Salvage surgeries for splanchnic artery aneurysms after failed endovascular therapy: case series

被引:3
作者
Lin, Yi-Chun [1 ,2 ]
Liao, Tzu-Chi [1 ,2 ]
Lin, Chien-Te [3 ]
Jeng, Long-Bin [1 ,3 ]
Yang, Horng-Ren [3 ]
Hsu, Chung-Ho [4 ]
Lin, Wei-Ching [5 ,6 ]
Wu, Ching-Feng [3 ]
Yeh, Chun-Chieh [1 ,3 ,7 ,8 ]
机构
[1] China Med Univ, Sch Med, Taichung, Taiwan
[2] Chang Gung Mem Hosp, Dept Med Educ, Kaohsiung, Taiwan
[3] China Med Univ, China Med Univ Hosp, Dept Surg, Taichung, Taiwan
[4] China Med Univ, China Med Univ Hosp, Dept Med, Taichung, Taiwan
[5] China Med Univ Hosp, Dept Med Imaging, Taichung, Taiwan
[6] China Med Univ, Sch Med, Dept Biomed Imaging & Radiol Sci, Taichung, Taiwan
[7] Asian Univ Hosp, Dept Surg, Taichung, Taiwan
[8] China Med Univ, Sch Med, 91 Xueshi Rd, Taichung 4043282, Taiwan
关键词
case series; chronic pancreatitis; failed endovascular therapy; false aneurysm; mass effect; salvage surgery; INTERVENTIONAL RADIOLOGY; MANAGEMENT; PSEUDOANEURYSM; OUTCOMES;
D O I
10.1097/JS9.0000000000000442
中图分类号
R61 [外科手术学];
学科分类号
摘要
Introduction: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. Materials and methods: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. Results: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 & PLUSMN;SD, 8.8 & PLUSMN;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 & PLUSMN;SD, 24 & PLUSMN;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. Conclusion:Surgical management is a feasible, effective, and safe alternative for splanchnic aneurysms after failed endovascular therapy.
引用
收藏
页码:1842 / 1851
页数:10
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