巨大真胰十二指肠下动脉动脉瘤合并腹腔轴闭塞:第一例成功治疗覆盖球囊可扩张支架移植使用VBX

IF 0.1 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Indian Journal of Vascular and Endovascular Surgery Pub Date : 2022-09-01 DOI:10.4103/ijves.ijves_42_22
Animesh Singla, Y. Cai, Krishna Kotecha, W. Mohabbat
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引用次数: 0

摘要

巨大的内脏动脉瘤并不常见。分支血管瘤,特别是胰十二指肠区域的动脉瘤,由于其位置、解剖结构和进入动脉瘤的途径,治疗起来很有挑战性。虽然开放性手术切除与显著的发病率相关,但血管内治疗正变得越来越主流。线圈栓塞的应用,特别是在破裂的情况下,已经得到了很好的描述。在这些环境中,访问和平台通常涉及腹腔轴。我们描述了一个巨大的胰十二指肠下动脉瘤和相关的腹膜后出血的特殊护理,通过扩张的肠系膜上动脉供血。这与乳糜泻轴闭塞有关。由于近端和远端着陆区异常大,可部署带盖球囊扩张支架,成功排除动脉瘤。这是第一例报道的腹膜后破裂和相关胰十二指肠动脉瘤用覆膜支架移植物治疗成功的病例报告。这种技术可以快速进入并排除动脉瘤。此外,它还可以通过侧支途径保留前肠流量,并成功地排除了大动脉瘤。
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Giant true inferior pancreaticoduodenal artery aneurysm associated with celiac axis occlusion: A first case of successful treatment with covered balloon-expandable stent grafting using VBX
Giant visceral artery aneurysms are uncommon. Branch vessel aneurysms, particularly of the pancreaticoduodenal territory are challenging to treat due to their location, anatomy, and access to an aneurysm. While open surgical resection is associated with significant morbidity, endovascular treatment is becoming increasingly mainstream. The utilization of coil embolization, particularly in the setting of rupture has been well described. Access and platform in these settings often involve the celiac axis. We describe unusual care of a large inferior pancreaticoduodenal aneurysm and associated retroperitoneal bleed, being fed through an ectatic superior mesenteric artery. This was associated with an occluded celiac axis. Due to the unusually large proximal and distal landing zones, a covered balloon-expandable stent was deployable with the successful exclusion of the aneurysm. This is the first reported case report of successful management of retroperitoneal rupture and associated pancreaticoduodenal aneurysm treated with a covered stent graft. This technique allowed for rapid access and exclusion of the aneurysm. In addition, it allowed the preservation of foregut flow through the collateral pathway and successfully excluded the large aneurysm.
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