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Chapter 85 - Splanchnic artery aneurysms Flashcards

1
Q

First reported repair of splanchnic artery aneurysm

A

Kehr 1903

Ligation of proper hepatic artery aneurysm

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2
Q

Paul 1951 on splanchnic artery aneurysms

A

Ligation and revascularization of traumatic hepatic artery aneurysm

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3
Q

Debakey and Cooley 1953 on splanchnic artery aneurysm

A

Repair of mycotic SMA

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4
Q

Definition of splanchnic artery aneurysms

A

Aneurysms affecting celiac, SMA, IMA and branches

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5
Q

Splanchnic aneurysm Association with aortic, renal, iliac or LE, cerebral aneurysms

A

33%

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6
Q

Incidence of splanchnic aneurysm

A

0.1-2%

10% in elderly

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7
Q

Distribution of types of splanchnic aneurysm by prevalence

A 
Splenic 60%
Hepatic artery 20%
SMA 6%
Celiac 4%
Gastric artery 4%
Jejunal/ileal/colic 4%
PDA 2%
GDA 1.5%
IMA < 1%
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8
Q

Causes of splanchnic aneurysms

A

1) atherosclerosis
2) medial degeneration
3) collagen vascular disease
4) FMD
5) infection/inflammatory
6) iatrogenic

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9
Q

Risk factors for splanchnic aneurysm

A

1) multiparity
2) portal hypertension
3) post transplant
4) celiac occlusive disease (GDA/PDA aneurysms)

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10
Q

Multiple splanchnic aneurysm potential systemic causes

A

1) von Recklinghausen disease
2) Ehlers-Danlos syndrome
3) periarteritis nodosa
4) Behcet disease
5) systemic arteritis
6) endocarditis with septic emboli
7) connective tissue disorders
8) excessive use of acetaminophen

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11
Q

Vaccination for post-splenectomy

A

1) Pneumococcal
2) Meningococcal
3) Haemophilus influenzae B

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12
Q

Splanchnic arteries that can be ligated in emergency

A

Splenic with splenectomy
proximal hepatic artery
PDA
gastric artery

SMA and celiac will need reconstruction or bowel resection of dead portions

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13
Q

Criteria to observe splanchnic artery aneurysms

A

1) less than 2cm
2) asymptomatic
3) minimal or no growth

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14
Q

Criteria to intervene on splanchnic artery aneurysms

A

1) women of child bearing age or are pregnant
2) pseudoaneurysms
3) SMA, GDA, PDA aneurysms

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15
Q

Methods of endovascular treatment of splanchnic aneurysm

A

1) nitinol coil, cyanoacrylate glue
2) particles or Gelfoam
3) covered stents
4) flow diverting stents
5) thrombin or ethyl alcohol injection

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16
Q

Down sides of endovascular treatment of splanchnic aneurysms

A

1) access related complication
2) contrast
3) end-organ embolization
4) higher rate of failure
5) prolonged surveillance

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17
Q

Mortality after endovascular treatment

A

8.3%

All related to emergent intervention with hemodynamic instability

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18
Q

Techniques for embolizing splanchnic aneurysms

A

End branches can be glued directly

For mid segments, distal coil, then glue or more coil, and proximal coil plug

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19
Q

Flow diverting stents

A

Non-covered stents geared to redirect flow away from the aneurysm itself without occluding branch vessels

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20
Q

Incidence of splenic artery aneurysm in general population

A

0.78%
Female:male 4:1

occur at younger age than other splanchnic aneurysms but still affects elderly more

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21
Q

Average size of splenic aneurysm at diagnosis and size at symptom onset

A

2cm at diagnosis

3cm with symptoms

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22
Q

Local of splenic aneurysm along splenic artery

A

1) Saccular

2) mid- or distal splenic artery and at bifurcations

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23
Q

Giant splenic artery aneurysm

A

> 10 cm more often in men

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24
Q

Cause of splenic artery aneurysm

A

1) atherosclerosis
2) FMD
3) arteritis

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25
Q

Parity association with splenic aneurysm

A

1) hormone, FMD, wall stress? etiology unclear
2) 50% of female with >6 preg have splenic aneurysm
3) 80% of female with splenic aneurysm had > 4.5 pregnancies

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26
Q

Incidence of splenic aneurysm in patients with portal HTN or cirrhosis waiting for liver transplant

A

10-50%

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27
Q

Causes of splenic artery PSEUDOaneurysm

A

1) trauma
2) infection
3) pancreatitis (diggest splenic artery)

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28
Q

Hemosuccus pancreaticus

A

rupture of visceral aneurysm into main pancreatic duct

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29
Q

% of splenic artery aneurysm rupture on presentation

A

10%

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30
Q

Rate of rupture of splenic artery aneurysm not during pregnancy

A

2%

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31
Q

Pregnancy rupture of splenic artery accounts for this % of all ruptures

A

50%

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32
Q

double rupture phenomenon of splenic artery aneurysm rupture

A

First into the lesser sac
tamponade up to 4 days
then free rupture into peritoneum

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33
Q

Mortality associated with splenic artery aneurysm rupture

A

10-25%

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34
Q

Mortality for maternal and fetal during splenic artery aneurysm rupture

A

75% mom

95% fetus

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35
Q

Rupture in pregnancy when does it occur

A

third trimester

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36
Q

Prevalence of splenic artery aneurysm in pregnant women

37
Q

How prevalent is portal hypertension in splenic artery aneurysm ruptures

38
Q

Indication to treat splenic artery aneurysms

A

1) Ruptures
2) symptomatic
3) women childbearing age
4) pseudoaneurysms
5) size > 2cm

