Search Results (43)

Background: This study aims to evaluate the prevalence, spectrum, and coexistence of anatomical variations in the major branches of the abdominal aorta using Multidetector Computed Tomography (MDCT) angiography, with a specific emphasis on analyzing sex-related differences in a large-scale cohort. Methods: A retrospective analysis was conducted on 1174 patients (63.8% male, 36.2% female; mean age 60.54) who underwent abdominal CT angiography between January 2023 and June 2024. Images were acquired using a 128-slice MDCT scanner and reconstructed for detailed vascular assessment. Statistical comparisons between genders were performed using Chi-square and Fisher–Freeman–Halton tests, with p < 0.05 considered significant. Results: The celiac trunk (93.3%), superior mesenteric artery (SMA) (97.1%), and inferior mesenteric artery (IMA) (98.5%) predominantly showed classical patterns. However, significant sex-related differences were identified. Females exhibited significantly higher rates of classical patterns for the celiac trunk (96.2% vs. 91.7%), IMA (99.1% vs. 98.1%), right hepatic artery (RHA) (91.5% vs. 82.6%), and left hepatic artery (LHA) (95.8% vs. 85.4%). Conversely, males showed a higher prevalence of complex variations, including replaced/accessory hepatic arteries and the absence of the common hepatic artery. The number of right and left renal arteries was similar between sexes and did not show a significant difference, while horseshoe kidney was detected only in males. Conclusions: Abdominal vascular structures adhere to classical anatomy more frequently in females, while males exhibit greater morphological variability. These findings emphasize the necessity of gender-specific preoperative vascular mapping to optimize surgical outcomes and reduce morbidity. Full article

In clinical practice, the coexistence of Superior Mesenteric Artery (SMA) syndrome (also known as Wilkie’s syndrome) and Celiac Artery Compression Syndrome (also referred to as Dunbar’s syndrome) is extremely rare. This combined pathology is characterized by simultaneous impairment of blood flow in the celiac trunk and compression of the duodenum, which complicates both diagnosis and treatment strategy selection. Traditional open surgical correction is associated with significant invasiveness due to the complexity of the anatomical relationships involved. Minimally invasive approaches, including robot-assisted surgery, allow precise dissection within confined anatomical spaces. This article presents a clinical case of simultaneous robot-assisted decompression of the celiac trunk and duodenum using the da Vinci Xi system. The case demonstrates the technical feasibility of a combined minimally invasive approach for the management of concurrent vascular and duodenal compression. Full article

Background and Objectives: Median arcuate ligament syndrome (MALS), also known as Dunbar syndrome, is a vascular compression disorder. Over time, laparoscopy has become increasingly important in the treatment of MALS, gradually replacing open surgical reconstruction as the preferred first-line approach in most cases. We present nine years of experience managing patients with MALS, aiming to contribute to the evidence supporting this long-debated condition. Materials and Methods: A single-center prospective observational cohort study analysis was conducted. CT angiography was used to confirm the diagnosis of MALS in all patients. All surgical patients completed the Gastrointestinal Quality of Life Index (GIQLI) and Gastrointestinal Symptom Rating Scale (GSRS) questionnaires preoperatively and postoperatively. All the patients underwent laparoscopic decompression. Postoperative follow-up visits were scheduled at one month and three years postoperatively. Results: During the study period, 37 patients were diagnosed with MALS, of whom 11 (29.7%) were symptomatic and underwent laparoscopic decompression. The operated cohort consisted of nine women and two men (mean age 56.7 ± 10.7 years). All patients reported postprandial epigastric pain, and 63.6% experienced weight loss. Laparoscopic decompression was successfully completed in all cases without intraoperative complications. Two patients had stenting after surgery, and in two, prior to surgery. The mean operative time was 103 ± 54 min, and the mean hospital stay was 4.2 ± 2.2 days. At 3-year follow-up, 36.4% of patients reported recurrent symptoms associated with recurrent celiac trunk stenosis on CT angiography. Overall, the patients had less indigestion and less pain; however, the differences did not reach a statistically significant level. Conclusions: Laparoscopic decompression of the median arcuate ligament is a feasible and safe treatment for carefully selected patients with symptomatic MALS, offering durable symptom relief in most cases with minimal morbidity. Full article

