Management of Mycotic Celiac Artery Aneurysm with Chimney Technique
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1 Management f Myctic Celiac Artery Aneurysm with Chimney Technique Authrs: Andreia Celh 1, Pedr Mnteir 1, Miguel Lb 1, Clara Ngueira 1, Ricard Guveia 1, Jacinta Camps 1, Rita August 1, Nun Celh 1, Ana Carlina Semiã 1, Alexandra Caned 1 ; 1 Angilgy and Vascular Surgery Department; Centr Hspitalar Vila Nva de Gaia/Espinh
2 Disclsure Andreia Pires Celh, M.D. I have the fllwing ptential cnflicts f interest t reprt: Cnsulting Emplyment in industry Stckhlder f a healthcare cmpany Owner f a healthcare cmpany Other(s) X I d nt have any ptential cnflict f interest
3 Intrductin Myctic celiac artery aneurysms (MCAA) are extremely rare Only 9 cases have been reprted t date Leading etilgy: Infective Endcarditis and septic embli (5/9; 56%)
4 Intrductin We present a case f MCAA invlving the stia, successfully treated by aneurysm exclusin using the Chimney Technique
5 Case Reprt 54 year-ld male Medical Histry: Immunglbulin A Nephrpathy CKD Stage 5 n Haemdialysis Radial-cephalic arterivenus fistulae Cannulatin by Buttnhle Technique
6 Case Reprt Emergency Department: Lumbsacral pain, asthenia, anrexia and fever fr 4 days N respiratry, gastrintestinal r geniturinary symptms Physical examinatin: mild epigastric pain with deep palpatin Analytic wrk-up: Nrmal WBC cunt; Elevated CRP (13.28 mg/dl nrmal <3.0) Nrmal Urinalysis N ther significant finding Thrax X-Ray: Nrmal Fever f Unkwn Origin (FUO) admitted fr further study
7 Case Reprt Diagnstic wrkup fr FUO Bld cultures: Methicilin-sensitive staphylccs aureus (MSSA) Transthracic Ecchardigraphy: Clinical suspicin f endcarditis - negative CTA: Primary clinical suspicin f spndyldiscitis negative Celiac trunk aneurysm
8 Case Reprt CTA Saccular aneurysm f the rigin f the celiac trunk Absence f a prximal nrmalizing neck at the celiac base 17mm maximum width
9 Case Reprt Repeated CTA (3 days later) Rapid aneurysm grwth (+15mm): Saccular aneurysm f the rigin f the celiac trunk, 32mm maximum width.
10 Case Reprt Angigraphy Suite Urgent Prcedure: Aneurysm exclusin with Chimney Technique
11 Case Reprt Angigraphy Suite Diagnstic Angigraphy
12 Case Reprt Angigraphy Suite 1. Chimney t the Celiac Trunk: Viabahn stentgraft, Gre 10x100mm
13 Case Reprt Angigraphy Suite 2. Single artic endprsthesis: Endurant II, Medtrnic 28x28x49mm
14 Case Reprt Angigraphy Suite 3. Radial frce strengthening: Wallstent, Bstn Scientific 10x70mm
15 Case Reprt CTA (5 days pstprcedure) Successful aneurysm exclusin N leak
16 Case Reprt Fllw-up After the prcedure the patient was asymptmatic, apyretic, with sustained decrease in inflammatry parameters; Discharged after a 2-week IV antibitic curse; Lifelng targeted IV antibitics were prescribed (n hemdyalisis sessins).
17 Case Reprt CTA (3 mnths pstprcedure) Cmplete aneurysm thrmbsis N leak
18 Discussin Presumptive Etilgy: Myctic MSSA bacteriemia Saccular anatmy Rapid grwth Fever Elevated inflammatry markers
19 Discussin Due t MCAA rarity, natural histry and prgnsis are unclear; Criteria fr interventin have nt been well established; Cnsensus exists fr repair regardless f size; Likelihd f prgressin t rupture in the face f vessel infectin seems t be t high
20 Discussin Saltzberg et al Endvascular repair as a first line f treatment fr all visceral artery aneurysms in anatmically suitable cases, excluding thse with lesins in the distal splenic artery Previus Reprts fr MCAA Endvascular Treatment: Emblizatin Stentgraft exclusin
21 Discussin N previus reprts in the literature f Chimney Technique fr MCAA treatment Saccular aneurysm f the rigin f the celiac trunk Absence f a prximal nrmalizing neck at the celiac base Celiac Trunk patency was maintained Shrt term results are encuraging
22 Discussin Endvascular implantatin f prsthetic material in an infected envirnment is a cncern Lifelng antibitherapy Clse mnitring Strict analytic fllw-up Serial imaging fllw-up CTA at 3,6 and 12 mnths
23 Management f Myctic Celiac Artery Aneurysm with Chimney Technique Authrs: Andreia Celh, Pedr Mnteir, Miguel Lb, Clara Ngueira, Ricard Guveia, Jacinta Camps, Rita August, Nun Celh, Ana Carlina Semiã, Alexandra Caned Thank yu fr the attentin
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