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"Visceral Aneurysm" in 2022: Recent Advances and Treatment

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Vascular Medicine".

Deadline for manuscript submissions: closed (20 April 2024) | Viewed by 21463

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Special Issue Editors

Dr. Enrico Maria Marone

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Guest Editor

1. Associate Professor of Vascular Surgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
2. Chief of Department of Vascular Surgery, Gruppo Policlinico di Monza, Monza, Italy
Interests: vascular surgery; endovascular surgery; aneurysm treatment; visceral arteries

Prof. Dr. Giovanni Pratesi

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Guest Editor

1. Full Professor of Vascular Surgery, Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, Italy
2. Director of the Clinic of Vascular Surgery, Hospital S. Martino, Genoa, Italy
Interests: vascular surgery; endovascular surgery; aneurysm treatment; visceral arteries

Dr. Luigi Federico Rinaldi

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Guest Editor

1. Vascular Surgery, Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, Genoa, Italy
2. Vascular Surgery, Ospedale Policlinico di Monza, Monza, Italy
Interests: vascular surgery; endovascular surgery; aneurysm treatment; visceral arteries

Special Issue Information

Dear Colleagues,

Although rare, visceral aneurysms represent a major challenge in vascular surgery, due to the associated morbidity/mortality and the difficult therapeutic choices. The most debated issues about the management of visceral artery aneurysms regard the indications and the optimal kind of treatment.

The guidelines followed in Europe and the US currently disagree on many aspects of this matter: on one hand, the traditional view sees visceral aneurysms as a single entity and bases the indication to surgery mainly on their size and the patient’s condition; on the other hand, the most recent SVS Guidelines (2020) started differentiating the aneurysms according to their location and the specific rupture risk of each visceral vessel.

The development of endovascular devices and the introduction of innovative and less invasive techniques (flow diverters, coils/microcoils or glue embolization, and robotic surgery) are multiplying the therapeutic possibilities, but they also require a deep knowledge of the risks and benefits of each technique and the correct selection of cases in order to achieve the best results.

The aim of this Special Issue is to depict the state of the art in terms of therapeutic options for visceral aneurysms, with a special focus on the most recent innovations and future perspectives in this field.

Dr. Enrico Maria Marone
Prof. Dr. Giovanni Pratesi
Dr. Luigi Federico Rinaldi
Guest Editors

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Keywords

visceral aneurysms
vascular surgery
endovascular treatment
lparoscopic surgery
robotic surgery
embolization
flow-diverting stents
covered stents

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Published Papers (9 papers)

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Editorial

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7 pages, 9097 KiB

Open AccessEditorial

Current Debates in the Management of Visceral Artery Aneurysms: Where the Guidelines Collide

by Enrico Maria Marone and Luigi Federico Rinaldi

J. Clin. Med. 2023, 12(9), 3267; https://doi.org/10.3390/jcm12093267 - 4 May 2023

Cited by 4 | Viewed by 2635

Abstract

On one hand, the main difficulties in establishing a wide, evidence-based consensus about the best approach to visceral artery aneurysms (VAAs) and pseudoaneurysms (VAPAs) are the paucity of data, due to their rarity in the general population, and the extreme heterogeneity of this group of diseases, which encompasses different aneurysm types, with different degrees of rupture risks according to their anatomical locations [...] Full article

(This article belongs to the Special Issue "Visceral Aneurysm" in 2022: Recent Advances and Treatment)

