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BOSTON – Endovascular interventions for ruptured visceral artery aneurysms are associated with reduced morbidity and mortality, compared with open interventions, according to findings from a retrospective chart review.
Both endovascular and open repairs are safe and durable for intact visceral artery aneurysms, Dr. Ankur J. Shukla reported at a the 2014 Vascular Annual Meeting.
Of 261 patients who presented with visceral artery aneurysms (VAAs), 174 underwent repair: 74 who presented with ruptured VAA and 100 who presented with intact VAA. The majority – 73% of ruptured VAA and 62% of intact VAA – were repaired with an endovascular approach.
Among those with ruptured VAA, 30-day mortality was 7.4% following endovascular repair, compared with 28.6% following open repair, a significant difference, said Dr. Shukla of the University of Pittsburgh Medical Center.
Survival at 3 years of ruptured VAA was about 70% vs. 46.4% in the endovascular and open repair groups, respectively, he said.
About 65% of patients with ruptured VAA presented with pain, and about 30% presented in hemodynamic shock. The most commonly identified etiology was "inflammatory/pancreatitis inflammatory," and 80% of the aneurysms were pseudoaneurysmal in nature.
A large proportion of the aneurysms were in the splenic and arterial beds, but 26% were located in the pancreaticoduodenal arcade, and those had a mean size of 12.7 mm. Most (95%) were pseudoaneurysms.
The outcomes with ruptured VAA were quite good, Dr. Shukla said, noting that the technical success rate was 98.7%.
Although the 30-day reintervention rate with endovascular repair was higher, the difference between the groups was not statistically significant, and there was a trend toward a lower rate of major complications with endovascular repair.
Factors found to be predictors of mortality risk were older age and steroid use, while endovascular repair was found to be protective.
As for the patients with intact VAA, most presented without symptoms, and the most common etiology was atherosclerosis.
"When we looked at the distribution, this was very consistent with what has been reported in the literature, with the splenic and arterial beds really making up the lion’s share of this group. Notable is the fact that 6.7% of our patients had intact aneurysms in the pancreaticoduodenal arcade," he said.
Outcomes in those with intact aneurysms were good. A slightly higher 30-day reintervention rate in those who underwent endovascular repair did not reach statistical significance, and both the endovascular and open repair groups had low rates of major complications.
Survival at 3 years for intact aneurysms did not differ in the endovascular and open repair groups. This was partly due to a 0% 30-day mortality, and – despite the fact that the overall mortality in those with intact aneurysms was 10% – there was zero overall aneurysm-related mortality, he said.
Patients in the study were treated at a single institution between 2003 and 2013. Most were in their mid to late 50s, and there were more men and more individuals on immunosuppressive therapy in the ruptured VAA group. However, comorbidities were similar in the ruptured and intact VAA groups.
Visceral artery aneurysms occur only rarely, affecting 0.1% to 2% of the general population, but because of the increasing use of noninvasive imaging, more of these aneurysms are being detected incidentally.
When they are not found incidentally, they often go undetected and present when they rupture, Dr. Shukla said.
"Because of the increasing utilization and improvement of endovascular technology, we now have a lot of options to fix these aneurysms. But the outcomes are not well defined. Even less well defined is the outcome of ruptured visceral artery aneurysms," he said, noting that most studies have a small sample size or look only at endovascular or open repairs.
Overall, the current study showed that there is "an acute and sharp drop-off in survival with open repair," related, most likely, to operative mortality, he said.
"Based on the findings, we recommend aggressive treatment of pseudoaneurysms and true aneurysms in the pancreaticoduodenal arcade, and advocate for an endovascular-first approach to treating ruptured visceral artery aneurysms, acknowledging that success in this is really predicated on good planning based on advanced imaging and endovascular set-up," he concluded.
Dr. Shukla reported having no disclosures
Visceral Artery Aneurysms (VAA) can be challenging to treat from an open approach especially when the aneurysm is adherent to the surrounding pancreatic, visceral or retroperitoneal tissue. In most areas of vascular disease endovascular therapy is easier. But, endovascular therapy for VAA can be as challenging as the open surgical repair because of vessel tortuosity and access, imaging challenges, and the few options available for durable aneurysm treatment. Dr. Shukla and colleagues reviewed their outcomes in treating VAA over a 10-year period and report high rates of technical success, low morbidity and mortality using endovascular means for both intact and ruptured VAA. The results for endovascular therapy for ruptured VAA were particularly promising. These results indicate that coils and other ablative maneuvers may suffice in the setting of hemorrhage and be preferable to open surgical repair or ligation. This study provides important information on a rare problem and reassures us that the mid-term durability of ablative techniques for VAA is acceptable.
Dr. Vikram Kashyap is professor of surgery, Case Western Reserve University and chief, Division of Vascular Surgery and Endovascular Therapy, and co-director, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center,Cleveland.
