Management Strategy Based on Disease Stages for Patients with Symptomatic Isolated Mesenteric Artery Dissection

This study aimed to evaluate the current status of spontaneous isolated celiac artery dissection (SICAD). The English-language literature published in various databases before December 2020 was reviewed. All case reports and series were included. If multiple reports came from the same hospital and covered the same period, only the most recent report was considered. The clinical characteristics, imaging features, and treatment outcome were analyzed. The study enrolled 88 English language publications between January 1959 and December 2020, including 70 case reports, two case series, and 16 clinical studies. Overall, 316 cases of SICAD were reported in the studies, including 268 men and 44 women (unavailable for 4, men: women ratio: 6:1, p < 0.05). The median age was 50.5 years (range: 6-72) in men and 53.9 years (range: 41-67) in women. Most patients (83.54%, 264/316) complained about stomach pain, primarily in the epigastric region (38.61%, 122/316). The misdiagnosis rate in this study was 3.16% (10/316). The most commonly used imaging modality was computed tomography angiography (CTA), with 97.47% (308/316) cases reporting its use in diagnosis and/or management. The rate of symptom improvement with Conservative Management, with or without antithrombotic agents, was 92.45% (98/106) and 96.58% (141/146), respectively. The rate of symptom improvement after surgical recanalization was 100% (13/13). Moreover, endovascular management resulted in a 100% (50/50) symptom improvement rate. Conservative management is the first-line treatment for SICAD. The surgical or endovascular intervention had a high technical success rate, suggesting that it should be reserved for patients who have failed conservative treatment.

Potential Metabolite Biomarkers for Acute Versus Chronic Stage of Ischemic Stroke: A Pilot Study

An experimental imaging platform for longitudinal monitoring and evaluation of cardiac morphology-function changes has been long desired. We sought to establish such a platform by using a rabbit model of reperfused myocardial infarction (MI) that develops chronic left ventricle systolic dysfunction (LVSD) within 7 weeks. Fifty-five New Zeeland white (NZW) rabbits received sham-operated or 60-min left circumflex coronary artery (LCx) ligation followed by reperfusion. Cardiac magnetic resonance imaging (cMRI), transthoracic echocardiography (echo), and blood samples were collected at baseline, in acute (48 hours or 1 week) and chronic (7 weeks) stage subsequent to MI for in vivo assessment of infarct size, cardiac morphology, LV function, and myocardial enzymes. Seven weeks post MI, animals were sacrificed and heart tissues were processed for histopathological staining. The success rate of surgical operation was 87.27%. The animal mortality rates were 12.7% and 3.6% both in acute and chronic stage separately. Serum levels of the myocardial enzyme cardiac Troponin T (cTnT) were significantly increased in MI rabbits as compared with sham animals after 4 hours of operation (P<0.05). According to cardiac morphology and function changes, 4 groups could be distinguished: sham rabbits (n=12), and MI rabbits with no (MI_NO_LVSD; n=10), moderate (MI_M_LVSD; n=9) and severe (MI_S_LVSD; n=15) LVSD. No significant differences in cardiac function or wall thickening between sham and MI_NO_LVSD rabbits were observed at both stages using both cMRI and echo methods. cMRI data showed that MI_M_LVSD rabbits exhibited a reduction of ejection fraction (EF) and an increase in end-systolic volume (ESV) at the acute phase, while at the chronic stage these parameters did not change further. Moreover, in MI_S_LVSD animals, these observations were more striking at the acute stage followed by a further decline in EF and increase in ESV at the chronic stage. Lateral wall thickening determined by cMRI was significantly decreased in MI_M_LVSD versus MI_NO_LVSD animals at both stages (P<0.05). As for MI_S_LVSD versus MI_M_LVSD rabbits, the thickening of anterior, inferior and lateral walls was significantly more decreased at both stages (P<0.05). Echo confirmed the findings of cMRI. Furthermore, these in vivo outcomes including those from vivid cine cMRI could be supported by exactly matched ex vivo histomorphological evidences. Our findings indicate that chronic LVSD developed over time after surgery-induced MI in rabbits can be longitudinally evaluated using non-invasive imaging techniques and confirmed by the entire-heart-slice histomorphology. This experimental LVSD platform in rabbits may interest researchers in the field of experimental cardiology and help strengthen drug development and translational research for the management of cardiovascular diseases.

