Excluding Gastroduodenal Artery Pseudoaneurysm from Circulation with Stent-Graft

Introduction. Aneurysms of visceral arteries in the abdominal cavity are very rare. Often aneurysms of branches of the abdominal aorta are an incidental finding as patients seldom present obvious clinical signs or pathological changes in the organ supplied by the artery involved. The incidence of aneurysms of branches connecting the celiac trunk and the upper mesenteric artery amounts to 3.5% of all the cases of aneurysms of abdominal aorta arteries, mostly the gastroduodenal artery. This paper presents a case of minimally invasive treatment of gastroduodenal artery pseudoaneurysm at the BSMU Clinic.Materials and methods. Patient K, a 47-year-old female, was admitted for emergency treatment at the Bashkir State Medical University Clinic in May 2019. The patient’s complaints included feeling weak, black stool for seven days prior, faintness and epigastric pain.Results and discussions. Instrumental examination and angiography data demonstrated that the size of the pseudoaneurysm has increased 2.5 times and reached 65×45 mm; the clinical picture led to the conclusion that the aneurysm was ready to rupture and that there was an immediate need to stop the blood flow to the gastroduodenal artery pseudoaneurysm.Conclusion. The range of currently available image-guided surgical procedures makes it possible to perform adequate embolization of pathological structures such as artery aneurysms.

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A challenging case of epigastric pain: diagnosis and mini-invasive treatment of a large gastroduodenal artery pseudoaneurysm

BMJ Case Reports ◽

10.1136/bcr.02.2012.5873 ◽

2012 ◽

Vol 2012 (sep13 1) ◽

pp. bcr0220125873-bcr0220125873 ◽

Cited By ~ 2

Author(s):

E. Mazza ◽

D. Abdulcadir ◽

C. Raspanti ◽

M. Acquafresca

Keyword(s):

Epigastric Pain ◽

Gastroduodenal Artery ◽

Invasive Treatment ◽

Artery Pseudoaneurysm ◽

Pain Diagnosis

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Splanchnic artery aneurysms

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0608283d ◽

2006 ◽

Vol 134 (7-8) ◽

pp. 283-289 ◽

Cited By ~ 2

Author(s):

Lazar Davidovic ◽

Miroslav Markovic ◽

Milos Bjelovic ◽

Slobodan Cvetkovic

Keyword(s):

Arteriovenous Fistula ◽

Abdominal Aorta ◽

Splenic Artery ◽

Splenic Vein ◽

Artery Aneurysm ◽

Celiac Trunk ◽

Gastroduodenal Artery ◽

Reconstructive Procedures ◽

Splanchnic Artery Aneurysm ◽

Splanchnic Artery

Introduction. Splanchnic artery aneurysms are uncommon but important vascular entity because nearly 25% of all cases present as surgical emergency. Objective. 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. Method. 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. Results. 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. CONCLUSION 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.

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Unusual case of upper gastrointestinal haemorrhage secondary to a ruptured gastroduodenal artery pseudoaneurysm: case presentation and literature review

BMJ Case Reports ◽

10.1136/bcr-2020-236463 ◽

2020 ◽

Vol 13 (11) ◽

pp. e236463

Author(s):

Gasim Ahmed ◽

Mehsim Abid ◽

Sharath Hosmane ◽

Smitha Mathew

Keyword(s):

Epigastric Pain ◽

Gastrointestinal Haemorrhage ◽

Gastroduodenal Artery ◽

Laboratory Evaluation ◽

Blood Collection ◽

Upper Gastrointestinal Endoscopy ◽

Amylase Level ◽

Dark Blood ◽

Artery Pseudoaneurysm ◽

Upper Gastrointestinal

Pseudoaneurysm rupture of the gastroduodenal artery (GDA) is life-threatening and can present as an acute upper gastrointestinal haemorrhage. Here, we present a case of upper gastrointestinal haemorrhage arising from a ruptured GDA pseudoaneurysm. A 56-year-old woman presented acutely with haematemesis. She reported ongoing upper epigastric pain for a few weeks. Laboratory evaluation revealed severe microcytic hypochromic anaemia (haemoglobin, 69 g/L; normal, 120–140 g/L) and a mildly raised serum amylase level. Upper gastrointestinal endoscopy revealed dark blood collection between the rugae of the distal stomach. An abdominal CT scan detected a homogeneously enhancing rounded lesion arising from the GDA adjacent to the second part of the duodenum. The median arcuate ligament was causing stenosis of the coeliac axis origin. The diagnosis of haematemesis secondary to a ruptured GDA pseudoaneurysm was confirmed by mesenteric angiography, and aneurysmal embolisation was done. The haemoglobin level stabilised after aneurysmal embolisation.

