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A 77-year-old male presented for an incidental 5-cm gastroduodenal artery aneurysm (GDAA). He underwent an endovascular GDAA coil embolization with 6 months of no aneurysmal growth on surveillance imaging. His 12-month scan revealed aneurysmal growth from 5 cm to 7.5 cm involving the hepatic confluence. He underwent successful open aneurysm resection and primary anastomosis of the hepatic artery. Although less invasive interventions are recommended for GDAAs, many vascular surgeons prefer to proceed with an open repair. Continued GDAA enlargement after perceived endovascular success demonstrates the importance of long-term surveillance and viability of open intervention, sparing patients from a potentially fatal rupture.

This report presents a unique case of concurrent mycotic aneurysms in a 64-year-old male left ventricular assist device (LVAD) recipient. Initially admitted with odontogenic maxillary fungal sinusitis and fungemia, he later presented to our clinic with significant weight loss, fatigue, and LVAD complications. Imaging revealed a large complex mid-superior mesenteric artery aneurysm with multiple associated jejunal branches and a ruptured splenic aneurysm. Although these aneurysms were successfully managed, it is important to note the challenges in postoperative care, including anticoagulation-related complications such as post-splenectomy hematoma and intracranial bleeding. This case highlights the delicate balance between therapeutic interventions and managing LVAD-related complexities.

True aneurysms of the pancreaticoduodenal artery (PDA) arcade are rare but require intervention due to the high risk of rupture. Historically, these aneurysms have been managed with open surgical methods. In this study, we describe a contemporary series of aneurysms treated using a modern approach that includes endovascular and hybrid techniques. All the patients with aneurysms of the PDA arcade in an institutional database were identified between 2008 and 2022. Patients with history of pancreatic resection were excluded. Data on demographics, presenting symptoms, imaging findings, operative approach, and outcomes were collected and reviewed. There were nine patients diagnosed with a PDA aneurysm, and all nine underwent endovascular intervention. Most were men (n = 5; 55.6%) and White (n = 7; 77.8%) and had American Society of Anesthesiologists class II or III. The median aneurysm size was 21 mm (range, 6-42 mm), and five (55.5%) were symptomatic. Of the five symptomatic cases, two presented with rupture and were treated urgently. The median time to intervention for the nonurgent cases was 30 days. All but one patient had concomitant celiac artery stenosis and two of the eight cases (25%) were due to extrinsic compression from median arcuate ligament syndrome. Both patients underwent median arcuate ligament syndrome release before endovascular intervention. Another patient required open surgical bypass before endovascular repair from the supraceliac aorta to hepatic artery using a Dacron graft to maintain hepatic perfusion. Among the eight patients with celiac axis stenosis, five (62.5%) required celiac stent placement within the same operation. Coil embolization of the aneurysm was used for all except for two patients (n = 7 of 9; 77.8%), with one patient receiving embolic plugs and another receiving an 8 × 38-mm balloon-expandable covered stent for aneurysm exclusion. The median operating room time was 134 minutes. All repairs were technically successful without any intraoperative or postoperative complications. The mean follow-up was 30 months. There was no morbidity, mortality, or unplanned secondary reinterventions within 6 months after aneurysm repair. Stent patency and aneurysm size remained stable at 2 years of follow-up. True pancreaticoduodenal artery arcade aneurysms can be safely and effectively treated using endovascular and hybrid techniques. Because many of these aneurysms have concomitant celiac artery stenosis, the use of endovascular technology allows for simultaneous treatment of both the aneurysm and the stenosis with exceptional results.

An arterial aneurysm is a localized weakening of the artery wall that results in pathological dilatation. All intra-abdominal artery aneurysms are labeled as visceral artery aneurysms (VAA), apart from the aorto-iliac artery aneurysms. VAA's are rare, gastroduodenal artery aneurysms (GDAA), constituting 1.5% of visceral artery aneurysms. A woman in her early 80s' presented with chronic epigastric pain, weight loss, and nausea. Conservative management was unsuccessful. Imaging revealed a GDAA, prompting endovascular coil embolization. Subsequent evaluation confirmed Polyarteritis Nodosa (PAN), treated with rituximab. The report underscores the diagnostic challenges, emphasizing the need for a multidisciplinary approach using imaging and angiography. GDAA's potential life-threatening rupture necessitates prompt intervention, as illustrated in this case. The rare association with PAN, although infrequent, underscores the importance of considering underlying etiologies in multiple visceral aneurysms. Early diagnosis and intervention are pivotal for this uncommon yet potentially lethal condition. [ABSTRACT FROM AUTHOR]

