scholarly journals Visceral Artery Aneurysms: Decision Making and Treatment Options in the New Era of Minimally Invasive and Endovascular Surgery

2019 ◽  
Vol 28 (01) ◽  
pp. 011-016 ◽  
Author(s):  
Jun Xu ◽  
Mel Sharafuddin ◽  
John Corson ◽  
Maen Hosn
Keyword(s):  
Mesenteric Artery ◽  
Incidental Finding ◽  
Treatment Options ◽  
Current Treatment ◽  
Celiac Artery ◽  
Visceral Artery ◽  
Management Guidelines ◽  
New Era ◽  
Visceral Artery Aneurysms ◽  
Arterial Aneurysms

AbstractThe abdominal viscera blood supply is derived from anterior branches of the abdominal aorta. Visceral artery aneurysms (VAAs) include aneurysms of the following arteries and their branches: the celiac artery, the hepatic artery, the splenic artery, the superior mesenteric artery, the inferior mesenteric artery, the pancreaticoduodenal artery, and the gastroduodenal artery. Overall VAAs comprise < 2% of all types of arterial aneurysms. Asymptomatic VAAs are now being encountered more frequently due to the widespread use of advanced diagnostic abdominal imaging. The incidental finding of a VAA frequently leaves clinicians with a dilemma as to the best course of management. The focus of this review is on current treatment options and management guidelines for both symptomatic and asymptomatic VAAs.

scholarly journals Current management strategies for visceral artery aneurysms: an overview

Surgery Today ◽  
2019 ◽  
Vol 50 (1) ◽  
pp. 38-49 ◽  
Author(s):  
Hideaki Obara ◽  
Matsubara Kentaro ◽  
Masanori Inoue ◽  
Yuko Kitagawa
Keyword(s):  
Mesenteric Artery ◽  
Management Strategies ◽  
Hybrid Approach ◽  
Celiac Artery ◽  
Visceral Artery ◽  
Anatomical Location ◽  
Current Management ◽  
Risk Of Rupture ◽  
Visceral Artery Aneurysms ◽  
History Of

Abstract Visceral artery aneurysms (VAAs) are rare and affect the celiac artery, superior mesenteric artery, and inferior mesenteric artery, and their branches. The natural history of VAAs is not well understood as they are often asymptomatic and found incidentally; however, they carry a risk of rupture that can result in death from hemorrhage in the peritoneal cavity, retroperitoneal space, or gastrointestinal tract. Recent advances in imaging technology and its availability allow us to diagnose all types of VAA. VAAs can be treated by open surgery, laparoscopic surgery, endovascular therapy, or a hybrid approach. However, there are still no specific indications for the treatment of VAAs, and the best strategy depends on the anatomical location of the aneurysm as well as the clinical presentation of the patient. This article reviews the literature on the etiology, clinical features, diagnosis, and anatomic characteristics of each type of VAA and discusses the current options for their treatment and management.

scholarly journals Celiacomesenteric trunk associated with superior mesenteric artery aneurysm: A case report and review of literature

2020 ◽  
Vol 8 ◽  
pp. 2050313X2093824
Author(s):  
Walid Alam ◽  
Mohammed Hussein Kamareddine ◽  
Amine Geahchan ◽  
Youssef Ghosn ◽  
Michel Feghaly ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Incidental Finding ◽  
Imaging Techniques ◽  
Artery Aneurysm ◽  
Celiac Trunk ◽  
Visceral Artery ◽  
Diffuse Abdominal Pain ◽  
Visceral Artery Aneurysms ◽  
Celiacomesenteric Trunk

In rare cases, the celiac artery and the superior mesenteric artery arise from a common origin known as a common celiacomesenteric trunk. Celiac trunk stenosis or occlusion has been reported to accompany this anatomical aberrancy. Even rarer, are aneurysms associated with this common celiacomesenteric trunk. In general, visceral artery aneurysms are uncommon. We hereby present a 39-year-old female patient with a 1-month history of mild diffuse abdominal pain, with an incidental finding of superior mesenteric artery aneurysm on abdominal ultrasound. Subsequent contrast-enhanced computed tomography revealed severe narrowing of the celiac trunk and saccular aneurysmal dilatation of the superior mesenteric artery. Coil embolization of the aneurysm was performed, while maintaining persistent flow in the superior mesenteric artery and celiacomesenteric trunk. Visceral artery aneurysms are increasingly being identified incidentally with improvement in imaging techniques. The question lies whether to treat these aneurysms or observe. No universal guidelines exist regarding that matter, but the decision to intervene is made based on aneurysm location, size, and patient characteristics.

scholarly journals An inferior mesenteric artery aneurysm in a patient with renal cell carcinoma

