Elsevier

Annals of Vascular Surgery

Volume 25, Issue 7, October 2011, Pages 981.e7-981.e11
Annals of Vascular Surgery

Case Report
Management and Urgent Repair of Ruptured Visceral Artery Aneurysms

https://doi.org/10.1016/j.avsg.2011.02.041Get rights and content

Five patients were treated for ruptured visceral artery aneurysms during the last 9 years, including two splenic and three pancreaticoduodenal aneurysms. The average size of aneurysm was 2.6 cm (range: 1.5-5 cm). All patients underwent open surgical treatment. There was one operative death. After a mean follow-up of 46.6 months, there were no cases of mortality or secondary complications. The authors conclude that operative treatment of ruptured visceral artery aneurysms is durable.

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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