The aneurysm of the gastroduodenal artery (AGDA) is a rare, but potentially fatal vascular disease. Chronic pancreatitis is considered to be the leading etiological cause. The most common complication is rupture, which is accompanied by extremely high mortality, due to the rapidly occurring massive blood loss. In such situations, a high index of clinical suspicion, followed by urgent imaging diagnosis and active treatment strategy in case of emergency can prevent a potentially fatal outcome. In the following paper, we present a case of a successfully treated ruptured aneurysm of the gastroduodenal artery(AGDA), that started with minor gastrointestinal bleeding. Endoscopic hemostasis was attempted, followed by an episode of massive recurrent bleeding, requiring emergency operation. A brief literature review, related to the diagnosis and treatment of this rare, but fatal complication of AGDA, is also presented. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Giant true aneurysms of the hepatic arteries are rare. Pseudoaneurysms of the hepatic arteries are more common and are mostly caused by intra-abdominal infection, iatrogenic injury, or trauma. Hepatic or cystic pseudoaneurysms are often successfully treated by embolization owing to their saccular nature as opposed to true aneurysms. We present a case of a patient with a giant true aneurysm of the proper hepatic artery, mimicking Mirizzi syndrome. Open reconstruction was successfully preformed, and the patient made a full recovery.

Inferior phrenic artery (IPA) aneurysms are the rarest type of visceral aneurysms. It usually occurs secondary to trauma, surgery, or as a complication of pancreatitis. In addition, it can be a manifestation of underlying systemic pathology such as vasculitis, collagen vascular disorders, sepsis, or segmental arterial mediolysis. It can be associated with hypertension in 43% of cases. The presentation of IPA aneurysm is nonspecific with abdominal pain, melena, hematochezia, and anemia. The ruptured and actively bleeding aneurysm can lead to hemorrhagic shock, and immediate management is required with angiography and endovascular embolization with coil or gel foam or stent etc. Inaccessible locations are reached with surgical intervention, but it is associated with high morbidity and mortality. We here report a rare case of spontaneously ruptured IPA pseudoaneurysm extending from the posterior mediastinum to the subdiaphragmatic area and managed with coil and gel foam embolization., (© 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

Purpose: The aim of the study is to analyze our single-center experience in endovascular treatment of splenic artery aneurysms (SAAs) with transcatheter coil embolization, comparing long-term outcomes of packing and sandwich techniques., Materials and Methods: Between January 2010 and December 2021, 28 patients with certain diagnosis of non-ruptured asymptomatic SAA were treated with 2 different embolization techniques (packing, n=10, and sandwich, n=18). Early outcomes assessed were technical success, overall mortality, mean hospital stay, post-embolization syndrome rate, and freedom from splenectomy rate. Estimated 5-year outcomes in terms of freedom from sac reperfusion, and freedom from reintervention were evaluated and compared between the 2 different embolization techniques., Results: The mean SAA diameter was 2.8±0.8 cm. Overall technical success rate was 100%. Intraoperative and 30-day mortality rates were 0 in both groups. One patient in the sandwich group required a postoperative splenectomy. The mean follow-up period was 58.3±44.5 months. Estimated overall 5-year survival was 86.7%. Five-year freedom from sac reperfusion was 100% in the sandwich group, and 85.7% in the packing group, with no difference between the 2 groups (p=0.131), whereas freedom from reintervention was 100% in the sandwich group, and 75% in the packing group with a statistically significant difference (p=0.049; log-rank=3.750)., Conclusions: Embolization of SAAs seemed to be safe and effective with 100% of technical success rate and good perioperative results. Both sandwich and packing techniques yielded promising results also in the long-term period., Clinical Impact: Transcatheter coil embolization of splenic artery aneurysms seems to be a safe and effective procedure with a 100% technical success and satisfactory perioperative outcomes. Sandwich and packing techniques offer good results in the long-term period. Freedom from reintervention seems to be optimal and comparable between the 2 techniques., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Median arcuate ligament syndrome (MALS) is a rare entity that occurs when the median arcuate ligament of the diaphragm is low-lying, causing a compression to the underlying celiac trunk. We reviewed the vascular changes associated with MALS in an effort to emphasize the seriousness of this disease and the complications that may result.Methods: This is a retrospective descriptive analysis of 23 consecutive patients diagnosed with MALS between January 1, 2012 and December 31, 2015 at a tertiary medical center. Computed tomographic (CT) scans, medical records, and patient follow-up were reviewed.Results: The number of patients included herein was 23. The median age was 56 years (17-83). Sixteen patients (69.6%) had a significant arterial collateral circulation. Eleven patients (47.8%) were found to have visceral artery aneurysms; 4 patients (36.4%) bled secondary to aneurysm rupture. All ruptured aneurysms were treated with endovascular approach. The severity of the hemodynamic changes appears to be greater with complete occlusion, CONCLUSIONS: MALS causes pathological hemodynamic changes within the abdominal vasculature. Follow-up is advised for patients who develop a collateral circulation. Resulting aneurysms should preferably be treated when the size ratio approaches three. Treatment of these aneurysms can be done via an endovascular approach coupled with possible celiac artery decompression to restore physiologic blood flow. [ABSTRACT FROM AUTHOR]

