Vandy Frank C, Sell Kristen A, Eliason Jonathan L, Coleman Dawn M, Rectenwald John E, Stanley James C
Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.
Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.
Ann Vasc Surg. 2017 May;41:32-40. doi: 10.1016/j.avsg.2016.09.018. Epub 2017 Feb 24.
The purpose of this study is to better define the clinical relevance of aneurysms affecting collateral vessels in patients with celiac artery (CA) occlusive disease.
True pancreaticoduodenal artery (PDA) and gastroduodenal artery (GDA) aneurysms associated with CA stenoses or occlusions reported from 1970 to 2010 in the English literature and similar cases treated at the University of Michigan were reviewed. Clinical presentations and differing treatment modalities were documented and analyzed.
One hundred twenty-five patients having CA occlusive disease exhibited true arterial aneurysms affecting the PDA (105 patients), GDA (10 patients), or both PDA and GDA and their branches (10 patients). Aneurysm size averaged 2.1 cm. Included were 110 patients culled from the literature and 15 treated by the authors. The mean age of patients in this series was 59 years and there was no gender predilection. Aneurysms were asymptomatic in 26%. Abdominal pain affected 54% of the patients, including all who experienced rupture. Rupture occurred in 48 patients of whom 15 were hemodynamically unstable, including 6 who died. Surgical interventions included endovascular embolization (39), aneurysmectomy alone (25), and aneurysmectomy with arterial reconstruction (20). Salutary outcomes occurred in 91% of the cases. Open surgical procedures have remained constant, but were equaled by endovascular interventions in 1996, with the latter having increased 3-fold in the past 15 years.
PDA and GDA aneurysms associated with CA occlusive disease carry a high risk of nonfatal rupture, warranting early treatment. Endovascular and open interventions may be successfully undertaken with minimal risks in treating these uncommon aneurysms.
本研究的目的是更好地明确影响腹腔干（CA）闭塞性疾病患者侧支血管的动脉瘤的临床相关性。
回顾了1970年至2010年英文文献报道的与CA狭窄或闭塞相关的真性胰十二指肠动脉（PDA）和胃十二指肠动脉（GDA）动脉瘤以及密歇根大学治疗的类似病例。记录并分析临床表现和不同的治疗方式。
125例患有CA闭塞性疾病的患者表现出影响PDA（105例患者）、GDA（10例患者）或PDA和GDA及其分支（10例患者）的真性动脉瘤。动脉瘤大小平均为2.1厘米。其中包括从文献中筛选出的110例患者和作者治疗的15例患者。该系列患者的平均年龄为59岁，无性别倾向。26%的动脉瘤无症状。54%的患者有腹痛，包括所有发生破裂的患者。48例患者发生破裂，其中15例血流动力学不稳定，包括6例死亡。手术干预包括血管内栓塞（39例）、单纯动脉瘤切除术（25例）和动脉瘤切除加动脉重建（20例）。91%的病例预后良好。开放手术的比例一直保持不变，但在1996年与血管内干预相当，在过去15年中后者增加了3倍。
与CA闭塞性疾病相关的PDA和GDA动脉瘤有较高的非致命性破裂风险，需要早期治疗。在治疗这些罕见动脉瘤时，血管内和开放干预可以成功进行且风险最小。
