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      Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives

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          Abstract

          Visceral artery aneurysms (VAAs) are rare, usually asymptomatic and incidentally discovered during a routine radiological examination. Shared guidelines suggest their treatment in the following conditions: VAAs with diameter larger than 2 cm, or 3 times exceeding the target artery; VAAs with a progressive growth of at least 0.5 cm per year; symptomatic or ruptured VAAs. Endovascular treatment, less burdened by morbidity and mortality than surgery, is generally the preferred option. Selection of the best strategy depends on the visceral artery involved, aneurysm characteristics, the clinical scenario and the operator’s experience. Tortuosity of VAAs almost always makes embolization the only technically feasible option. The present narrative review reports state of the art and new perspectives on the main endovascular and other interventional options in the treatment of VAAs. Embolization techniques and materials, use of covered and flow-diverting stents and percutaneous approaches are accurately analyzed based on the current literature. Visceral artery-related considerations and targeted approaches are also provided and discussed.

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          Most cited references132

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          The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms

          These Society for Vascular Surgery Clinical Practice Guidelines describe the care of patients with aneurysms of the visceral arteries. They include evidence-based size thresholds for repair of aneurysms of the renal arteries, splenic artery, celiac artery, and hepatic artery, among others. Specific open surgical and endovascular repair strategies are also discussed. They also describe specific circumstances in which aneurysms may be repaired at smaller sizes than these size thresholds, including in women of childbearing age and false aneurysms. These Guidelines offer important recommendations for the care of patients with aneurysms of the visceral arteries and long-awaited guidance for clinicians who treat these patients.
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            Surgical treatment of visceral artery aneurysms: A 25-year experience.

            The aim of this study was to analyze our 25-year experience with surgical treatment of visceral artery aneurysms (VAAs), with particular attention paid to early and long-term results. From January 1982 to September 2007, 55 patients (32 males, 58%, and 23 females, 42%) underwent surgical treatment of 59 VAAs. Only one patient was treated with an endovascular procedure. Mean patient age was 59.3 years (range, 36-78 years). The site of aneurysmal disease was splenic artery in 30 (50.8%) cases, renal artery in nine (15.2%) cases, common hepatic artery in seven (11.9%) cases, pancreaticoduodenal artery in four (6.8%) cases, celiac trunk in three (5.1%) cases, superior mesenteric artery in two (3.4%) cases, and gastroduodenal, inferior mesenteric, middle colic and right gastroepiploic in one (1.7%) case for each artery. Two (3.6%) patients had multiple VAAs. In five (9.1%) patients, an abdominal aortic aneurysm coexisted. Early results in terms of mortality and major complications were assessed. Follow-up consisted of clinical and ultrasound examinations at 1 and 12 months, and yearly thereafter. Long-term results in terms of survival and aneurysm-related complications were analyzed. In all but two cases, elective intervention in asymptomatic patients was performed. Two (3.6%) patients had a ruptured aneurysm (one pancreaticoduodenal artery and one middle colic artery). The one perioperative death was due to an acute pancreatitis in a patient operated on for a giant inflammatory splenic artery aneurysm, yielding a perioperative mortality rate of 1.8%. Two major complications (retroperitoneal hematoma and acute pancreatitis) were recorded. Mean duration of follow-up was 82.1 months (range, 0-324 months). Estimated 10-year survival rate was 79.5%. During follow-up two aneurysm-related complications occurred, with an estimated 10-year, aneurysm-related, complication-free survival rate of 75.2%. In the era of minimally invasive therapeutic approaches, elective open surgical treatment of visceral artery aneurysms is safe and effective, and offers satisfactory early and long-term results.
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              Visceral artery aneurysms: Incidence, management, and outcome analysis in a tertiary care center over one decade