The aim of the present study was to analyze the outcome of open surgical and endovascular interventions for the treatment of visceral aneurysms. A retrospective review of a cohort of visceral aneurysm patients treated at a single tertiary referral center was conducted. STROBE guidelines were followed. The primary endpoint was postoperative in-hospital mortality. Secondary endpoints were major morbidity (Dindo-Clavien score, >3), the duration of the procedure, technical success and the length of hospital stay. As a result, 12 patients underwent open or endovascular surgery. No 30-day mortality or major morbidity were observed. The median aneurysm diameter was 2.0 cm (range, 1.5-5.0 cm). The median postoperative stay was four days for all procedures and significantly longer after open surgery compared with endovascular repair (ER) (7 vs. 3 days). Overall, the evidence from the present retrospective analysis shows no mortality and a shorter length of stay for patients undergoing ER for the treatment of a visceral aneurysm (VAA). Although the results are in line with the fact that ER is considered to be the first line treatment for VAA, this may be prone to selection bias. [ABSTRACT FROM AUTHOR]

Background: Studies on the prevalence of rare visceral aneurysms are still scarce and the few studies that have focused on these aneurysms present prevalence rates in groups of patients with visceral aneurysms, but little is known about their prevalence in the general population., Objectives: To assess the prevalence of rare visceral aneurysms on CAT scans performed for diagnosis and follow-up of patients with other vascular pathologies., Methods: This cross-sectional study began by accessing all reports from CAT scans performed between January 2005 and July 2021 at a private hospital of excellence located in the city of São Paulo. A software program for pre-indexed reports was used to search the Radiological Information System (RIS) database to identify reports of patients with intra-abdominal aneurysms., Results: CAT scan reports from 92,883 patients were accessed. Of these, 2,597 (2.795%) showed intra-abdominal aneurysms, 937 (1.063%) of which were visceral, including 158 (0.171%) rare visceral aneurysms, which were more frequent among male patients and in the following segments: celiac trunk (0.098%), superior mesenteric (0.033%), left gastric (0.010%), pancreatic-duodenal (0.009%), and gastroduodenal arteries (0.005%) and the pancreatic arch (0.004%). Lower prevalence was found in other segments. Additional findings revealed concomitance of rare visceral aneurysms with other intra-abdominal aneurysms ranging from 11.11% to 66.67%., Conclusions: The prevalence of rare visceral aneurysms in a large population undergoing CAT scan was 0.171%, with greater involvement in male patients., Competing Interests: Conflicts of interest: No conflicts of interest declared concerning the publication of this article., (Copyright© 2023.)

