rome and Aneurysm

Visceral artery aneurysms (VAAs), although rare, represent a life-threatening disease with high mortality rates. With the more frequent use of diagnostic tests, there has been an incidental detection of these lesions which are mostly asymptomatic. It follows that surgeons are increasingly called to decide on the most appropriate management of VAAs between an open surgical or endovascular approach and among the different endovascular options currently available. The aim of this retrospective study was to evaluate the results of open surgery and interventional endovascular strategies of visceral artery aneurysms with respect to technical success, therapy-associated complications, and postinterventional follow-up in the elective and emergency situation.. From January 1992 to January 2017, 125 open surgical or endovascular interventions for VAA were performed at our institution. Once the VAA was diagnosed and the indication for treatment was assessed, the preoperative diagnostic work-up consisted of contrast computed tomography (CT) or magnetic resonance imaging (MRI) and, in some patients, digital subtraction angiography. Follow-up included clinical and duplex ultrasound scan (DUS) and contrast-enhanced ultrasound to assess the treated vessel patency and organ perfusion after 1, 6, and 12 months, and yearly thereafter. CT or MRI controls were also performed at 1 year of follow-up and only when DUS was not diagnostic or showed a complication thereafter. After the first 5 years of follow-up, the status of the patient was obtained by a structured telephone survey.. The treatment option was endovascular in 56 of 125 cases (44.8%). Technical success was 98.3%. In one case, the procedure was interrupted for the extensive dissection of the afferent vessel. Twenty-six patients were treated by coil embolization while 29 with covered stenting. The endovascular approach was in emergency in two cases (3.6%). In the endovascular group, mortality was nil. Complications occurred in 5 cases (8.9%): 1 subacute intestinal ischemia caused by superior mesenteric artery dissection, 2 aneurysm reperfusion, 1 stent thrombosis, and 1 massive splenic hematoma. In 69 (55.2%) cases, surgical treatment was preferred, with 24 VAA resections and 45 arterial reconstructions. In 20 cases (29%), open surgery was performed in emergency conditions. In the surgical group, 8 emergency patients (40%) died intraoperatively. The mortality after elective surgical interventions was nil. Complications after surgery were 4 graft late thrombosis (5.8%): asymptomatic in three cases and requiring splenectomy in one.. There is no overall consensus regarding the indications for treatment of VAA. Currently in emergent setting, the endovascular approach should be considered as the first choice because of its reduced invasiveness, faster way to access and bleeding control; this accounts for the lower morality of the interventional therapy than open surgery. Endovascular approach is effective for elective repair of VAAs, but procedure-related complications may occur in a not negligible number of patients. Given comparable mortality rates and low procedure-related complication rate, surgical approach still has space in the elective management of VAAs, especially for aneurysms unsuitable or challenging for the endovascular option in patients with low surgical risk. The size, location, and morphology of VAAs, systemic or local comorbidities, and specific anatomical situations such as previous abdominal surgery should dictate treatment choice.

Topics: Aged; Aneurysm; Arteries; Elective Surgical Procedures; Embolization, Therapeutic; Emergencies; Endovascular Procedures; Female; Humans; Male; Postoperative Complications; Retrospective Studies; Risk Factors; Rome; Stents; Time Factors; Treatment Outcome; Viscera

The aim of this study was to assess the technical success and clinical long-term results of renal artery aneurysm (RAA) treatment using covered stents.. We performed a retrospective study on endovascular treatment of nine patients with 10 RAAs, arising from the main renal artery or from the proximal portion of large segmental arteries. All procedures were performed in our department between 2004 and 2011. The aneurysms were excluded using covered stents. Our follow-up included laboratories indexes, Computed Tomography-angiography (CTA) at 1-6-12-24 months and 48-month Duplex-ultrasound examination.. Study population included 4 males and 5 females (mean age: 63.5±7.3 y.o.). Six were affected by fibromuscular dysplasia and associated renal artery stenosis. The population showed a significant decrease of arterial blood pressure (from baseline values of 163.9±19.4/98.9±9.2 mmHg to 128.9±6.5/79.4±4.6 mmHg at 24 months follow-up) and of drug posology (baseline 3.7±0.7 drugs to 1.6±0.7 drugs at 24 months). Also they showed a significant decrease of serum creatinine levels (baseline 1.9±1.4 mg/dL vs.1.1±0.4 mg/dL at 12 months) and increase of glomerular filtration rate (from baseline values 46.9±23 mL/min/1.73 m2 to 69.1±20 mL/min/1.73 m2 at 24 months follow-up). CTA demonstrated patency of the cover stents, absence of endoleaks and re-stenosis in all patients. Only in one patient the inferior segmental artery was sacrificed due to the presence of its early origin, resulting in a small area of renal parenchyma infarction with no significant clinical consequences.. The procedure revealed to be safe for renal function, feasible and effective for the exclusion of the aneurismal sac and restoring vessel patency.

Topics: Aged; Aneurysm; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Computed Tomography Angiography; Endovascular Procedures; Female; Humans; Male; Middle Aged; Prosthesis Design; Renal Artery; Retrospective Studies; Rome; Stents; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Duplex

Although rare, popliteal artery aneurysms (PAAs) are the most commonly observed peripheral arterial aneurysms. Surgical repair is considered the gold standard, even if with debated results. The aim of our study is to evaluate the outcome of endovascular treatment of PAAs using the Viabahn peripheral endograft (W. L. Gore and Associates, Inc., Flagstaff, AZ) in 2 high-volume Italian centers.. All consecutive PAA patients treated by endovascular procedures between January 2004 and December 2013 were retrospectively reviewed. True atherosclerotic aneurysms, symptomatic and asymptomatic, were included in the analysis. All patients were treated by high-skilled vascular surgeons. The outcome measures were graft thrombosis, reintervention rate, and limb salvage at early and long-term follow-up.. Fifty-three PAAs were treated. Patients were more frequently male (98.1%) with a mean age of 73.6 ± 7.8 years. Twelve patients (22.6%) were symptomatic and in 8 of them a local fibrinolysis was required before definitive surgery. Mean PAA diameter was 30.9 ± 10.9 mm (range 17-60). Fifty-two patients (98.1%) had at least 1 patent runoff vessel. Technical success was achieved in all patients. Overall, 80 stent grafts were deployed and in 21 patients (39.6%) more than 1 stent graft was deployed. In-hospital mortality rate and 30-day reinterventions were null. At a mean follow-up of 37.4 ± 29.3 months, primary patency, secondary patency, and limb salvage were respectively 73.6%, 92.4%, and 100%.. In our limited, retrospective experience, the endovascular treatment of PAA by Viabahn stent graft allowed satisfactory technical and clinical results even at long-term follow-up.

Topics: Aged; Aged, 80 and over; Aneurysm; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Disease-Free Survival; Endovascular Procedures; Female; Graft Occlusion, Vascular; Humans; Kaplan-Meier Estimate; Limb Salvage; Male; Middle Aged; Popliteal Artery; Prosthesis Design; Reoperation; Retrospective Studies; Risk Factors; Rome; Stents; Thrombosis; Time Factors; Treatment Outcome; Vascular Patency