演題

IS-1-8

Management options for visceral artery aneurysms

[演者] 松原 健太郎:1
[著者] 尾原 秀明:1, 下河原 達也:1, 落合 剛二:1, 北川 雄光:1
1:慶應義塾大学外科

[Purpose] Visceral artery aneurysms (VAAs) are uncommon but important as they have a significant potential for rupture, resulting in high mortality rates. The aim of this study was to review our experience with VAAs treatment at a single institution. [Methods and Results] Between January 1997 and August 2014, 43 VAAs were treated in 41 patients (29 males, 12 females) with mean age of 58.2 years. Postoperative visceral artery pseudoaneurysms were excluded. The lesion involved the splenic artery (n=20), superior mesenteric artery (n=7), pancreaticoduodenal artery (n=5), celiac trunk (n=3), gastroduodenal artery (n=3), hepatic artery (n=2), common celiomesenteric trunk (n=2), and gastroepiploic artery (n=1). The aneurysms of 7 patients were symptomatic, including 3 patients with rupture. 24 VAAs had endovascular procedures, 18VAAs underwent open surgical repair, and one VAA underwent embolization with bypass surgery. In the endovascular group, VAAs were treated by embolization (n=22), stent graft placement (n=1), and embolization with stent graft placement (n=1). In the surgical group, VAAs were treated by splenectomy (n=5), aneurysmectomy (n=4), aneurysmorrhaphy (n=2), and aneurysmectomy with arterial reconstruction (n=7). There was no severe perioperative complication or death, but one patient had a mild duodenal stenosis. No aneurysm reperfusion or enlargement was observed at follow-up.[Conclusions] This study suggests that an aggressive treatment of VAAs even in the asymptomatic case is justified because of the low morbidity and mortality rates. Regardless of the type of intervention, it is important to assess and maintain end organ perfusion via adequate collateral circulation or direct revascularization.
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