Basile Antonio, Ragazzi Salvatore, Piazza Diego, Tsetis Dimitrios, Lupattelli Tommaso, Patti Maria Teresa
Department of Diagnostic and Interventional Radiology, Ospedale Ferrarotto, Catania, Italy.
Eur Radiol. 2008 Nov;18(11):2579-81. doi: 10.1007/s00330-008-1053-3. Epub 2008 May 27.
Endovascular treatment options for visceral artery pseudoaneurysms depend on lesion location and size. Exclusion methods fall into two categories, embolization and stent placement, and these procedures aim to exclude the pseudoaneurysm from the circulation and if possible to maintain distal blood flow. Embolization of the afferent artery can be used in pseudoaneurysms that arise from a donor artery without collateral supply such as a visceral branch, whereas in the case of visceral arteries with well-established collateral supply, the embolization of both proximal and distal branches to the pseudoaneurysm is mandatory in preventing backflow from the collateral circulation. A direct embolization delivering coils or glue into the sac can also be performed if the aneurismal neck is narrow. Stent-graft placement represents another option to exclude the pseudoaneurysm, in the case of wide neck, reduced arterial tortuosity and large-diameter arteries. We present a case of common hepatic artery pseudoaneurysm involving the gastroduodenal artery origin treated by a combination of techniques. An hepatic stent-graft implantation plus retrograde embolization of the gastroduodenal artery through the pancreaticoduodenal anastomosis from the superior mesenteric artery was performed.
内脏动脉假性动脉瘤的血管内治疗方案取决于病变部位和大小。排除方法分为两类，即栓塞和支架置入，这些操作旨在将假性动脉瘤排除在循环之外，并尽可能维持远端血流。对于由无侧支供应的供血动脉（如内脏分支）引起的假性动脉瘤，可采用供血动脉栓塞；而对于侧支供应良好的内脏动脉，为防止侧支循环逆流，必须对假性动脉瘤的近端和远端分支进行栓塞。如果动脉瘤颈部狭窄，也可直接向瘤腔内输送弹簧圈或胶水进行栓塞。对于瘤颈较宽、动脉迂曲度较小且动脉直径较大的情况，覆膜支架置入是排除假性动脉瘤的另一种选择。我们报告一例涉及胃十二指肠动脉起源的肝总动脉假性动脉瘤，采用联合技术进行治疗。通过肠系膜上动脉经胰十二指肠吻合口对胃十二指肠动脉进行逆行栓塞，并植入肝覆膜支架。
