Scholtz V, Meyer F, Udelnow A, Pech M, Halloul Z
Arbeitsbereich Gefäßchirurgie, Klinik für Allgemein-, Viszeral- & Gefäßchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland.
Klinik für Radiologie & Nuklearmedizin, Universitätsklinikum Magdeburg A. ö. R., Deutschland.
Zentralbl Chir. 2015 Oct;140(5):478-85. doi: 10.1055/s-0034-1383101. Epub 2014 Nov 13.
AIM, PATIENTS AND METHODS: 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.
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).
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.
目的、患者与方法：通过一项系统性单中心前瞻性观察性研究，分析不同内脏动脉瘤部位的频谱（症状学、频率）和诊断方法，以及根据局部检查结果、患者临床状况和危险因素采用的各种治疗方案的介入后病程，以对比不同治疗方法（保守治疗、影像引导下放射介入治疗、开放血管手术）的决策标准及其早期介入后结局（基于并发症发生率、围介入期发病率和医院死亡率），并纳入文献中的相关参考文献。
在14年的时间段内，共登记了22例患者（性别比：12例男性/10例女性；平均年龄：54.3岁[范围：22 - 76岁]）。内脏动脉瘤最常发生于脾动脉（50%）。胃十二指肠动脉、肝动脉和右肾动脉受累比例均为13.6%（n = 3/22），肠系膜上动脉受累比例为9.1%（n = 2/22）。大多数患者（54.5%）接受了影像引导下放射介入治疗，31.8%的患者接受了开放血管手术，13.6%的病例采用“密切观察等待”。发病率为21.1%（n = 4/19），总体死亡率为9.1%（n = 2/22）。
对于特定治疗方法的决策应在以下情况下做出：（i）采取充分的诊断措施（经腹超声、磁共振血管造影、双功超声检查，必要时行CT血管造影/数字减影血管造影）之后；（ii）基于个体化病例；（iii）在血管外科中心进行；（iv）根据具体局部检查结果（特别是根据大小/破裂的特定概率[注意：妊娠情况]）；（v）根据个体风险状况，采用所有治疗方案（保守治疗与介入治疗；影像引导下放射介入治疗[如栓塞、支架或覆膜支架等血管腔内修复术]与开放血管手术[根据逐步升级方法]；开放血管结扎术与动脉瘤切除后的重建术），包括对治疗结果进行充分的质量保证以及在专门的血管外科门诊中心在适当时间间隔内进行对照检查（双功超声检查；必要时行磁共振血管造影）。