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Research

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9 pages, 5581 KiB

Open AccessArticle

Visceral Artery Aneurysms in the Presence of Upstream Stenoses

by Amun Hofmann, Philipp Schuch, Franz Berger, Fadi Taher and Afshin Assadian

J. Clin. Med. 2024, 13(11), 3170; https://doi.org/10.3390/jcm13113170 - 28 May 2024

Cited by 1 | Viewed by 2112

Abstract

Background: Sutton–Kadir syndrome describes a rare pathology that commonly includes an aneurysm of the inferior pancreaticoduodenal artery in combination with a celiac trunk stenosis or occlusion, often caused by median arcuate ligament compression. Several therapeutic approaches exist including open surgical, endovascular, and hybrid treatments. Other combinations of visceral artery aneurysms and upstream stenoses exist but the cumulative body of evidence on these combinations is weak due to their rarity. Methods: A retrospective analysis of patient data from a single center was carried out. Electronic patient records were filtered for keywords including “visceral aneurysm”, “Sutton–Kadir”, and “median arcuate ligament”. Imaging studies were re-examined by two blinded vascular surgeons with a third vascular surgeon as a referee in case of diverging results. Results: Sixteen patients had a visceral artery aneurysm with an upstream stenosis. All cases had a celiac trunk obstruction while one patient also had a concomitant superior mesenteric artery stenosis. Both median arcuate ligament compression and atherosclerotic lesions were identified. The location of the aneurysms varied even though the inferior pancreaticoduodenal artery was most frequently affected. A classification system based on the different combinations of stenoses and aneurysms is presented and introduced as a new pathologic entity: visceral artery aneurysm in the presence of upstream stenosis (VAPUS). Conclusions: The concomitant presence of visceral artery aneurysms, especially in the pancreaticoduodenal arteries, and blood flow impairment of the celiac axis or superior mesenteric artery is a rare pathology. The proposed VAPUS classification system offers an accessible and transparent route to the precise localization of the affected vessels. Full article

(This article belongs to the Special Issue "Visceral Aneurysm" in 2022: Recent Advances and Treatment)

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10 pages, 5000 KiB

Open AccessArticle

Interventional Radiology for High-Flow Aneurysm of the Pancreaticoduodenal Arcades with Median Arcuate Ligament Syndrome: Review of 14 Patients

by Valentin Siauve, Olivier Chevallier, Amin Mazit, Nicolas Falvo, Pierre-Olivier Comby and Romaric Loffroy

J. Clin. Med. 2023, 12(14), 4692; https://doi.org/10.3390/jcm12144692 - 14 Jul 2023

Cited by 3 | Viewed by 1643

Abstract

Transarterial embolization (TAE) for high-flow pancreaticoduodenal artery (PDA) aneurysms in patients with celiac-trunk stenosis by the median arcuate ligament (MAL) has been found effective both after rupturing and to prevent rupture. The objective was to describe the TAE techniques used and their effectiveness in excluding PDA aneurysms due to MAL syndrome. This single-center retrospective study done at the Dijon-Bourgogne University Hospital included all patients treated by TAE in 2010–2022 for ruptured or unruptured high-flow PDA aneurysms caused by MAL syndrome. We identified 14 patients (7 women and 7 men; mean age, 64 years). Packing and trapping techniques were used alone or together. Occlusion was with microcoils, co-polymer, or cyanoacrylate glue, used separately or combined. Technical success was achieved in 13 (93%) patients. Clinical success was achieved in 12 (86%) patients. One major and two minor complications were recorded within the first 30 days. No complications occurred after 30 days. Follow-up ranged from 1 to 84 months. No cases of aneurysm recanalization have been recorded to date. TAE had high technical and clinical success rates in our patients with unruptured or ruptured PDA aneurysms due to MAL syndrome. Full article

(This article belongs to the Special Issue "Visceral Aneurysm" in 2022: Recent Advances and Treatment)

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10 pages, 851 KiB

Open AccessArticle

Can Color Doppler Ultrasound Be Effectively Used as the Follow-Up Modality in Patients Undergoing Splenic Artery Aneurysm Embolization? A Correlational Study between Doppler Ultrasound, Magnetic Resonance Angiography and Digital Subtraction Angiography

by Krzysztof Lamparski, Grzegorz Procyk, Krzysztof Bartnik, Krzysztof Korzeniowski, Rafał Maciąg, Vadym Matsibora, Michał Sajdek, Alicja Dryjańska, Emilia Wnuk, Grzegorz Rosiak, Edyta Maj, Magdalena Januszewicz, Aleksandra Gąsecka, Tomasz Ostrowski, Piotr Kaszczewski, Zbigniew Gałązka and Mikołaj Wojtaszek