2020 ◽  
Vol 28 (4) ◽  
pp. 680-683
Author(s):  
Bülent Mert
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Left Kidney ◽  
Artery Aneurysm ◽  
Visceral Artery ◽  
Left Renal Artery ◽  
Visceral Artery Aneurysms

An inferior mesenteric artery aneurysm is considered one of the visceral artery aneurysms, which is extremely rare, although its incidence of detection has been increasing in recent years. A 59-year-old male patient with a renal cell carcinoma in the left kidney was diagnosed with an inferior mesenteric artery aneurysm and treated surgically. Computed tomography revealed atrophy of the right kidney and occlusion of the celiac trunk, superior mesenteric artery, and left renal artery. There were no complications during the hospital stay and no mortality or morbidity was observed at three months of follow-up. In conclusion, the treatment of inferior mesenteric artery aneurysms is usually recommended, due to possible complications such as rupture and thromboembolism with high mortality and morbidity rates.

Visceral Artery Aneurysms

2015 ◽  
Author(s):  
Louise A. Corle ◽  
Erica L. Mitchell
Keyword(s):  
Early Recognition ◽  
Imaging Techniques ◽  
Celiac Artery ◽  
Liver Trauma ◽  
Preoperative Imaging ◽  
Visceral Artery ◽  
Management Options ◽  
Visceral Artery Aneurysms ◽  
Arterial Trauma ◽  
Splanchnic Artery

Although rare, visceral artery aneurysms are being increasingly identified with the widespread use of advanced imaging techniques. Their incidence, based on routine autopsies, has been estimated at 0.01 to 0.2% but is thought to be increasing with the rise in percutaneous biliary procedures, endovascular chemoembolization therapies, liver transplantation, arterial trauma secondary to laparoscopic manipulation of vessels, and a trend toward nonoperative management of blunt liver trauma. The morbidity and mortality associated with visceral aneurysms remain high—up to 22% in some reports. Therefore, early recognition and treatment prior to rupture are a priority. Management is evolving and includes open repair, laparoscopic and robotic-assisted repair, and a more important role for endovascular therapies. This review covers splenic artery aneurysms, hepatic artery aneurysms, superior mesenteric artery aneurysms, celiac artery aneurysms, and gastroduodenal and pancreaticoduodenal artery aneurysms. Tables highlight the estimated frequency of aneurysms by anatomic distribution, current management options, etiology of splanchnic artery aneurysms, average visceral artery diameters, and preoperative imaging options. Angiographic images and intraoperative photos are provided. This review contains 12 figures, 5 tables, and 25 references.

The Potential Impacts of Tylophora Alkaloids and their Derivatives in Modulating Inflammation, Viral Infections, and Cancer

2019 ◽  
Vol 26 (25) ◽  
pp. 4709-4725 ◽  
Author(s):  
Duc-Hiep Bach ◽  
Sang Kook Lee
Keyword(s):  
Immune Modulation ◽  
Antitumor Agents ◽  
Viral Infections ◽  
Treatment Options ◽  
Current Treatment ◽  
Cytotoxic Agents ◽  
Targeted Agents ◽  
Cancer Treatments ◽  
New Era ◽  
Cancer Pathogenesis

Cancer chemotherapies or antitumor agents mainly remain the backbone of current treatment based on killing the rapidly dividing cancer cell such as tylophora alkaloids and their analogues which have also demonstrated anticancer potential through diverse biological pathways including regulation of the immune system. The introduction of durable clinically effective monoclonal antibodies, however, unmasked a new era of cancer immunotherapies. Therefore, the understanding of cancer pathogenesis will provide new possible treatment options, including cancer immunotherapy and targeted agents. Combining cytotoxic agents and immunotherapies may offer several unique advantages that are complementary to and potentially synergistic with biologic modalities. Herein, we highlight the dynamic mechanism of action of immune modulation in cancer and the immunological aspects of the orally active antitumor agents tylophora alkaloids and their analogues. We also suggest that future cancer treatments will rely on the development of combining tumor-targeted agents and biologic immunotherapies.

