Case ReportManagement and Urgent Repair of Ruptured Visceral Artery Aneurysms
Section snippets
Methods
Over the last 10 years (2000-2009), 23 patients (13 males) were referred to our facility after a diagnosis of VAA. The arteries involved in aneurysmatic pathology were 12 splenic arteries (SAs), four hepatic arteries, three superior mesenteric arteries, three pancreaticoduodenal arteries (PDAs), and one celiac axis. In this retrospective review, we considered only patients presenting with ruptured VAA; patients with ruptured renal artery aneurysms and those with acute, traumatic pseudoaneurysms
Case 1
A 43-year-old man presenting with back and abdominal pain, and who was in a severe state of shock, immediately underwent CT scan without contrast media agent because he was suffering from shock with acute renal failure. The CT scan showed a ruptured SA aneurysm, 5 cm in diameter (Fig. 1). The patient immediately underwent surgical repair. The operation was carried out with the patient being in a severe state of shock since the beginning. The aneurysmal sac was excluded and surgical ligature of
Discussion
VAAs may be caused by atherosclerosis, fibromuscular dysplasia, mycotic embolization, spontaneous dissection, local inflammatory conditions (such as pancreatitis or peptic ulcer disease) or collagen vascular diseases, and autoimmune disorders. However, large prospective series of aneurysms in different areas of the visceral circulation are unavailable and the risk of rupture may be understated. Stanley and Pry estimate that the risk of rupture of asymptomatic SA aneurysms is 2%.5 Risk factors
Conclusion
The results of emergency treatment of visceral aneurysm, in our experience, are the same as in previously published data. In our opinion, the treatment of ruptured VAA in an unstable patient should always be surgical, when patients are hemodynamically stable, arteriography can be useful to confirm diagnosis, determine the exact location of the aneurysm, and assess the possibility of endovascular treatment. Even if endovascular treatment presents a good alternative in treatment of VAA rupture,
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