OBJECTIVE: Patients with poor-grade subarachnoid hemorrhage (SAH) have been considered good candidates for endovascular treatment. The results of treatment of Grade V SAH, the poorest grade, however, have not been fully elucidated. METHODS: The clinical characteristics and outcome parameters of 22 World Federation of Neurosurgical Societies Grade V SAH patients treated endovascularly in the acute stage between 1998 and 2000 are summarized and compared with those of 18 Grade V SAH patients treated conservatively between 1995 and 1997. RESULTS: Among the 22 patients treated endovascularly, 8 patients (36.4%) survived. The rate was significantly higher than that of the 18 patients treated conservatively (5.6%), only one of whom survived. The favorable outcome rate, however, was not significantly different between the two groups (4.5% versus 6.0%). Subdivision of both treatment groups according to Glasgow Coma Scale (GCS) score showed that the improved survival among those treated endovascularly was attributable to the improved survival in those with a preprocedural GCS score of 6 but not of 4 or 5. CONCLUSION: Endovascular treatment of the 22 World Federation of Neurosurgical Societies Grade V SAH patients improved their survival rate but not their favorable outcome rate in comparison with conservative treatment. Further accumulation of clinical data is essential to determine whether endovascular treatment can improve the functional outcome of those with GCS scores of 6 and whether there is no role for endovascular treatment in those with GCS scores of 4 or 5.

MMP-9 mRNA as a Therapeutic Marker in Acute and Chronic Stages of Arthritis Induced by Type II Collagen Antibody

To evaluate late gadolinium-enhanced (LGE) assessment of infarct size, a comparison with manganese-enhanced magnetic resonance imaging (MEMRI), and histology was performed in a permanent infarction model in the mouse at the acute and chronic stage. In a paired fashion at the acute and chronic stage after infarction (3-4 days and 21 days, respectively), LGE and MEMRI was performed using a self-gated fast low flip angle shot (FLASH). Infarct size was evaluated as the enhanced area relative to the complete myocardial wall area in a mid-ventricular slice. Paired comparisons were made between contrast agents and between timepoints, as well as to histology. At the acute stage, LGE delineated a larger infarct size as compared to both MEMRI and histology. Infarct size from LGE decreased from the acute to chronic stage, a temporal development not seen with MEMRI. At the chronic stage, no significant differences in infarct size were found between the methods. This study indicates an overenhancement of infarct size when using LGE, supported by an initial overestimation at the acute stage and a temporal decrease in infarct size from the acute to chronic stage, as compared to infarct size from MEMRI.

The Rate of Patients for Endovascular Repair of Popliteal Aneurysms may be Overestimated Following the Instructions for Use. CTA and MRA are Mandatory to Select Patients

Hypopituitorism is a common complication of traumatic brain injury (TBI) , which can happen both at acute and chronic stages after TBI. There are different clinical features of hypopituitorism happened at acute and chronic stages. At acute stage, dysfunction of pituitary-adrenal cortical axis is of the most clinical significance, which can cause hypotension, hypoglycemia, hyponatremia and lead to life-threatening complications. Growth hormone deficiency and hypogonadotropic hypogonadism are the two most common endocrine deficits at chronic stage. Symptoms of hypopituitorism at chronic stage include fatigue, cognitive impairment, decreased exercise capacity, decreased libido and so on. Assessment of pituitary function should be carried out for patients with moderate to severe TBI during the acute phase, focusing on the function of pituitary-adrenal axis. If patients manifest symptoms related to hypopituitorism during chronic stage, comprehensive evaluation of pituitary function should be carried out. The diagnosis of hypopituitorism should be based on basic hormone level and corresponding stimulation test. Hypofunction of pituitary-adrenal cortical axis in the acute phase of TBI should be treated with glucocorticoid immediately because of its potential contribution to the acute morbidity and mortality. Severe hypofunction of pituitary-thyroid axis should also be treated with thyroxine replacement. Most growth hormone deficiency and hypofunction of pituitary-gonadal axis occurred in the acute phase could be improved by themselves with time migration, so there is no need to be treated in this phase. Hypopituitorism occurred in the chronic phase of TBI may have lasting effect on cognition and life quality. Hormone replacement should be carried out once the diagnosis is confirmed. Key words: Traumatic brain injury; Hypopituitorism; Hypocortisolism; Hormone replacement