Background: Down syndrome (DS) is commonly associated with complex respiratory phenotypes due to anatomical, immunological, and vascular factors. Pulmonary sequestration (PS) is a rare congenital malformation of non-functioning lung tissue with anomalous systemic arterial supply, occasionally reported in syndromic individuals. Case presentation: We report the case of a female infant with DS who developed acute respiratory distress secondary to respiratory syncytial virus infection. Chest imaging revealed an intralobar pulmonary pseudosequestration in the right lower lobe, supplied by the celiac trunk and draining into the pulmonary veins, with a communication to the bronchial tree. The patient required pediatric intensive care support and nutritional rehabilitation. Surgical resection was deferred until adequate weight optimization could be achieved. Discussion: This is, to our knowledge, the first description of intralobar pulmonary pseudosequestration in a patient with DS. The association suggests possible overlapping developmental mechanisms involving abnormal angiogenesis and emphasizes the importance of considering congenital pulmonary malformations in DS patients presenting with recurrent or severe respiratory symptoms. Conclusions: Early recognition and tailored management may improve clinical outcomes in this vulnerable population. Full article

Background/Objectives: Understanding anatomical variations in the abdominal vasculature, particularly of the inferior phrenic arteries (IPAs) and renal arteries (RAs), is essential in surgery and radiology, as such variations directly influence preoperative planning and therapeutic strategies. Although IPAs most commonly arise from the abdominal aorta (AA) or the celiac trunk, and RAs from the AA, anomalous origins have clinical significance, notably the emergence of the IPA from the RA. This study reports the concomitant occurrence of a triple right renal artery and the atypical origin of the ipsilateral inferior phrenic artery. Case Report: During a routine cadaveric dissection, three right renal arteries (superior, middle, and inferior) were identified in an adult male specimen, along with an anomalous origin of the right inferior phrenic artery (RIPA). The RIPA originated from the superior renal artery (SRA), ascended superolaterally to the inferior vena cava and bifurcated at the diaphragmatic dome. The SRA also gave rise to two right inferior suprarenal arteries. Conclusions: The coexistence of a triple renal artery and anomalous origin of the IPA represents an exceptionally uncommon and scarcely reported vascular configuration. This finding underscores the importance of meticulous preoperative vascular mapping, crucial for preventing intraoperative and iatrogenic complications. Broader anatomical and radiological studies are warranted to better elucidate the prevalence, developmental basis, and clinical implications of such variations. Full article

Pararenal abdominal aortic aneurysm/pseudoaneurysms (PAAA/PAAP) are rare, high-risk complex aortic lesions involving the renal arteries. Management includes open surgical repair (OSR), endovascular aortic repair (EVAR), or hybrid repair, each with specific advantages and limitations. A review of the literature was performed to assess treatment strategies and outcomes for PAAA and PAAP. A PubMed search using relevant MeSH terms identified 184 articles published in the last five years. After applying inclusion and exclusion criteria, 34 studies comprising 6460 patients with complex AAA/AAP were included for analysis. Treatment strategies were predominantly endovascular (79.4%), followed by open (5.8%) and hybrid approaches (2.9%) (11.7% have used EVAR or OSR in the same study). To emphasize difficulties in the management of this pathology, a case report of a large PAAP involving both renal arteries and occluded celiac trunk with retrograde flow from patent superior mesenteric artery (SMA) is presented. Given the complex anatomy and high surgical risk, hybrid treatment was chosen consisting of bilateral ilio-renal Dacron bypasses followed by ChEVAR (chimney stenting of the SMA), with favorable postoperative recovery. The management of PAAP requires an individualized, anatomy- and risk-adapted approach. Open surgical repair remains preferable for younger, low-risk patients for superior long-term durability, whereas endovascular repair offers lower perioperative morbidity in high-risk cohorts. Optimal outcomes are dependent on high-volume centers with multidisciplinary expertise. Full article

The myeloproliferative neoplasms (MPN), a heterogeneous group of disorders characterized by specific genetic mutations, have the development of arterial and venous thrombosis as their main complication. Almost 40–50% of MPN patients encountered arterial or venous thrombosis during the course of their disease. Moreover, arterial thrombosis is linked to significant mortality, progression to myelofibrosis, and an increased risk of developing second cancers. Despite significant advancements in medical research, there are still unmet needs in this field. Our narrative review provides clinical and genetic insights into thrombosis associated with myeloproliferative neoplasms. We focus on the underlying pathophysiological processes, assessment methods, and risk stratification related to thrombotic events. This information aims to assist clinicians in accurately assessing the risks associated with MPN thrombosis, enabling a more personalized and effective approach to patient care. We based our review on a rare case of MPN-associated thrombosis, whose clinical presentation was marked by acute ischemia in both lower limbs. The thrombosis affected the distal aortic arch, thoracic and abdominal aorta, celiac trunk, common and proper hepatic arteries, proximal left renal artery, several segmental arteries in the right kidney, and the portal vein thrombosis. Our review presents various therapeutic options for these conditions. In the presented case, the multiple thrombi were treated medically, except for the popliteal artery thromboses, which required surgical management. This case may serve as a valuable reference for choosing treatment options for aortic and portal vein thrombosis, highlighting the multidisciplinary approach. Full article

