Scholarlink

Purpose <p>To identify the frequency and association of visceral arterial (VA) stenosis in peripancreatic aneurysms (PPAs) and to develop a uniform, more detailed treatment strategy for PPAs in case of accompanying VA stenosis, as current guidelines do not adequately address this constellation.</p> Materials and methods <p>Patients with PPAs diagnosed at a tertiary care hospital were retrospectively analyzed. In case of multiple PPAs, the aneurysm with the highest aneurysm-to-vessel ratio (AVR) within the celiac-mesenteric collateral circulation was classified as the primary aneurysm and categorized as "critical" or "non-critical" based on the risk of organ ischemia.</p> <p>Celiac artery and superior mesenteric artery stenoses were graded as low (&lt; 50%), high (&gt; 50%), or total occlusion. Treatment strategies were based on VA stenosis severity, aneurysm classification, and morphology. Treatment strategies included endovascular, surgical and watch-and-wait management.</p> Results <p>Thirty-one patients with PPAs were included with a total of 53 aneurysms; mean aneurysm size: 12.5 ± 7.9&#xa0;mm (range 5–38&#xa0;mm), AVR: 3.5 ± 2.1 (range 1–11.3). The superior and inferior pancreaticoduodenal arteries as well as the pancreaticoduodenal arcade were affected in most cases (67.9%). AVR was significantly higher in cases of aneurysm rupture (6.2 ± 2.8; <i>p</i> = 0.031). Celiac artery stenosis was present in 87.1%.</p> <p>Aneurysm size and occurrence of active bleeding did not correlate (<i>p</i> = 0.925). 11 patients presented with critical aneurysms, with 10 patients requiring individually tailored treatment. Non-critical aneurysms were treated with coil embolization in most cases.</p> Conclusion <p>CA stenosis, aneurysm position, and AVR significantly influence treatment decisions. Individualized approaches based on anatomical and hemodynamic factors are needed in PPA treatment.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Interventional treatment of peripancreatic aneurysms: can one strategy fit all?

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年3月19日

查看全文
  • Marilia B Voigt,
  • Patrick A Kupczyk,
  • Alexander Kania,
  • Carsten Meyer,
  • Julia Wagenpfeil,
  • Tatjana Dell,
  • Claus-Christian Pieper,
  • Julian A Luetkens,
  • Daniel Kuetting

摘要

Purpose

To identify the frequency and association of visceral arterial (VA) stenosis in peripancreatic aneurysms (PPAs) and to develop a uniform, more detailed treatment strategy for PPAs in case of accompanying VA stenosis, as current guidelines do not adequately address this constellation.

Materials and methods

Patients with PPAs diagnosed at a tertiary care hospital were retrospectively analyzed. In case of multiple PPAs, the aneurysm with the highest aneurysm-to-vessel ratio (AVR) within the celiac-mesenteric collateral circulation was classified as the primary aneurysm and categorized as "critical" or "non-critical" based on the risk of organ ischemia.

Celiac artery and superior mesenteric artery stenoses were graded as low (< 50%), high (> 50%), or total occlusion. Treatment strategies were based on VA stenosis severity, aneurysm classification, and morphology. Treatment strategies included endovascular, surgical and watch-and-wait management.

Results

Thirty-one patients with PPAs were included with a total of 53 aneurysms; mean aneurysm size: 12.5 ± 7.9 mm (range 5–38 mm), AVR: 3.5 ± 2.1 (range 1–11.3). The superior and inferior pancreaticoduodenal arteries as well as the pancreaticoduodenal arcade were affected in most cases (67.9%). AVR was significantly higher in cases of aneurysm rupture (6.2 ± 2.8; p = 0.031). Celiac artery stenosis was present in 87.1%.

Aneurysm size and occurrence of active bleeding did not correlate (p = 0.925). 11 patients presented with critical aneurysms, with 10 patients requiring individually tailored treatment. Non-critical aneurysms were treated with coil embolization in most cases.

Conclusion

CA stenosis, aneurysm position, and AVR significantly influence treatment decisions. Individualized approaches based on anatomical and hemodynamic factors are needed in PPA treatment.