through the hepatic and lienal artery was achieved by Dacron grafts. In a patient with the inferior mesenteric artery aneurysm, the resection of aneurysm was followed by reimplantation of medial part of the artery into bifurcated Dacron graft which replaced abdominal aorta. In 5 patients, some of additional surgical procedures were performed. There were 4 reconstructive procedures of abdominal aorta and one splenectomy. The patient with ruptured hepatic artery aneurysm died during surgery due to uncontrolled hemorrhage. In other patients, there was neither morbidity nor mortality in the early postoperative period (first 30 days after surgery). Mean follow up was 1 to 5 years (mean 3.4 years). One patient died after 5 years due to myocardial infarction. Although the introduction of precise diagnostic procedures (computerized tomography, magnetic resonance imaging, spiral scan) make diagnosis easier, the splanchnic artery aneurysms are still difficult to detect due to their uncommon clinical presentations.

Ruptured Left Gastric Artery Aneurysm: Unique Presentation with Hemothorax and Hemomediastinum

Although splanchnic artery aneurysms are uncommon and remain mostly asymptomatic, they are associated with a high mortality rate when they rupture. We discuss the case of a 66-year-old woman who had successful embolization of a left gastric artery aneurysm after presenting with acute chest pain and the unusual computed tomography findings of hemothorax and hemomediastinum. To our knowledge, only one other similar case has been published in the literature.

‘All That Glitters isn't Gold’: Rupture of an Undiagnosed Splanchnic Aneurysm in the Presence of an Aortic Aneurysm

We present a case of a ruptured aneurysm of the left gastroepiploic artery in the presence of a known aortic aneurysm, which presented a diagnostic and management dilemma. The patient was too unfit for an emergency repair of his aortic aneurysm but underwent successful coil embolisation and thrombin injection of the splanchnic artery aneurysm. Splanchnic artery aneurysms carry a high rate of rupture and poor survival, often because of delay and difficulty in diagnosis. A high index of suspicion and radiological expertise are required for diagnosis, but early recognition may allow successful endovascular intervention and obviate the need for open surgery.

Diagnosis of splanchnic artery aneurysms and pseudoaneurysms, with special reference to contrast enhanced 3D magnetic resonance angiography: a review

Splanchnic artery aneurysms are rare. In the past, conventional angiography was the only way to detect them, but today non-invasive techniques are available. Breath-hold contrast-enhanced 3D magnetic resonance angiography has become a routine examination for evaluation of the aorta and its visceral branches. In this article, we briefly discuss the technical aspects of 3D contrast-enhanced magnetic resonance angiography and illustrate various splanchnic artery aneurysms-pseudoaneurysms with their main characteristics.

Treatment of Six Hepatic Artery Aneurysms

Hepatic artery aneurysms are rare lesions but of significant clinical importance because rupture is associated with elevated mortality. Although diagnosis using CT scanning and, more importantly, angiography has been well defined, the therapeutic choices are less clear. We retrospectively selected patients from 1985 to 2000 who were treated with either traditional surgical or percutaneous techniques. In total we treated six patients, four males and two females. This represents 17.6% of 34 patients treated by us for splanchnic artery aneurysms. The treatment was surgical in two cases (33.3%) and percutaneous in four cases (66.6%). All lesions were successfully treated with exclusion/ablation of the aneurysm. Mortality was nil; in one of the surgical cases we reported a transient hepatic failure and in the endovascular group, one right pleural effusion, one small splenic infarction, and one pseudoaneurysm of the gastroduodenal artery. The first therapeutic strategy to be taken into consideration is always the percutaneous approach. However, surgery still has a role in those cases where the lesion cannot be repaired percutaneously. Based on our own experience (good results, no mortality, and few complications) and in accordance with the literature, it is clear that an aggressive approach is warranted in those patients.