J. Clin. Med. 2023, 12(3), 792; https://doi.org/10.3390/jcm12030792 - 19 Jan 2023

Cited by 1 | Viewed by 2306

Abstract

Splenic artery aneurysm (SAAs) rupture is associated with a high mortality rate. Regular surveillance with imaging before and after intervention is crucial to guide best evidence treatment. The following study aimed to determine the efficacy of color Doppler ultrasound imaging (DUS) compared to digital subtraction angiography (DSA) and magnetic resonance angiography (MRA) as a follow-up modality after selective coil embolization of true SAAs. We analyzed data from 20 patients, 15 females (48.1 ± 16.1 years) undergoing selective SAA coil embolization using detachable fibered embolization coils. Imaging using DUS, MRA, and DSA was performed 3 months after the initial embolization or the consequent re-embolization procedure. Primary clinical success, defined as Class I aneurysm occlusion, on 3-month follow-up was seen in 16 (80.0%) patients. DUS had a sensitivity of 94.4% and a specificity of 42.9% when compared to DSA and 92.3% and 30%, respectively, when compared to MRA in identifying Class I aneurysm occlusion. The positive predictive value (PPV) of DUS in identifying the need for re-embolization was 75.0%, while the NPV of DUS in these terms was 90.5%. DUS showed a high sensitivity in detecting aneurysm occlusion and clinical success, simultaneously exhibiting poor specificity. Still, with caution, this follow-up modality could be used for monitoring select low-risk patients after selective embolization of SAAs. DUS could provide a higher cost-to-benefit ratio, enabling more systematic post-procedural follow-up, as it is far more commonly used compared to MRA and non-invasive compared to DSA. Full article

(This article belongs to the Special Issue "Visceral Aneurysm" in 2022: Recent Advances and Treatment)

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Review

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15 pages, 960 KiB

Open AccessReview

Endovascular Stent-Graft Repair of True and False Aneurysms of the Splenic Artery

by Ottavia Borghese, Angelo Pisani, Antonio Luparelli, Simona Sica, Fabrizio Minelli, Tommaso Donati and Yamume Tshomba

J. Clin. Med. 2024, 13(10), 2802; https://doi.org/10.3390/jcm13102802 - 9 May 2024

Cited by 3 | Viewed by 1585

Abstract

Objective: In treatment of aneurysms (SAAs) and pseudoaneurysms (SAPs) of the splenic artery, endovascular coil embolization is the approach most commonly used as it is minimally invasive and safe. However, it carries a significant rate of primary failure (up to 30%) and might be complicated by splenic infarction. The use of stent grafts might represent a valuable alternative when specific anatomical criteria are respected. We report a comprehensive review on technical and clinical outcomes achieved in this setting. Methods: We performed a comprehensive review of the literature through the MedLine and Cochrane databases (from January 2000 to December 2023) on reported cases of stenting for SAAs and SAPs. Outcomes of interest were clinical and technical success and related complications. The durability of the procedure in the long-term was also investigated. Results: Eighteen papers were included in the analysis, totalling 41 patients (n = 20 male 48.8%, mean age 55.5, range 32–82 years; n = 31, 75.6% SAAs). Mean aneurysm diameter in non-ruptured cases was 35 mm (range 20–67 mm), and most lesions were detected at the proximal third of the splenic artery. Stent grafting was performed in an emergent setting in n = 10 (24.3%) cases, achieving immediate clinical and technical success rate in 90.2% (n = 37) of patients regardless of the type of stent-graft used. There were no procedure-related deaths, but one patient died in-hospital from septic shock and n = 2 (4.9%) patients experienced splenic infarction. At the last available follow-up, the complete exclusion of the aneurysm was confirmed in 87.8% of cases (n = 36/41), while no cases of aneurysm growing nor endoleak were reported. None of the patients required re-intervention during follow-up. Conclusions: When specific anatomical criteria are respected, endovascular repair of SAAs and SAAPs using stent grafts appears to be safe and effective, and seems to display a potential advantage in respect to simple coil embolization, preserving the patient from the risk of end-organ ischemia. Full article

