Endovascular treatment of a hepatic artery aneurysm causing chronic abdominal pain; a case report
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"documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Ann Hepatol. 2010;9:107-11" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 68 "formatos" => array:3 [ "EPUB" => 13 "HTML" => 25 "PDF" => 30 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Liver involvement in severe human influenza A H1N1" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "107" "paginaFinal" => "111" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 935 "Ancho" => 981 "Tamanyo" => 57045 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Mechanisms of liver damage in influenza H1N1. Severe infection with human influenza A H1N1 generates cytokine dysregulation and cytokine storm which promotes ARDS, oxida-tive stress and severe sepsis with vasodilatory shock which generate splachnic hypoperfusion and hepatocellular damage.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Raúl Carrillo Esper, Estela Pérez Bustos, Sofía Ornelas Arroyo, Jorge Albores Saavedra, Misael Uribe" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Raúl" "apellidos" => "Carrillo Esper" ] 1 => array:2 [ "nombre" => "Estela" "apellidos" => "Pérez Bustos" ] 2 => array:2 [ "nombre" => "Sofía" "apellidos" => "Ornelas Arroyo" ] 3 => array:2 [ "nombre" => "Jorge" "apellidos" => "Albores Saavedra" ] 4 => array:2 [ "nombre" => "Misael" "apellidos" => "Uribe" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119316916?idApp=UINPBA00004N" "url" => "/16652681/0000000900000001/v1_201906230851/S1665268119316916/v1_201906230851/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1665268119316898" "issn" => "16652681" "doi" => "10.1016/S1665-2681(19)31689-8" "estado" => "S300" "fechaPublicacion" => "2010-01-01" "aid" => "71375" "copyright" => "Fundación Clínica Médica Sur, A.C." "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Ann Hepatol. 2010;9:99-103" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 55 "formatos" => array:3 [ "EPUB" => 10 "HTML" => 22 "PDF" => 23 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Pitfall alveolar echinococcosis in non-endemic areas Alveolar echinococcosis migrating northward" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "99" "paginaFinal" => "103" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 803 "Ancho" => 997 "Tamanyo" => 178434 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">A diagnostic biopsy was done because of a suspected metastasis of a carcinoma of unknown origin. Histological examination showed a rope ladder like germinal layer on the cyst like inner membrane-typical for AE. The surrounding connective tissue showed a granulomatous inflammation and sclerosing process.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ulrike Tennert, Stefan Schubert, Michael Tröltzsch, Lidia Ivanova Tchavdarova, Joachim Mössner, Konrad Schoppmeyer" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Ulrike" "apellidos" => "Tennert" ] 1 => array:2 [ "nombre" => "Stefan" "apellidos" => "Schubert" ] 2 => array:2 [ "nombre" => "Michael" "apellidos" => "Tröltzsch" ] 3 => array:2 [ "nombre" => "Lidia" "apellidos" => "Ivanova Tchavdarova" ] 4 => array:2 [ "nombre" => "Joachim" "apellidos" => "Mössner" ] 5 => array:2 [ "nombre" => "Konrad" "apellidos" => "Schoppmeyer" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119316898?idApp=UINPBA00004N" "url" => "/16652681/0000000900000001/v1_201906230851/S1665268119316898/v1_201906230851/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "titulo" => "Endovascular treatment of a hepatic artery aneurysm causing chronic abdominal pain; a case report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "104" "paginaFinal" => "106" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Gabrielle L de Ruiter-Derksen, Rutger CG Bruijnen, Frank Joosten, Michel MPJ Reijnen" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Gabrielle L" "apellidos" => "de Ruiter-Derksen" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff1" ] ] ] 1 => array:3 [ "nombre" => "Rutger CG" "apellidos" => "Bruijnen" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "Frank" "apellidos" => "Joosten" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff2" ] ] ] 3 => array:4 [ "nombre" => "Michel MPJ" "apellidos" => "Reijnen" "email" => array:1 [ 0 => "mmpj.reijnen@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Surgery, Alysis Zorggroep, Location Rijnstate, The Netherlands" "etiqueta" => "*" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Departments of Radiology, Arnhem, The Netherlands" "etiqueta" => "**" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence and reprint request:" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1585 "Ancho" => 997 "Tamanyo" => 189749 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Atherosclerotic aneurysm of the hepatic artery <span class="elsevierStyleBold">A.