39
Q

Rate of splenic artery aneurysm growth

A

Most 90% do not grow

those that grow grow at 0.06-0.2 mm/year

40
Q

Collateral to supply spleen without splenic artery

A

Short gastric vessels

41
Q

Hepatic artery aneurysms first described by

A

Wilson 1809

ligated it in 1903

42
Q

Hepatic artery aneurysms as a % of all splanchnic aneurysms

43
Q

Incidence of hepatic artery aneurysm

44
Q

Distribution of the hepatic artery aneurysms

A

Extrahepatic vasculature 75-80%
Extraparenchymal liver space 20%
Exlusively intrahepatic 5%

45
Q

Distribution of hepatic artery aneurysm along the extrahepatic vasculature

A

1) CHA 63%
2) Right hepatic 28%
3) Left hepatic 5%
4) bilateral hepatic 4%

46
Q

Association of hepatic artery aneurysm with sex and pregnancy

A

Male:Female 3:2

No association with pregnancy

47
Q

Mean age of occurence without trauma of hepatic artery aneurysms

48
Q

Most common cause of hepatic artery aneurysm

A

Atherosclerosis 30%

49
Q

Comorbidities associated with hepatic artery aneurysm

A

1) HTN
2) arterial dysplasia
3) medial degeneration
4) trauma
5) polyarteritis nodosa
6) biliary disease

50
Q

Rate of other splanchnic and nonsplanchnic aneurysms in the presence of hepatic artery aneurysm

A

20% splenic artery aneurysm

40% nonsplanchnic mostly aortic

51
Q

Quincke’s triad

A

Rupture of hepatic aneurysm into bile ducts:

1) hemobilia
2) jaundice
3) RUQ pain

52
Q

Mortality of hepatic artery aneurysm rupture

53
Q

Treatment of hepatic parenchyma aneurysms

A

Embolization and hepatic resection or lobectomy

54
Q

Consequence of ligating right hepatic artery

A

Gallbladder necrosis

55
Q

SMA aneurysm incidence

A

1 in 12000-19000

56
Q

Where along SMA do aneurysms occur

A

first 5 cm

57
Q

Causes of SMA aneurysms

A

1) Mycotic 60%
2) atherosclerosis
3) connective tissue disease
4) PAN
5) pancreatitis
6) trauma

58
Q

Rupture rates for SMA aneurysms and mortality rate

A

Rupture 38-50%

Mortality 30-90%

59
Q

Most common organism for mycotic SMA aneurysm

A

Streptococcus 47%

Staphylococcus 28%

60
Q

SMA aneurysm symptoms

A

1) abdominal pain
2) nausea/vomiting
3) GI bleeding

61
Q

mortality of SMA surgical repsair

62
Q

Indication to repair SMA aneurysms

A

1) Size > 2.5 cm
2) pseudoaneurysms
3) mycotic aneurysms

63
Q

Celiac aneurysm as percentage of all splanchnic aneurysms

64
Q

Prevalence of celiac aneurysms

65
Q

Celiac aneurysm with concomitant splanchnic aneurysm or AAA

A

40% other splanchnic

20% AAA

66
Q

Causes of celiac artery aneurysms

A

1) Atherosclerosis

2) infection 20%

67
Q

Epidemiology of celiac artery aneurysms

A

1) male

2) 50-60’s of age

68
Q

Celiac artery aneurysm rate of rupture and subsequent mortality

A

10-20% rupture

50% mortality if ruptured

69
Q

Factors associated with celiac artery aneurysm rupture

A

none found

70
Q

Consensus size for celiac artery aneurysm repair

71
Q

Rate of gastric and gastroepiploic aneurysms of all splanchnic artery aneurysms

72
Q

Causes of gastric/gastroepiploic aneurysms

A

1) Atherosclerosis 30%
2) trauma 25%
3) infection 15%

73
Q

Epidemiology of gastric/gastroepiploic aneurysms

A

1) male

2) age 60-70

74
Q

Ratio of aneurysms in the left/right gastric (lesser curvature) vs gastroepiploic (greater curvature)

A

10:1, more in gastric

75
Q

Clinical presentation of gastric/gastroepiploic aneurysm

A

Rupture 90%

76
Q

Mortality after rupture of gastric/gastroepiploic aneurysm

77
Q

GDA and PDA aneurysms as % of all sphlanchnic aneurysms

A

2% PDA

1.5% GDA

78
Q

Ferguson 1895 on splanchnic aneurysms

A

First description of superior PDA aneurysm

79
Q

Causes of GDA/PDA aneurysms

A

1) pancreatic pathology
2) celiac stenosis/occlusion
3) abdominal trauma
4) iatrogenic injury

80
Q

Epidemiology of GDA/PDA aneurysms

A

Male: female 4:1

60’s age

81
Q

Size of GDA/PDA aneurysm that predispose rupture

A

no evidence

82
Q

% of patients with GDA/PDA aneurysms that present with rupture

83
Q

Mortality after GDA/PDA rupture

84
Q

Rate of IMA branch aneurysms of all splanchnic aneurysms

85
Q

Causes of IMA branch aneurysms

A

1) inflammation and infection accounts 1/3

86
Q

IMA branch aneurysm epidemiology

A

5:1 male : female

87
Q

Mortality after mesenteric branch aneurysm rupture

88
Q

Most common location of visceral venous aneurysms

A

1) main portal vein
2) junction of SMV and splenic vein
3) hepatic hilus

R9 (200 decks)

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