[Differential Vascular Medical Management of Visceral Artery Aneurysms in a Single-Centre Consecutive Patient Cohort as Part of an Ongoing Disease-Specific Systematic Clinical Prospective Observational Study].
OBJECTIVE
By means of a systematic single-centre prospective observational study, spectrum (symptomatology, frequency) and diagnostics of the different visceral artery aneurysm sites as well as the postinterventional course of the various therapeutic options used according to local finding and patient's clinical status as well as risk factors were analysed to contrast the different procedures (conservative, image-guided radiological intervention, open vascular surgery) in consideration of their decision-making criteria and their early postinterventional outcome (on the basis of complication rate, peri-interventional morbidity and hospital lethality) including relevant references from the literature.


RESULTS
During a time period of 14 years, 22 patients (sex ratio: 12 males/10 females; mean age: 54.3 [range: 22-76] years) were registered. Most frequently, visceral artery aneurysms occurred in the splenic artery (50 %). The gastroduodenal artery, the hepatic artery and the right renal artery were affected in each with 13.6 % (n = 3/22), the superior mesenteric artery in 9.1 % (n = 2/22). The majority of patients (54.5 %) were treated with image-guided radiological intervention, whereas in 31.8 %, the patient underwent open vascular surgery and 13.6 % of cases were managed with "watchful waiting". While morbidity was 21.1 % (n = 4/19), overall lethality was 9.1 % (n = 2/22).


CONCLUSIONS
Decision-making for a specific therapeutic approach should be made (i) after adequate diagnostic measures (transabdominal ultrasound, MR angiography, duplex ultrasonography, CT-A/DSA if required), (ii) on an individual case-adapted base, (iii) in a vascular surgical centre, (iv) case-associated to the specific local finding (in particular, according to size/specific probability of rupture [cave: gravidity]) and (v) according to the individual risk profile using the whole spectrum of therapeutic options (conservative vs. interventional; image-guided radiological intervention [endovascular repair such as embolisation, stent or stent graft] vs. open vascular surgery [according to a step-up approach]; open vascular ligation vs. reconstruction after exclusion of the aneurysm) including sufficient quality assurance of the treatment results as well as control investigations (duplex ultrasonography; MR-A if required) in a specialised vascular surgical out-patient centre within appropriate time intervals.
Arbeitsbereich Gefäßchirurgie, Klinik für Allgemein-, Viszeral- & Gefäßchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland.
V
V
Scholtz
Arbeitsbereich Gefäßchirurgie, Klinik für Allgemein-, Viszeral- & Gefäßchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland.
F
F
Meyer
Arbeitsbereich Gefäßchirurgie, Klinik für Allgemein-, Viszeral- & Gefäßchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland.
A
A
Udelnow
Klinik für Radiologie & Nuklearmedizin, Universitätsklinikum Magdeburg A. ö. R., Deutschland.
M
M
Pech
Arbeitsbereich Gefäßchirurgie, Klinik für Allgemein-, Viszeral- & Gefäßchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland.
Z
Z
Halloul
D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000175:diagnosis / Q000601:surgery*; D015901:Angiography, Digital Subtraction; D019917:Blood Vessel Prosthesis Implantation; D015331:Cohort Studies; D020000:Decision Support Systems, Clinical; D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents; D025321:Surgery, Computer-Assisted; D014781:Viscera / Q000098:blood supply*; D055815:Young Adult