Objective To investigate clinical characteristics, diagnosis and treatment of insidious vascular injuries in orthopaedic cases. Methods Between March 2003 and October 2010, we treated 649 cases of orthopedic and vascular injuries, 50 (7. 7% ) of which were identified as insidious injuries. They were 42 men and 8 women, aged from 13 to 66 years (average, 34. 0 years). The insidious injury affected the vein in one case, the artery in 42 cases and both in 7 cases. The vascular injuries were categorized as type A (14 cases), type B (20 cases) and type C (16 cases) according to the classification system proposed by Zhang Ying-ze. The diagnoses were made after an average of 43. 4 days from primary injuries, with the assistance of color Doppler ultrasound in 17 cases, CT angiography in 7 and X-ray angiography in 25. Clinical manifestations included limb ischemia, compartment syndrome, hematoma or pseudoaneurysm, hemorrhage and nerve entrapment. Forty-three patients were treated by a variety of surgical options, such as angiorrhaphy, anastomosis, transplantation of autogenous venous graft, ligation and amputation. Among them, hemofiltration was performed in 2 cases as adjuvant therapy. Endovascular embolization was performed in 4 cases and conservative treatment in the other 3. Results Forty-six patients had their limbs salvaged, with normal temperature and color of the skin and existence of distal arterial pulses at discharge from hospital. The other 4 patients had to sustain amputation. An average follow-up of 6. 7 months (from one to 42 months) revealed that all the affected limbs regained normal blood circulation. Conclusions The insidious presentations and atypical clinical manifestations make diagnosis of insidious vascular injury very difficult. We recommend angiography as the first step in diagnosis. Surgical approaches should be considered as the main treatment choice, and hemopurification can be used as adjuvant therapy if necessary. In some cases, endovascular intervention may be faster and safer. Key words: Blood vessels; Wounds and injuries; Diagnosis; Therapy

Disorders of consciousness (DoCs) after severe brain injury are considered to be conditions with dire prognosis. Despite the accumulating evidence, inpatient rehabilitation is often denied by payers referring to the Medicare/Medicaid criteria, under the assumption that such patients will not "actively" participate in therapy or make "measurable improvements." This study aimed to report on the effectiveness and efficiency of a specialized inpatient DoC rehabilitation program based on measurable clinical parameters. A retrospective cohort study was conducted. The cohort comprised 137 patients with DoC admitted to a specialized acute inpatient rehabilitation program between January 2014 and October 2018. Patients were categorized as having been admitted at the acute stage (<=28 days post-injury), subacute stage (29-365 days following a traumatic brain injury (TBI) or 29-90 days following a non-TBI), or chronic stage (>365 days following a TBI or >90 days following a non-TBI). Outcomes included changes in level of consciousness (based on the Coma Recovery Scale-Revised (CRS-R), while also acknowledging scenarios beyond those captured by the CRS-R via Individualized Qualitative Behavioral Assessment and team consensus); Functional Independence Measure (FIM) levels; achievements in decannulation and initiation of oral diet; and time to those achievements. The rates of emergence from a minimally conscious state were 90, 62, and 18% among patients admitted at the acute, subacute, and chronic stages, respectively. Among patients who emerged, 100, 85, and 67%, respectively, had measurable FIM scores. Approximately 60 and 20% of patients at the acute and subacute stages, respectively, required moderate assistance or less in transfer/communication/eating/grooming/upper body dressing by the time of discharge from Phase I admission. The decannulation rates were 94, 67, and 17%. The oral diet initiation rates were 70, 23, and 6%. The time to reach these achievements lengthened as chronicity increased. There was a weak positive correlation (r s = 0.308) in the case of decannulation and a strong positive correlation (r s = 0.606, both p < 0.01) in the case of oral diet between days since injury on admission and days to the achievement after admission. Patients with TBI and hypoxic brain injury had comparable recovery rates when admitted at the acute and subacute stages. Specialized intensive inpatient rehabilitation is crucial and time-sensitive for functional recovery from DoC caused by TBI and hypoxic-ischemic brain injury. Specific goals and different outcome measures need to be developed to appraise the benefits of acute inpatient rehabilitation for DoC.

