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Clinical Profile, Management, and Outcome of Visceral Artery Pseudoaneurysms: 5-Year Experience in a Tertiary Care
Faiz Altaf Shera1, Tahleel Altaf Shera1, Naseer Ahmad Choh1
1Department of Radio-diagnosis and Imaging, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu & Kashmir, India.
Insights
Visceral artery pseudoaneurysms are dangerous but treatable. Minimally invasive endovascular embolotherapy offers high success rates and fewer complications compared to surgery or no intervention, significantly improving patient outcomes.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Visceral artery pseudoaneurysms (VAPs) are life-threatening vascular lesions with a high risk of rupture.
- Prompt intervention is crucial for managing VAPs.
- Common etiologies include pancreatitis, trauma, and post-surgical complications.
Purpose of the Study:
- To review the experience with splanchnic visceral artery pseudoaneurysms.
- To analyze the etiology, clinical presentation, management, and outcomes.
- To compare the effectiveness of endovascular versus surgical interventions.
Main Methods:
- Retrospective study of 27 patients with VAPs over a 5-year period.
- Data collected from hospital image database and medical records.
- Analysis of vessel of origin, size, etiology, clinical features, treatment, and outcome.
Main Results:
- Pancreatitis, surgery, and trauma were the most common causes of VAPs.
- Fifteen patients were managed with endovascular embolotherapy, 6 with surgery, and 6 received no intervention.
- Endovascular treatment achieved 100% technical and clinical success with minor complications.
- Surgery and no intervention were associated with high mortality rates (66% and 50%, respectively).
Conclusions:
- Visceral pseudoaneurysms are frequently caused by pancreatitis, surgery, or trauma.
- Minimally invasive endovascular embolotherapy is a highly effective and safe treatment for VAPs.
- Surgical intervention and conservative management are linked to increased morbidity and mortality.
Abstract:
Visceral artery pseudoaneurysms are potentially lethal lesions and tend to rupture in a high proportion of cases, thereby warranting an immediate and active intervention. We present our experience of splanchnic visceral artery pseudoaneurysms in a university hospital over a 5-year time interval with emphasis on etiology, clinical presentation, management (endovascular/surgical), and final outcome. This was a retrospective study in which we searched our image database for pseudoaneurysms of visceral arteries over a period of 5 years. The clinical and operative details were retrieved from the medical record section of our hospital. The lesions were analyzed for the vessel of origin, size, etiology, clinical features, mode of treatment, and outcome. Twenty-seven patients with pseudoaneurysms were encountered. Pancreatitis (8) was the most common cause, followed by previous surgery (7) and trauma (6). Fifteen were managed by the interventional radiology (IR) team, 6 by surgery, and in 6 no intervention was done. Technical and clinical success was achieved in all patients in the IR group with few minor complications. Surgery and no intervention carry a high mortality in such a setting (66 and 50%, respectively). Visceral pseudoaneurysms are potentially fatal lesions, commonly encountered after trauma, pancreatitis, surgeries, and interventional procedures. These lesions are easily salvageable by minimally invasive interventional techniques (endovascular embolotherapy), and surgeries carry a lot of morbidity and mortality in such cases and a prolonged hospital stay.
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