The Endovascular Treatment Of Visceral Aneurysms: Single Center Experience
ROBERTO GATTUSO, Associated Professor, MD, FEBVS, OMBRETTA MARTINELLI, MD, Giglio Alessandra, LUIGI IRACE, MD, BRUNO GOSSETTI, MD, Professor.
SAPIENZA UNIVERSITY - ROME - ITALY, rome, Italy.
Objective(s): Visceral artery aneurysms (VAA) represent a pathological condition with high mortality rates, because of their high frequency of rupture and consequent fatal bleeding (22% - 70%). The increased incidental detection related to frequent use of advanced imaging technology let vascular surgeons must choose between endovascular or open surgical treatment. The primary end points of this retrospective study is: evaluation of technical success and periprocedural mortality rate; the first is defined as the successful exclusion of the true aneurysm from the main stream of the blood flow as confirmed by completion angiography and the second as the mortality incidence within the first 30 days after the treatment. Methods: From January 1992 to December 2015, 122 open and endovascular interventions for VAA were performed. The preoperative diagnostic workup consists of computed tomography, CTscan. The treatment option was endovascular in 52/122 (42.6%) cases, of which 25 were treated by embolizations, while 27 with covered stents deployment. In more than half of the cases, 69/122 (56.5%), open surgical treatment was preferred, with 24 resections and 45 reconstructions. In one case, the endovascular treatment failed because of superior mesenteric artery dissection during the procedure. In 20 cases (29%), surgery was performed in emergency conditions. Follow-up consisted of clinical and ultrasound scan examination, at 1, 6, and 12 months, and yearly thereafter, covering a period of 60 months. All patients had at least on CT scan during follow-up. Results: In the endovascular group, the intra and post-operative mortality was nil. In this group, major complications were intestinal ischemia for superior mesenteric artery dissection and a massive splenic hematoma. In the surgical group, 8 patients, treated in emergency, died (40% mortality).
There is no standardized consensus regarding the indications for treatment of VAA. Generally, these should always be treated if: symptomatic, larger than 2 cm in a good-risk surgical candidate, with a rapid growth of more than 0.5 cm/year, when present in a pregnant women or those of childbearing age, or in patients undergoing an orthotopic liver transplantation. In the emergent setting, the endovascular approach should be considered as first choice. When electively performed, endovascular treatment has shown good results in the short and mid term and so it rapresent the first option in our experience
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