Natural History of Unruptured Visceral Artery Aneurysms Due to Segmental Arterial Mediolysis and Efficacy of Transcatheter Arterial Embolization: A Retrospective Multiinstitutional Study in Japan

Thirty-three consecutive patients with previously untreated hepatocellular carcinoma (HCC) and 6 patients with recurrent HCC were treated with transcatheter arterial embolization (TAE). The patients were not eligible for surgical resection or percutaneous ethanol injection. TAE was performed with Lipiodol Ultra-Fluid, epidoxorubicin and Gelfoam, with a mean of 1.7 treatments per patient. CT was performed 15 days after TAE. The mean cumulative survival was 14.2 months in patients with previously untreated HCC. The survival of patients stages Okuda I and II did not differ significantly (p > 0.05); tumor size did not affect survival (p > 0.05). Two patients with recurrent HCC died 7.0 and 9.3 months after the diagnosis of tumor recurrence; the remaining 4 patients are still alive with a maximum follow-up of 22.5 months from the diagnosis of HCC recurrence. Ten complications occurred in 8 patients, and were controlled by medical therapy. Eleven patients died during the study; no death was related to TAE. The series was not randomized, but comparison with the natural history of HCC suggests that TAE is effective as palliative treatment of advanced or recurrent HCC.

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Current management strategies for visceral artery aneurysms: an overview

Surgery Today ◽

10.1007/s00595-019-01898-3 ◽

2019 ◽

Vol 50 (1) ◽

pp. 38-49 ◽

Cited By ~ 8

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.

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Successful hybrid treatment for huge visceral artery aneurysms with contained rupture complicating segmental arterial mediolysis

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivv249 ◽

2015 ◽

pp. ivv249 ◽

Cited By ~ 1

Author(s):

Yasutoshi Kimura ◽

Toshiro Ito ◽

Masafumi Imamura ◽

Koichi Hirata

Keyword(s):

Visceral Artery ◽

Hybrid Treatment ◽

Segmental Arterial Mediolysis ◽

Visceral Artery Aneurysms

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Safety of Transcatheter Arterial Embolization for Visceral Artery Pseudoaneurysms: Incidence of Intraprocedural Rupture

Vascular and Endovascular Surgery ◽

10.1177/1538574421992938 ◽

2021 ◽

Vol 55 (4) ◽

pp. 361-366

Author(s):

Masashi Shimohira ◽

Keiichi Nagai ◽

Kengo Ohta ◽

Yusuke Sawada ◽

Keita Nakayama ◽

...

Keyword(s):

Success Rate ◽

Transcatheter Arterial Embolization ◽

Arterial Embolization ◽

Major Complication ◽

Visceral Artery ◽

Technical Success ◽

Advanced Level ◽

Technical Success Rate ◽

A Minor

Introduction: Transcatheter arterial embolization is the first-line treatment for visceral artery pseudoaneurysms (VAPAs); however, the intraprocedural rupture of pseudoaneurysms is an important complication. The present study was performed to evaluate the safety of embolization for VAPAs, including the incidence of intraprocedural rupture. Methods: Among 56 consecutive patients with 57 VAPAs who underwent treatment between April 2009 and October 2020, 46 patients with 47 VAPAs underwent embolization. Complications related to embolization including intraprocedural rupture, the technical success rate, and clinical outcomes were evaluated. Complications that required extended hospitalization, an advanced level of care, or resulted in permanent adverse sequelae or death were classified as major complications, while the remainder were considered to be minor. Technical success was defined as the completion of embolization. Results: The intraprocedural rupture of pseudoaneurysms occurred in 3 out of 47 VAPAs treated with embolization (6%) and resulted in minor complications. One liver abscess requiring drainage was regarded as a major complication (2%). Focal infarction after embolization was observed as a minor complication in 20 cases. Complications occurred in 24 out of 47 cases (51%), comprising one major complication (2%) and 23 minor complications (48%). The technical success rate was 100% (47/47). Fifty-three out of 56 patients (95%) were alive in a median follow-up period of 18 months (range: 2 days-137 months). Conclusions: Embolization is safe and useful for the treatment of VAPAs; however, the intraprocedural rupture of pseudoaneurysms may occur, and, thus, care is needed during this procedure.

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Successful Transcatheter Arterial Embolization of a Ruptured Left Gastroepiploic Artery Aneurysm Caused by Segmental Arterial Mediolysis

The Japanese Journal of Gastroenterological Surgery ◽

10.5833/jjgs.2014.0028 ◽

2015 ◽

Vol 48 (3) ◽

pp. 255-263 ◽

Cited By ~ 2

Author(s):

Takahiro Asada ◽

Katsumi Koshikawa ◽

Koichi Sawaki ◽

Tetsuji Yoneyama ◽

Tomoki Fukuoka ◽

...

Keyword(s):

Transcatheter Arterial Embolization ◽

Artery Aneurysm ◽

Arterial Embolization ◽

Gastroepiploic Artery ◽

Segmental Arterial Mediolysis

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Transcatheter Arterial Embolization Treatment for Bleeding Visceral Artery Pseudoaneurysms in Patients with Pancreatitis or following Pancreatic Surgery

Cancers ◽

10.3390/cancers12102733 ◽

2020 ◽

Vol 12 (10) ◽

pp. 2733

Author(s):

Isao Numoto ◽

Masakatsu Tsurusaki ◽

Teruyoshi Oda ◽

Yukinobu Yagyu ◽

Kazunari Ishii ◽

...

Keyword(s):

Transcatheter Arterial Embolization ◽

Clinical Success ◽

Arterial Embolization ◽

Bleeding Complications ◽

Visceral Artery ◽

Recurrent Bleeding ◽

Success Rates ◽

Embolization Treatment ◽

Clinically Significant ◽

Ischemic Events

Purpose: To evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for pseudoaneurysms occurring secondary to pancreatitis or because of leakage of pancreatic juice after pancreatectomy. Materials and Methods: This retrospective study included 42 consecutive patients (38 males and 4 females; mean age, 60 years; range, 33–80 years) who underwent TAE for bleeding visceral artery pseudoaneurysms between March 2004 and December 2018. The technical and clinical success rates, incidence of recurrent bleeding, complications, including pancreatitis, and overall survival after TAE were evaluated. Results: Of the 42 enrolled patients, 23 had bleeding due to a complication of pancreatectomy and 19 had bleeding as a complication of pancreatitis. TAE with N-butyl cyanoacrylate (NBCA) or NBCA plus microcoils recurrent bleeding or inability to control bleeding was 15.8% (3 of 19) following TAE with NBCA and 17.4% (4 of 23) following TAE with coils. No clinically significant ischemic events of the pancreas or duodenum were observed in the embolized areas. Serum amylase did not increase compared with the initial levels after any of the procedures. At 30 days after TAE, 32 patients were alive. Conclusion: TAE has a high success rate for the management of hemorrhage, with few complications. The procedure appears to be safe and effective for pseudoaneurysms associated with either pancreatitis or pancreatectomy.

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