In February 2013, results of two key clinical trials assessing clinical efficacy of endovascular management in acute ischemic stroke were presented at annual meeting of International Stroke Conference (ISC) in Honolulu. The trials, SYNTHESIS expansion and IMS-III, had received great attention from many neurologists and neurointerventionalists, as they were multicenter, randomized, controlled trials comparing clinical results of endovascular approach versus standard intravenous (IV) recombinant tissue plasminogen activator (tPA) alone. Although it had already been demonstrated that endovascular treatment had higher recanalization rates than standard medical care (IV tPA), clinical outcomes of two methods had not yet been compared directly. The SYNTHESIS expansion trial, led by Alfonso Ciccone (Carlo Poma Hospital, Mantua, Italy), randomly assigned 362 acute ischemic stroke patients within 4.5 hours of symptom onset to receive IV tPA or intraarterial endovascular treatment, including intraarterial thrombolysis with tPA, mechanical clot disruption or retrieval, or a combination of these interventions. This study was initiated under hypothesis that the disadvantage of endovascular treatment in terms of time spent may be offset by more effective recanalization achieved with endovascular This hypothesis was supported by preliminary results of SYNTHESIS study. The primary outcome of survival (free from disability, modified Rankin score (mRS) ≤ 1) was assessed at 3 months. 30.4% of 181 patients given endovascular therapy and 34.8% of 181 patients given tPA were free of disability (mRS ≤ 1). This result demonstrated that intraarterial intervention was not superior to standard medical care for patients with acute ischemic stroke. In addition, there were no between-group differences in mortality at 90 days (14.4% in endovascular group versus 9.9% in IV tPA group, p = 0.22) or symptomatic intracranial hemorrhage within 7 days (6% in each group). Notably, patients in endovascular group did not undergo treatment initiation until one hour after tPA group, with median onset-to-treatment times of 3.75 hours and 2.75 hours, respectively. In conclusion, clinical benefit of endovascular treatment of acute stroke, when compared with IV tPA, could not be proven by SYNTHESIS expansion trial. However, Ciccone and colleagues presented that generalizability of results may be limited because demonstrating presence of an occlusion was not necessary for inclusion in trial. They said that selection of patients on basis of demonstration of vascular occlusion with noninvasive method may provide endovascular treatment superiority. Another recent trial, IMS III, is a randomized, multicenter, open-label clinical trial that examined whether combined intravenous and endovascular treatment is superior to standard IV tPA treatment alone for patients with acute stroke. Subjects were randomly assigned to combined or standard therapy within 3 hours of stroke onset in a 2:1 ratio. Endovascular treatment included a choice of catheters and devices or intraarterial tPA based upon lesion characteristics, experience and training of investigator, and specified use of devices. At outset, only one device was available, Concentric Merci retriever, but trial leadership recognized that endovascular technology would evolve. In order to keep trial clinically relevant and optimize endovascular approach, additional devices including stent retriever, Penumbra system, and microsonic SV infusion system were allowed as each became cleared for clinical use by Food and Drug Administration. Contrary to SYNTHESIS trial, computed tomography angiography (CTA) was routinely used in identification of occlusion except at beginning of trial. According to journal articles, IMS III study was stopped after 656 participants had been randomized, because it was clear there was no significant difference between two approaches. In overall analysis, 90 day rate of survival free from disability (mRS < 2) was 30.4% in endovascular group and 34.8% in IV tPA group, an insignificant difference (OR 0.71; 95% confidence CI, 0.44 to 1.14). There was no statistically significant difference between interventions for primary endpoint. The absolute difference between groups was 1.5% (95% CI, -6.1% to 9.1%) when adjusted for stroke severity by National Institutes of Health Stroke Scale (NIHSS) score. Although high recanalization rates using endovascular approach were achieved with active use of a thrombectomy device in this study, clinical outcome was disappointing. This result of IMS III also demonstrated that effective recanalization rate of endovascular therapy cannot offset time required for completion of endovascular treatment. Additionally, it was concluded that bridging therapy should not be considered routine protocol but instead should be thought of as a highly-selective therapeutic option. Despite fact that these two trials comprise research on extended application of endovascular approach in overcoming standard medical treatment, management guidelines for acute ischemic stroke have remained unchanged. However, merit of bridging method, which has been commonly used to recanalize large artery occlusions, was brought into question by these trials. The window of time during which endovascular approach may be attempted (4.5-6h) is so narrow that amount of patients for which this procedure may be indicated was significantly decreased. With fewer patients receiving endovascular recanalization therapy, there is less opportunity for trainees to gain experience in intraarterial thrombectomy, and hospitals or medical insurance companies may hesitate to use willingly money for maintenance of emergent neuroendovascular system. Even more damaging, ability to recruit patients to new trials that assess superiority of endovascular treatment will be difficult. Not every result was unfriendly to endovascular treatment, however. In IMS III, for predefined subgroups of patients with an NIHSS score of 20 or higher, indicating severe stroke (endovascular therapy, 23.5%; IV tPA alone, 16.7%, p = 0.07), comparison of functional outcomes between endovascular and medical groups showed a tendency toward a better outcome in endovascular group. This result may indicate that more severe stroke associated with proximal arterial occlusion, including carotid T and proximal M1, would potentially have a greater benefit with endovascular approach, as these clot locations may be highly amenable to endovascular therapy. The role of endovascular therapy is considered to be more critical in proximal artery occlusion than distal artery occlusion. To this end, it would be helpful if IMS III investigators additionally report rescult of subgroup comparisons using CTA. Each time encountering patients with acute stroke, we will be conflicted between our empirical knowledge and verified evidence. The myth has been debunked, but challenge is still present. The endovascular therapy system that is able to start endovascular approach as soon as patient come to hospital and more effective thrombectomy device such as stentriever, will allow endovascular treatment to play critical role in treatment of stroke.

