Multimodal approach to endovascular treatment of visceral artery aneurysms and pseudoaneurysms.
OBJECTIVE
To assess the feasibility and the effectiveness of endovascular treatment of visceral arteries aneurysms (VAAs) using a "multimodal approach".


METHODS
Twenty-five patients (mean age 60.1 years) with 29 VAAs (13 splenic, 4 hepatic, 3 gastroduodenal, 6 renal, 2 pancreatic-duodenal, 1 superior mesenteric) were considered suitable for endovascular treatment; 8/29 were ruptured. Saccular aneurysms (9/29) were treated by sac embolization with coils (in 4 cases associated with cyanoacrylate or thrombin) with preservation of artery patency. Fusiform aneurysms (6/29), were treated by an "endovascular exclusion". In 10/29 cases, supplied by a terminal branch, we performed an embolization of the afferent artery, with coils and cyanoacrylate or thrombin. 2/29 cases were treated with a stent-graft and 2/29 cases with a percutaneous ultrasound-guided thrombin injection and coils embolization of the afferent artery. The follow-up was performed by ultrasonography and/or CT-angiography 1 week after the procedure and then after 1, 6, and 12 months and thereafter annually.


RESULTS
In 29/29 cases we obtained an immediate exclusion. Two patient died for other reasons. Complication rate was 27.6% (7 spleen ischemia and 1 stent-graft occlusion). During the follow-up (range: 7 days-36 months, mean 18.7 months), we observed 3/29 (10.3%) cases of reperfusion in the first month, all treated successfully with a further endovascular procedure. Primary technical success was 89.7%; secondary technical success was 100%.


CONCLUSIONS
Endovascular therapy can be considered a feasible and effective approach for VAAs with good primary and secondary success rates.
Laganà
Domenico
D
Vascular and Interventional Radiology, Department of Radiology, University of Insubria, Varese, Italy.
Carrafiello
Gianpaolo
G
Mangini
Monica
M
Dionigi
Gianlorenzo
G
Caronno
Roberto
R
Castelli
Patrizio
P
Fugazzola
Carlo
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000628:therapy*; D000792:Angiography; D019917:Blood Vessel Prosthesis Implantation; D004621:Embolization, Therapeutic; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography; D014781:Viscera / Q000098:blood supply*