This article provides an overview of acute mesenteric ischemia, chronic mesenteric ischemia, and visceral aneurysms, with a focus on treatment. Acute mesenteric ischemia can be a challenging diagnosis. Early recognition and adequate revascularization are key to patient outcomes. Chronic mesenteric ischemia is a more insidious process, typically caused by atherosclerosis. Various options for revascularization exist, which must be tailored to each patient. Visceral aneurysms are rare and the natural history is not well defined. However, given the risk of rupture and high mortality, treatment may be complex., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objectives: Endovascular embolization is a valid option for the management of visceral artery aneurysms. Imaging is crucial for providing anatomical assessments, but preoperative non-invasive investigations may not be exhaustive. The aim of this work is to present preliminary experience with the use of three-dimensional rotational angiography (3DRA) in this particular theatre.Methods: Seven patients were treated for eight visceral aneurysms (six splenic and two renal) by endovascular embolization. 3DRA was performed before the treatment using a standard protocol. Different parameters (location of the lesion, the afferent and efferent vessels, aneurysm neck, vascular diameters, working incidence) were analyzed.Results: 3DRA was successfully accomplished in all procedures. Mean aneurysm diameter was 23 mm and mean C-arm working incidence was 29° (R-L) and 9° (C-C). The sandwich technique was used in four lesions and the packing in the remaining four. Technical success was 100 %. The mean radiation dose per procedure was 291 600 mGy.cm(2). The mean procedural time was 2.25 hours. There were no immediate or short-term complications.Conclusions: 3DRA could be an interesting intraoperative tool to provide anatomical and technical assessments of the visceral arteries necessary for endovascular treatment, especially when information from preoperative imaging is not exhaustive.Key Points: Endovascular embolization is a valid alternative solution for visceral artery aneurysm treatment. Imaging is crucial for anatomical assessments and treatment guidance. 3DRA can contribute to endovascular treatment in lieu of preoperative imaging. [ABSTRACT FROM AUTHOR]

Hydrogel-coated coils are truly detachable coils with a platinum core covered with hydrogel. The coils are available in 0.018- and 0.035-in systems. These coils have the ability to expand up to four times their size ~20 minutes after deployment, thus providing a very effective mechanical vascular occlusion effect. The vessel-occlusive effect of these coils is a volume, space-occupying effect, not a thrombotic effect, as seen in fibered coils. Hydrogel-coated coils were originally developed and designed to treat brain aneurysms; however, their use has expanded to peripheral applications. Hydrogelcoated coils have been used in the management of visceral aneurysms, high-flow vascular arteriovenous fistulae, and endoleaks after endovascular thoracic and abdominal aneurysm repair. The purpose of this article is to describe the hydrogel-coated coil system, the mechanism of action, technical details for optimal deployment, and clinical applications. [ABSTRACT FROM AUTHOR]

Entamoeba histolytica is a protozoan parasite with worldwide distribution, higher in countries with poor sanitation due to its oral-faecal way of transmission. It is the causative agent of amoebic colitis and extraintestinal amoebiasis, and accounts for 40 000–100 000 deaths yearly. Amoebiasis can be complicated by liver abscess in 9% of cases. Rarely, vascular complications have been reported. Aneurysms of the hepatic artery have been described, rarely, in patients with amoebic hepatic abscess. Aim of our study was to describe clinical presentation, details of vascular lesions, treatment and outcome of patients with a history of amoebiasis complicated by hepatic abscess and aneurysm of hepatic vessels (key words "Amoebiasis AND aneurysm). Six case report were included. Mean age of patients was of 44.8 ± 8 years (range 31–52). All patients were male. Leucocytosis, anaemia, fever, abdominal pain, hematemesis, haemobilia, melena and hepatomegaly were the most frequently reported signs and symptoms. Aneurysms lesions occurred in hepatic artery or in its branches. In 2 cases rupture occurred. In 3 cases aneurysm embolization has been successful in treating arterial lesion. Spontaneous regression after abscess drainage occurred in 2 cases. Uneventful recovery was reported in the five patients with available follow up data. Hepatic artery aneurysms may complicate amoebiasis in patients with hepatic abscess. Notwithstanding the high burden of the disease, majorly in developing countries, only data from sporadic case report are available, suggesting underreporting bias. Further studies are needed to better understand the vascular involvement in this setting of parasitological interest. [ABSTRACT FROM AUTHOR]