Visceral Artery Aneurysms (VAA) can be challenging to treat from an open approach especially when the aneurysm is adherent to the surrounding pancreatic, visceral or retroperitoneal tissue. In most areas of vascular disease endovascular therapy is easier. But, endovascular therapy for VAA can be as challenging as the open surgical repair because of vessel tortuosity and access, imaging challenges, and the few options available for durable aneurysm treatment. Dr. Shukla and colleagues reviewed their outcomes in treating VAA over a 10-year period and report high rates of technical success, low morbidity and mortality using endovascular means for both intact and ruptured VAA. The results for endovascular therapy for ruptured VAA were particularly promising. These results indicate that coils and other ablative maneuvers may suffice in the setting of hemorrhage and be preferable to open surgical repair or ligation. This study provides important information on a rare problem and reassures us that the mid-term durability of ablative techniques for VAA is acceptable.
Dr. Vikram Kashyap is professor of surgery, Case Western Reserve University and chief, Division of Vascular Surgery and Endovascular Therapy, and co-director, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center,Cleveland.
Visceral Artery Aneurysms (VAA) can be challenging to treat from an open approach especially when the aneurysm is adherent to the surrounding pancreatic, visceral or retroperitoneal tissue. In most areas of vascular disease endovascular therapy is easier. But, endovascular therapy for VAA can be as challenging as the open surgical repair because of vessel tortuosity and access, imaging challenges, and the few options available for durable aneurysm treatment. Dr. Shukla and colleagues reviewed their outcomes in treating VAA over a 10-year period and report high rates of technical success, low morbidity and mortality using endovascular means for both intact and ruptured VAA. The results for endovascular therapy for ruptured VAA were particularly promising. These results indicate that coils and other ablative maneuvers may suffice in the setting of hemorrhage and be preferable to open surgical repair or ligation. This study provides important information on a rare problem and reassures us that the mid-term durability of ablative techniques for VAA is acceptable.
Dr. Vikram Kashyap is professor of surgery, Case Western Reserve University and chief, Division of Vascular Surgery and Endovascular Therapy, and co-director, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center,Cleveland.
BOSTON – Endovascular interventions for ruptured visceral artery aneurysms are associated with reduced morbidity and mortality, compared with open interventions, according to findings from a retrospective chart review.
Both endovascular and open repairs are safe and durable for intact visceral artery aneurysms, Dr. Ankur J. Shukla reported at a the 2014 Vascular Annual Meeting.
Of 261 patients who presented with visceral artery aneurysms (VAAs), 174 underwent repair: 74 who presented with ruptured VAA and 100 who presented with intact VAA. The majority – 73% of ruptured VAA and 62% of intact VAA – were repaired with an endovascular approach.
Among those with ruptured VAA, 30-day mortality was 7.4% following endovascular repair, compared with 28.6% following open repair, a significant difference, said Dr. Shukla of the University of Pittsburgh Medical Center.
Survival at 3 years of ruptured VAA was about 70% vs. 46.4% in the endovascular and open repair groups, respectively, he said.
About 65% of patients with ruptured VAA presented with pain, and about 30% presented in hemodynamic shock. The most commonly identified etiology was "inflammatory/pancreatitis inflammatory," and 80% of the aneurysms were pseudoaneurysmal in nature.
A large proportion of the aneurysms were in the splenic and arterial beds, but 26% were located in the pancreaticoduodenal arcade, and those had a mean size of 12.7 mm. Most (95%) were pseudoaneurysms.
The outcomes with ruptured VAA were quite good, Dr. Shukla said, noting that the technical success rate was 98.7%.
Although the 30-day reintervention rate with endovascular repair was higher, the difference between the groups was not statistically significant, and there was a trend toward a lower rate of major complications with endovascular repair.
Factors found to be predictors of mortality risk were older age and steroid use, while endovascular repair was found to be protective.
As for the patients with intact VAA, most presented without symptoms, and the most common etiology was atherosclerosis.
"When we looked at the distribution, this was very consistent with what has been reported in the literature, with the splenic and arterial beds really making up the lion’s share of this group. Notable is the fact that 6.7% of our patients had intact aneurysms in the pancreaticoduodenal arcade," he said.
Outcomes in those with intact aneurysms were good. A slightly higher 30-day reintervention rate in those who underwent endovascular repair did not reach statistical significance, and both the endovascular and open repair groups had low rates of major complications.
Survival at 3 years for intact aneurysms did not differ in the endovascular and open repair groups. This was partly due to a 0% 30-day mortality, and – despite the fact that the overall mortality in those with intact aneurysms was 10% – there was zero overall aneurysm-related mortality, he said.
Patients in the study were treated at a single institution between 2003 and 2013. Most were in their mid to late 50s, and there were more men and more individuals on immunosuppressive therapy in the ruptured VAA group. However, comorbidities were similar in the ruptured and intact VAA groups.
Visceral artery aneurysms occur only rarely, affecting 0.1% to 2% of the general population, but because of the increasing use of noninvasive imaging, more of these aneurysms are being detected incidentally.
When they are not found incidentally, they often go undetected and present when they rupture, Dr. Shukla said.