</span> Transversal view (arrow). <span class="elsevierStyleBold">B.</span> Coronal view.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="p0005" class="elsevierStylePara elsevierViewall">Aneurysms of the visceral arteries are rare but potentially life-threatening lesions. The estimated incidence is between 0.1% and 0.2%, as observed in routine autopsies.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The etiology of visceral artery aneurysms is mostly atherosclerotic. Trauma and inflammation may cause pseudoaneurysm formation, such as in case of an acute pancreatitis causing periarterial inflammation or vessel erosion from an adjacent pseudocyst.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Other conditions which are associated with hepatic artery aneurysms are medial degeneration, fibromuscular dysplasia and vasculitis.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Atherosclerotic aneurysms are typically extrahepatic while traumatic aneurysms or pseudoaneurysms are more commonly intrahepatic.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="p0010" class="elsevierStylePara elsevierViewall">Aneurysms of the hepatic artery represent 20-40% of all visceral artery aneurysms.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> As with other visceral artery aneurysms, they are mostly asymptomatic but may present as a life-threatening emergency.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> A hepatic artery aneurysm may be diagnosed by duplex scanning, that may demonstrate flow in the lesion, confirming its vascular origin, its dimensions and the eventual presence of thrombus. Contrast-enhanced CT scanning is effective in providing additional information regarding the vascular anatomic variations, collateral circulation and the relation between the aneurysm and adjacent organs. Digital subtraction angiography is still considered the gold standard for diagnosis and pre-operative planning.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="p0015" class="elsevierStylePara elsevierViewall">Historically, visceral artery aneurysms have been treated with either surveillance or open surgical reconstruction. Endovascular approaches may offer an alternative to conventional open surgery with the benefit of low procedural morbidity and mortality.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> We report the case of successful endovascular exclusion of a hepatic artery aneurysm that caused chronic abdominal pain.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case Report</span><p id="p0020" class="elsevierStylePara elsevierViewall">A 68-year-old man was admitted for chronic abdominal pain that had existed for ten months. It was a recurrent right-sided abdominal pain that was unrelated to eating. There were no other abdominal symptoms. Patient had a history of hypertension, inguinal hernia repair, hernia nuclei pulposi, myocardial infarction and coronary artery bypass surgery. Extensive analysis, including abdominal ultrasound, gastroscopy and colonoscopy did not reveal a diagnosis. A diagnostic contrast-enhanced CT scan showed an 18 mm atherosclerotic aneurysm of the hepatic artery (<a class="elsevierStyleCrossRef" href="#f0005">Figure 1</a>). Initially, the aneurysm was considered to be too small to explain his abdominal complaints. When all other pathology was excluded, however, it was decided to exclude the aneurysm endovascular.</p><elsevierMultimedia ident="f0005"></elsevierMultimedia><p id="p0025" class="elsevierStylePara elsevierViewall">The patient received 5000 I.U. heparin and 1 gram cefazolin intravenously. The right femoral artery was punctured to position a catheter into the celiac trunk. The aneurysm was localized distally from the origin of the splenic artery and left gastric artery and proximally from the origin of the duodenal artery (<a class="elsevierStyleCrossRef" href="#f0010">Figure 2A</a>). A stiff Terumo guidewire was positioned distally of the hepatic artery aneurysm and the hepatic artery was pre-dilated with a 5 mm balloon angioplasty. Subsequently, an ePTFE-covered nitinol stent graft (5 mm, 25 mm Viabahn, W.L. Gore & associates, Flagstaff, AZ) was positioned and deployed under fluoroscopy. Control angiography showed a distal type-1 endoleak and therefore an additional bare stent (6 mm, 40 mm, Misago, Terumo, Ann Arbor, MI) was deployed more distally. Post-deployment angiograms showed a complete exclusion of the aneurysm (<a class="elsevierStyleCrossRef" href="#f0010">Figure 2B</a>). There was no flow in the gastroduodenal artery originating just distally of the aneurysm. Immediately after the procedure the abdominal pain completely resolved. There were no postoperative complications and the patient was discharged after 3 days. Post-procedural pharmacotherapy consisted of carbasalaatcalcium 100 mg and simvastatin 40 mg daily for life.