(This article belongs to the Special Issue "Visceral Aneurysm" in 2022: Recent Advances and Treatment)

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20 pages, 2285 KiB

Open AccessReview

Promising Novel Therapies in the Treatment of Aortic and Visceral Aneurysms

by Theodora M. Stougiannou, Konstantinos C. Christodoulou, Efstratios Georgakarakos, Dimitrios Mikroulis and Dimos Karangelis

J. Clin. Med. 2023, 12(18), 5878; https://doi.org/10.3390/jcm12185878 - 10 Sep 2023

Cited by 2 | Viewed by 2456

Abstract

Aortic and visceral aneurysms affect large arterial vessels, including the thoracic and abdominal aorta, as well as visceral arterial branches, such as the splenic, hepatic, and mesenteric arteries, respectively. Although these clinical entities have not been equally researched, it seems that they might share certain common pathophysiological changes and molecular mechanisms. The yet limited published data, with regard to newly designed, novel therapies, could serve as a nidus for the evaluation and potential implementation of such treatments in large artery aneurysms. In both animal models and clinical trials, various novel treatments have been employed in an attempt to not only reduce the complications of the already implemented modalities, through manufacturing of more durable materials, but also to regenerate or replace affected tissues themselves. Cellular populations like stem and differentiated vascular cell types, large diameter tissue-engineered vascular grafts (TEVGs), and various molecules and biological factors that might target aspects of the pathophysiological process, including cell-adhesion stabilizers, metalloproteinase inhibitors, and miRNAs, could potentially contribute significantly to the treatment of these types of aneurysms. In this narrative review, we sought to collect and present relevant evidence in the literature, in an effort to unveil promising biological therapies, possibly applicable to the treatment of aortic aneurysms, both thoracic and abdominal, as well as visceral aneurysms. Full article

(This article belongs to the Special Issue "Visceral Aneurysm" in 2022: Recent Advances and Treatment)

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Other

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23 pages, 4064 KiB

Open AccessSystematic Review

Endovascular and Open Surgical Treatment of Ruptured Splenic Artery Aneurysms: A Case Report and a Systematic Literature Review

by Luigi Federico Rinaldi, Chiara Brioschi and Enrico Maria Marone

J. Clin. Med. 2023, 12(18), 6085; https://doi.org/10.3390/jcm12186085 - 20 Sep 2023

Cited by 4 | Viewed by 2657

Abstract

Background: Ruptured splenic artery aneurysms (r-SAA), although rare, are burdened by high morbidity and mortality, even despite emergent surgical repair. It is suggested that endovascular treatment can achieve reduction in peri-operative death and complication rates, as in other vascular diseases, but evidence of such benefits is still lacking in this particular setting. We report a case of an r-SAA treated by trans-arterial embolization and then converted to open surgery for persistent bleeding, and we provide a systematic review of current results of open and endovascular repair of r-SAAs. Materials and Methods: A 50-year-old male presenting in shock for a giant r-SAA underwent emergent coil embolization and recovered hemodynamic stability. On the following day, he underwent laparotomy for evacuation of the huge intraperitoneal hematoma, but residual bleeding was noted from the splenic artery, which was ligated after coil removal, and a splenectomy was performed. A systematic literature review of the reported mortality and complications of r-SAA undergoing open (OSR) or endovascular (EVT) treatment was performed using the main search databases. All primary examples of research published since 1990 were included regardless of sample size. The main outcome measures were mortality and reinterventions. Secondary outcomes were post-operative complications. Results: We selected 129 studies reporting on 350 patients—185 treated with OSR and 165 with EVT. Hemodynamically unstable patients and ruptures during pregnancy were more frequently treated with open repair. Overall, there were 37 deaths (mortality: 10.6%)—24 in the OSR group and 13 in the EVTr group (mortality: 12.9% and 7.8% respectively, p-value: 0.84). There were 37 reinterventions after failed or complicated endovascular repair —6 treated with endovascular re-embolization and 31 with laparotomy and splenectomy (22.4%); there were 3 (1.6%) reinterventions after open repair. Overall complication rates were 7.3% in the EVT group (n: 12) and 4.2% in the OSR group (n: 7), and did not require reintervention. No significant differences in overall complications or in any specific complication rate were observed between the two groups. Conclusions: Current results of r-SAA treatment show equipoise terms of morbidity and mortality between open and endovascular repair; however, in case of hemodynamic instability and rupture during pregnancy, open surgery might still be safer. Moreover, endovascular repair is still burdened by a significantly higher rate of reinterventions, mostly with conversions to open surgery. Full article

