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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... show more
13,025 views • 3 years ago •via X (Twitter)
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@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

@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.

@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

@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?

@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.👍🏾

@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...

@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!!

@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?

@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

@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?