Purpose: To assess the feasibility and the effectiveness of endovascular treatment of visceral arteries aneurysms (VAAs) using a "multimodal approach". Material and Methods: Twenty-five patients (mean age 60.1 years) with 29 VAAs (13 splenic, 4 hepatic, 3 gastroduodenal, 6 renal, 2 pancreatic-duodenal, 1 superior mesenteric) were considered suitable for endovascular treatment; 8/29 were ruptured. Saccular aneurysms (9/29) were treated by sac embolization with coils (in 4 cases associated with cyanoacrylate or thrombin) with preservation of artery patency. Fusiform aneurysms (6/29), were treated by an "endovascular exclusion". In 10/29 cases, supplied by a terminal branch, we performed an embolization of the afferent artery, with coils and cyanoacrylate or thrombin. 2/29 cases were treated with a stent-graft and 2/29 cases with a percutaneous ultrasound-guided thrombin injection and coils embolization of the afferent artery. The follow-up was performed by ultrasonography and/or CT-angiography 1 week after the procedure and then after 1, 6, and 12 months and thereafter annually. Results: In 29/29 cases we obtained an immediate exclusion. Two patient died for other reasons. Complication rate was 27.6% (7 spleen ischemia and 1 stent-graft occlusion). During the follow-up (range: 7 days-36 months, mean 18.7 months), we observed 3/29 (10.3%) cases of reperfusion in the first month, all treated successfully with a further endovascular procedure. Primary technical success was 89.7%; secondary technical success was 100%. Conclusion: Endovascular therapy can be considered a feasible and effective approach for VAAs with good primary and secondary success rates. [ABSTRACT FROM AUTHOR]

Renal artery aneurysms (RAAs) are rare, with an estimated incidence of 0.01% to 0.97%. These aneurysms are often asymptomatic, although they occasionally manifest with hypertension, back pain, hematuria, or rupture. Despite limited evidence guiding treatment, women of childbearing age are consistently offered treatment because of the high risk of rupture. We present a case of a woman planning pregnancy with bilateral RAAs after failed endovascular management. She underwent bilateral laparoscopic nephrectomy, ex vivo reconstruction, and autotransplantation for treatment of her aneurysms. This appears to be safe and effective for treatment of RAAs and should be considered in similar patients., (© 2020 The Authors.)

Celiac artery aneurysms (CAAs) are rare but potentially devastating lesions. Given the high rates of mortality on rupture at large sizes, they should be treated promptly with either surgical or endovascular interventions in appropriate-risk patients. Several options exist for treatment, including surgical repair and endovascular embolization with or without stent or stent graft placement. Because of their rarity, there are few reports of successfully treated CAA lesions. Herein, we describe successful endovascular treatment of one of the largest CAAs reported in the literature., (© 2019 The Author(s).)

Inferior mesenteric artery aneurysms are amongst the rarest of visceral aneurysms. We present here a case associated with occlusion of the superior mesenteric artery, coeliac trunk and right renal artery. Operative treatment was resection of the aneurysm, with end-to-end anastomosis. This is the first description of this condition from the UK, with only nine other reports worldwide. Such pathology may be caused by a “jet disorder” phenomenon, with increased flow through the inferior mesenteric artery due to chronic mesenteric occlusive disease. [Copyright &y& Elsevier]

Segmental arterial mediolysis (SAM) is a rare arteriopathy that can cause acute abdomen. This report describes the case of a 31-year old male suffering from huge visceral aneurysms with contained rupture. We established a treatment strategy using a hybrid procedure that consisted of endovascular and surgical techniques for these splenic, common hepatic artery and coeliac axis aneurysms related to SAM. The patient was successfully treated with aorto-superior mesenteric artery bypass followed by endovascular aortic stent grafting to interrupt inflow to coeliac aneurysms, and distal splenopancreatectomy with en bloc resection of those aneurysms. We conclude that this hybrid procedure consisting of endovascular and surgical techniques is useful and is a safe treatment option for SAM-related visceral aneurysms., (© The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)