Treatment of a celiac artery aneurysm with endovascular stent grafting--a case report.
As a result of more sophisticated and more commonly performed investigative procedures, aneurysms of the visceral abdominal vasculature, including celiac artery aneurysms, are increasingly recognized. Traditional therapy for visceral artery aneurysms has been limited to open aneurysmectomy or aneurysmorrhaphy to prevent catastrophic aneurysmal rupture. However, these procedures are associated with significant postoperative morbidity and mortality despite technical successes. High complication rates are likely related to poor preoperative conditions among the patient population typically presenting with these visceral artery aneurysms. This report introduces an alternative therapy for visceral artery aneurysms and highlights the potential for catheter-based interventions. This case report depicts a 61-year-old morbidly obese woman diagnosed with a 10-centimeter celiac artery aneurysm during investigation of upper abdominal pain. Given the patient's poor medical condition, punctuated by hemodynamic instability, open operation was avoided, and percutaneous embolization was not feasible owing to a large aneurysm neck. Therefore, inflow to the celiac artery aneurysm was excluded by placing a modular stent graft component within the abdominal aorta at the celiac artery orifice. During the intervening 12 months since stent graft deployment, the aneurysm sac diameter has steadily decreased, as determined by serial computed tomography scans. This report underscores the potential for catheter-based techniques to offer new therapeutic options for patients with visceral artery aneurysms. Careful individualization is required given the highly variable size, location, and character of such lesions.
Atkins
B Zane
BZ
Department of Surgery, Duke University Medical Center, Durham, NC, USA. broadus.atkins@lackland.af.mil
Ryan
J Mark
JM
Gray
John L
JL
D000783:Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D000792:Angiography / Q000379:methods; D017130:Angioplasty / Q000295:instrumentation* / Q000379:methods; D002445:Celiac Artery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications; D018570:Risk Assessment; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome