De Bakey and Cooley did the first successful operation for a visceral artery aneurysm (VAA) in 1953. They are relatively rare and the risk of rupture is associated with high mortality .The majority of patients are asymptomatic prior to rupture and the main indication of elective treatment is size, VAA larger than 2 cm and aneurysms in women of childbearing age is recommended. The goal of treatment is to prevent aneurysm expansion by excluding it from the arterial circulation saving branchs patency and freedom from rupture or reperfusion. Surgery has been considered the treatment of VAA for several decades, but now a days endovascular procedures as embolization or covered stents have increased the treatment options available to comorbid patients not suitable for open repair.
Hi Paulo, my opinion is that it depend by the general condition of patient, by the site (wich artery is affected and which portion of the artery), the etiology (ATS or inflammatory) the form and size and of the aneurysm. It's a possibility but it's not always the first choice.
Hi Paulo,
Well, the best would be to treat with a covered stent. Another option is flow diverting stents which are commonly used by neuroradiologists for the treatment of intracranial aneurysms. One other option can be, if you do not have covered stent or flow diverting stents, use of regular stents and some coils. You implant the stent between the healthy segments of the artery and then coil the aneurysm through the struts of the stent.
Dear All,
About covered stents, as we are working with arteries of low diametres and some with great tortuosity as splenic arteries, the more frequently seen visceral aneurisms, what do you think about difficulties of navegation with covered stents in those arteries and which one do you prefer?
It is very important to just obliterate the aneurysm since the pressure thrust then will be transferred unabated to the vessel wall and rupture might follow any time. Therefore Murat's solution undoubtedly is the best (of endovascular solutions)! However, as Paulo justly remarks it will be more after than not impossible to deploy a covered stent in a splenic aneurysm, since these splenic aneurysms tend to be located peripherally in the splenic artery. This very location enables successful embolisation since then, after filling the artery from beyond the aneurysm, as far peripherally as possible, to its origin from the celiac artery, enough firm clot will develop to nullify the pressure thrust at aneurysm level.
For this reason, ccluding the artery above and below the aneurysm with properly sized vascular plugs (like Amplatzer's) would be the second best endovascula solution but those too cannot be navigated through tortuous arteries.
Amplatzer is an excellent option in case of rupture due to rapid solution, when possible,.
I believe that speaking about the best endovascular technique in the treatment of visceral aneurysms(VA) the answer is: It depends.
The pre operative planning in the cases of not ruptured VA and studing and choosing the best technique for each case individually!
Dear Paulo, A very correct summary if you keep in mind that thrombus without fibrosis does transfer the pressure thrust. Kind regards!
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