Objective: Type B aortic dissection is a life-threatening medical condition. Endovascular closure of the primary entry by means of TEVAR is considered, nowadays, the gold standard if operative treatment is necessary. The aim of this study is to analyse the theoretical applicability of selective endovascular entry sealing using different occluder systems. Methods: A CT-graphic analysis of 102 patients who received TEVAR from January 2017 to June 2023 was performed. Patients with an intramural haematoma were excluded. The study patients were divided in two groups: type B aortic dissection (n = 87) and distal stent graft-induced new entry (n = 15). The TBAD group included patients with acute (n = 63), subacute (n = 12), and chronic aortic dissections (n = 12). The CTA analysis of the location, length, and width of the entry was performed using Aquarius iNtuition (TeraRecon, Inc., Foster City, CA, USA). After completion of the data collection, the possible application of all three occluder systems (ASD-Occluder, Septal-Occluder, and Amplatzer™-Occluder) was analysed, with reference to the Instructions for Use. Results: The ASD-Occluder from GORE is produced in five different sizes. It can be used in 81.4% (n = 83) of all patients in the overall study, including 82.8% TBAD (n = 72) and 73.3% of dSINE (n = 11) patients. When using the ASD-Occluder, 10.3% (n = 9) of patients are expected to have complete vascular coverage of the LSA based on our CTA analysis. The Septal-Occluder from GORE is offered in three different sizes. Complete entry closure can theoretically be achieved in fifty patients (57.5%) with TBAD and in nine patients (60%) with dSINE, based on CTA analysis and IFU criteria. With the use of the Septal-Occluder, 3.9% (n = 4) of the dSINE patients and 4.6% (n = 4) of the TBAD patients were expected to have complete aortic branch occlusion. The Amplatzer™-Occluder from Abbott is provided in 27 different sizes to effectively seal defects with a diameter of 4 to 56 mm. It can technically be used in 90.1% of patients (n = 92), of which 89.7% with TBAD (n = 78) and 93.3% with dSINE (n = 14) to completely seal the entry. Conclusions: CTA analysis in patients with TBAD and dSINE demonstrated that by the theoretical application of occluder systems, a seal of the entry would be achieved in 57.8% to 90.1% of the patients. However, in addition to entry closure, the use of occluder systems can also lead to unintentional partial (10.7–23.5%) or complete (3.9–22.5%) coverage of adjacent aortic branches. The clinical significance and applicability of the occluder system should be reviewed in future studies and practical applications to evaluate safety, efficacy, and possible complications in order to define the benefit–risk balance. Full article

Background: This study evaluated the effects of veno-arterial (V-A) and veno-venoarterial (V-VA) ECMO in a porcine model of septic endotoxemia-induced acute pulmonary arterial hypertension (PAH). Our hypotheses were as follows: (1) V-VA ECMO lowers pulmonary vascular resistance (PVR) by delivering oxygenated blood to the pulmonary circulation, and (2) both V-A and V-VA ECMO improve perfusion to vital organs while simultaneously unloading the right ventricle (RV). Methods: Acute PAH was induced with Salmonella abortus equi lipopolysaccharide (LPS) in 34 pigs. Animals were randomized to either a control group without ECMO or to two groups receiving V-A or V-VA ECMO. Results: All animals developed PAH after one hour of LPS infusion: mean pulmonary artery pressure (PAP) increased significantly from 26 (24–30) mmHg to 40 (34–46) mmHg (p < 0.0001), and PVR increased from 314 (221–390) to 787 (549–1073) (p < 0.0001). Neither V-A nor V-VA ECMO significantly reduced PVR compared to controls. RV end-diastolic area increased in the control group [6.1 (4.3–8.6) cm vs. 8.5 (7.8–9.7) cm, p = 0.2], but not in the V-A [4.7 (3.3–7.6) cm] and V-VA [4.3 (2.5–8.3) cm] ECMO groups. Blood flow in the cranial mesenteric artery and celiac trunk did not differ significantly with or without ECMO. Conclusions: Elevating pulmonary artery oxygen tension through V-A or V-VA ECMO did not reduce PVR or PAP. However, both ECMO configurations effectively unloaded the RV and maintained perfusion to abdominal organs. Full article

