Visceral artery aneurysms: evolving interdisciplinary management and future role of the abdominal surgeon.
Emergency bleeding
Hemorrhage
Interventional radiology
Open surgery
Visceral artery aneurysms
Journal
European journal of medical research
ISSN: 2047-783X
Titre abrégé: Eur J Med Res
Pays: England
ID NLM: 9517857
Informations de publication
Date de publication:
28 Feb 2019
28 Feb 2019
Historique:
received:
19
11
2018
accepted:
14
02
2019
entrez:
2
3
2019
pubmed:
2
3
2019
medline:
15
8
2019
Statut:
epublish
Résumé
Visceral artery aneurysms (VAA) are rare vascular lesions. Clinically silent VAA are increasingly detected by cross-sectional imaging but some lesions are at risk for rupture with severe bleeding. The aim of the present study was to evaluate the trends in the interdisciplinary management at a tertiary center. Patients who underwent treatment for VAA at University Hospital of Bonn between 2005 and 2018 were enrolled in this retrospective study. Demographic, clinical, VAA-specific data as well as information on therapy, early and long-term outcome were collected and statistically analyzed. Forty-two consecutive patients, 19 females and 23 males with a median age of 59 years (range 30-91 years), were diagnosed with 56 VAA. The majority were true aneurysms (N = 32; 57%), whereas 43% (N = 24) were pseudoaneurysms. The most common localization was the splenic artery (N = 18; 32%) and the average diameter was 3 cm (range 1-5 cm). Twenty-five patients (59.5%) had VAA-related symptoms such as chronic abdominal pain and hemorrhage at primary diagnosis, while the diagnosis was incidental in 17 patients (40.5%). Eleven patients (26%) underwent open surgery whereas 29 patients (69%) received an endovascular treatment. Patients with pseudoaneurysms were significantly older (P = 0.003), suffered more often from associated symptoms (P < 0.001) and required more emergency interventions (P < 0.0001) compared to those with true VAA. In the last years, the number and proportion of true VAA increased significantly (P < 0.001) while a significantly larger proportion could be managed interventionally (P = 0.017). VAA are increasingly detected on imaging with lesions presenting very heterogeneously. Due to the risk of lethal rupture and in the absence of reliable prognostic markers, all the patients with VAA should be offered definite treatment. Localization, anatomy and the end-organ perfusion after intervention or operation are the most important aspects to consider when planning a treatment for VAA. For this reason, a multidisciplinary evaluation of every individual patient is necessary for an optimized outcome.
Sections du résumé
BACKGROUND
BACKGROUND
Visceral artery aneurysms (VAA) are rare vascular lesions. Clinically silent VAA are increasingly detected by cross-sectional imaging but some lesions are at risk for rupture with severe bleeding. The aim of the present study was to evaluate the trends in the interdisciplinary management at a tertiary center.
METHODS
METHODS
Patients who underwent treatment for VAA at University Hospital of Bonn between 2005 and 2018 were enrolled in this retrospective study. Demographic, clinical, VAA-specific data as well as information on therapy, early and long-term outcome were collected and statistically analyzed.
RESULTS
RESULTS
Forty-two consecutive patients, 19 females and 23 males with a median age of 59 years (range 30-91 years), were diagnosed with 56 VAA. The majority were true aneurysms (N = 32; 57%), whereas 43% (N = 24) were pseudoaneurysms. The most common localization was the splenic artery (N = 18; 32%) and the average diameter was 3 cm (range 1-5 cm). Twenty-five patients (59.5%) had VAA-related symptoms such as chronic abdominal pain and hemorrhage at primary diagnosis, while the diagnosis was incidental in 17 patients (40.5%). Eleven patients (26%) underwent open surgery whereas 29 patients (69%) received an endovascular treatment. Patients with pseudoaneurysms were significantly older (P = 0.003), suffered more often from associated symptoms (P < 0.001) and required more emergency interventions (P < 0.0001) compared to those with true VAA. In the last years, the number and proportion of true VAA increased significantly (P < 0.001) while a significantly larger proportion could be managed interventionally (P = 0.017).
CONCLUSIONS
CONCLUSIONS
VAA are increasingly detected on imaging with lesions presenting very heterogeneously. Due to the risk of lethal rupture and in the absence of reliable prognostic markers, all the patients with VAA should be offered definite treatment. Localization, anatomy and the end-organ perfusion after intervention or operation are the most important aspects to consider when planning a treatment for VAA. For this reason, a multidisciplinary evaluation of every individual patient is necessary for an optimized outcome.
Identifiants
pubmed: 30819253
doi: 10.1186/s40001-019-0374-9
pii: 10.1186/s40001-019-0374-9
pmc: PMC6396446
doi:
Types de publication
Journal Article
Langues
eng
Pagination
17Références
Ann Vasc Surg. 2000 May;14(3):223-9
pubmed: 10796953
J Vasc Surg. 2001 Apr;33(4):806-11
pubmed: 11296336
Ann Vasc Surg. 2002 Jul;16(4):442-9
pubmed: 12089631
N Engl J Med. 2004 Apr 29;350(18):1862-71
pubmed: 15115832
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
Radiology. 2005 Mar;234(3):824-32
pubmed: 15681686
Ann Vasc Surg. 2005 Jan;19(1):42-8
pubmed: 15714366
J Vasc Surg. 2006 Oct;44(4):718-24
pubmed: 17011997
Eur J Vasc Endovasc Surg. 2007 Mar;33(3):293-301
pubmed: 17097898
J Vasc Surg. 2007 Feb;45(2):276-83; discussion 283
pubmed: 17264002
Mayo Clin Proc. 2007 Apr;82(4):472-9
pubmed: 17418076
J Vasc Surg. 2008 Jun;47(6):1212-9
pubmed: 18440188
J Vasc Surg. 2008 Aug;48(2):334-42
pubmed: 18644480
Eur J Obstet Gynecol Reprod Biol. 2009 Oct;146(2):133-7
pubmed: 19596508
JAMA. 2010 Apr 28;303(16):1625-31
pubmed: 20424253
Zentralbl Chir. 2010 Oct;135(5):416-20
pubmed: 20976644
Semin Intervent Radiol. 2009 Sep;26(3):196-206
pubmed: 21326564
Ann Vasc Surg. 2011 Aug;25(6):841.e5-8
pubmed: 21620662
Ann Vasc Surg. 2011 Oct;25(7):936-46
pubmed: 21620671
Eur J Vasc Endovasc Surg. 2011 Sep;42(3):340-6
pubmed: 21628100
Ann Vasc Surg. 2011 Oct;25(7):981.e7-11
pubmed: 21665424
Cardiovasc Intervent Radiol. 2012 Apr;35(2):234-43
pubmed: 21674280
Vasc Endovascular Surg. 2011 Nov;45(8):681-7
pubmed: 22262112
Radiographics. 2013 May;33(3):E71-96
pubmed: 23674782
Ann Vasc Dis. 2013;6(4):687-93
pubmed: 24386016
J Vasc Surg. 2014 Jul;60(1):160-9
pubmed: 24650746
Eur Radiol. 2015 Jul;25(7):2004-14
pubmed: 25693662
Acad Emerg Med. 2015 May;22(5):625-31
pubmed: 25731864
Diagn Interv Imaging. 2015 Jul-Aug;96(7-8):797-806
pubmed: 26054246