True about Visceral aneurysm
a) Splenic artery is commonly involved
b) Hepatic aneurysm is operated irrespective of symptoms
c) Splenic artery aneurysm is most commonly followed by trauma
d) True aneurysms are more common nowadays with increasing abdominal trauma
Ans: A Reference: Blumgarts 6th ed; pg. 1905 and Maingot’s abdominal operations; pg. 1245 Explanation:
Splenic artery aneurysm Hepatic artery aneurysm Most common visceral aneurysm 60% Second most common 20% Female predominance 1:4 Male predominance 2:1 Associated with Cirrhosis, Portal hypertension and pancreatitis Associated with congenital or acquired factors Mean age at presentation 62 years Mean age at presentation 60 years Majority are solitary, extrahepatic 80% and true aneurysms Pseudoaneurysms occur following trauma Pseudoaneurysms occur following trauma, iatrogenic procedures
Risk of rupture: Females Pregnant women Aneurysms > 2cm
Most common site is Common hepatic 63% > right hepatic 28% and then left hepatic HAAs have the highest risk of rupture – false aneurysm, multiple aneurysm, more than 2 cm
All aneurysms > 2cm even if asymptomatic needs intervention
Most common site of rupture – Intraperitoneal rupture
Most rupture intraperitoneally, but intrahepatic aneurysms rupture – Quincke’s triad – pain, jaundice and hemobilia
Proximal lesions – Resection of aneurysm and end to end anastomoses Distal lesions – Laparoscopic splenectomy
Extrahepatic aneurysm: Proximal to GDA – ligated Distal to GDA – aneurysmectomy and revascularization Intrahepatic aneurysm Percutaneous angioembolization