Thesis Type: Expertise In Medicine
Institution Of The Thesis: Gazi Üniversitesi, Tıp Fakültesi, Turkey
Approval Date: 2013
Student: SERHAT TEKEREK
Supervisor: ERHAN TURGUT ILGITAbstract:
Visceral artery aneurysms (VAA) are uncommon but potentially life-threatening in case of rupture. The purpose of this study is to evaluate the efficacy and safety percutaneous endovascular treatment options as a minimally invasive method for VAA. Patient archives and department databases were evaluated and retrospectively analyzed. Patients with a diagnosis of VAA, confirmed by computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography and treated exclusively with percutaneous endovascular approaches, were included in the study. The medical records of 29 patients (14 male, 15 female; mean age 42; range 12-76 years) with 34 VAAs and treated with various percutaneous endovascular therapeutic modalities were analyzed. In total, three true aneurysms (mean diameter 36,6 mm, range 25?55 mm) and 31 pseudoaneurysms (mean diameter 10,5, range 3?60 mm) were treated. The lesions involved the branches of renal artery (n=13), branches of superior mesenteric artery (n=4), right hepatic artery (n=3), left gastric artery (n=2), branches of gastroduodenal artery (n=2), segmenter branch of splenic artery (n=1), and common hepatic artery (n=1) for the pseudoaneurysm group and renal artery (n=1), splenic artery (n=1) and common hepatic artery (n=1) at the true aneurysm group. Emergency treatment was performed in 25 patients, and elective procedure for the other four. N-butyl-cyanoacrylate (n-BCA) mixture (n=10), microcoil (n=9), polyvinyl alcohol (PVA) (n=3), microcoil and PVA combination (n=3), microcoil and n-BCA mixture combination (n=3), vascular plug (n=1), stent assisted coiling (n=1), stent-graft (n=1) and flow diverter (n=1) were used for aneurysm exclusion. Procedural technical success was achieved in 97% of the cases, while target lesion reintervention rate was 10% (3 of 29). Postprocedural imaging was performed after 45% (n=13) of interventions at a mean of 12 months (range; 1 day-36 month). Overall periprocedural mortality rate was 7% (n=2). Postembolization syndrome developed in two patients after splenic artery embolization and one patient after renal artery embolization. Transbrachial access site hematoma occurred in one patient. Percutaneous endovascular treatment of VAAs is safe and effective with low morbidity and mortality, especially in the emergency cases and older patients. Endovascular treatment modalities of interventional radiology seems to be the treatment of choice with its high efficaes and safety profile.