</p><elsevierMultimedia ident="f0010"></elsevierMultimedia><p id="p0030" class="elsevierStylePara elsevierViewall">Follow-up consisted of clinical examination and contrast-enhanced CT study after 1 month, showing a completely thrombosed aneurysm and a patent stent-graft. The gastroduodenal artery was vascularized by collaterals. After 18 months of follow-up the patient had not suffered from recurrent abdominal pain, supporting the diagnosis that the abdominal pain was aneurysm-related. Duplex ultrasound scanning showed a patent stent graft.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="p0035" class="elsevierStylePara elsevierViewall">Although very rare, hepatic artery aneurysms are the second commonest visceral aneurysms, after splenic artery aneurysms.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> They usually are asymptomatic and discovered as an incidental finding during diagnostic imaging procedures performed for other reasons. Some patients, however, experience abdominal pain, and others are diagnosed during surgery for rupture. These patients usually are in hemorrhagic shock and reported survival rates are as low as 50%.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The risk of rupture appears to be related to the size of the aneurysm. The size threshold at which treatment becomes advisable is controversial, although it has been suggested that aneurysms less than 2 cm may not require treatment.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="p0040" class="elsevierStylePara elsevierViewall">The clinical presentation of a hepatic artery aneurysm may be non-specific and variable. The classic triad is epigastric pain, hemobilia and obstructive jaundice, although only one-third of patients with hepatic artery aneurysm present with all three symptoms.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Our patient only suffered from chronic recurrent pain in the abdominal right upper quadrant, that completely resolved immediately after exclusion of the aneurysm. The latter confirmed the presumption that the abdominal complaints were indeed caused by the 18 mm aneurysm.</p><p id="p0045" class="elsevierStylePara elsevierViewall">Open surgical treatment of visceral artery aneurysms is safe and effective, and offers satisfactory early and long-term results.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Recently, Grotemeyer et al. have described a series of 23 patients with a visceral artery aneurysm of which 14 patients presented with symptoms attributable to their aneurysms, 4 presented with a rupture and 9 were asymptomatic. In their series the morbidity and mortality rate associated with surgical treatment was low. After a mean follow-up of 55 months, the patency rate of the reconstructed visceral arteries was 90.4% and re-interventions were rare. Nevertheless, the minimal invasive character of endovascular repair might provide a benefit in both elective and emergency interventions.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Endovascular exclusion may be accomplished by coil embolization or the selective use of N-butyl-2-cyanoacrylate.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Coil embolization has been used in anatomically difficult cases due to its relative simplicity. Stent-grafting offers a more physiologic repair in its ability to maintain blood flow through the affected artery.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In our opinion an anatomic reconstruction, preserving flow trough the affected artery, should always be preferred. In our patient we managed to remain flow through the hepatic artery, although the gastroduodenal artery was occluded, not causing clinical symptoms.</p><p id="p0050" class="elsevierStylePara elsevierViewall">In conclusion we have shown that small hepatic artery aneurysms may cause chronic recurrent abdominal pain and that they may be safely excluded using an ePTFE covered nitinol stent graft.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:3 [ "identificador" => "xres1210976" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abs0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1127260" "titulo" => "Key words" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Case Report" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-10-27" "fechaAceptado" => "2009-12-06" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec1127260" "palabras" => array:4 [ 0 => "Hepatic artery aneurysm" 1 => "Stent graft" 2 => "Symptomatic" 3 => "Abdominal pain" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abs0005" class="elsevierStyleSection elsevierViewall"><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Background.