Objective To investigate the causes of arterial reocclusion in diabetic feet patients after endovascular treatment and its remedial measures.Methods From January 2009 to October 2013,clinical data of 371 arterial reocclusion of diabetic feet patients after endovascular treatment in Tianjin First Central Hospital were reviewed retrospectively.We summarized the causes of reocclusion,treatment methods and the short term results.Results According to the Trans-Alantic Inter-Society Consensus (TASC) Ⅱ grading standards,the first time when the endovascular treatment started there were 37 cases of grade A,85 cases of grade B,143 cases of grade C,106 cases of grade D.Arterial re-occlusion developed from one day to 36 months,averaging at (21 ± 8) months.Causes of re-occlusion included intimal hyperplasia in 263 cases (70.9％),thrombosis in 65 cases (17.5％),dissection in 19 cases (5.1％),stent fracture in 17 cases (4.6％),vascular rupture in 7 cases (1.9％).Remedial therapy adopted for arterial reocclusion was repeated endovascular treatment in 327 cases (88.1％),arterial bypass surgery in 23 cases (6.2％),conservative treatment in 13 cases (3.5％),amputation (cut toe) in 4 cases (1.1％),4 cases (1.1％) died perioperatively.275 cases were followed up for 1 to 36 months,the average was (13 ± 8) months.patency rate was 82.9％,71.3％ and 63.0％ at 6 months,1 year and 2 years.Amputation rate was 1.1％,1.8％ and 2.5％ at 6 months,1 year and 2 years.Conclusions Intimal hyperplasia is to blame for arterial reocclusion after endovascular treatment of diabetic foot.In this case most patients still can benefit from second time endovascular treatment,with a satisfactory short term patency rate. Key words: Diabetic foot; Angioplasty; Postoperative complications; Intimal hyperplasia

It is well recognized that cerebral circulation is regulated by perfusion pressure together with cerebrovascular resistance. Cerebrovascular resistance is dependent upon intracranial pressure, organic changes and tonus of cerebral vessels, blood viscosity in the cerebral vessels, and so on. Blood viscosity is determined by factors such as hematocrit, red blood cell (RBC) deformability, RBC aggregability, and plasma viscosity. Among these factors, it is believed that RBC aggregation is one of the major determinants of microcirculation, especially in low-shear flow areas. In other words, the kinetics of RBC aggregation play an important role in the alteration of the microcirculation in regions where the speed of blood flow approaches or falls below the critical level. In our previous observation [1], we conducted a multivariate analysis of the factors influencing cerebral blood flow (CBF) measured by the 133Xe intravenous injection method in patients with cerebral infarction and found that, although the size of cerebral infarction was the most important factor determining CBF value in the acute stage, in the chronic stage (more than 30 days after the onset of cerebral infarction) high Ht was the most important factor and the accelerated value of RBC aggregation time was the second most important. In other words, hemorheological factors for increasing blood viscosity, such as high hematocrit and accelerated RBC aggregation, were more important determinants of CBF value than other factors such as blood pressure, size of lesion, age, and PaC02 in the chronic stage. Furthermore, the acceleration of RBC aggregation time has been observed in patients with cerebral infarction in acute and chronic stages [1. 2].

