Interventional treatment of peripancreatic aneurysms: can one strategy fit all?

IF 1.2 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Marilia B Voigt, Patrick A Kupczyk, Alexander Kania, Carsten Meyer, Julia Wagenpfeil, Tatjana Dell, Claus-Christian Pieper, Julian A Luetkens, Daniel Kuetting
{"title":"Interventional treatment of peripancreatic aneurysms: can one strategy fit all?","authors":"Marilia B Voigt, Patrick A Kupczyk, Alexander Kania, Carsten Meyer, Julia Wagenpfeil, Tatjana Dell, Claus-Christian Pieper, Julian A Luetkens, Daniel Kuetting","doi":"10.1186/s42155-025-00533-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To identify the frequency and association of visceral arterial (VA) stenosis in peripancreatic aneurysms (PPAs) and to develop a uniform, more detailed treatment strategy for PPAs in case of accompanying VA stenosis, as current guidelines do not adequately address this constellation.</p><p><strong>Materials and methods: </strong>Patients with PPAs diagnosed at a tertiary care hospital were retrospectively analyzed. In case of multiple PPAs, the aneurysm with the highest aneurysm-to-vessel ratio (AVR) within the celiac-mesenteric collateral circulation was classified as the primary aneurysm and categorized as \"critical\" or \"non-critical\" based on the risk of organ ischemia. Celiac artery and superior mesenteric artery stenoses were graded as low (< 50%), high (> 50%), or total occlusion. Treatment strategies were based on VA stenosis severity, aneurysm classification, and morphology. Treatment strategies included endovascular, surgical and watch-and-wait management.</p><p><strong>Results: </strong>Thirty-one patients with PPAs were included with a total of 53 aneurysms; mean aneurysm size: 12.5 ± 7.9 mm (range 5-38 mm), AVR: 3.5 ± 2.1 (range 1-11.3). The superior and inferior pancreaticoduodenal arteries as well as the pancreaticoduodenal arcade were affected in most cases (67.9%). AVR was significantly higher in cases of aneurysm rupture (6.2 ± 2.8; p = 0.031). Celiac artery stenosis was present in 87.1%. Aneurysm size and occurrence of active bleeding did not correlate (p = 0.925). 11 patients presented with critical aneurysms, with 10 patients requiring individually tailored treatment. Non-critical aneurysms were treated with coil embolization in most cases.</p><p><strong>Conclusion: </strong>CA stenosis, aneurysm position, and AVR significantly influence treatment decisions. Individualized approaches based on anatomical and hemodynamic factors are needed in PPA treatment.</p>","PeriodicalId":52351,"journal":{"name":"CVIR Endovascular","volume":"8 1","pages":"23"},"PeriodicalIF":1.2000,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923352/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"CVIR Endovascular","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s42155-025-00533-2","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

Abstract

Purpose: To identify the frequency and association of visceral arterial (VA) stenosis in peripancreatic aneurysms (PPAs) and to develop a uniform, more detailed treatment strategy for PPAs in case of accompanying VA stenosis, as current guidelines do not adequately address this constellation.

Materials and methods: Patients with PPAs diagnosed at a tertiary care hospital were retrospectively analyzed. In case of multiple PPAs, the aneurysm with the highest aneurysm-to-vessel ratio (AVR) within the celiac-mesenteric collateral circulation was classified as the primary aneurysm and categorized as "critical" or "non-critical" based on the risk of organ ischemia. Celiac artery and superior mesenteric artery stenoses were graded as low (< 50%), high (> 50%), or total occlusion. Treatment strategies were based on VA stenosis severity, aneurysm classification, and morphology. Treatment strategies included endovascular, surgical and watch-and-wait management.

Results: Thirty-one patients with PPAs were included with a total of 53 aneurysms; mean aneurysm size: 12.5 ± 7.9 mm (range 5-38 mm), AVR: 3.5 ± 2.1 (range 1-11.3). The superior and inferior pancreaticoduodenal arteries as well as the pancreaticoduodenal arcade were affected in most cases (67.9%). AVR was significantly higher in cases of aneurysm rupture (6.2 ± 2.8; p = 0.031). Celiac artery stenosis was present in 87.1%. Aneurysm size and occurrence of active bleeding did not correlate (p = 0.925). 11 patients presented with critical aneurysms, with 10 patients requiring individually tailored treatment. Non-critical aneurysms were treated with coil embolization in most cases.

Conclusion: CA stenosis, aneurysm position, and AVR significantly influence treatment decisions. Individualized approaches based on anatomical and hemodynamic factors are needed in PPA treatment.

胰腺周围动脉瘤的介入治疗:一种策略能满足所有需求吗?
目的:确定胰腺周围动脉瘤(PPAs)中内脏动脉(VA)狭窄的频率和相关性,并为PPAs合并VA狭窄的情况制定统一、更详细的治疗策略,因为目前的指南没有充分解决这一问题。材料和方法:回顾性分析在三级医院诊断的PPAs患者。多发PPAs时,腹腔-肠系膜侧支循环内动脉瘤与血管比值(AVR)最高的动脉瘤为原发性动脉瘤,并根据器官缺血的危险性将其分为“危重”或“非危重”。腹腔动脉和肠系膜上动脉狭窄分级为低(50%)或完全闭塞。治疗策略基于VA狭窄的严重程度、动脉瘤的分类和形态。治疗策略包括血管内、手术和观察等待管理。结果:纳入PPAs患者31例,动脉瘤53个;平均动脉瘤大小:12.5±7.9 mm(范围5-38 mm), AVR: 3.5±2.1(范围1-11.3)。以胰十二指肠上、下动脉及拱廊为主(67.9%)。动脉瘤破裂组AVR明显高于动脉瘤破裂组(6.2±2.8;p = 0.031)。腹腔动脉狭窄占87.1%。动脉瘤大小与活动性出血的发生无相关性(p = 0.925)。11名患者出现了严重的动脉瘤,10名患者需要单独治疗。非危重性动脉瘤多数采用线圈栓塞治疗。结论:CA狭窄、动脉瘤位置和AVR显著影响治疗决策。PPA治疗需要基于解剖学和血流动力学因素的个体化方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CVIR Endovascular
CVIR Endovascular Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
2.30
自引率
0.00%
发文量
59
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信