Maingard Julian, Kok Hong Kuan, Phelan Emma, Logan Caitriona, Ranatunga Dinesh, Brooks Duncan Mark, Chandra Ronil V, Lee Michael J, Asadi Hamed
Interventional Radiology Service, Department of Radiology, Austin Hospital, Heidelberg, Melbourne, Australia.
Interventional Radiology Service, Department of Radiology, Beaumont Hospital, and Royal College of Surgeons in Ireland, Dublin, Ireland.
Cardiovasc Intervent Radiol. 2017 Nov;40(11):1784-1791. doi: 10.1007/s00270-017-1733-y. Epub 2017 Jun 29.
Visceral and renal artery aneurysms (VRAAs) are an uncommon clinical entity but carry a risk of rupture with associated morbidity and mortality. The rupture risk is particularly high when the aneurysms are large, of unfavourable morphology or in the setting of pregnancy and perioperative period. Endovascular approaches are now first line in the treatment of VRAA, but conventional techniques may be ineffective in excluding aneurysms with unfavourable anatomy such as those with wide necks or at arterial bifurcation points. The neurovascular Comaneci neck-bridging device is used to temporarily cover the neck of intracranial aneurysms without occluding forward arterial flow during endovascular coiling. We report the novel use of the Comaneci neck-bridging device for the treatment of complex peripheral VRAAs.
We describe the treatment of two patients with renal and splenic artery aneurysms demonstrating unfavourable anatomic morphology for conventional endovascular approaches.
In the first patient, the renal artery aneurysm was situated at the intrarenal bifurcation of the main renal artery in the setting of a solitary kidney. In the second patient, the splenic artery aneurysm was situated close to the splenic hilum at the distal splenic arterial bifurcation. The Comaneci neck-bridging device was successfully used in both cases to assist coil embolisation with visceral preservation.
The Comaneci neck-bridging device is potentially safe and effective for the treatment of peripheral VRAA with unfavourable anatomic characteristics that would have been deemed unsuitable for treatment using conventional techniques.
Level 4, Technical Report.
内脏和肾动脉瘤（VRAAs）是一种不常见的临床病症，但存在破裂风险，会伴有相关的发病率和死亡率。当动脉瘤较大、形态不佳或处于妊娠及围手术期时，破裂风险尤其高。血管内治疗方法目前是VRAA治疗的一线选择，但传统技术在排除解剖结构不佳的动脉瘤（如颈宽或位于动脉分叉处的动脉瘤）时可能无效。神经血管科马内奇颈桥接装置用于在血管内栓塞期间临时覆盖颅内动脉瘤的颈部，同时不阻断动脉向前血流。我们报告了科马内奇颈桥接装置在治疗复杂外周VRAAs中的新应用。
我们描述了两名患有肾动脉瘤和脾动脉瘤患者的治疗情况，这些动脉瘤显示出传统血管内治疗方法的解剖形态不佳。
第一例患者的肾动脉瘤位于孤立肾的主肾动脉肾内分叉处。第二例患者的脾动脉瘤位于脾动脉远端分叉处靠近脾门的位置。科马内奇颈桥接装置在这两例中均成功用于辅助线圈栓塞并保留内脏。
科马内奇颈桥接装置对于治疗具有不利解剖特征的外周VRAA可能是安全有效的，而这些特征以往会被认为不适合采用传统技术进行治疗。
4级，技术报告。
