Successful surgical treatment of a patient with multiple visceral artery aneurysms due to fibromuscular dysplasia

Background: Fibromuscular dysplasia is a non-inflammatory, non-atherosclerotic vascular disease that commonly affects renal and carotid arteries but involvement of virtually any vascular territory has been observed. Research Design/ Study sample: This is a case report of a ruptured left gastric artery aneurysm as the first presentation of fibromuscular dysplasia. Data collection: After written consent from the patient, relevant clinical notes and imaging were retrospectively reviewed and critically analysed. Purpose: This case reiterates the importance of considering fibromuscular dysplasia as an uncommon cause of visceral artery aneurysms. In addition, this case shows that the impact of visceral artery vasospasm on endovascular access should not be underestimated and subsequent attempts can be successful after a period of resuscitation. Results: After initial difficulty in endovascular treatment due to visceral vasospasm, the case was successfully managed with with staged open ligation and endovascular embolization after a period of resuscitation. Conclusions: FMD is an important differential diagnosis to consider in cases of visceral aneurysms.

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Interdisciplinary Management of Visceral Artery Aneurysms and Visceral Artery Pseudoaneurysms

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2020.14 ◽

2020 ◽

Vol 63 (1) ◽

pp. 43-48 ◽

Cited By ~ 1

Author(s):

Peter Berek ◽

Ivan Kopolovets ◽

Csaba Dzsinich ◽

Juraj Bober ◽

Peter Štefanič ◽

...

Keyword(s):

Surgical Treatment ◽

Endovascular Treatment ◽

Artery Aneurysm ◽

Visceral Artery ◽

Interdisciplinary Management ◽

Artery Pseudoaneurysm ◽

Endovascular Interventions ◽

Visceral Artery Aneurysms ◽

Choice Of Treatment ◽

Visceral Arteries

The paper presents the results of treating 14 patients, namely eight patients with visceral artery aneurysms and six patients with visceral artery pseudoaneurysms. In 64.3% of the patients, the initial diagnosis was made based on the ultrasound examination. All the patients (100%) underwent CT angiography, while angiography was performed in 71.4% of the cases. Five (35.7%) patients with visceral artery pseudoaneurysms were emergently hospitalized; among them, the signs of bleeding were observed in 2 patients. In 9 patients, pathology was detected during tests for other conditions. Five (35.7%) patients underwent endovascular treatment, while 9 (64.3%) patients received surgical treatment. Endovascular interventions and open surgery demonstrated a nil mortality rate. After endovascular treatment, stent thrombosis was found in 1 patient. In the case of surgical treatment, visceral artery aneurysm was observed in 1 patient who underwent the resection of superior mesenteric artery pseudoaneurysm. Conclusions. The choice of the method of treating visceral artery aneurysms and visceral artery pseudoaneurysms depends on the location, size, anatomic features of the visceral arteries and the clinical course of the disease. Both endovascular and surgical treatment demonstrate good postoperative outcomes. Visceral ischemia is one of the most serious complications in the postoperative period, which can complicate both the diagnosis and the choice of treatment tactics.

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Surgical treatment of visceral artery aneurysms: A 25-year experience

Journal of Vascular Surgery ◽

10.1016/j.jvs.2008.03.043 ◽

2008 ◽

Vol 48 (2) ◽

pp. 334-342 ◽

Cited By ~ 187

Author(s):

Raffaele Pulli ◽

Walter Dorigo ◽

Nicola Troisi ◽

Giovanni Pratesi ◽

Alessandro Alessi Innocenti ◽

...

Keyword(s):

Surgical Treatment ◽

Visceral Artery ◽

Visceral Artery Aneurysms

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Characteristic Distribution Pattern of Lysophosphatidylcholine in Fibromuscular Dysplasia-Associated Visceral Artery Aneurysms Compared with Atherosclerotic Visceral Artery Aneurysms

Journal of Atherosclerosis and Thrombosis ◽

10.5551/jat.32318 ◽

2016 ◽

Vol 23 (6) ◽

pp. 673-680 ◽

Cited By ~ 8

Author(s):

Hiroki Tanaka ◽

Nobuhiro Zaima ◽

Takeshi Sasaki ◽

Naoto Yamamoto ◽

Kazunori Inuzuka ◽

...

Keyword(s):

Distribution Pattern ◽

Fibromuscular Dysplasia ◽

Visceral Artery ◽

Characteristic Distribution ◽

Visceral Artery Aneurysms

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Management of mycotic visceral artery aneurysms in the endovascular era: short- and midterm outcome

Chirurgia ◽

10.23736/s0394-9508.18.04944-6 ◽

2020 ◽

Vol 33 (1) ◽

Author(s):

Baker M. Ghoniem ◽

Ahmed A. Shaker ◽

Mahmoud Nasser ◽

Amr Gad

Keyword(s):

Visceral Artery ◽

Midterm Outcome ◽

Visceral Artery Aneurysms

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The Aftermath of a Hepatic Artery Aneurysm—A Rare Etiology of Biliary Obstruction!

Clinical Medicine Insights Gastroenterology ◽

10.1177/1179552217711430 ◽

2017 ◽

Vol 10 ◽

pp. 117955221771143 ◽

Cited By ~ 1

Author(s):

Catherine Linzay ◽

Abhishek Seth ◽

Kunal Suryawala ◽

Ankur Sheth ◽

Moheb Boktor ◽

...

Keyword(s):

Obstructive Jaundice ◽

Hepatic Artery ◽

Significant Risk ◽

Artery Aneurysm ◽

Biliary Tree ◽

Visceral Artery ◽

Biliary Stenting ◽

Hepatic Artery Aneurysm ◽

Skin Imaging ◽

Visceral Artery Aneurysms

Background: Hepatic artery aneurysms (HAAs) constitute 14% to 20% of visceral artery aneurysms. Most HAAs are asymptomatic. Although rare, obstructive jaundice due to external bile duct compression or rupture of the HAA into the biliary tree with occlusion of the lumen from blood clots has been reported. Case presentation: A 56-year-old white man presented to an outside hospital with symptoms of obstructive jaundice, including abdominal pain and yellowing of the skin. Imaging showed a large HAA. Patient was transferred to our hospital where an endoscopic retrograde cholangiopancreatography with biliary stenting was performed. This was followed by coil embolization of the HAA with improvement in symptoms and liver chemistries. Conclusions: Most clinicians agree that management of HAA is highly variable and depends on clinical presentation and anatomic location. Biliary stenting provides temporary relief for patients with obstructive jaundice. Definitive options include open aneurysmal repair versus endovascular therapy. Hepatic artery aneurysms represent a significant risk for hemorrhage and therefore must be addressed promptly once discovered.

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