Place de la chirurgie dans le traitement de l’hypertension réno-vasculaire de l’enfant

The aim of this retrospective study was to report our experience of the surgical treatment of renovascular hypertension in children and to define the role of surgery in the treatment of this form of hypertension. The author's series included 83 patients (49 girls, 34 boys), 28 months to 18 years of age (mean: 10.3) operated on from 1970 to 2001. All patients had elevated blood pressure and underwent the investigations usually performed in patients with hypertension. Lesions were bilateral in 28 cases. The operation was decided after failure of percutaneous angioplasty in the patients treated since 1982. Due to bilateral procedures and to secondary or late re-operations, the number of surgical procedures was 114 (15 nephrectomies and 99 arterial repairs). The repairs were performed by extracorporeal surgery in 25 cases and by conventional in situ surgery in 74 cases. Whenever an arterial substitute was necessary, an arterial autograft was preferred since this material does not undergo late degenerative changes with time. Fibrodysplasia of the renal artery was the prevailing pathologic finding (70%). Associated lesions were observed in 59% of the patients: coarctation of the abdominal aorta (23 patients), stenoses, obstructions or aneurysms of splanchnic arteries (23 lesions in 17 patients), pheochromocytoma (2 patients), arterial lesions of distant arterial territories in patients with Takayasu's aortitis (7 patients). There was no postoperative death in this series. Seven postoperative thromboses occurred (7% of the repairs). In the long-term follow-up, three recurrent stenoses and two aneurysms of a venous autograft were repaired surgically. In two patients, a stenosis of the opposite artery occurred and was also repaired. In two patients, a stenosis of the abdominal aorta worsened and required an aortic by-pass 3 and 12 years after the renal artery repair. In patients with Takayasu's disease, operations in other arterial territories (supra-aortic trunks, coronary arteries) were required in two patients. The complete cure of arterial hypertension was obtained in 82% of the patients. In young children, growth of the repairs was normal when age increased. Surgery still keeps a major place in the treatment of renovascular hypertension in children. Its prognosis is favourable since atheroma, visceral or renal lesions are usually lacking.

Visceral Artery Aneurysms: A Single Center Experience

Background Splanchnic artery areurysm is a rare but clinically relevant disease, showing a high mortality rate in emergency surgery. Reports on splanchnic aneurysms are rare and often anecdotal. The aim of this study is to discuss data obtained from 16 patients in a single vascular surgery center. Materials and methods Between January 1987 and December 2000. 16 patients underwent surgery for splanchnic artery aneurysms. In 13 patients the localization was single (in two associated with an infrarenal abdominal aortic aneurysm) and in 3 patients multiple. The arteries involved were: splenic (8). hepatic (4). celiac (3), superior mesenteric (3), ileocolic (2), and pancreatoduodenal (1). 13 patients were asymptomatic and 3 presentee with abdominal pain. All patients underwent CT scan, and abdominal aortic and selective visceral artery angiography. Before surgery, all patients underwent cerebral MR or cerebral CT scan. 13 patients underwent open vascular surgery; 3 patients (2 splenic and 1 hepatic) underwent endovascular procedure (angioembolization). Histological examination of the aneurysmal wall was obtained in 14 patients. Ultrasound examination was performed after 6 months, then yearly. 14 patients underwent abdominal CT scan during the long-term follow-up. Results Perioperative mortality was absent. 12 cases were classified as displastic, with minor or major secondary atherosclerotic changes, and in many cases severe caseations. 2 cases were classified as atherosclerotic. Cerebral MR did not show any cases of intracerebral displastric aneurismal disease. One patient was lost at follow-up after 9 years. One patient showed a recurrence at 6 years (superior mesenteric artery): the patient underwent a new surgical procedure and died 20 days after surgery for intestinal infarction. All abdominal follow-up CT scans show good results of the vascular reconstruction and escluded other new visceral or aortic aneurysms. Conclusions Visceral artery aneurysms are an uncommon form of abdominal vascular disease showing a high postoperative mortality rate in emergencies. Surgery, and in selected cases, endovascular treatment, can successfully manage splanchnic artery aneurysms with few complications and low recurrence.

