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Complications of open repair of splanchnic aneurysms
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Bjoern D. Suckow, David H. Stone
Celiac artery aneurysms are rare, comprising less than 4% of splanchnic artery aneurysms, and are most commonly detected concomitantly with other splanchnic or aortic aneurysms (40% of the time).2,13,22 Historically, celiac artery aneurysms were primarily caused by a presumptive infectious etiology (syphilis); in the contemporary era, they are most often caused by medial degeneration and/or atherosclerosis.23 There appears to be no association between pregnancy and celiac artery aneurysms. However, a significant percentage of aneurysms are noted to develop in the setting of post-stenotic dilation from median arcuate ligament compression. Therefore, a modest number of celiac artery aneurysms may be encountered in younger patients.24 The majority of celiac artery aneurysms are diagnosed incidentally on imaging. Rupture rates are reported between 10–20% with an associated mortality risk of 50%.23,25 Unfortunately, aneurysm size, morphology, calcification, and etiology are not associated with rupture risk (likely a phenomenon of low incidence), and therefore traditional consensus criteria recommended treatment of all diagnosed celiac artery aneurysms unless prohibited by patient comorbidities.25,26 Several modern series, however, report no rupture among patients with celiac artery aneurysms measuring less than 2.5 cm diameter.13,26 In our practice, we have reserved treatment for celiac artery aneurysms which measure greater than 2.5 cm, and, have not encountered any ruptured celiac artery aneurysms less than that size.
Endovascular management of splanchnic artery aneurysms
Published in Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long, Endovascular and Open Vascular Reconstruction, 2017
Those in the celiac artery are usually fusiform aneurysms (Figure15.6) and can be associated with celiac compression from the arcuate ligament or post-stenotic dilation. Stone and collaborators reported that 38% of patients with celiac artery aneurysms (CAAs) have other splanchnic artery aneurysms and 18% have abdominal aorta aneurysms.24 Atherosclerosis is associated with 27% of CAAs.24
Mesenteric and renal angiography
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
Selective angiography of the celiac trunk is performed with a 15°-30° LAO angulation to demonstrate the celiac axis origin and trifurcation into the left gastric, common hepatic, and splenic arteries. In cases of suspected celiac artery compression, comparative, selective views should be obtained at end-inspiration and end-expiration as expiration may exacerbate vessel compression (Figure 24.11). Given its course to the rightward pelvis, angiography of the SMA should be performed in a 15°-30° LAO. In comparison, the IMA has a leftward course; thus, selective angiography of this vessel should be performed in a 15°-30° RAO projection. As with abdominal aortography, digital subtraction angiography is recommended. The field of view should be adequate to visualize the mesenteric vessel of interest, as well as all potential collateral networks in cases of occlusion.
Gastric bleeding in giant cell arteritis
Published in Baylor University Medical Center Proceedings, 2021
Austin Childress, Thomas J. Kwarcinski, Joseph Scott H. Bittle, Clayton Trimmer
In this case, there was extravasation from an irregular left gastric artery, concerning for vasculitis. Visceral arteriopathy is an atypical manifestation of GCA and abdominal symptoms may not manifest due to the extensive collateral network of vessels maintaining visceral perfusion in the abdomen.4 Indeed, many of the patients in the described reports presented only after acute abdominal events such as bowel ischemia or infarction. In this patient with angiographic evidence of vasculitis, arterial extravasation, hemoperitoneum, and a history of GCA, extracranial involvement of the celiac artery is a strong consideration. It should be noted that the patient had extensive atherosclerosis; thus, GCA superimposed on an already weakened vessel wall is a possibility that could have led to the hemoperitoneum/extravasation.
Efficacy of combination therapy with transcatheter arterial chemoembolization and radiofrequency ablation for intermediate-stage hepatocellular carcinoma
Published in Scandinavian Journal of Gastroenterology, 2018
Kei Endo, Hidekatsu Kuroda, Takayoshi Oikawa, Yohei Okada, Yudai Fujiwara, Tamami Abe, Hiroki Sato, Kei Sawara, Yasuhiro Takikawa
We inserted a 5Fr-sheath from the femoral artery using the Seldinger technique. A catheter was advanced to the superior mesenteric artery and CT during hepatic arteriography was performed to investigate the site and size of the HCCs and to confirm patency of the portal vein in all patients. A catheter was then advanced to the celiac artery to perform CT during hepatic arteriography and digital subtraction angiography to obtain information on tumor vascularity and feeding vessels. After the micro catheter was inserted closest (as feasible) to the target branch, an anticancer drug in iodized oil (Lipiodol, Guerbet, Tokyo, Japan) was injected. We used one of the three kinds of anticancer drugs based on the judgment of the operator. Cisplatin powder (50 mg) (IA-Call, Nippon Kayaku Co. Ltd, Tokyo, Japan), Miriplatin (70 mg) (Miripla, Dainippon-Sumitomo Pharmaceutical Co. Ltd, Osaka, Japan), and Epirubicin (30 mg) (Epirubicin, Nippon Kayaku Co. Ltd, Tokyo, Japan) were suspended in 10 mL of iodized oil. The dose of anticancer drug and iodized oil depended upon the size and vascularity of the tumor. After that, 1 mm of gelatin sponge particle (Gelpart, Nippon Kayaku Co. Ltd, Tokyo, Japan) was slowly injected into the feeding arteries. The sites of injection of the gelatin sponge particle were segmental or sub-segmental in all patients. At the end of the procedure, lipiodol deposition was assessed using plain CT.
Gastroscopy assisted laser Doppler flowmetry and visible light spectroscopy in patients with chronic mesenteric ischemia
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2019
Simen T. Berge, Nathkai Safi, Asle W. Medhus, Kim Ånonsen, Jon O. Sundhagen, Jonny Hisdal, Syed S. H Kazmi
During a period of 24 months, a total of 104 patients were referred to the Department of Vascular Surgery, Oslo University Hospital, Aker, for evaluation of mesenteric ischemia (Figure 2). Of these, 40 patients were included in the study. Of the remaining 64 not eligible for inclusion, 13 had median arcuate ligament syndrome (MALS), an external compression of the celiac artery by the arcuate ligament without atherosclerotic changes, eight were asymptomatic on referral (incidental find of changes to the intestinal arteries on CT angiography), 17 presented with AMI, and 24 had no significant changes to the intestinal arteries on CT angiography. Two patients refused to undergo upper endoscopy.