Background/Objective: Bridging stent optimal choice in fenestrated and branched endovascular aortic repair (f/bEVAR) is under investigation. This systematic review and meta-analysis studied the outcomes of the BeGraft peripheral and peripheral PLUS as bridging stents in f/bEVAR. Methods: The methodology was pre-registered to the PROSPERO (CRD420251007695). Following the PRISMA guidelines and PICO model, the PubMed, Cochrane and Embase databases were searched for observational studies and randomized control trials, in English, from 2015 to 2025, reporting on f/bEVAR patients using the second-generation BeGraft peripheral or the BeGraft peripheral PLUS balloon expandable covered stent (BECS; Bentley InnoMed, Hechingen, Germany) for bridging. The ROBINS-I assessed the risk of bias and GRADE the quality of evidence. Target vessel technical success, occlusion/stenosis, endoleak Ic/IIIc, reintervention and instability during follow-up were primary outcomes, assessed using proportional meta-analysis. Results: Among 1266 studies, eight were included (1986 target vessels; 1791 bridged via BeGraft); all retrospective, except one. The ROBINS-I showed that seven were at serious risk of bias. According to GRADE, the quality of evidence was “very low” for primary outcomes. Target vessel technical success was 99% (95% CI 98–100%; I² = 12%). The mean follow-up was 20.2 months. Target-vessel instability was 3% (95% CI 2–5%; I² = 44%), occlusion/stenosis was 1% (95% CI 1–4%; I² = 8%) and endoleak Ic/IIIc was 1% (95% CI 0–3%; I² = 0%). The estimated target-vessel reintervention was 2% (95% CI 2–4%; I² = 12%). Celiac trunk, superior mesenteric and renal artery instability were 1% (95% CI 0–16%; I² = 0%;), 1% (95% CI 0–5%; I² = 14%) and 4% (95% CI 2–7%; I² = 40%), respectively. Conclusions: The BeGraft peripheral and peripheral PLUS BECS performed with high technical success and low instability when used for bridging in f/bEVAR. Cautious interpretation is required due to the very low quality of evidence. Full article

Objectives: To develop and internally validate a pre-treatment score for the safe selection of the best candidates for the transradial approach when performing liver cancer intra-arterial procedures. Methods: One hundred and twenty-two patients undergoing hepatic endovascular treatments via radial access between January and December 2022 were retrospectively selected to develop a prediction model. Pre-procedural imaging data were analyzed, and variables were selected to develop the RAD-access score. Intra-procedural data were analyzed to assess effective procedural complexity (ePC). The relationship between ePC and pre-procedural variables was statistically tested, and cutoff points were defined. Results: A final score (RAD-access) was created and prospectively validated on 139 patients enrolled between June and September 2023. Aortic arch diameter and angulation, left subclavian artery angulation, suprarenal abdominal aorta diameter, celiac trunk take-off angle, and radial artery diameter were the significant variables used to build the score. In the validation cohort, based on the pre-treatment RAD-access score, 69 patients underwent a transradial approach, with a significantly lower ePC rate obtained (78.2% easy, 20.3% intermediate, 1.5% complex). No major adverse events occurred. Conclusions: Pre-treatment RAD-access score provides a good prediction for the procedural complexity of the transradial approach in patients undergoing liver cancer intra-arterial treatments, identifying the best candidates for an easy and safe transradial procedure. Full article

Background and Objectives: The pancreas receives blood through a complex network of multiple branches, primarily originating from the celiac trunk (CeT) and the superior mesenteric artery (SMA). This blood supply is structured into three main arterial groups, each serving different regions of the pancreas to effectively support its endocrine and exocrine functions. Materials and Methods: The databases Medline, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Latin American and the Caribbean Literature in Health Sciences (LILACS) were searched until January 2025. Methodological quality was evaluated using an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model. Results: A total of sixteen studies met the established selection criteria in this study for meta-analysis. Pancreatic irrigation variants presented a prevalence of 11.2% (CI: 7–14%) and a heterogeneity of 88.2%. The other studies were analyzed by subgroups, showing statistically significant differences in the following subgroups: (1) sample type—a larger sample of images analyzed in the included studies (p = 0.312), which did not show statistically significant differences; (2) geographical region (p = 0.041), which showed a greater presence in the Asian population studied, and this was statistically significant; and (3) sex (male or female) (p = 0.12), where there were no statistically significant differences. Conclusions: The discovery of variations in pancreatic irrigation is common due to the numerous blood vessels involved in supplying this vital organ. Understanding different vascular patterns (such as those from the splenic and mesenteric arteries) is crucial for surgical interventions on the pancreas. For transplant patients, a thorough vascular analysis of both the donor and recipient is essential. Variations can impact blood flow and compatibility, potentially leading to transplant rejection if not addressed. To enhance outcomes, it is recommended to develop more accurate imaging tools for pre-surgical analysis, necessitating ongoing research in this area. Full article