(This article belongs to the Special Issue "Visceral Aneurysm" in 2022: Recent Advances and Treatment)

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6 pages, 2055 KiB

Open AccessCase Report

Rupture of Splenic Artery Aneurysm in Patient with ACTN2 Mutation

by Martina Palughi, Pasqualino Sirignano, Nazzareno Stella, Michele Rossi, Laura Fiorani and Maurizio Taurino

J. Clin. Med. 2023, 12(14), 4729; https://doi.org/10.3390/jcm12144729 - 17 Jul 2023

Cited by 1 | Viewed by 1664

Abstract

Here, we report a case of splenic artery aneurysm rupture in a patient with known heterozygosity mutation of the ACTN2 gene (variant c.971G > A p.Arg324Gln). The patient came to our emergency department with epigastric pain radiating to the lumbar area, with an absence of peritonism signs. An abdominal computed tomography angiography showed a ruptured huge (5 cm) splenic artery aneurysm. Therefore, the patient underwent emergency endovascular coil embolization with complete aneurysm exclusion. The postoperative course was uneventful, until postoperative day five when the patient developed a symptomatic supraventricular tachycardia in the absence of echocardiographic alterations. The signs and symptoms disappeared after three days of medical management. The patient was discharged on the 14th postoperative day in good clinical condition under verapamil and anti-platelet therapy. Although ACTN2 mutation was associated with cardiac and peripheral vascular disease occurrence, to the best of our knowledge, the present case is the first report of a visceral (splenic) aneurysm directly linked with this rare mutation. Full article

(This article belongs to the Special Issue "Visceral Aneurysm" in 2022: Recent Advances and Treatment)

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13 pages, 6333 KiB

Open AccessCase Report

Endovascular Management of Vascular Complications in Ehlers–Danlos Syndrome Type IV

by Mubarak Alqahtani, Amandine Claudinot, Marine Gaudry, Axel Bartoli, Pierre Antoine Barral, Vincent Vidal, Louis Boyer, Tiffany Busa, Farah Cadour, Alexis Jacquier, Mariangela De Masi and Laurence Bal

J. Clin. Med. 2022, 11(21), 6344; https://doi.org/10.3390/jcm11216344 - 27 Oct 2022

Cited by 8 | Viewed by 2279

Abstract

(1) Background: The vascular type of Ehlers–Danlos syndrome (vEDS) is a rare genetic connective tissue disorder caused by pathogenic variants in the COL3A1 gene that result in arterial and organ fragility and premature death. We present five cases of vEDS that highlight the diagnosis and treatment challenges encountered by clinicians with these patients. (2) Case presentations: we present the cases of five patients with vascular complications of vEDS who were successfully managed using endovascular interventions or hybrid techniques at our institution from 2005 to 2022. (3) Conclusions: These data emphasize that a multidisciplinary approach is needed for vEDS patients and that when endovascular or hybrid treatment is performed in a timely manner by a skilled team of interventional radiologists, good results can be achieved. Our report also demonstrates that the prognosis of vEDS patients has improved over the past 20 years with a new prevention program including celiprolol therapy, physical activity adaptation and limitation, and scheduled monitoring by expert clinicians. Full article

(This article belongs to the Special Issue "Visceral Aneurysm" in 2022: Recent Advances and Treatment)

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