Incidence, morbidity, and mortality of traumatic superior mesenteric artery injuries compared to other visceral arteries

Vascular ◽  
2019 ◽  
Vol 28 (2) ◽  
pp. 142-151
Author(s):  
Shelley Maithel ◽  
Areg Grigorian ◽  
Roy M Fujitani ◽  
Nii-Kabu Kabutey ◽  
Brian M Sheehan ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Celiac Artery ◽  
Visceral Artery ◽  
Trauma Patients ◽  
Mechanism Of Injury ◽  
Artery Injury ◽  
Risk Of Mortality ◽  
Increased Risk

Objectives Celiac artery, superior mesenteric artery, and inferior mesenteric artery injuries are often grouped together as major visceral artery injuries with an incidence of <1%. The mortality rates range from 38–75% for celiac artery injuries and 25–68% for superior mesenteric artery injuries. No large series have investigated the mortality rate of inferior mesenteric artery injuries. We hypothesize that from all the major visceral artery injuries, superior mesenteric artery injury leads to the highest risk of mortality in adult trauma patients. Methods The Trauma Quality Improvement Program (2010–2016) was queried for patients with injury to the celiac artery, superior mesenteric artery, or inferior mesenteric artery. A multivariable logistic regression model was used for analysis. Separate subset analyses using blunt trauma patients and penetrating trauma patients were performed. Results From 1,403,466 patients, 1730 had single visceral artery injuries with 699 (40.4%) involving the celiac artery, 889 (51.4%) involving the superior mesenteric artery, and 142 (8.2%) involving the inferior mesenteric artery. The majority of patients were male (79.2%) with a median age of 39 years old, and median injury severity score of 22. Compared to celiac artery and inferior mesenteric artery injuries, superior mesenteric artery injuries had a higher rate of severe (grade >3) abbreviated injury scale for the abdomen (57.5% vs. 42.5%, p < 0.001). The overall mortality for patients with a single visceral artery injury was 20%. Patients with superior mesenteric artery injury had higher mortality compared to those with celiac artery and inferior mesenteric artery injuries (23.7% vs. 16.3%, p < 0.001). After controlling for covariates, traumatic superior mesenteric artery injury increased risk of mortality (OR = 1.72, CI = 1.24–2.37, p < 0.01) in adult trauma patients, while celiac artery ( p = 0.59) and inferior mesenteric artery ( p = 0.31) injury did not. After stratifying by mechanism, superior mesenteric artery injury increased risk of mortality (OR = 3.65, CI = 2.01–6.45, p < 0.001) in adult trauma patients with penetrating mechanism of injury but not in those with blunt force mechanism (OR = 1.22, CI = 0.81–1.85, p = 0.34). Conclusions Compared to injuries of the celiac artery and inferior mesenteric artery, traumatic superior mesenteric artery injury is associated with a higher mortality. Moreover, while superior mesenteric artery injury does not act as an independent risk factor for mortality in adult patients with blunt force trauma, it nearly quadruples the risk of mortality in adult trauma patients with penetrating mechanism of injury. Future prospective research is needed to confirm these findings and evaluate factors to improve survival following major visceral artery injury.

Comparison of open surgery and endovascular procedures as a therapeutic choice for visceral artery aneurysms

Vascular ◽  
2017 ◽  
Vol 26 (4) ◽  
pp. 387-392 ◽  
Author(s):  
Chao Song ◽  
Jian Dong ◽  
Guanyu Yu ◽  
Jian Zhou ◽  
Feng Xiang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Endovascular Repair ◽  
Open Surgery ◽  
Endovascular Procedures ◽  
Visceral Artery ◽  
Complication Rates ◽  
Term Survival ◽  
Visceral Artery Aneurysms ◽  
Perioperative Complication ◽  
Arterial Aneurysms

Objectives Visceral arterial aneurysms may be treated using open surgery or endovascular repair, but the best approach remains controversial. This was a retrospective study aiming to compare open surgery and endovascular treatment strategies for visceral arterial aneurysms. Methods The study included all 93 patients who were admitted with visceral artery aneurysms between January 2001 and January 2011 at the Department of Vascular Surgery, Changhai Hospital, Shanghai, China. All cases underwent either open or endovascular procedures. Overall survival and adverse events were compared between the groups. Success rate, blood loss, length of surgery, and length of hospital stay were also compared. The patients were followed up at three, six, and 12 months then every year until April 2014. Results Open surgery was performed on 34 patients and endovascular procedures on 59. There were no differences in characteristics of the patients between the open surgery and endovascular groups. The perioperative complication rate was 52.9 and 13.6% in the open surgery and endovascular groups, respectively. Mean follow-up was 36.8 months (range: 11 months to 10 years). The one- and five-year survival rates were 100 and 60.6%, respectively, in the open surgery group, compared to 100 and 84.5% in the endovascular group. Multivariate analysis for factors related to overall survival showed that there was a significant relationship with the treatment approach (HR = 0.479, 95%CI: 0.278–0.825; P = 0.008) and the presence of false aneurysm (HR = 2.929, 95%CI: 1.388–6.180, P = 0.005). Conclusions Endovascular repair could be considered as an effective method for visceral artery aneurysm. Endovascular repair showed lower perioperative complication rates and better long-term survival.

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