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Visceral artery aneurysms: evolving interdisciplinary management and future role of the abdominal surgeon

BACKGROUND: Visceral artery aneurysms (VAA) are rare vascular lesions. Clinically silent VAA are increasingly detected by cross-sectional imaging but some lesions are at risk for rupture with severe bleeding. The aim of the present study was to evaluate the trends in the interdisciplinary management...

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Autores principales: Branchi, Vittorio, Meyer, Carsten, Verrel, Frauke, Kania, Alexander, Bölke, Edwin, Semaan, Alexander, Koscielny, Arne, Kalff, Jörg C., Matthaei, Hanno
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6396446/
https://www.ncbi.nlm.nih.gov/pubmed/30819253
http://dx.doi.org/10.1186/s40001-019-0374-9
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author Branchi, Vittorio
Meyer, Carsten
Verrel, Frauke
Kania, Alexander
Bölke, Edwin
Semaan, Alexander
Koscielny, Arne
Kalff, Jörg C.
Matthaei, Hanno
author_facet Branchi, Vittorio
Meyer, Carsten
Verrel, Frauke
Kania, Alexander
Bölke, Edwin
Semaan, Alexander
Koscielny, Arne
Kalff, Jörg C.
Matthaei, Hanno
author_sort Branchi, Vittorio
collection PubMed
description BACKGROUND: Visceral artery aneurysms (VAA) are rare vascular lesions. Clinically silent VAA are increasingly detected by cross-sectional imaging but some lesions are at risk for rupture with severe bleeding. The aim of the present study was to evaluate the trends in the interdisciplinary management at a tertiary center. METHODS: Patients who underwent treatment for VAA at University Hospital of Bonn between 2005 and 2018 were enrolled in this retrospective study. Demographic, clinical, VAA-specific data as well as information on therapy, early and long-term outcome were collected and statistically analyzed. RESULTS: Forty-two consecutive patients, 19 females and 23 males with a median age of 59 years (range 30–91 years), were diagnosed with 56 VAA. The majority were true aneurysms (N = 32; 57%), whereas 43% (N = 24) were pseudoaneurysms. The most common localization was the splenic artery (N = 18; 32%) and the average diameter was 3 cm (range 1–5 cm). Twenty-five patients (59.5%) had VAA-related symptoms such as chronic abdominal pain and hemorrhage at primary diagnosis, while the diagnosis was incidental in 17 patients (40.5%). Eleven patients (26%) underwent open surgery whereas 29 patients (69%) received an endovascular treatment. Patients with pseudoaneurysms were significantly older (P = 0.003), suffered more often from associated symptoms (P < 0.001) and required more emergency interventions (P < 0.0001) compared to those with true VAA. In the last years, the number and proportion of true VAA increased significantly (P < 0.001) while a significantly larger proportion could be managed interventionally (P = 0.017). CONCLUSIONS: VAA are increasingly detected on imaging with lesions presenting very heterogeneously. Due to the risk of lethal rupture and in the absence of reliable prognostic markers, all the patients with VAA should be offered definite treatment. Localization, anatomy and the end-organ perfusion after intervention or operation are the most important aspects to consider when planning a treatment for VAA. For this reason, a multidisciplinary evaluation of every individual patient is necessary for an optimized outcome.
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spelling pubmed-63964462019-03-11 Visceral artery aneurysms: evolving interdisciplinary management and future role of the abdominal surgeon Branchi, Vittorio Meyer, Carsten Verrel, Frauke Kania, Alexander Bölke, Edwin Semaan, Alexander Koscielny, Arne Kalff, Jörg C. Matthaei, Hanno Eur J Med Res Research BACKGROUND: Visceral artery aneurysms (VAA) are rare vascular lesions. Clinically silent VAA are increasingly detected by cross-sectional imaging but some lesions are at risk for rupture with severe bleeding. The aim of the present study was to evaluate the trends in the interdisciplinary management at a tertiary center. METHODS: Patients who underwent treatment for VAA at University Hospital of Bonn between 2005 and 2018 were enrolled in this retrospective study. Demographic, clinical, VAA-specific data as well as information on therapy, early and long-term outcome were collected and statistically analyzed. RESULTS: Forty-two consecutive patients, 19 females and 23 males with a median age of 59 years (range 30–91 years), were diagnosed with 56 VAA. The majority were true aneurysms (N = 32; 57%), whereas 43% (N = 24) were pseudoaneurysms. The most common localization was the splenic artery (N = 18; 32%) and the average diameter was 3 cm (range 1–5 cm). Twenty-five patients (59.5%) had VAA-related symptoms such as chronic abdominal pain and hemorrhage at primary diagnosis, while the diagnosis was incidental in 17 patients (40.5%). Eleven patients (26%) underwent open surgery whereas 29 patients (69%) received an endovascular treatment. Patients with pseudoaneurysms were significantly older (P = 0.003), suffered more often from associated symptoms (P < 0.001) and required more emergency interventions (P < 0.0001) compared to those with true VAA. In the last years, the number and proportion of true VAA increased significantly (P < 0.001) while a significantly larger proportion could be managed interventionally (P = 0.017). CONCLUSIONS: VAA are increasingly detected on imaging with lesions presenting very heterogeneously. Due to the risk of lethal rupture and in the absence of reliable prognostic markers, all the patients with VAA should be offered definite treatment. Localization, anatomy and the end-organ perfusion after intervention or operation are the most important aspects to consider when planning a treatment for VAA. For this reason, a multidisciplinary evaluation of every individual patient is necessary for an optimized outcome. BioMed Central 2019-02-28 /pmc/articles/PMC6396446/ /pubmed/30819253 http://dx.doi.org/10.1186/s40001-019-0374-9 Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Branchi, Vittorio
Meyer, Carsten
Verrel, Frauke
Kania, Alexander
Bölke, Edwin
Semaan, Alexander
Koscielny, Arne
Kalff, Jörg C.
Matthaei, Hanno
Visceral artery aneurysms: evolving interdisciplinary management and future role of the abdominal surgeon
title Visceral artery aneurysms: evolving interdisciplinary management and future role of the abdominal surgeon
title_full Visceral artery aneurysms: evolving interdisciplinary management and future role of the abdominal surgeon
title_fullStr Visceral artery aneurysms: evolving interdisciplinary management and future role of the abdominal surgeon
title_full_unstemmed Visceral artery aneurysms: evolving interdisciplinary management and future role of the abdominal surgeon
title_short Visceral artery aneurysms: evolving interdisciplinary management and future role of the abdominal surgeon
title_sort visceral artery aneurysms: evolving interdisciplinary management and future role of the abdominal surgeon
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6396446/
https://www.ncbi.nlm.nih.gov/pubmed/30819253
http://dx.doi.org/10.1186/s40001-019-0374-9
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