Skip to main content
SpringerLink
Log in

Endovascular Repair of 40 Visceral Artery Aneurysms and Pseudoaneurysms with the Viabahn Stent-Graft: Technical Aspects, Clinical Outcome and Mid-Term Patency

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

Endovascular repair of true visceral artery aneurysms (VAAs) and pseudoaneurysms (VAPAs) with stent-grafting (SG) can simultaneously allow aneurysm exclusion and vessel preservation, minimizing the risk of ischemic complications. Our aim was to report a single-center experience on SG of visceral aneurysms, focusing on technical aspects, clinical outcome and mid-term patency.

Materials and Methods

Consecutive patients affected by VAAs–VAPAs and submitted to endovascular treatment were retrospectively reviewed, and SG cases with the self-expandable peripheral Viabahn stent-graft were analyzed (2003–2017). Aneurysm type, patient number, SG clinical setting, procedural data, peri-procedural complications, technical success, 30-day clinical success, 30-day mortality and follow-up period (aneurysm exclusion, stent-graft patency, ischemic complications) were analyzed.

Results

SG was performed in 40 patients (24 VAPAs/16 VAAs) and in 44 procedures (25 in emergency, 19 in elective treatments), via transfemoral in 37 cases (transaxillary in 7 cases). One peri-procedural complication was recorded (a splenic artery dissection successfully converted to transcatheter embolization). The overall technical and clinical success rates were, respectively, 96 and 84%, with excellent trend in elective treatments (both 100%). Overall 30-day mortality was 12.5% (septic shock after pancreatic surgery). Stent-graft thrombosis occurred in 2 patients within 3 months, with aneurysm exclusion and without ischemic complications. Stent-graft patency and aneurysm exclusion were confirmed at 6, 12 and 36 months in 18, 12 and 7 patients, respectively.

Conclusion

SG of VAAs and VAPAs was safe and effective, particularly in elective treatments. The Viabahn stent-graft, flexible and without shape memory, is suitable for endovascular repair of tortuous visceral arteries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Nosher JL, Chung J, Brevetti LS, Graham AM, Siegel RL. Visceral and renal artery aneurysms: a pictorial essay on endovascular therapy. Radiographics. 2006;26(6):1687–704.

    Article  PubMed  Google Scholar 

  2. Chiesa R, Astore D, Guzzo G, Frigerio S, Tshomba Y, Castellano R, et al. Visceral artery aneurysms. Ann Vasc Surg. 2005;19(1):42–8.

    Article  CAS  PubMed  Google Scholar 

  3. Pitton MB, Dappa E, Jungmann F, Kloeckner R, Schotten S, Wirth GM, et al. Visceral artery aneurysms: incidence, management, and outcome analysis in a tertiary care center over one decade. Eur Radiol. 2015;25(7):2004–14.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chiaradia M, Novelli L, Deux JF, Tacher V, Mayer J, You K, et al. Ruptured visceral artery aneurysms. Diagn Interv Imaging. 2015;96(7–8):797–806.

    Article  CAS  PubMed  Google Scholar 

  5. Verde F, Fishman EK, Johnson PT. Arterial pseudoaneurysms complicating pancreatitis: literature review. J Comput Assist Tomogr. 2015;39(1):7–12.

    Article  PubMed  Google Scholar 

  6. Sanchez Arteaga A, Orue-Echebarria MI, Zarain L, Lusilla A, Martinez CM, Moreno A, et al. Acute bleeding from pseudoaneurysms following liver and pancreatobiliary surgery. Eur J Trauma Emerg Surg. 2017;43(3):307–11.

    Article  CAS  PubMed  Google Scholar 

  7. Regus S, Lang W. Rupture risk and etiology of visceral artery aneurysms and pseudoaneurysms: a single-center experience. Vasc Endovasc Surg. 2016;50(1):10–5.

    Article  Google Scholar 

  8. Kok HK, Asadi H, Sheehan M, Given MF, Lee MJ. Systematic review and single-center experience for endovascular management of visceral and renal artery aneurysms. J Vasc Interv Radiol. 2016;27(11):1630–41.