"Because of the increasing utilization and improvement of endovascular technology, we now have a lot of options to fix these aneurysms. But the outcomes are not well defined. Even less well defined is the outcome of ruptured visceral artery aneurysms," he said, noting that most studies have a small sample size or look only at endovascular or open repairs.
Overall, the current study showed that there is "an acute and sharp drop-off in survival with open repair," related, most likely, to operative mortality, he said.
"Based on the findings, we recommend aggressive treatment of pseudoaneurysms and true aneurysms in the pancreaticoduodenal arcade, and advocate for an endovascular-first approach to treating ruptured visceral artery aneurysms, acknowledging that success in this is really predicated on good planning based on advanced imaging and endovascular set-up," he concluded.
Dr. Shukla reported having no disclosures
BOSTON – Endovascular interventions for ruptured visceral artery aneurysms are associated with reduced morbidity and mortality, compared with open interventions, according to findings from a retrospective chart review.
Both endovascular and open repairs are safe and durable for intact visceral artery aneurysms, Dr. Ankur J. Shukla reported at a the 2014 Vascular Annual Meeting.
Of 261 patients who presented with visceral artery aneurysms (VAAs), 174 underwent repair: 74 who presented with ruptured VAA and 100 who presented with intact VAA. The majority – 73% of ruptured VAA and 62% of intact VAA – were repaired with an endovascular approach.
Among those with ruptured VAA, 30-day mortality was 7.4% following endovascular repair, compared with 28.6% following open repair, a significant difference, said Dr. Shukla of the University of Pittsburgh Medical Center.
Survival at 3 years of ruptured VAA was about 70% vs. 46.4% in the endovascular and open repair groups, respectively, he said.
About 65% of patients with ruptured VAA presented with pain, and about 30% presented in hemodynamic shock. The most commonly identified etiology was "inflammatory/pancreatitis inflammatory," and 80% of the aneurysms were pseudoaneurysmal in nature.
A large proportion of the aneurysms were in the splenic and arterial beds, but 26% were located in the pancreaticoduodenal arcade, and those had a mean size of 12.7 mm. Most (95%) were pseudoaneurysms.
The outcomes with ruptured VAA were quite good, Dr. Shukla said, noting that the technical success rate was 98.7%.
Although the 30-day reintervention rate with endovascular repair was higher, the difference between the groups was not statistically significant, and there was a trend toward a lower rate of major complications with endovascular repair.
Factors found to be predictors of mortality risk were older age and steroid use, while endovascular repair was found to be protective.
As for the patients with intact VAA, most presented without symptoms, and the most common etiology was atherosclerosis.
"When we looked at the distribution, this was very consistent with what has been reported in the literature, with the splenic and arterial beds really making up the lion’s share of this group. Notable is the fact that 6.7% of our patients had intact aneurysms in the pancreaticoduodenal arcade," he said.
Outcomes in those with intact aneurysms were good. A slightly higher 30-day reintervention rate in those who underwent endovascular repair did not reach statistical significance, and both the endovascular and open repair groups had low rates of major complications.
Survival at 3 years for intact aneurysms did not differ in the endovascular and open repair groups. This was partly due to a 0% 30-day mortality, and – despite the fact that the overall mortality in those with intact aneurysms was 10% – there was zero overall aneurysm-related mortality, he said.
Patients in the study were treated at a single institution between 2003 and 2013. Most were in their mid to late 50s, and there were more men and more individuals on immunosuppressive therapy in the ruptured VAA group. However, comorbidities were similar in the ruptured and intact VAA groups.
Visceral artery aneurysms occur only rarely, affecting 0.1% to 2% of the general population, but because of the increasing use of noninvasive imaging, more of these aneurysms are being detected incidentally.
When they are not found incidentally, they often go undetected and present when they rupture, Dr. Shukla said.
"Because of the increasing utilization and improvement of endovascular technology, we now have a lot of options to fix these aneurysms. But the outcomes are not well defined. Even less well defined is the outcome of ruptured visceral artery aneurysms," he said, noting that most studies have a small sample size or look only at endovascular or open repairs.
Overall, the current study showed that there is "an acute and sharp drop-off in survival with open repair," related, most likely, to operative mortality, he said.
"Based on the findings, we recommend aggressive treatment of pseudoaneurysms and true aneurysms in the pancreaticoduodenal arcade, and advocate for an endovascular-first approach to treating ruptured visceral artery aneurysms, acknowledging that success in this is really predicated on good planning based on advanced imaging and endovascular set-up," he concluded.
Dr. Shukla reported having no disclosures
AT THE 2014 VASCULAR ANNUAL MEETING
Key clinical point: The researchers recommend aggressive treatment of visceral artery pseudoaneurysms and true aneurysms, with an endovascular-first approach to treating ruptured aneurysms.
Major finding: Thirty-day mortality was 7.4% vs. 26% with endovascular vs. open repair of ruptured VAAs.
Data source: A retrospective chart review involving 174 cases.
Disclosures: Dr. Shukla reported having no disclosures.