Concerning endovascular treatment for acute ischemic stroke with intracranial vessel occlusion, shortening the door-to-puncture time (DTP) improves the patient's outcome. To determine endovascular treatment, magnetic resonance angiography or computed tomography angiography is performed for occluded vessel detection. Another detection method of internal carotid artery (ICA) occlusion or middle cerebral artery first segment (M1) occlusion is ultrasound (US). Bilateral flow pattern analysis of common carotid arteries by US leads to the diagnosis of ICA or M1 occlusion within a few minutes. Moreover, it can be conducted in the emergency department. The addition of the US for the initial evaluation of vessel occlusion can shorten the DTP. In this study, we evaluated the effectiveness of carotid artery US imaging in detecting large vessel occlusion (LVO) and shortening the DTP. This is a retrospective case-control study. Our analysis was based on the data from 150 patients with LVO or medium vessel occlusion who underwent endovascular revascularization treatment at our hospital between January 2015 and December 2022. Among them, 104 patients who had an anterior circulation vessel occlusion were included. They were divided into the US evaluation group and the non-US evaluation group, and their characteristics, treatment time course, and outcomes were compared. This study included 104 patients with a median age of 81 years (interquartile range: 73-89 years), 57.7% were females, and the pre-stroke modified Rankin Scale (mRS) median was 0.5 (interquartile range: 0-3). Our cohort included advanced aged patients; therefore, this study included 56.7% of patients over 80 years old and 35.6% of pre-stroke mRS over 3. The US (US group) and non-US (non-US group) evaluation groups included 54 and 50 patients, respectively. As magnetic resonance imaging evaluation in the non-US group was performed over the 4.5 hours delayed arrival of patients from the last known well (LKW) to consider the evaluation of tPA administration, selection bias occurred. The US group included high National Institutes of Health Stroke Scale (NIHSS) patients (P = 0.0152) and more ICA occlusions (P = 0.0146). Onset (LKW) to door time was shorter in the US group (median, 75 min (35-146.5 minutes)) than the non-US group (median, 179 minutes (47.3-432.8 minutes); P = 0.0426), and the DTP was shorter for the US group (median, 75.5 minutes (63.8-87.3 minutes)) than for the non-US group (median, 85 minutes (67-129 minutes); P = 0.0102). Statistical difference was not seen in puncture to reperfusion time among the US group (median, 71.5 minutes (51-114 minutes)) and non-US group (median, 67 minutes (42.3-98.5 minutes); P = 0.5581). The onset (LKW) to reperfusion was shorter for the US group (median, 251 minutes (201-327.3 minutes)) than for the non-US group (median, 319 minutes (200-633.5 minutes); P = 0.0348). No statistical differences were seen for thrombolysis in cerebral infarction grade 2b-3 after treatment, improvement of NIHSS, and mRS at 90 days. US is a useful imaging method to identify an anterior circulation LVO. It can distinguish patients with severe internal carotid or middle cerebral artery occlusion from medium vessel occlusion or other peripheral vessel occlusions. US helps to shorten the DTP time of LVO.

To evaluate the organ microvascularization after operative versus endovascular treatment of visceral artery aneurysms (VAAs) by contrast-enhanced ultrasound (CEUS) and colour-coded duplex sonography (CCDS). Between April 1995 to January 2016, 168 patients (78 males, 90 females; median age: 62 years) were diagnosed with VAAs at our hospital site. 60/168 patients (36%) fulfilled treatment criteria and had either open (29/60, 48%) or endovascular (31/60, 52%) aneurysm repair. Patients' characteristics and presentations were consecutively reviewed. Technical success and organ microvascularization were determined by CCDS/CEUS and correlated to computed tomography angiography (CTA) or magnetic resonance imaging (MRI). 18/60 patients (30%) presented with acute bleeding. 16/18 emergency patients (89%) were treated by endovascular means. After emergency treatment, two patients showed segmental liver malperfusion by CEUS and CTA. One small bowel resection had to be performed.42/60 patients (70%) were electively treated. 27/42 patients (64%) had open and 15/42 (36%) endovascular aneurysm repair. There were no liver or bowel infarctions after elective treatment of hepatic or mesenteric artery aneurysms (n = 13) in CCDS/CEUS and in CTA. Treatment of patients with splenic or renal artery aneurysms led to partial or complete organ loss in 42% (8/19) after operative and in 50% (5/10) after endovascular treatment (p < 0.05). The endovascular approach is the preferred therapeutic option in emergency to control bleeding. In contrast to hepatic or mesenteric procedures, patients for elective splenic or renal artery aneurysm repair have to be evaluated very carefully because of a high rate of partial or complete organ loss demonstrated by CEUS - either after open or endovascular aneurysm repair.