</span> Aneurysms of the visceral arteries are rare but potentially lethal lesions. We describe a case of a successful endovascular exclusion of a hepatic artery aneurysm in a patient that suffered from chronic abdominal pain.</p><p id="sp1015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Case Report.</span> A 68-year old man presented with chronic abdominal pain that had existed for 10 months. A diagnostic contrast-enhanced CT scan showed an 18 mm atherosclerotic aneurysm of the hepatic artery. When other pathology was excluded the aneurysm was excluded using an ePTFE-cove-red nitinol stent graft. Post-deployment angiograms showed a complete exclusion of the aneurysm. The abdominal complaints immediately resolved. After a follow-up period of 18 months patient had a patent endograft and remained free of symptoms.</p><p id="sp1020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclusions.</span> Small hepatic artery aneurysms may cause chronic recurrent abdominal pain and can be safely excluded using a covered stent graft.</p></span>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "f0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1585 "Ancho" => 997 "Tamanyo" => 189749 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Atherosclerotic aneurysm of the hepatic artery <span class="elsevierStyleBold">A.</span> Transversal view (arrow). <span class="elsevierStyleBold">B.</span> Coronal view.</p>" ] ] 1 => array:7 [ "identificador" => "f0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1681 "Ancho" => 996 "Tamanyo" => 238144 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">A.</span>The aneurysm (arrow) was localized distally from the origin of the splenic artery and left gastric artery and proximally from the origin of the duodenal artery. <span class="elsevierStyleBold">B.</span> An ePTFE covered nitinol stentgraft was positioned and deployed under fluoroscopy. Because of type-1 endoleak an additional bare stent was deployed. Post-deployment angiograms showed a complete exclusion of the aneurysm.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Visceral artery aneurysms-follow up of 23 patients with 31 aneurysms after surgical or interventional therapy." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:4 [ 0 => "Grotemeijer D." 1 => "Duran M." 2 => "Park E-J" 3 => "Hoffmann N." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Lan-genbecks Arch Surg" "fecha" => "2009" "volumen" => "12" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 20 | 3 | 23 |
| 2024 September | 39 | 4 | 43 |
| 2024 August | 41 | 3 | 44 |
| 2024 July | 49 | 5 | 54 |
| 2024 June | 28 | 2 | 30 |
| 2024 May | 44 | 1 | 45 |
| 2024 April | 32 | 4 | 36 |
| 2024 March | 41 | 3 | 44 |
| 2024 February | 31 | 4 | 35 |
| 2024 January | 61 | 6 | 67 |
| 2023 December | 42 | 9 | 51 |
| 2023 November | 49 | 12 | 61 |
| 2023 October | 56 | 11 | 67 |
| 2023 September | 39 | 4 | 43 |
| 2023 August | 40 | 1 | 41 |
| 2023 July | 40 | 3 | 43 |
| 2023 June | 60 | 3 | 63 |
| 2023 May | 83 | 4 | 87 |
| 2023 April | 73 | 7 | 80 |
| 2023 March | 62 | 2 | 64 |
| 2023 February | 47 | 8 | 55 |
| 2023 January | 39 | 2 | 41 |
| 2022 December | 34 | 10 | 44 |
| 2022 November | 34 | 7 | 41 |
| 2022 October | 45 | 7 | 52 |
| 2022 September | 72 | 7 | 79 |
| 2022 August | 38 | 5 | 43 |
| 2022 July | 36 | 8 | 44 |
| 2022 June | 37 | 13 | 50 |
| 2022 May | 44 | 6 | 50 |
| 2022 April | 36 | 14 | 50 |
| 2022 March | 73 | 8 | 81 |
| 2022 February | 42 | 9 | 51 |
| 2022 January | 60 | 15 | 75 |
| 2021 December | 24 | 7 | 31 |
| 2021 November | 30 | 6 | 36 |
| 2021 October | 37 | 7 | 44 |
| 2021 September | 28 | 11 | 39 |
| 2021 August | 23 | 5 | 28 |
| 2021 July | 18 | 5 | 23 |
| 2021 June | 15 | 7 | 22 |
| 2021 May | 28 | 4 | 32 |
| 2021 April | 63 | 15 | 78 |
| 2021 March | 11 | 7 | 18 |
| 2021 February | 4 | 7 | 11 |
| 2021 January | 4 | 4 | 8 |
| 2020 December | 5 | 7 | 12 |
| 2020 November | 7 | 7 | 14 |
| 2020 October | 7 | 5 | 12 |
| 2020 September | 5 | 2 | 7 |
| 2020 August | 7 | 4 | 11 |
| 2020 July | 7 | 3 | 10 |
| 2020 June | 8 | 1 | 9 |
| 2020 May | 7 | 2 | 9 |
| 2020 April | 2 | 0 | 2 |
| 2020 March | 5 | 2 | 7 |
| 2020 February | 3 | 1 | 4 |
| 2020 January | 6 | 5 | 11 |
| 2019 December | 6 | 6 | 12 |
| 2019 November | 4 | 1 | 5 |
| 2019 October | 1 | 0 | 1 |
| 2019 September | 4 | 4 | 8 |
| 2019 August | 1 | 1 | 2 |
| 2019 July | 1 | 6 | 7 |
| 2019 June | 1 | 5 | 6 |
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