Emergency stent graft implantation for ruptured visceral artery pseudoaneurysm

• Published in: Journal of vascular surgery 2011-06, Vol.53 (6), p.1625-1631
• Main Authors: Boufi, Mourad, MD, Belmir, Hicham, MD, Hartung, Olivier, MD, Ramis, Olivier, MD, Beyer, Laura, MD, Alimi, Yves S., PhD
• Format: Article
• Language: English
• Subjects: Aneurysm, False - surgery; Aneurysm, Ruptured - surgery; Biological and medical sciences; Blood Vessel Prosthesis Implantation; Emergencies; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Retrospective Studies; Stents; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Viscera - blood supply
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2011.02.003

Background Literature series that include visceral artery pseudoaneurysms rarely separate them from true aneurysms, although they address different issues. Guidelines for optimal management of these lesions are lacking. We report our experience of stent graft treatment of these lesions with midterm results. Methods We retrospectively reviewed all patients with a visceral pseudoaneurysm who were treated with a stent graft in our institution. Patient history, clinical characteristics, procedure details, and outcome were recorded and analyzed. Results From March 2004 to June 2009, 10 consecutive patients (9 men), who were a mean age of 59 years, were treated for symptomatic visceral artery pseudoaneurysm, with hemorrhagic shock in 8 patients (80%), after pancreaticoduodenectomy in 8, gastrectomy in 1, and abdominal trauma in 1. A mean of 24 days (range, 7–60 days) passed between the initial surgery or trauma and pseudoaneurysm diagnosis. Septic complications were associated in six patients (60%). The pseudoaneurysm was in the hepatic artery in 8 patients, the splenic artery in 1, and the superior mesenteric artery in 1. Technical and clinical success was achieved in 80% of patients. Two failures of catheterization were followed by redo surgery and death (20%). No patients died postoperatively, and no complications among the patients who were treated successfully. Mean follow-up was 37 months (range, 10–63 months). All stent grafts were patent, with no signs of infection. Two patients died secondary to neoplasm. No rebleeding or recurrent aneurysms were noted. Conclusion Stent graft exclusion of visceral artery pseudoaneurysm seems to be a valid therapeutic approach regardless of the patient's septic or hemodynamic status.