Salam T A, Lumsden A B, Martin L G, Smith R B
Section of Vascular Surgery, Emory University School of Medicine, Atlanta, Georgia.
Am J Surg. 1992 Sep;164(3):215-9. doi: 10.1016/s0002-9610(05)81073-6.
During the period from 1975 to 1991, 41 patients with 60 visceral artery aneurysms were treated at the Affiliated Hospitals of Emory University. The total included 13 patients in whom 16 aneurysms were treated primarily by transarterial embolization. There were seven hepatic artery aneurysms, three splenic artery aneurysms, three gastroduodenal artery aneurysms, two left gastric artery aneurysms, and one right gastroepiploic artery aneurysm. Average age of these patients was 50 years; there were eight males and five females. Seven patients presented with gastrointestinal bleeding, and two patients presented with abdominal pain. In four patients, the aneurysm was an incidental finding. Etiology of the true or false aneurysms consisted of pancreatitis in two patients, trauma in three patients, connective tissue disease in one, and was unknown in the remainder. Embolization was performed in seven cases with Gianturco coils and Gelfoam, with coils alone in four, with Gelfoam alone in four, and with detachable balloons in one instance. Complete occlusion was achieved initially in 13 cases. Recanalization occurred in two patients over a mean follow-up period of 8.6 months, requiring re-embolization in one patient, whereas the other patient was managed expectantly. In three cases, embolization was unsuccessful: two cases required surgical correction, and one case was managed expectantly. Only one complication was related to the embolization procedure, which was a common hepatic arterial dissection that proceeded to the formation of a false aneurysm. Embolization as the primary treatment modality for visceral artery aneurysms should be considered in patients with the following diagnoses: pseudoaneurysms associated with pancreatitis, intrahepatic aneurysms, most splenic artery aneurysms, and gastric, gastroduodenal, and gastroepiploic aneurysms. The procedure has a low risk and may obviate a difficult surgical procedure, but it does not preclude surgical intervention should the need arise.
1975年至1991年期间，埃默里大学附属医院共收治了41例患有60个内脏动脉瘤的患者。其中13例患者的16个动脉瘤主要接受了经动脉栓塞治疗。包括7个肝动脉瘤、3个脾动脉瘤、3个胃十二指肠动脉瘤、2个胃左动脉瘤和1个胃网膜右动脉瘤。这些患者的平均年龄为50岁，男性8例，女性5例。7例患者出现胃肠道出血，2例患者出现腹痛。4例患者的动脉瘤为偶然发现。真性或假性动脉瘤的病因包括2例胰腺炎、3例创伤、1例结缔组织病，其余病因不明。7例使用Gianturco弹簧圈和明胶海绵进行栓塞，4例仅使用弹簧圈，4例仅使用明胶海绵，1例使用可脱性球囊。13例最初实现了完全闭塞。2例患者在平均8.6个月的随访期内发生再通，其中1例需要再次栓塞，另1例采取观察等待。3例栓塞失败：2例需要手术矫正，1例采取观察等待。仅1例并发症与栓塞操作有关，为常见的肝动脉夹层，进而形成假性动脉瘤。对于以下诊断的患者，应考虑将栓塞作为内脏动脉瘤的主要治疗方式：与胰腺炎相关的假性动脉瘤、肝内动脉瘤、大多数脾动脉瘤以及胃、胃十二指肠和胃网膜动脉瘤。该操作风险较低，可能避免困难的外科手术，但如有需要并不排除手术干预。