Median Arcuate Ligament Syndrome, also known as Dunbar’s syndrome, is a rare condition caused by stenosis of the celiac artery (CAS) through the fibrous arch connecting the diaphragmatic branches. It manifests as postprandial abdominal pain, nausea, vomiting, weight loss and increased epigastric tenderness. The condition most commonly affects young females without coexisting vascular comorbidities. Diagnosis is difficult due to the non-specific symptoms, often overlapping with other gastrointestinal diseases. Standard investigations include duplex ultrasound, computed tomography angiography (CTA) and contrast-enhanced magnetic resonance imaging (CE-MRA). Treatment mainly consists of surgical release of the arch ligament, which can be performed by open, laparoscopic or robotic methods. Surgery is often supported by celiac truncal stenting for residual stenosis, which significantly improves vascular flow. Alternative approaches include visceral plexus blocks and novel hybrid techniques, such as a combination of ligament release and endovascular treatment of the celiac trunk. In severe cases, vascular by-passes are recommended. The aim of this paper is to discuss the clinical manifestations, diagnostic possibilities, therapeutic options and directions for further research on MALS from the perspective of a vascular surgeon. It emphasizes the need for a multidisciplinary approach, including collaboration between the surgeon, radiologist, gastroenterologist and psychologist, which enables comprehensive disease management and improved quality of life for patients. In addition, the need for further development of diagnostic and therapeutic methods for early diagnosis and effective treatment was pointed out. Full article

The abdominal aorta enters the diaphragm at the level of the 12th thoracic vertebra and gives branches such as the celiac trunk (CT), superior mesenteric, and inferior mesenteric arteries. The main aim of the present research study was to observe the CT with regard to (i) variations in the dimensions among different age groups compared to gender, (ii) the vertebral level of origin, and (iii) the variation in the branching pattern. This cross-sectional retrospective study was performed on 116 subjects (n = 91 males, n = 25 females) over one year. The CT was interpreted by using contrast-enhanced computed tomography angiography. The results were assessed using parametric and non-parametric statistical tests. The length and diameter between gender and the three age groups (i.e., 29 years and below, 30–39 years, and more than 40 years) were compared and a p-value of less than or equal to 0.05 was considered significant. There was a significant difference in the length (p = 0.016) and diameter of the CT (p = 0.05) among males and females, respectively. Moreover, there was a significant difference in the length (p = 0.038) and diameter (p = 0.013) of the CT among the three age groups. Individuals aged 30–39 years had the highest mean for the length of the CT, while patients aged 29 years and younger had the highest diameter. The most common level for CT origin was at the vertebral level of the 12th thoracic vertebra (73.3%). Anatomical knowledge of the CT is important for diagnostic imaging, organ transplantations, and surgical and laparoscopic interventions. Full article

Background and Objective: High-flow pancreaticoduodenal artery (PDA) aneurysms secondary to celiac trunk occlusion or stenosis have a high risk of rupture. Embolization offers a less invasive alternative to surgery. We evaluated the effectiveness and safety of retrograde embolization via the superior mesenteric artery of high-flow PDA aneurysms without celiac trunk revascularization. Methods: This retrospective bicentric study included patients who underwent embolization of high-flow PDA aneurysms due to significant celiac trunk stenosis or occlusion. All patients underwent pre-interventional dynamic contrast-enhanced computed tomography. Retrograde embolization was performed using microcoils and/or liquid agents without celiac trunk revascularization. Follow up involved clinical and radiological assessment at one month. Technical and clinical success were evaluated, and complications were categorized as minor or major. Results: Twenty-three patients (mean age 65 ± 14 years; 52% male) were included. Emergency embolization was required in 12 patients (52%). The technical success rate was 100%. Patients were monitored for a median of 16 months. Clinical success was 87%. No hemorrhagic recurrences were observed. Minor complications occurred in two cases. One major complication involved splenic infarction due to glue migration, requiring splenectomy and intensive unit care admission. Conclusions: Retrograde embolization of high-flow PDA aneurysms is effective and safe without needing celiac trunk revascularization. Full article