    Article  PubMed  Google Scholar 

  9. Hemp JH, Sabri SS. Endovascular management of visceral arterial aneurysms. Tech Vasc Interv Radiol. 2015;18(1):14–23.

    Article  PubMed  Google Scholar 

  10. Rebonato A, Rossi M, Rebonato S, Cagini L, Scialpi M. Giant hepatic artery aneurysm: a fatal evolution. J Emerg Med. 2013;45(6):217–9.

    Article  Google Scholar 

  11. van Rijn MJ, Ten Raa S, Hendriks JM, Verhagen HJ. Visceral aneurysms: old paradigms, new insights? Best Pract Res Clin Gastroenterol. 2017;31(1):97–104.

    Article  PubMed  Google Scholar 

  12. Marone EM, Mascia D, Kahlberg A, Brioschi C, Tshomba Y, Chiesa R. Is open repair still the gold standard in visceral artery aneurysm management? Ann Vasc Surg. 2011;25(7):936–46.

    Article  PubMed  Google Scholar 

  13. Ikeda O, Nakasone Y, Tamura Y, Yamashita Y. Endovascular management of visceral artery pseudoaneurysms: transcatheter coil embolization using the isolation technique. Cardiovasc Intervent Radiol. 2010;33(6):1128–34.

    Article  PubMed  Google Scholar 

  14. Yasumoto T, Osuga K, Yamamoto H, Ono Y, Masada M, Mikami K, et al. Long-term outcomes of coil packing for visceral aneurysms: correlation between packing density and incidence of coil compaction or recanalization. J Vasc Interv Radiol. 2013;24(12):1798–807.

    Article  PubMed  Google Scholar 

  15. Venturini M, Marra P, Colombo M, Alparone M, Agostini G, Bertoglio L, et al. Endovascular treatment of visceral artery aneurysms and pseudoaneurysms in 100 Patients: covered stenting vs transcatheter embolization. J Endovasc Ther. 2017;24(5):709–17.

    Article  PubMed  Google Scholar 

  16. Bratby MJ, Lehmann ED, Bottomley J, Kessel DO, Nicholson AA, McPherson SJ, et al. Endovascular embolization of visceral artery aneurysms with ethylene-vinyl alcohol (Onyx): a case series. Cardiovasc Interv Radiol. 2006;29:1125–8.

    Article  CAS  Google Scholar 

  17. Madhusudhan KS, Gamanagatti S, Garg P, Shalimar Dash NR, Pal S, et al. Endovascular embolization of visceral artery pseudoaneurysms using modified injection technique with N-butyl cyanoacrylate glue. J Vasc Interv Radiol. 2015;26(11):1718–25.

    Article  PubMed  Google Scholar 

  18. Cavalcante RN, Couto VA, da Fonseca AV, et al. Endovascular treatment of a giant hepatic artery with Amplatzer vascular plug. J Vasc Surg. 2014;60:500–2.

    Article  PubMed  Google Scholar 

  19. Chauhan U, Puri SK, Jain N, Garg L, Kapoor A, Gupta N, Goel V. Percutaneous thrombin injection under sonographic guidance for exclusion of non-catheterizable post-pancreatitis pseudoaneurysm of the superior mesenteric artery: a minimally invasive and expeditious treatment option. J Med Ultrason. 2016;43(2):295–9.

    Article  Google Scholar 

  20. Krueger K, Zaehringer M, Lackner K. Percutaneous treatment of a splenic artery pseudoaneurysm by thrombin injection. J Vasc Interv Radiol. 2005;16(7):1023–5.

    Article  PubMed  Google Scholar 

  21. Larson RA, Solomon J, Carpenter JP. Stent graft repair of visceral artery aneurysms. J Vasc Surg. 2002;36(6):1260–3.

    Article  PubMed  Google Scholar 

  22. Rossi M, Rebonato A, Greco L, Citone M, David V. Endovascular exclusion of visceral artery aneurysms with stent-grafts: technique and long term follow-up. Cardiovasc Interv Radiol. 2008;31(1):36–42.

    Article  Google Scholar 

  23. Herzog T, Suelberg D, Belyaev O, Uhl W, Seemann M, Seelig MH. Treatment of acute delayed visceral hemorrhage after pancreatic surgery from hepatic arteries with covered stents. J Gastrointest Surg. 2011;15(3):496–502.

