title: Contrast-enhanced ultrasound to evaluate organ microvascularization after operative versus endovascular treatment of visceral artery aneurysms.
abstract: OBJECTIVE
  To evaluate the organ microvascularization after operative versus endovascular treatment of visceral artery aneurysms (VAAs) by contrast-enhanced ultrasound (CEUS) and colour-coded duplex sonography (CCDS).
  
  
  METHODS
  Between April 1995 to January 2016, 168 patients (78 males, 90 females; median age: 62 years) were diagnosed with VAAs at our hospital site. 60/168 patients (36%) fulfilled treatment criteria and had either open (29/60, 48%) or endovascular (31/60, 52%) aneurysm repair. Patients' characteristics and presentations were consecutively reviewed. Technical success and organ microvascularization were determined by CCDS/CEUS and correlated to computed tomography angiography (CTA) or magnetic resonance imaging (MRI).
  
  
  RESULTS
  18/60 patients (30%) presented with acute bleeding. 16/18 emergency patients (89%) were treated by endovascular means. After emergency treatment, two patients showed segmental liver malperfusion by CEUS and CTA. One small bowel resection had to be performed.42/60 patients (70%) were electively treated. 27/42 patients (64%) had open and 15/42 (36%) endovascular aneurysm repair. There were no liver or bowel infarctions after elective treatment of hepatic or mesenteric artery aneurysms (n = 13) in CCDS/CEUS and in CTA. Treatment of patients with splenic or renal artery aneurysms led to partial or complete organ loss in 42% (8/19) after operative and in 50% (5/10) after endovascular treatment (p < 0.05).
  
  
  CONCLUSIONS
  The endovascular approach is the preferred therapeutic option in emergency to control bleeding. In contrast to hepatic or mesenteric procedures, patients for elective splenic or renal artery aneurysm repair have to be evaluated very carefully because of a high rate of partial or complete organ loss demonstrated by CEUS - either after open or endovascular aneurysm repair.
authors: Division of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany.
authors: Karin
authors: K
authors: Pfister
authors: Division of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany.
authors: Piotr M
authors: PM
authors: Kasprzak
authors: Department of Radiology, University Medical Center Regensburg, Regensburg, Germany.
authors: Ernst M
authors: EM
authors: Jung
authors: Department of Radiology, University Medical Center Regensburg, Regensburg, Germany.
authors: René
authors: R
authors: Müller-Wille
authors: Department of Radiology, University Medical Center Regensburg, Regensburg, Germany.
authors: Walter
authors: W
authors: Wohlgemuth
authors: Division of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany.
authors: Reinhard
authors: R
authors: Kopp
authors: Division of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany.
authors: Wilma
authors: W
authors: Schierling
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery; D001158:Arteries / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D003287:Contrast Media; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: Visceral artery aneurysms; contrast-enhanced ultrasound; endovascular treatment; open repair; organ microvascularization