Visceral artery aneurysms: a single center experience

Background: Splanchnic artery areurysm is a rare but clinically relevant disease, showing a high mortality rate in emergency surgery. Reports on splanchnic aneurysms are rare and often anecdotal. The aim of this study is to discuss data obtained from 16 patients in a single vascular surgery center. Materials and methods: Between January 1987 and December 2000, 16 patients underwent surgery for splanchnic artery aneurysms. In 13 patients the localization was single (in two associated with an infrarenal abdominal aortic aneurysm) and in 3 patients multiple. The arteries involved were: splenic (8), hepatic (4), celiac (3), superior mesenteric (3), ileocolic (2), and pancreatoduodenal (1). 13 patients were asymptomatic and 3 presentec with abdominal pain. All patients underwent CT scan, and abdominal aortic and selective visceral artery angiography. Before surgery, all patients underwent cerebral MR or cerebral CT scan. 13 patients underwent open vascular surgery; 3 patients (2 splenic and 1 hepatic) underwent endovascular procedure (angioembolization). Histological examination of the aneurysmal wall was obtained in 14 patients. Ultrasound examination was performed after 6 months, then yearly. 14 patients underwent abdominal CT scan during the long-term follow-up. Results: Perioperative mortality was absent. 12 cases were classified as displastic, with minor or major secondary atherosclerotic changes, and in many cases severe calcications. 2 cases were classified as atherosclerotic. Cerebral MR did not show any cases of intracerebral displastric aneurismal disease. One patient was lost at follow-up after 9 years. One patient showed a recurrence at 6 years (superior mesenteric artery): the patient underwent a new surgical procedure and died 20 days after surgery for intestinal infarction. All abdominal follow-up CT scans show good results of the vascular reconstruction and escluded other new visceral or aortic aneurysms. Conclusions: Visceral artery aneurysms are an uncommon form of abdominal vascular disease showing a high postoperative mortality rate in emergencies. Surgery, and in selected cases, endovascular treatment, can successfully manage splanchnic artery aneurysms with few complications and low recurrence.

Transcatheter embolization of splanchnic aneurysms/pseudoaneurysms: early imaging allows detection of incomplete procedure.

The purpose of this work is to discuss results of transcatheter embolization for splanchnic aneurysms/pseudoaneurysms and to evaluate the value of color Doppler ultrasonography and CT within the first week after the procedure. Retrospective review of selected patients from our database with splanchnic artery aneurysms and pseudoaneurysms treated by transcatheter embolization was conducted. Patients were selected and treated in the hospital of Edouard Herriot (Lyon, France). Conventional angiography was performed by the transfemoral route in all patients. We used association of steel coils with or without hemostatic sponge after selective catheterization of the parent vessel for the embolization of the aneurysm. Color flow imaging on ultrasonography and CT scan with contrast medium injection were performed to analyze feeding arteries, treated aneurysm, and presence of complications within the first week after embolization. Eighteen transcatheter embolizations were performed in 14 patients. A total of 25 ultrasonograms and/or CT scans were performed within the first week after the embolization procedure. Complete embolization in one attempt was achieved in eight patients. Imaging follow-up confirmed the absence of recurrence, recanalization, or severe complication for these patients. In one patient, a CT scan with injection of contrast medium done after the first complete procedure of embolization for mycotic pseudoaneurysm identified new aneurysms. Further embolization was done to complete the procedure. In the remaining four patients, large aneurysms were identified, with failure of transcatheter embolization. Follow-up imaging confirmed either the incomplete packing of the aneurysm or recanalization by a new feeding artery. Imaging follow-up with ultrasonography and CT scan provides significant information after transcatheter embolization. We confirm that large visceral aneurysms are difficult to treat by embolization, with failed procedures in our series.