              Objectives To evaluate the incidence, management, and outcome of visceral artery aneurysms (VAA) over one decade. Methods 233 patients with 253 VAA were analyzed according to location, diameter, aneurysm type, aetiology, rupture, management, and outcome. Results VAA were localized at the splenic artery, coeliac trunk, renal artery, hepatic artery, superior mesenteric artery, and other locations. The aetiology was degenerative, iatrogenic after medical procedures, connective tissue disease, and others. The rate of rupture was much higher in pseudoaneurysms than true aneurysms (76.3 % vs.3.1 %). Fifty-nine VAA were treated by intervention (n = 45) or surgery (n = 14). Interventions included embolization with coils or glue, covered stents, or combinations of these. Thirty-five cases with ruptured VAA were treated on an emergency basis. There was no difference in size between ruptured and non-ruptured VAA. After interventional treatment, the 30-day mortality was 6.7 % in ruptured VAA compared to no mortality in non-ruptured cases. Follow-up included CT and/or MRI after a mean period of 18.0 ± 26.8 months. The current status of the patient was obtained by a structured telephone survey. Conclusions Pseudoaneurysms of visceral arteries have a high risk for rupture. Aneurysm size seems to be no reliable predictor for rupture. Interventional treatment is safe and effective for management of VAA. Key Points • Diagnosis of visceral artery aneurysms is increasing due to CT and MRI. • Diameter of visceral arterial aneurysms is no reliable predictor for rupture. • False aneurysms/pseudoaneurysms and symptomatic cases need emergency treatment. • Interventional treatment is safe and effective.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                J Clin Med
                J Clin Med
                jcm
                Journal of Clinical Medicine
                MDPI
                2077-0383
                07 June 2021
                June 2021
                : 10
                : 11
                : 2520
                Affiliations
                [1 ]Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; filippo.piacentino@ 123456asst-settelaghi.it (F.P.); andrea.coppola@ 123456asst-settelaghi.it (A.C.); valeria.bettoni@ 123456asst-settelaghi.it (V.B.); edoardo.macchi@ 123456asst-settelaghi.it (E.M.); giuseppe.demarchi@ 123456asst-settelaghi.it (G.D.M.); federico.fontana@ 123456uninsubria.it (F.F.)
                [2 ]Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; curti.marco.33@ 123456gmail.com (M.C.); c.ossola7@ 123456gmail.com (C.O.); gabriele.piffaretti@ 123456uninsubria.it (G.P.); matteo.tozzi@ 123456uninsubria.it (M.T.); giulio.carcano@ 123456uninsubria.it (G.C.)
                [3 ]Department of Diagnostic Radiology, Giovanni XXIII Hospital, Milano-Bicocca University, 24127 Bergamo, Italy; pmarra@ 123456asst-pg23.it
                [4 ]Department of Radiology, IRCCS San Raffaele Scientific Institute, San Raffaele School of Medicine Vita-Salute University, 20132 Milan, Italy; anna.palmisano@ 123456hsr.it (A.P.); francesco.decobelli@ 123456hsr.it (F.D.C.)
                [5 ]Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; alberta.cappelli@ 123456aosp.bo.it (A.C.); rita.golfieri@ 123456unibo.it (R.G.)
                [6 ]Department of Medical and Surgical Sciences and Advanced Technologies, Radiodiagnostic and Radiotherapy Unit, University Hospital “Policlinico-Vittorio Emanuele”, 95123 Catania, Italy; basile.antonello73@ 123456gmail.com
                [7 ]Vascular Surgery Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
                [8 ]Department of General, Emergency and Transplants Surgery, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
                Author notes
                [* ]Correspondence: massimo.venturini@ 123456uninsubria.it ; Tel.: +39-0332-393607
                Author information
                https://orcid.org/0000-0002-3840-6693
                https://orcid.org/0000-0003-0672-1573
                https://orcid.org/0000-0003-4935-8110
                https://orcid.org/0000-0001-8809-9989
                Article
                jcm-10-02520
                10.3390/jcm10112520
                8201262
                34200171
                62c1be21-1af2-4830-afb1-958b5eec490b
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

                History
                : 22 April 2021
                : 03 June 2021
                Categories
                Review

                visceral aneurysm,endovascular treatment,embolization,coiling,covered stent,flow-diverting stent

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