“Background” Aneurysms and pseudo-aneurysms of the superior mesenteric artery are rare and potentially lethal. Such aneurysms may be found incidentally or they may be diagnosed after complications have occurred. “Aims” To report a case of Superior Mesenteric Artery Aneurysm, diagnosed incidentally, and successfully treated by Selective Angiography and Embolization To review the literature on Superior Mesenteric Artery aneurysms “Case Report” A lady who has been followed up for hepatitis C and cirrhosis of liver had MRI scan of the abdomen which showed a 1.9 cm lesion in her liver which was consistent with hepato-cellular carcinoma. She had previously had ultrasound scan of her liver and liver biopsy which confirmed cirrhosis of liver and no evidence of malignancy. She successfully underwent 3 sections of selective angiography and embolization of the hepatocellular carcinoma with disappearance of the tumour. During the process of the embolization of the hepato-cellular carcinoma the patient’s previous MRI scans and CT scans were reviewed and these revealed that the patient had a Superior Mesenteric Artery Aneurysm which had enlarged over a period of 3 years. Selective Superior Mesenteric Artery Angiography and embolization of the aneurysm was successfully carried out using Terumo hydro-coil. Literature review revealed that cases of Superior Mesenteric Artery Aneurysms are rare and they have been treated traditionally by means of open surgery however, some cases of Superior Mesenteric Artery Aneurysms have been treated recently by embolization but coil migration has been reported. Conclusions: With developments in interventional radiology and coil technology selective superior mesenteric artery angiography and embolization of superior mesenteric artery aneurysm has become a safe alternative modality of treatment instead of open surgery. This technique has the added advantage of: avoiding general anaesthesia and laparotomy; being less invasive; being associated with low morbidity; short period of hospitalization. The Terumo hydrocoil which is now available for such embolizations has the added advantage of expanding to fill up the aneurismal cavity up to 5.8 times more than conventional coils and it does not dislodge easily.
Objectives : With developments in interventional radiology, selective renal artery angiography and super-selective embolization is gradually being used as an alternative treatment modality for angiomyolipoma of the kidney instead of nephrectomy or partial nephrectomy. It has been suggested that the use of steroids around the time of embolization may reduce or avoid post-embolization syndrome. Our aim is to report two cases of angiomyolipoma of kidney that were treated electively and as an emergency procedure with a review of the literature. Methods : Detailed clinical records of the two patients were obtained from their case notes, ALS records of clinic letters and discharge summaries, PACS system for records of all radiological procedures, computerized results of all laboratory tests in order to document the presentation, investigation, management and outcome of management of the patients. Literature was reviewed on embolization of angiomyolipoma of the kidney. Results : Two patients with angiomyolipoma of the kidney, (the first patient a lady with an enlarging angiomyolipoma of the right kidney and the second patient a lady who had spontaneous haemorrhage into a large angiomyolipoma of her right kidney), underwent selective right renal artery angiography and supers-selective embolization of the feeding vessels of their angiomyolipomas. The first patient was given steroid cover (Hydrocortisone and prednisolone) for two weeks in order to reduce or minimise the development of post-embolization syndrome. The second patient was not given any steroid cover. The first patient was discharged home on the first day after her embolization procedure and she did not develop any complications. The second patient who was not given any steroid cover developed post-embolization syndrome which eventually resolved after about six weeks. Literature review indicates that post-embolization syndrome is common after embolization. There is some evidence in the literature to suggest that the use of a short course of steroids around the time of embolization procedure reduces or prevents the development of post-embolization syndrome. Conclusions: Selective renal artery angiography can be used to diagnose a non-bleeding-angiomyolipoma, as well as bleeding enlarged angiomyolipoma of kidney. Super-selective renal artery embolization of a large angiomyolipoma of the kidney is a useful alternative to partial nephrectomy or full nephrectomy; it has the advantage of not requiring general anaesthesia and it is associated with less morbidity than nephrectomy or partial nephrectomy. Our limited experience and literature review would suggest that perhaps the use of steroids around the time of embolization may reduce the incidence of post-embolization syndrome.
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