School of Medicine, China Medical University, Taichung.
Department of Medical Education, Chang Gung Memorial Hospital, Kaohsiung.
Int J Surg. 2023 Jul 1;109(7):1842-1851. doi: 10.1097/JS9.0000000000000442.
Splanchnic arterial aneurysms are a rare but potentially lethal disease with a mortality rate of more than 10% after rupture. Endovascular therapy is the first-line treatment for splanchnic aneurysms. However, appropriate management for splanchnic aneurysms after failed endovascular therapy remained inconclusive.
A retrospective review was performed for consecutive patients (from 2019 to 2022) who underwent salvage surgeries for splanchnic artery aneurysms following failed endovascular therapy. The authors defined failed endovascular therapy as the technical infeasibility to apply endovascular therapy, the incomplete exclusion of the aneurysm, or the incomplete resolution of preoperative aneurysm-associated complications. Salvage operations included aneurysmectomy with vascular reconstruction and partial aneurysmectomy with directly closing of bleeders from the intraluminal space of the aneurysms.
Seventy-three patients received endovascular therapies for splanchnic aneurysms, and 13 failed endovascular trials. The authors performed salvage surgeries for five patients and enrolled them in this study, including four false aneurysms of the celiac or superior mesenteric arteries and a true aneurysm of the common hepatic artery. The causes of failed endovascular therapy included coil migration, insufficient space for safely deploying the covered stent, a persistent mass effect from the postembolized aneurysm, or infeasibility for catheter cannulation. The mean hospital stay was nine days (mean±SD, 8.8±1.6 days), with no one suffering 90-day surgical morbidity and mortality, and all patients getting symptoms improvement. During the follow-up period (mean±SD, 24±10 months), one patient suffered a small residual asymptomatic celiac artery aneurysm (8 mm in diameter) and was treated conservatively due to underlying liver cirrhosis.
Surgical management is a feasible, effective, and safe alternative for splanchnic aneurysms after failed endovascular therapy.
内脏动脉动脉瘤是一种罕见但潜在致命的疾病，破裂后死亡率超过 10%。血管内治疗是内脏动脉瘤的首选治疗方法。然而，对于血管内治疗失败后的内脏动脉瘤的适当治疗仍存在争议。
对连续患者（2019 年至 2022 年）进行回顾性研究，这些患者在血管内治疗失败后因内脏动脉动脉瘤而行挽救性手术。作者将血管内治疗失败定义为血管内治疗的技术不可行、动脉瘤不完全排除或术前与动脉瘤相关的并发症不完全解决。挽救性手术包括动脉瘤切除术伴血管重建和部分动脉瘤切除术伴直接闭合动脉瘤腔内的出血点。
73 例患者接受了内脏动脉瘤的血管内治疗，其中 13 例血管内治疗失败。作者对 5 例患者进行了挽救性手术，并将其纳入本研究，包括 4 例腹腔干或肠系膜上动脉假性动脉瘤和 1 例肝总动脉真性动脉瘤。血管内治疗失败的原因包括线圈迁移、覆盖支架安全放置的空间不足、栓塞后动脉瘤持续的肿块效应或导管插管不可行。平均住院时间为 9 天（均数±标准差，8.8±1.6 天），无 90 天手术发病率和死亡率，所有患者症状均得到改善。在随访期间（均数±标准差，24±10 个月），1 例患者因肝硬化而患有小的无症状腹腔干动脉瘤（直径 8 毫米），并保守治疗。
对于血管内治疗失败后的内脏动脉瘤，手术治疗是一种可行、有效且安全的替代方法。