    Article  PubMed  Google Scholar 

  24. Venturini M, Angeli E, Salvioni M, De Cobelli F, Trentin C, Carlucci M, et al. Hemorrhage from a right hepatic artery pseudoaneurysm: endovascular treatment with a coronary stent graft. J Endovasc Ther. 2002;9(2):221–4.

    Article  PubMed  Google Scholar 

  25. Reekers JA, Kromhout JG, de Vries R. Treatment of a false visceral aneurysm with the Symbiot covered stent. J Endovasc Ther. 2007;14(3):429–30.

    Article  PubMed  Google Scholar 

  26. Ruffino MA, Rabbia C. Endovascular repair of peripheral and visceral aneurysms with the Cardiatis multilayer flow modulator: one-year results from the Italian multicenter registry. J Endovasc Ther. 2012;19(5):599–610.

    Article  PubMed  Google Scholar 

  27. Akkan K, Ilgit E, Karaman K, Onal B, Dökdök M, Ersöz E, et al. The new double-layer micromesh stent (Roadsaver < sup > ®</sup >): use in endovascular treatment of supraaortic and visceral artery aneurysms and pseudoaneurysms. Cardiovasc Intervent Radiol. 2017;40(9):1338–43.

    Article  PubMed  Google Scholar 

  28. Zhang Y, Lu Q, Zhao Z, Bao J, Feng X, Feng R, et al. Multiple overlapping uncovered stents as an alternative flow-diverting strategy in the management of peripheral and visceral aneurysms. J Vasc Surg. 2014;60(5):1209–17.

    Article  PubMed  Google Scholar 

  29. Laganà D, Carrafiello G, Mangini M, Dionigi G, Caronno R, Castelli P, et al. Multimodal approach to endovascular treatment of visceral artery aneurysms and pseudoaneurysms. Eur J Radiol. 2006;59(6):104–11.

    Article  PubMed  Google Scholar 

  30. Carrafiello G, Rivolta N, Fontana F, Piffaretti G, Mariscalco G, Bracchi E, et al. Combined endovascular repair of a celiac trunk aneurysm using celiac-splenic stent graft and hepatic artery embolization. Cardiovasc Intervent Radiol. 2010;33(2):352–4.

    Article  PubMed  Google Scholar 

  31. Angle JF, Siddigi NH, Wallace MJ, Kundu S, Stokes L, Wojak JC, Cardella JF. Quality improvement guidelines for percutaneous transcatheter embolization: society of interventional radiology standards of practice committee. J Vasc Interv Radiol. 2010;21(10):1479–86.

    Article  PubMed  Google Scholar 

  32. Pugliese F, Cademartiri F, van Mieghem C, Meijboom WB, Malagutti P, Mollet NR, et al. Multidetector CT for visualization of coronary stents. Radiographics. 2006;26(3):887–904.

    Article  PubMed  Google Scholar 

  33. Rebonato A, Maiettini D, Krokidis M, Graziosi L, Rossi M. Late Migration of a Covered Stent into the Stomach after Repair of a Splenic Artery Pseudoaneurysm. J Radiol Case Rep. 2016;10(2):26–32.

    PubMed  PubMed Central  Google Scholar 

  34. Hogendoorn W, Lavida A, Hunink MG, Moll FL, Geroulakos G, Muhs BE, Sumpio BE. Cost-effectiveness of endovascular repair, open repair, and conservative management of splenic artery aneurysms. J Vasc Surg. 2015;61(6):1432–40.

    Article  PubMed  Google Scholar 

  35. Cochennec F, Riga CV, Allaire E, Cheshire NJ, Hamady M, Jenkins MP, et al. Contemporary management of splanchnic and renal artery aneurysms: results of endovascular compared with open surgery from two European vascular centers. Eur J Vasc Endovasc Surg. 2011;42(3):340–6.

    Article  CAS  PubMed  Google Scholar 

  36. Roberts KJ, McCulloch N, Forde C, Mahon B, Mangat K, Olliff SP, Jones RG. Emergency treatment of haemorrhaging coeliac or mesenteric artery aneurysms and pseudoaneurysms in the era of endovascular management. Eur J Vasc Endovasc Surg. 2015;49(4):382–9.

