Julian Maingard1, Hong Kuan Kok2,3, Emma Phelan2, Caitriona Logan2, Dinesh Ranatunga4, Duncan Mark Brooks4,5, Ronil V Chandra6,7, Michael J Lee2, Hamed Asadi4,2,6,7,5,8. 1. Interventional Radiology Service, Department of Radiology, Austin Hospital, Heidelberg, Melbourne, Australia. julian.maingard@austin.org.au. 2. Interventional Radiology Service, Department of Radiology, Beaumont Hospital, and Royal College of Surgeons in Ireland, Dublin, Ireland. 3. Department of Interventional Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK. 4. Interventional Radiology Service, Department of Radiology, Austin Hospital, Heidelberg, Melbourne, Australia. 5. Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Australia. 6. Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Australia. 7. Department of Imaging, Monash University, Melbourne, Australia. 8. School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia.
Abstract
INTRODUCTION: Visceral and renal artery aneurysms (VRAAs) are an uncommon clinical entity but carry a risk of rupture with associated morbidity and mortality. The rupture risk is particularly high when the aneurysms are large, of unfavourable morphology or in the setting of pregnancy and perioperative period. Endovascular approaches are now first line in the treatment of VRAA, but conventional techniques may be ineffective in excluding aneurysms with unfavourable anatomy such as those with wide necks or at arterial bifurcation points. The neurovascular Comaneci neck-bridging device is used to temporarily cover the neck of intracranial aneurysms without occluding forward arterial flow during endovascular coiling. We report the novel use of the Comaneci neck-bridging device for the treatment of complex peripheral VRAAs. MATERIALS AND METHODS: We describe the treatment of two patients with renal and splenic artery aneurysms demonstrating unfavourable anatomic morphology for conventional endovascular approaches. RESULTS: In the first patient, the renal artery aneurysm was situated at the intrarenal bifurcation of the main renal artery in the setting of a solitary kidney. In the second patient, the splenic artery aneurysm was situated close to the splenic hilum at the distal splenic arterial bifurcation. The Comaneci neck-bridging device was successfully used in both cases to assist coil embolisation with visceral preservation. CONCLUSIONS: The Comaneci neck-bridging device is potentially safe and effective for the treatment of peripheral VRAA with unfavourable anatomic characteristics that would have been deemed unsuitable for treatment using conventional techniques. LEVEL OF EVIDENCE: Level 4, Technical Report.
INTRODUCTION: Visceral and renal artery aneurysms (VRAAs) are an uncommon clinical entity but carry a risk of rupture with associated morbidity and mortality. The rupture risk is particularly high when the aneurysms are large, of unfavourable morphology or in the setting of pregnancy and perioperative period. Endovascular approaches are now first line in the treatment of VRAA, but conventional techniques may be ineffective in excluding aneurysms with unfavourable anatomy such as those with wide necks or at arterial bifurcation points. The neurovascular Comaneci neck-bridging device is used to temporarily cover the neck of intracranial aneurysms without occluding forward arterial flow during endovascular coiling. We report the novel use of the Comaneci neck-bridging device for the treatment of complex peripheral VRAAs. MATERIALS AND METHODS: We describe the treatment of two patients with renal and splenic artery aneurysms demonstrating unfavourable anatomic morphology for conventional endovascular approaches. RESULTS: In the first patient, the renal artery aneurysm was situated at the intrarenal bifurcation of the main renal artery in the setting of a solitary kidney. In the second patient, the splenic artery aneurysm was situated close to the splenic hilum at the distal splenic arterial bifurcation. The Comaneci neck-bridging device was successfully used in both cases to assist coil embolisation with visceral preservation. CONCLUSIONS: The Comaneci neck-bridging device is potentially safe and effective for the treatment of peripheral VRAA with unfavourable anatomic characteristics that would have been deemed unsuitable for treatment using conventional techniques. LEVEL OF EVIDENCE: Level 4, Technical Report.