المؤلفون: Maingard J; Interventional Radiology Service, Department of Radiology, Austin Hospital, Heidelberg, Melbourne, Australia. julian.maingard@austin.org.au., Kok HK; Interventional Radiology Service, Department of Radiology, Beaumont Hospital, and Royal College of Surgeons in Ireland, Dublin, Ireland.; Department of Interventional Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK., Phelan E; Interventional Radiology Service, Department of Radiology, Beaumont Hospital, and Royal College of Surgeons in Ireland, Dublin, Ireland., Logan C; Interventional Radiology Service, Department of Radiology, Beaumont Hospital, and Royal College of Surgeons in Ireland, Dublin, Ireland., Ranatunga D; Interventional Radiology Service, Department of Radiology, Austin Hospital, Heidelberg, Melbourne, Australia., Brooks DM; Interventional Radiology Service, Department of Radiology, Austin Hospital, Heidelberg, Melbourne, Australia.; Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Australia., Chandra RV; Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Australia.; Department of Imaging, Monash University, Melbourne, Australia., Lee MJ; Interventional Radiology Service, Department of Radiology, Beaumont Hospital, and Royal College of Surgeons in Ireland, Dublin, Ireland., Asadi H; Interventional Radiology Service, Department of Radiology, Austin Hospital, Heidelberg, Melbourne, Australia.; Interventional Radiology Service, Department of Radiology, Beaumont Hospital, and Royal College of Surgeons in Ireland, Dublin, Ireland.; Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Australia.; Department of Imaging, Monash University, Melbourne, Australia.; Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Australia.; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia.

المصدر: Cardiovascular and interventional radiology [Cardiovasc Intervent Radiol] 2017 Nov; Vol. 40 (11), pp. 1784-1791. Date of Electronic Publication: 2017 Jun 29.

نوع المنشور: Case Reports; Journal Article

بيانات الدورية: Publisher: Springer Verlag Country of Publication: United States NLM ID: 8003538 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-086X (Electronic) Linking ISSN: 01741551 NLM ISO Abbreviation: Cardiovasc Intervent Radiol Subsets: MEDLINE

مواضيع طبية MeSH: Aneurysm/*surgery , Blood Vessel Prosthesis Implantation/*methods , Endovascular Procedures/*instrumentation , Endovascular Procedures/*methods , Renal Artery/*surgery , Splenic Artery/*surgery, Adult ; Aneurysm/diagnostic imaging ; Blood Vessel Prosthesis ; Computed Tomography Angiography/methods ; Equipment Design ; Female ; Humans ; Renal Artery/diagnostic imaging ; Splenic Artery/diagnostic imaging ; Treatment Outcome

مستخلص: Introduction: Visceral and renal artery aneurysms (VRAAs) are an uncommon clinical entity but carry a risk of rupture with associated morbidity and mortality. The rupture risk is particularly high when the aneurysms are large, of unfavourable morphology or in the setting of pregnancy and perioperative period. Endovascular approaches are now first line in the treatment of VRAA, but conventional techniques may be ineffective in excluding aneurysms with unfavourable anatomy such as those with wide necks or at arterial bifurcation points. The neurovascular Comaneci neck-bridging device is used to temporarily cover the neck of intracranial aneurysms without occluding forward arterial flow during endovascular coiling. We report the novel use of the Comaneci neck-bridging device for the treatment of complex peripheral VRAAs.
Materials and Methods: We describe the treatment of two patients with renal and splenic artery aneurysms demonstrating unfavourable anatomic morphology for conventional endovascular approaches.
Results: In the first patient, the renal artery aneurysm was situated at the intrarenal bifurcation of the main renal artery in the setting of a solitary kidney. In the second patient, the splenic artery aneurysm was situated close to the splenic hilum at the distal splenic arterial bifurcation. The Comaneci neck-bridging device was successfully used in both cases to assist coil embolisation with visceral preservation.
Conclusions: The Comaneci neck-bridging device is potentially safe and effective for the treatment of peripheral VRAA with unfavourable anatomic characteristics that would have been deemed unsuitable for treatment using conventional techniques.
Level of Evidence: Level 4, Technical Report.

المؤلفون: Kok HK; Department of Interventional Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Beaumont Road, Dublin 9, Ireland., Asadi H; Department of Interventional Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Beaumont Road, Dublin 9, Ireland; School of Medicine, Faculty of Health, Deakin University, Victoria, Australia., Sheehan M; Department of Interventional Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Beaumont Road, Dublin 9, Ireland., Given MF; Department of Interventional Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Beaumont Road, Dublin 9, Ireland., Lee MJ; Department of Interventional Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Beaumont Road, Dublin 9, Ireland. Electronic address: mlee@rcsi.ie.

المصدر: Journal of vascular and interventional radiology : JVIR [J Vasc Interv Radiol] 2016 Nov; Vol. 27 (11), pp. 1630-1641. Date of Electronic Publication: 2016 Sep 28.

