Keschenau Paula R, Kaisaris Nikitas, Jalaie Houman, Grommes Jochen, Kotelis Drosos, Kalder Johannes, Jacobs Michael J
European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, RWTH University Hospital Aachen, Aachen, Germany.
European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, RWTH University Hospital Aachen, Aachen, Germany -
J Cardiovasc Surg (Torino). 2020 Jun;61(3):340-346. doi: 10.23736/S0021-9509.19.11036-1. Epub 2019 Oct 4.
Visceral artery aneurysms (VAA) are rare and the literature regarding management strategies is limited. The study aim was to evaluate our 13-year experience with VAA treatment including conservative, open surgical and endovascular therapy.
This retrospective single-center study included 37 patients (31 male, median age 70 years [46-79 years]) with true and dissecting VAA treated between January 2006 and December 2018. Indications for invasive therapy were ruptured (N.=1) and symptomatic (N.=8) VAA or asymptomatic VAA>20 mm (N.=15). The decision on the treatment type was made after interdisciplinary (vascular surgeons/radiologists) discussion.
The aneurysms affected the celiac trunk (N.=18, 49%), the splenic artery (N.=11, 30%), the superior mesenteric artery (SMA, N.=6, 16%), the hepatic artery (N.=5, 14%) and proximal SMA side branches (N.=2, 5%). Six patients had multiple VAA, one had an intrahepatic artery aneurysm and one had peripheral mesocolic artery aneurysms plus a VAA. 46% of the patients (N.=17) had coexisting aneurysms in other vascular territories. Thirteen patients were managed conservatively (median VAA diameter 15 [14-25] mm), 18 underwent open surgery with venous or prosthetic bypass or interposition graft implantation and 6 were treated by endovascular means (coiling [N.=3] or endograft [N.=3]). Median follow-up (FU) was 21 months (4-123 months). In-hospital mortality was 0%. Median length of hospital stay was 11 days (5-28 days) after surgical and 3 days (2-71 days) after endovascular treatment. Complications included an early type I endoleak, 3 secondary open abdominal surgeries for bleeding/peritonitis after endovascular treatment of a ruptured intrahepatic aneurysm, an asymptomatic aorto-truncal bypass occlusion and aneurysm recurrence after a venous SMA interposition graft. None of the conservatively treated VAA required invasive treatment during FU.
Small (<20 mm) asymptomatic VAA can be managed conservatively. Whenever invasive treatment is indicated, both open and endovascular treatments can be performed with low complication rates. In order to choose the optimal therapeutic approach, anatomical features and patient comorbidities should be considered and, ideally, discussed interdisciplinarily.
内脏动脉动脉瘤（VAA）较为罕见，关于其治疗策略的文献有限。本研究旨在评估我们13年来对VAA治疗的经验，包括保守治疗、开放手术和血管内治疗。
这项回顾性单中心研究纳入了2006年1月至2018年12月期间治疗的37例真性和夹层VAA患者（男性31例，中位年龄70岁[46 - 79岁]）。侵入性治疗的指征为破裂的（n = 1）和有症状的（n = 8）VAA或无症状的VAA>20 mm（n = 15）。治疗类型的决定是在跨学科（血管外科医生/放射科医生）讨论后做出的。
动脉瘤累及腹腔干（n = 18，49%）、脾动脉（n = 11，30%）、肠系膜上动脉（SMA，n = 6，16%）、肝动脉（n = 5，14%）和SMA近端分支（n = 2，5%）。6例患者有多个VAA，1例有肝内动脉瘤，1例有结肠系膜周围动脉动脉瘤加一个VAA。46%的患者（n = 17）在其他血管区域有并存的动脉瘤。13例患者接受保守治疗（VAA中位直径15[14 - 25]mm），18例接受开放手术，行静脉或人工血管旁路或间置移植术植入，6例接受血管内治疗（栓塞[n = 3]或腔内移植物[n = 3]）。中位随访（FU）时间为21个月（4 - 123个月）。住院死亡率为0%。手术后中位住院时间为11天（5 - 28天），血管内治疗后为3天（2 - 71天）。并发症包括早期I型内漏、3例在肝内动脉瘤破裂血管内治疗后因出血/腹膜炎进行的二次开放性腹部手术、1例无症状的主动脉 - 干旁路闭塞以及静脉SMA间置移植术后动脉瘤复发。在随访期间，保守治疗的VAA均无需侵入性治疗。
小型（<20 mm）无症状VAA可进行保守治疗。只要有侵入性治疗指征，开放手术和血管内治疗均可进行，且并发症发生率较低。为选择最佳治疗方法，应考虑解剖特征和患者合并症，理想情况下应进行跨学科讨论。
