32 Clinical Importance and Management of Splanchnic Artery Aneurysms скачать в хорошем качестве

32 Clinical Importance and Management of Splanchnic Artery Aneurysms

#SplanchnicArteryAneurysm #VascularSurgery #AneurysmRupture #EndovascularRepair #OpenSurgery #SplenicArteryAneurysm #MycoticAneurysm #LandmarkPaper #SVSGuidelines #Atherosclerosis #Pancreatitis This video explores splanchnic artery aneurysms (SAAs), bulges in arteries supplying abdominal organs, referencing a foundational 1986 paper by Stanley and colleagues. The 1986 study revealed almost 22% of SAA cases presented as emergencies, with over 8% being fatal. SAAs are dangerous if they rupture. The most common location is the splenic artery. Causes for splenic artery aneurysms include arterial fibrodysplasia, portal hypertension, and multiparity. Rupture risk is extremely high during pregnancy (95%), with devastating maternal (70%) and fetal (95%) mortality. Outside of pregnancy, splenic rupture mortality is around 25%. The 1986 paper recommended surgery for splenic aneurysms over 2.5 cm, in pregnant/childbearing women, or if symptomatic. Hepatic artery aneurysms are often linked to atherosclerosis, medial degeneration, trauma, or infection. Superior mesenteric artery aneurysms are frequently mycotic (infected), often from bacterial endocarditis, requiring surgery to remove and reconstruct the artery due to high rupture risk. Pancreaticoduodenal artery aneurysms are often tied to pancreatitis, have a high rupture risk (up to 75%), and high mortality (~50%). Since 1986, better imaging (CT, MRI) allows earlier detection of smaller, asymptomatic aneurysms. Endovascular techniques (embolization, covered stents) offer minimally invasive alternatives with quicker recovery and potentially fewer major complications than open surgery. However, endovascular repair may require more reinterventions. Current guidelines, like the 2020 SVS guidelines, generally recommend intervention for most pseudoaneurysms, mycotic aneurysms, and many larger true aneurysms due to rupture risk. The goal remains preventing rupture while preserving blood flow. Location significantly influences strategy; for example, splenic artery aneurysms can often be ligated or embolized due to collateral circulation. While the 1986 paper highlighted the dangers and pushed for intervention, modern management combines this understanding with advanced imaging and endovascular tools, tailoring treatment to each unique case.