نوع المنشور: Journal Article; Review; Systematic Review

بيانات الدورية: Publisher: Society of Cardiovascular and Interventional Radiology Country of Publication: United States NLM ID: 9203369 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1535-7732 (Electronic) Linking ISSN: 10510443 NLM ISO Abbreviation: J Vasc Interv Radiol Subsets: MEDLINE

مواضيع طبية MeSH: Endovascular Procedures*/adverse effects , Endovascular Procedures*/instrumentation , Endovascular Procedures*/mortality , Renal Artery*/diagnostic imaging, Aneurysm/*therapy , Aneurysm, False/*therapy , Viscera/*blood supply, Adult ; Aged ; Aged, 80 and over ; Aneurysm/diagnostic imaging ; Aneurysm/mortality ; Aneurysm, False/diagnostic imaging ; Aneurysm, False/mortality ; Female ; Humans ; Ireland ; Male ; Middle Aged ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Tertiary Care Centers ; Treatment Outcome

مستخلص: Purpose: To report a systematic review of endovascular management of visceral and renal artery aneurysms (VRAA) and results at a tertiary referral center.
Materials and Methods: A literature review was performed via a comprehensive electronic search of PubMed, MEDLINE, EMBASE, and Cochrane databases, followed by retrospective analysis of all VRAAs treated at a tertiary referral center from January 1999 to December 2015.
Results: The systematic review included 22 studies published between 2005 and 2016 describing endovascular treatment of VRAA. In the systematic review cohort, 646 aneurysms (432 true, 151 false, 63 unclassified) were treated using endovascular methods with 93.2% technical success, 99.3% visceral preservation, 3.5% major complication (classified based on Society of Interventional Radiology criteria), 1.5% 30-day periprocedural mortality, and 4.6% reintervention rates. In the local cohort, 19 aneurysms (12 true, 7 false) were treated with 100% technical success, 94.7% visceral preservation, and 10.5% major complication rates. There was no periprocedural mortality. Over mean follow-up of 31.9 months (range, 2-170 months), there were 2 aneurysm reperfusions, which required no further treatment. Results incorporating data from the systematic review and local cohorts (665 aneurysms) showed 93.6% technical success, 99.1% visceral preservation, 3.7% major complication, 1.5% periprocedural mortality, and 4.4% reintervention rates.
Conclusions: Endovascular treatment of VRAA is associated with excellent technical success and visceral preservation rates. Major complication and periprocedural mortality rates are comparatively low. A few VRAA (4.4%) required future reintervention suggesting that imaging follow-up is essential after initial treatment.
(Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.)

المؤلفون: Maingard, Julian^{Aff1, Aff2, Aff3}, Lamanna, Anthony^Aff1, Kok, Hong Kuan^{Aff3, Aff4}, Ranatunga, Dinesh^Aff1, Ravi, Rajeev^Aff1, Chandra, Ronil V.^{Aff5, Aff6}, Lee, Michael J.^{Aff7, Aff8}, Brooks, Duncan Mark^{Aff1, Aff2, Aff3, Aff9}, Asadi, Hamed^{Aff1, Aff2, Aff3, Aff5, Aff9}

المصدر: CVIR Endovascular. 2(1)

المؤلفون: Larner, Brett, Maingard, Julian, Ren, Yifan, Kok, Hong Kuan, Chandra, Ronil V, Lee, Michael J, Schelleman, Anthony, Brooks, Duncan Mark, Asadi, Hamed

المصدر: Journal of Medical Imaging & Radiation Oncology; Dec2019, Vol. 63 Issue 6, p765-769, 5p

مصطلحات موضوعية: PERICARDIUM, HEPATIC artery, RENAL artery, RANGE management, FALSE aneurysms, ANEURYSMS

مستخلص: Visceral and renal artery aneurysms (VRAAs) and pseudoaneurysms are rare. Their increasing incidence is largely thought to be due to advances in medical imaging. Twenty percent of VRAAs occur in hepatic arteries, with approximately fifty percent of these represented by pseudoaneurysms, which are prone to spontaneous rupture. Many treatments for VRAAs exist, with the endovascular approach being favoured. Treatment aims to preserve visceral perfusion and exclude the aneurysm; however, complex aneurysms may require parent artery or end-organ sacrifice. Covered stents allow rapid aneurysm exclusion while preserving parent artery patency, a favourable outcome when parent artery or end-organ sacrifice is undesirable. The AneuGraft pericardium covered stent (PCS) combines the benefits of a low-profile covered stent with those of a low immunogenic material. We describe the endovascular treatment of a patient with a hepatic artery pseudoaneurysm, where parent artery sacrifice was considered unacceptable. The AneuGraft PCS was used to provide immediate and complete exclusion, with dual antiplatelet therapy for 1 week, followed by single antiplatelet use. The procedure was a technical success, with preservation of the hepatic arteries and complete exclusion of the pseudoaneurysm. There were no complications immediately following the procedure or on post-procedural follow-up. The pseudoaneurysm remained excluded at 6-week CT angiogram (CTA) follow-up. This case describes a safe and effective method for completely excluding a complex pseudoaneurysm, utilising the AneuGraft PCS, allowing for the potential management of a wider range of aneurysms with unfavourable morphology. [ABSTRACT FROM AUTHOR]

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