Evaluation of the efficacy of endovascular treatment in visceral artery aneurysms (vaas) and arteriovenous fistulas (AVFs)

Evaluation of the Efficacy of Endovascular Treatment in Visceral Artery Aneurysms (VAAs) and Arteriovenous Fistulas (AVFs)Purpose: The aim of this study was to evaluate the efficacy of endovascular therapy of VAAs and AVFs, which is an alternative method of treatment to surgery.Material/Methods: 24 patients having VAA and AVF between the age of 10 and 71 (16 male, 8 female, mean age 40.5) were catheterized by using Seldinger method and abdominal aorta and than selectively celiac, mesenteric and renal angiography was performed between March 1995 and June 2009. Hystoacryl® (glue) and coil were used for the treatment of VAAs and AVFs. Glue?Lipiodol® mixture ratio (10-80%) was chosen according to flow rate in the lesion. Coil, glue and coil with glue were used in 6, 9 and 8 patients respectively. Amplatzer® vascular plug was used for a patient having high flow rate in AVF.Results: We detected renal arteriovenous fistulas in 9 patients, renal pseudoaneurysms in 4 patients, in 2 patients renal AVF and pseudoaneurysm were together. Hepatic artery aneurysm in 5 patients, hepatic arterioportal fistula in 2 patients, splenic artery aneurysm in 1 patient and right gastroepiploic artery aneurysm in 1 patient were also detected. Except one lesion, all lesions were totally embolised. Partial embolisation was achieved in one patient with multiple hepatoportal AVF. Splenic enfarct (30%) had occurred in one patient with splenic artery aneurysm after the procedure.Conclusion: Endovascular embolisation with coils or hystoacryl is an effective alternative method to open surgery for the management of VAAs or AVFs. Coils and hystoacryl can be used together for high flow lesions and Hystoacryl® may be preferred for low flow lesions. Embolisation has a low mortality and morbidity rate and protects the native vessels and target organs more than surgery does.