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Interrelationship of dyslipidemia with indicators of regional hemodynamics in patients with atherosclerosis of the visceral branches of the abdominal aorta

Regional blood circulation and microcirculation ◽

10.24884/1682-6655-2016-15-3-44-49 ◽

2016 ◽

Vol 15 (3) ◽

pp. 44-49 ◽

Cited By ~ 1

Author(s):

A. S. Kuznetsova

Keyword(s):

Shear Rate ◽

Total Cholesterol ◽

Abdominal Aorta ◽

Apolipoprotein B ◽

Regional Blood Flow ◽

Celiac Trunk ◽

Apolipoprotein A1 ◽

Inverse Association ◽

Remnant Cholesterol ◽

Visceral Arteries

Introduction and aim - to determine the relationship of dyslipidemia and endothelial shear rate in the unpaired visceral arteries in patients with atherosclerosis in the abdominal aorta pool. Mathereals and methods. The study included 50 people. All patients were examined by a single protocol. Conduct a full clinical-laboratory and instrumental examination, supplemented by the following laboratory parameters: total cholesterol (TC), triglycerides, HDL, LDL, apolipoprotein A1, apolipoprotein B, Remnant cholesterol calculated using the formula: total cholesterol - (HDL+LDL). All patients underwent Doppler ultrasound unpaired branches of the abdominal aorta ultrasound scanner Voluson E6 (General Electric) was performed, Toshiba Aplio 500. Measurement of the shear rate (shear rate) is determined by the formula: SR=4xVpeak/Vd, Vpeak - peak flow rate visceral branches of the abdominal aorta, Vd - end-diastolic diameter of the visceral branches of the abdominal aorta. Results and discussion. The analysis of the various characteristics of the regional blood flow showed lower values of shear rate in the celiac trunk in patients with atherosclerosis of the visceral branches of the aorta. In the group of patients with abdominal aortic atherosclerosis pool demonstrated significantly lower levels of HDL, higher levels of VLDL, atherogenic factor, apolipoprotein B, triglycerides and Remnant cholesterol. Correlation analysis revealed an inverse association between the level of Remnant cholesterol and shear rate in the celiac trunk (r = -0.284, p = 0.04). Conclusions. The development of atherosclerosis in the celiac trunk and/or the superior mesenteric artery is associated with higher triglycerides, VLDL, Remnant cholesterol, apoliporoteinom B. In patients with atherosclerosis of visceral arteries decrease in endothelial shear rate in the celiac trunk was correlated with increased levels of Remnant cholesterol.

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Ultrasound-Guided Radiofrequency Ablation of Chemodectomas in Five Dogs

Animals ◽

10.3390/ani11102790 ◽

2021 ◽

Vol 11 (10) ◽

pp. 2790

Author(s):

Pablo Gómez Ochoa ◽

María Dolores Alférez ◽

Ignacio de Blas ◽

Telmo Fernendes ◽

Xavier Sánchez Salguero ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Clinical Management ◽

Incidental Finding ◽

Clinical Signs ◽

Frictional Heat ◽

Coagulation Necrosis ◽

Invasive Treatment ◽

Electrical Currents ◽

Low Prevalence ◽

Time Of Presentation

Chemodectomas are low prevalence tumors with complex clinical management. Many present as an incidental finding however, in other dogs, they produce pericardial effusion and/or compression, leading to the appearance of severe clinical signs. There are currently several approaches: surgery, radiotherapy, stent placement and chemotherapy. This is the first description of percutaneous echo-guided radiofrequency ablation of aortic body tumors. This minimally invasive treatment is based on high frequency alternating electrical currents from an electrode that produces ionic agitation and generates frictional heat, causing coagulation necrosis. Five dogs with an echocardiographic and cytological diagnosis of chemodectoma underwent percutaneous echo-guided radiofrequency ablation. At the time of presentation, all the dogs showed clinical signs, such as ascites and/or collapse. There were no complications either during the procedure or in the following 24 hours. Rapid clinical improvement associated with a reduction in size and change in sonographic appearance of the mass were achieved with no complications. Six months follow-up was carried out in all dogs. A second percutaneous echo-guided RFA was performed eight months after the first procedure in one dog. Based on our experience, radiofrequency ablation seems to be a feasible and safe technique, making it a potential alternative therapeutic approach in the clinical management of aortic body tumors leading to severe clinical compromise.

