title: Successful hybrid treatment for huge visceral artery aneurysms with contained rupture complicating segmental arterial mediolysis.
abstract: Segmental arterial mediolysis (SAM) is a rare arteriopathy that can cause acute abdomen. This report describes the case of a 31-year old male suffering from huge visceral aneurysms with contained rupture. We established a treatment strategy using a hybrid procedure that consisted of endovascular and surgical techniques for these splenic, common hepatic artery and coeliac axis aneurysms related to SAM. The patient was successfully treated with aorto-superior mesenteric artery bypass followed by endovascular aortic stent grafting to interrupt inflow to coeliac aneurysms, and distal splenopancreatectomy with en bloc resection of those aneurysms. We conclude that this hybrid procedure consisting of endovascular and surgical techniques is useful and is a safe treatment option for SAM-related visceral aneurysms.
authors.affiliation: Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan kimuray@sapmed.ac.jp.
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Kimura
authors.affiliation: Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Imamura
authors.affiliation: Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology / Q000601:surgery*; D000328:Adult; D000714:Anastomosis, Surgical; D017542:Aneurysm, Ruptured / Q000601:surgery*; D001011:Aorta / Q000601:surgery*; D001158:Arteries / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002445:Celiac Artery; D057510:Endovascular Procedures; D006499:Hepatic Artery; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000601:surgery*; D010180:Pancreatectomy; D013156:Splenectomy; D013157:Splenic Artery; D015607:Stents; D017540:Tunica Media / Q000473:pathology*; D014781:Viscera / Q000098:blood supply
keywords: Aorto-superior mesenteric artery bypass; Endovascular aortic stent grafting; Hybrid operation; Segmental arterial mediolysis; Visceral aneurysms