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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE
A Journal on Internal Medicine and Pharmacology
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Gazzetta Medica Italiana Archivio per le Scienze Mediche 2006 February;165(1):35-45
Celiac artery aneurysms. Personal experience and review of the literature
Cinà C. S., Safar H. A., Laganà A.
Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
Aim. The purpose of this study was to review the management of celiac artery aneurysms and propose a new classification.
Methods. Five patients operated upon at a tertiary vascular centre, represent the basis of our experience. Reports of celiac artery aneurysms were identified through a Medline search (1966-December 2000).
Results. 192 cases were identified. The mean age of the patients was 51±12 years, 66% of them were males, 38% asymptomatic, of the one which were symptomatic 60% had gastrointestinal symptoms. Twelve percent of aneurysms presented with rupture. Size ranged from 1 to 10 cm (mean, 4±1.5). Aneurysms of other arteries were present in 42 patients (41%), 8 had more than one aneurysm in other arteries. Aetiology was atherosclerosis in 54%, fibromuscular dysplasia 12%, infection 6%, congenital anomalies 4%, medial degeneration and trauma 3%, and aortic dissection 1%. Excision of the aneurysm without reconstruction was performed in 31% of patients, excision with revascularization in 65% (end-to-end repair 53%, and interposition graft 47%). Perioperative mortality was 9% for elective, and 43% for the ruptured aneurysms . In our series the aneurysm size ranged from 3-4 cm. All patients survived surgery, one died of myocardial infarction 3 years after surgery, and the others are alive at 77±39 months.
Conclusions. Celiac artery aneurysms are uncommon. Surgery is indicated for a diameter ? 3. We propose a classification based on the prevalent involvement of the origin, body or trifurcation of the celiac artery: Type I, and large type II aneurysms may be repaired through a retroperitoneal low thoracoabdominal incision, and type II of small size and type III, with a transabdominal approach.