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Massive hemobilia caused by rupture of gastroduodenal artery pseudoaneurysm, a delayed complication of laparoscopic cholecystectomy: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02915-1 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Kurniawan Kurniawan ◽

I Dewa Nyoman Wibawa ◽

Gde Somayana ◽

I Ketut Mariadi ◽

I Made Mulyawan

Keyword(s):

Laparoscopic Cholecystectomy ◽

Gastrointestinal Bleeding ◽

Abdominal Trauma ◽

Upper Gastrointestinal Bleeding ◽

Rare Complication ◽

Gastroduodenal Artery ◽

Time Interval ◽

Artery Pseudoaneurysm ◽

History Of ◽

Upper Gastrointestinal

Abstract Background Hemobilia is a rare cause of upper gastrointestinal bleeding that originates from the biliary tract. It is infrequently considered in diagnosis, especially in the absence of abdominal trauma or history of hepatopancreatobiliary procedure, such as cholecystectomy, which can cause arterial pseudoaneurysm. Prompt diagnosis is crucial because its management strategy is distinct from other types of upper gastrointestinal bleeding. Here, we present a case of massive hemobilia caused by the rupture of a gastroduodenal artery pseudoaneurysm in a patient with a history of laparoscopic cholecystectomy 3 years prior to presentation. Case presentation A 44-year-old Indonesian female presented to the emergency department with complaint of hematemesis and melena accompanied by abdominal pain and icterus. History of an abdominal trauma was denied. However, she reported having undergone a laparoscopic cholecystectomy 3 years prior to presentation. On physical examination, we found anemic conjunctiva and icteric sclera. Nonvariceal bleeding was suspected, but esophagogastroduodenoscopy showed a blood clot at the ampulla of Vater. Angiography showed contrast extravasation from a gastroduodenal artery pseudoaneurysm. The patient underwent pseudoaneurysm ligation and excision surgery to stop the bleeding. After surgery, the patient’s vital signs were stable, and there was no sign of rebleeding. Conclusion Gastroduodenal artery pseudoaneurysm is a rare complication of laparoscopic cholecystectomy. The prolonged time interval, as compared with other postcholecystectomy hemobilia cases, resulted in hemobilia not being considered as an etiology of the gastrointestinal bleeding at presentation. Hemobilia should be considered as a possible etiology of gastrointestinal bleeding in patients with history of cholecystectomy, regardless of the time interval between the invasive procedure and onset of bleeding.

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Right inferior phrenic artery pseudoaneurysm after a laparoscopic gastrectomy: a case report

Surgical Case Reports ◽

10.1186/s40792-019-0739-x ◽

2019 ◽

Vol 5 (1) ◽

Author(s):

Kaoruko Funakoshi ◽

Yuji Ishibashi ◽

Shuntaro Yoshimura ◽

Ryoto Yamazaki ◽

Fumihiko Hatao ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Dissection ◽

Laparoscopic Gastrectomy ◽

Rare Complication ◽

Clinical Signs ◽

Node Dissection ◽

Artery Pseudoaneurysm ◽

Inferior Phrenic Artery ◽

Thermal Spread ◽

Phrenic Artery

Abstract Background Ruptured pseudoaneurysms are a rare complication of gastrectomy, but when they do develop, they are often fatal. We presented herein the first report of a case of pseudoaneurysm arising from the right inferior phrenic artery (RIPA) after a laparoscopic gastrectomy. Case presentation A 61-year-old male patient underwent a laparoscopic distal gastrectomy and D1+ lymph node dissection with Roux-en-Y reconstruction for early gastric cancer. He was discharged on postoperative day (POD) 9 without any complications, such as anastomotic or pancreatic leakage. On POD 19, he was referred to the emergency room for upper abdominal pain. Enhanced abdominal computed tomography revealed a 60 × 70 mm hematoma, indicating intra-abdominal bleeding and a 10-mm pseudoaneurysm in the RIPA. Selective digital subtraction angiography confirmed the presence of a pseudoaneurysm in the RIPA, which was embolized using multiple microcoils. Thereafter, no clinical signs were observed, and the patient was discharged from the hospital 15 days after angiography without any recurrence of bleeding. We hypothesized that the cause of the pseudoaneurysm was mechanical vascular injury due to the thermal spread of the ultrasonically activated devices (USADs) during lymphatic node dissection. Conclusion Given the thermal spread of USADs, safe and appropriate lymph node dissection based on precise anatomical knowledge is crucial to preventing postoperative pseudoaneurysms.

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