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Incidental finding. How would you treat? Athanasios Saratzis Robert A Lookstein MD, MHCDL frank arko Athanasios Diamantopoulos Vascupedia Sabeen Dhand Dr. K. Katsanos Eric Secemsky MD MSc Flavius_IR Hady Lichaa, MD, FACC, FSCAI, FSVM, RPVI GVATAKEN Keith Pereira MD, #VIrad Kumar Madassery @K_Stavroulakis Srini Tummala MD FSIR FSVM Don...

13,025 views • 3 years ago •via X (Twitter)

10 Comments

BAO BUI's profile picture
BAO BUI3 years ago

@a_saratzis @roblookstein @farkomd @ADiamantop @Vascupedia_com @SDhandMD @DrKKatsanos @EricSecemskyMD @Flavius_IR @HadyLichaaMD @VISLAMDSCAIP @keithppereira @kmadass @K_Stavroulakis @SriniTummala @DonGarbettMD @t_intheleadcoat @_backtable The aneurysm is secondary to celiac occlusion and increased retrograde flow imho. Would treat celiac and follow the aneurysm.We had similar cases where this kind of aneurysm has decreased in size following celiac stenting

Flavius_IR's profile picture
Flavius_IR3 years ago

@a_saratzis @roblookstein @farkomd @ADiamantop @Vascupedia_com @SDhandMD @DrKKatsanos @EricSecemskyMD @HadyLichaaMD @VISLAMDSCAIP @keithppereira @kmadass @K_Stavroulakis @SriniTummala @DonGarbettMD @t_intheleadcoat @_backtable Is this an IPDA aneurysm? If so, guidelines say you must treat. And, if so, we have an identical case in our unit, with occluded celiac, which I'm planning to stentgraft, but that's a decision taken after very careful analysis of the CTA (MPR, 3D recons) and MDT discussion.

Saher Sabri's profile picture
Saher Sabri3 years ago

@a_saratzis @roblookstein @farkomd @ADiamantop @Vascupedia_com @SDhandMD @DrKKatsanos @EricSecemskyMD @Flavius_IR @HadyLichaaMD @VISLAMDSCAIP @keithppereira @kmadass @K_Stavroulakis @SriniTummala @DonGarbettMD @t_intheleadcoat @_backtable Nice case of PDA aneurysm secondary to MALS. Decision to release MAL prior to embolization relies on number of collaterals on angio. If other collaterals are present, then coil the outflow and aneurysm (may do balloon assisted if needed but neck looks narrow). All done thru SMA

Lorenzo Patrone's profile picture
Lorenzo Patrone3 years ago

@a_saratzis @roblookstein @farkomd @ADiamantop @Vascupedia_com @SDhandMD @DrKKatsanos @EricSecemskyMD @Flavius_IR @HadyLichaaMD @VISLAMDSCAIP @keithppereira @kmadass @K_Stavroulakis @SriniTummala @DonGarbettMD @t_intheleadcoat @_backtable Thanks! Would you put a cover stent into the SMA to exclude the aneurysm proximally?

Venkat Tummala MD's profile picture
Venkat Tummala MD3 years ago

@a_saratzis @roblookstein @farkomd @ADiamantop @Vascupedia_com @SDhandMD @DrKKatsanos @EricSecemskyMD @Flavius_IR @HadyLichaaMD @VISLAMDSCAIP @keithppereira @kmadass @K_Stavroulakis @SriniTummala @DonGarbettMD @_backtable Lorenzo, interesting case. Celiac is occluded. Hard to say if aneursym is CHA or GDA. You mentioned incidental but suspect CT was done looking for answers for pain/ other symptomatology? Angio, if you have it can be available, preferably a selective SMA run.👍🏾

Lorenzo Patrone's profile picture
Lorenzo Patrone3 years ago

@a_saratzis @roblookstein @farkomd @ADiamantop @Vascupedia_com @SDhandMD @DrKKatsanos @EricSecemskyMD @Flavius_IR @HadyLichaaMD @VISLAMDSCAIP @keithppereira @kmadass @K_Stavroulakis @SriniTummala @DonGarbettMD @_backtable CT done for ?pneumonia. Coeliac highly stenotic, the aneurysm comes out from the SMA with no neck...

Sabeen Dhand's profile picture
Sabeen Dhand3 years ago

@a_saratzis @roblookstein @farkomd @ADiamantop @Vascupedia_com @DrKKatsanos @EricSecemskyMD @Flavius_IR @HadyLichaaMD @VISLAMDSCAIP @keithppereira @kmadass @K_Stavroulakis @SriniTummala @DonGarbettMD @t_intheleadcoat @_backtable Nice incidental finding!! We’d embo that ticking time bomb and then refer to surgery for MALS release, presuming that’s the etiology!!

Lorenzo Patrone's profile picture
Lorenzo Patrone3 years ago

@a_saratzis @roblookstein @farkomd @ADiamantop @Vascupedia_com @DrKKatsanos @EricSecemskyMD @Flavius_IR @HadyLichaaMD @VISLAMDSCAIP @keithppereira @kmadass @K_Stavroulakis @SriniTummala @DonGarbettMD @t_intheleadcoat @_backtable Very wise! How would you embo that?

Raphaël Coscas's profile picture
Raphaël Coscas3 years ago

@a_saratzis @roblookstein @farkomd @ADiamantop @Vascupedia_com @SDhandMD @DrKKatsanos @EricSecemskyMD @Flavius_IR @HadyLichaaMD @VISLAMDSCAIP @keithppereira @kmadass @K_Stavroulakis @SriniTummala @DonGarbettMD @t_intheleadcoat @_backtable May be infectious/inflammatory - more explorations with biology and nuclear imaging may help - open surgery will allow to keep all patent branches and have samples for analysis

Lorenzo Patrone's profile picture
Lorenzo Patrone3 years ago

@a_saratzis @roblookstein @farkomd @ADiamantop @Vascupedia_com @SDhandMD @DrKKatsanos @EricSecemskyMD @Flavius_IR @HadyLichaaMD @VISLAMDSCAIP @keithppereira @kmadass @K_Stavroulakis @SriniTummala @DonGarbettMD @t_intheleadcoat @_backtable Interesting point.. could it be "mycotic"? Would you treat it open then?

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