Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany.
Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany.
Eur J Med Res. 2019 Feb 28;24(1):17. doi: 10.1186/s40001-019-0374-9.
Visceral artery aneurysms (VAA) are rare vascular lesions. Clinically silent VAA are increasingly detected by cross-sectional imaging but some lesions are at risk for rupture with severe bleeding. The aim of the present study was to evaluate the trends in the interdisciplinary management at a tertiary center.
Patients who underwent treatment for VAA at University Hospital of Bonn between 2005 and 2018 were enrolled in this retrospective study. Demographic, clinical, VAA-specific data as well as information on therapy, early and long-term outcome were collected and statistically analyzed.
Forty-two consecutive patients, 19 females and 23 males with a median age of 59 years (range 30-91 years), were diagnosed with 56 VAA. The majority were true aneurysms (N = 32; 57%), whereas 43% (N = 24) were pseudoaneurysms. The most common localization was the splenic artery (N = 18; 32%) and the average diameter was 3 cm (range 1-5 cm). Twenty-five patients (59.5%) had VAA-related symptoms such as chronic abdominal pain and hemorrhage at primary diagnosis, while the diagnosis was incidental in 17 patients (40.5%). Eleven patients (26%) underwent open surgery whereas 29 patients (69%) received an endovascular treatment. Patients with pseudoaneurysms were significantly older (P = 0.003), suffered more often from associated symptoms (P < 0.001) and required more emergency interventions (P < 0.0001) compared to those with true VAA. In the last years, the number and proportion of true VAA increased significantly (P < 0.001) while a significantly larger proportion could be managed interventionally (P = 0.017).
VAA are increasingly detected on imaging with lesions presenting very heterogeneously. Due to the risk of lethal rupture and in the absence of reliable prognostic markers, all the patients with VAA should be offered definite treatment. Localization, anatomy and the end-organ perfusion after intervention or operation are the most important aspects to consider when planning a treatment for VAA. For this reason, a multidisciplinary evaluation of every individual patient is necessary for an optimized outcome.
内脏动脉动脉瘤（VAA）是罕见的血管病变。通过横断面成像，越来越多的临床无症状性 VAA 被发现，但一些病变有破裂并严重出血的风险。本研究旨在评估在一家三级中心进行的跨学科治疗趋势。
回顾性研究了 2005 年至 2018 年期间在波恩大学医院接受 VAA 治疗的患者。收集了人口统计学、临床、VAA 特异性数据以及治疗、早期和长期结果信息，并进行了统计学分析。
42 例连续患者，19 例女性和 23 例男性，中位年龄 59 岁（范围 30-91 岁），诊断为 56 个 VAA。大多数是真性动脉瘤（N=32；57%），而 43%（N=24）是假性动脉瘤。最常见的部位是脾动脉（N=18；32%），平均直径为 3cm（范围 1-5cm）。25 例患者（59.5%）在初次诊断时存在 VAA 相关症状，如慢性腹痛和出血，而 17 例患者（40.5%）为偶然诊断。11 例患者（26%）接受了开放手术，而 29 例患者（69%）接受了血管内治疗。假性动脉瘤患者明显更年长（P=0.003），更常伴有相关症状（P<0.001），需要更多的紧急干预（P<0.0001），与真性 VAA 患者相比。在过去的几年中，真性 VAA 的数量和比例显著增加（P<0.001），而可以进行介入治疗的比例显著增加（P=0.017）。
VAA 在影像学上的检出率越来越高，病变表现非常异质。由于致命破裂的风险以及缺乏可靠的预后标志物，所有 VAA 患者均应接受确定性治疗。定位、解剖和干预或手术后的终末器官灌注是制定 VAA 治疗计划时需要考虑的最重要方面。因此，对每个患者进行多学科评估对于获得优化的结果是必要的。