    Article  CAS  PubMed  Google Scholar 

  37. Ding X, Zhu J, Zhu M, Li C, Jian W, Jiang J, et al. Therapeutic management of hemorrhage from visceral artery pseudoaneurysms after pancreatic surgery. J Gastrointest Surg. 2011;15(8):1417–25.

    Article  PubMed  Google Scholar 

  38. Stoupis C, Ludwig K, Inderbitzin D, Doo DD, Triller J. Stent grafting of acute hepatic artery bleeding following pancreatic head resection. Eur Radiol. 2007;17(2):401–8.

    Article  PubMed  Google Scholar 

  39. Mine T, Murata S, Ueda T, Takeda M, Onozawa S, Yamaguchi H, et al. Contribution of extra-hepatic collaterals to liver parenchymal circulation after proper hepatic artery embolization. J Gastroenterol Hepatol. 2014;29(7):1515–21.

    Article  PubMed  Google Scholar 

  40. Ching KC, Santos E, Mc Cluskey KM, Orons PD, Bandi R, Friend J. Covered stents and coil embolization for treatment of postpancreatectomy arterial hemorrhage. J Vasc Interv Radiol. 2016;27(1):73–9.

    Article  PubMed  Google Scholar 

  41. Boufi M, Belmir H, Hartung O, Ramis O, Beyer L, Alimi YS. Emergency stent graft implantation for ruptured visceral artery pseudoaneurysm. J Vasc Surg. 2011;53(6):1625–31.

    Article  PubMed  Google Scholar 

  42. Pedersoli F, Isfort P, Keil S, Goerg F, Zimmermann M, Liebl M, et al. Stentgraft implantation for the treatment of postoperative hepatic artery pseudoaneurysm. Cardiovasc Interv Radiol. 2016;39(4):575–81.

    Article  CAS  Google Scholar 

  43. Lee HG, Heo JS, Choi SH, Choi DW. Management of bleeding from pseudoaneurysms following pancreaticoduodenectomy. World J Gastroenterol. 2010;16(10):1239–44.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Patel SR, Hughes CO, Jones KG, Holt PGE, Thompson MM, Hinchliffe RJ, Karthikesalingam A. A systematic review and meta-analysis of endovascular popliteal aneurysm repair using the Hemobahn/Viabahn sten graft. J Endovasc Ther. 2015;22(3):330–7.

    Article  PubMed  Google Scholar 

  45. Greenhalgh RM, Powell JT. Endovascular repair of abdominal aortic aneurysm. N Engl J Med. 2008;358(5):494–501.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, San Raffaele Scientific Institute, Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy

    Massimo Venturini, Paolo Marra, Michele Colombo, Marta Panzeri, Simone Gusmini, Claudio Sallemi, Marco Salvioni, Carolina Lanza, Giulia Agostini, Francesco De Cobelli & Alessandro Del Maschio

  2. Department of Vascular Surgery, San Raffaele Scientific Institute, Milan, Italy

    Gianpaolo Balzano & Massimo Falconi

  3. Department of Pancreatic Surgery, San Raffaele Scientific Institute, Milan, Italy

    Yamume Tshomba, Germano Melissano & Roberto Chiesa

  4. Vita-Salute San Raffaele University, Milan, Italy

    Yamume Tshomba, Germano Melissano, Massimo Falconi, Roberto Chiesa, Francesco De Cobelli & Alessandro Del Maschio

Authors
  1. Massimo Venturini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paolo Marra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michele Colombo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marta Panzeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Simone Gusmini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Claudio Sallemi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marco Salvioni
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Carolina Lanza
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Giulia Agostini
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Gianpaolo Balzano
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yamume Tshomba
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Germano Melissano
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Massimo Falconi
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Roberto Chiesa
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Francesco De Cobelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Alessandro Del Maschio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Massimo Venturini.

Ethics declarations

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Venturini, M., Marra, P., Colombo, M. et al. Endovascular Repair of 40 Visceral Artery Aneurysms and Pseudoaneurysms with the Viabahn Stent-Graft: Technical Aspects, Clinical Outcome and Mid-Term Patency. Cardiovasc Intervent Radiol 41, 385–397 (2018). https://doi.org/10.1007/s00270-017-1844-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-017-1844-5

Keywords

Search

Navigation