Long-term Effect Of Interventional Minimally Invasive Treatment Of Visceral True Aneurysm

Objective:To explore various types of VAAs applicable minimally invasive treatment therapies,causes of complications.To summarize the long-term effect of interventional minimally invasive treatment of visceral artery aneurysms(VAAs).Methods:Collect the information of 59 patients with VAAs who were followed up for more than 12 months in our institution from February 2011 to February 2019.All the patients in this group were diagnosed as true aneurysms by imaging examination.According to the size of aneurysm neck,blood supply of target organ,the arterial path of the aneurysm and the general situation of the patient,Choosing aneurysm embolization,aneurysm tamponade,arterial stent implantation and conservative observation.Follow-up observation of the aneurysm cavity closure,size change,whether the aneurysm artery is unobstructed,whether the target organ is infarcted or infarcted area increased,and whether aneurysm-related death.Result:37 cases of VAAs were treated with interventional therapy,and 22 cases received conservative observation.The success rate of initial intervention therapy was100%(37/37),and embolization was performed in 14 of 37 cases(including 12 splenic aneurysms,1 hepatic aneurysm,and 1 multiple splenic aneurysm),multiple splenic aneurysmafter embolization plus splenectomy.13 patients underwent tamponade(7 renal aneurysms,1 hepatic aneurysm,1 superior mesenteric aneurysm,1 multiple right renal aneurysm,1 left and right renal aneurysm for the right renal aneurysm,1 left renal aneurysm with single abdominal cavity aneurysm for left renal aneurysm,1 case of single splenic aneurysm combined with single left renal aneurysm,coiling for splenic aneurysm),3 cases of renal aneurysm,1 case of multiple right renal artery underwent tamponade assisted by stent.Four cases underwent stent implantation(one renal aneurysm was implanted with stent graft.One renal aneurysm,one multiple left renal aneurysm,and one multiple superior mesenteric aneurysm were implanted with multilayer bare stent).One patient with multiple splenic aneurysms underwent stent graft implantation plus coiling,one patient with superior mesenteric aneurysm recurred after two tamponades,and the third implantation plus coiling,No recurrence after treatment.53 cases were followed up,including 31 cases of interventional treatment and 22 cases of conservative observation.The follow-up period range from 12 months to 99months(mean 28.8months),and the follow-up rate was 89.8%(53/59).One case of superior mesenteric aneurysm recurred,with a recurrence rate of 3.2%(1/31).The repeatable interventional was both successfully.A total of 10 patients in this group used stents.The stent patency rate was 100%(10/10).One case had partial splenic infarction after splenic artery embolization,and the incidence of organ infarction was3.2%(1/31).During the follow-up period,there was no increase in infarct size and abscess formation.One patient with splenic aneurysm died 12 months after embolization due to other causes,and the aneurysm-related mortality was 0.Among the 31 patients with interventional therapy,9 patients had abdominal and lumbar discomfort before treatment,1 patient still feel slightly painful,the rest all relieved spontaneously.In 4 cases of multiple aneurysms,untreated aneurysms did not increase during follow-up.Among the 22 conservatively observed patients,1 patient had a mesenteric aneurysm rupture.He was discharged after conservative treatment,no rupture occurred during the follow-up period.Despite a slightly enlargement of aneurysm in 5 cases but no rupture occurred.Conclusion:VAAs are relatively rare but fatal,and the mortality after rupture is high,and clinical diagnosis mainly depends on imaging examination.For aneurysm with a diameter of greater than 2 cm and no calcification in the wall,there is an increasing trend of follow-up,and they are in women of childbearing age and pregnancy,or VAAs are located in the celiac artery,gastroduodenal artery,and pancreaticoduodenal artery.Once aneurysm diagnosed should be actively treated.Interventional treatment has the advantages of minimally invasive technology,repetition,less time hospitalization,and less postoperative complications.Choosing the appropriate treatment according to the aneurysm site has good short-term efficacy and the same long-term efficacy.