Current management strategies for visceral artery aneurysms: an overview

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Abstract

Visceral artery aneurysms (VAAs) are rare and affect the celiac artery, superior mesenteric artery, and inferior mesenteric artery, and their branches. The natural history of VAAs is not well understood as they are often asymptomatic and found incidentally; however, they carry a risk of rupture that can result in death from hemorrhage in the peritoneal cavity, retroperitoneal space, or gastrointestinal tract. Recent advances in imaging technology and its availability allow us to diagnose all types of VAA. VAAs can be treated by open surgery, laparoscopic surgery, endovascular therapy, or a hybrid approach. However, there are still no specific indications for the treatment of VAAs, and the best strategy depends on the anatomical location of the aneurysm as well as the clinical presentation of the patient. This article reviews the literature on the etiology, clinical features, diagnosis, and anatomic characteristics of each type of VAA and discusses the current options for their treatment and management.

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Surgical treatment of visceral artery aneurysms: A 25-year experience.

Giovanni Pratesi, J. Dorigo-Zetsma, Nicola Troisi … (2008)

The aim of this study was to analyze our 25-year experience with surgical treatment of visceral artery aneurysms (VAAs), with particular attention paid to early and long-term results. From January 1982 to September 2007, 55 patients (32 males, 58%, and 23 females, 42%) underwent surgical treatment of 59 VAAs. Only one patient was treated with an endovascular procedure. Mean patient age was 59.3 years (range, 36-78 years). The site of aneurysmal disease was splenic artery in 30 (50.8%) cases, renal artery in nine (15.2%) cases, common hepatic artery in seven (11.9%) cases, pancreaticoduodenal artery in four (6.8%) cases, celiac trunk in three (5.1%) cases, superior mesenteric artery in two (3.4%) cases, and gastroduodenal, inferior mesenteric, middle colic and right gastroepiploic in one (1.7%) case for each artery. Two (3.6%) patients had multiple VAAs. In five (9.1%) patients, an abdominal aortic aneurysm coexisted. Early results in terms of mortality and major complications were assessed. Follow-up consisted of clinical and ultrasound examinations at 1 and 12 months, and yearly thereafter. Long-term results in terms of survival and aneurysm-related complications were analyzed. In all but two cases, elective intervention in asymptomatic patients was performed. Two (3.6%) patients had a ruptured aneurysm (one pancreaticoduodenal artery and one middle colic artery). The one perioperative death was due to an acute pancreatitis in a patient operated on for a giant inflammatory splenic artery aneurysm, yielding a perioperative mortality rate of 1.8%. Two major complications (retroperitoneal hematoma and acute pancreatitis) were recorded. Mean duration of follow-up was 82.1 months (range, 0-324 months). Estimated 10-year survival rate was 79.5%. During follow-up two aneurysm-related complications occurred, with an estimated 10-year, aneurysm-related, complication-free survival rate of 75.2%. In the era of minimally invasive therapeutic approaches, elective open surgical treatment of visceral artery aneurysms is safe and effective, and offers satisfactory early and long-term results.

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Visceral artery aneurysms: Incidence, management, and outcome analysis in a tertiary care center over one decade

Michael B. Pitton, Evelyn Dappa, Florian Jungmann … (2015)

Objectives To evaluate the incidence, management, and outcome of visceral artery aneurysms (VAA) over one decade. Methods 233 patients with 253 VAA were analyzed according to location, diameter, aneurysm type, aetiology, rupture, management, and outcome. Results VAA were localized at the splenic artery, coeliac trunk, renal artery, hepatic artery, superior mesenteric artery, and other locations. The aetiology was degenerative, iatrogenic after medical procedures, connective tissue disease, and others. The rate of rupture was much higher in pseudoaneurysms than true aneurysms (76.3 % vs.3.1 %). Fifty-nine VAA were treated by intervention (n = 45) or surgery (n = 14). Interventions included embolization with coils or glue, covered stents, or combinations of these. Thirty-five cases with ruptured VAA were treated on an emergency basis. There was no difference in size between ruptured and non-ruptured VAA. After interventional treatment, the 30-day mortality was 6.7 % in ruptured VAA compared to no mortality in non-ruptured cases. Follow-up included CT and/or MRI after a mean period of 18.0 ± 26.8 months. The current status of the patient was obtained by a structured telephone survey. Conclusions Pseudoaneurysms of visceral arteries have a high risk for rupture. Aneurysm size seems to be no reliable predictor for rupture. Interventional treatment is safe and effective for management of VAA. Key Points • Diagnosis of visceral artery aneurysms is increasing due to CT and MRI. • Diameter of visceral arterial aneurysms is no reliable predictor for rupture. • False aneurysms/pseudoaneurysms and symptomatic cases need emergency treatment. • Interventional treatment is safe and effective.

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Splenic artery aneurysms: two decades experience at Mayo clinic.

Shaymaa Abbas, Jonathan Stone, W Oldenburg … (2002)

Although rare, splenic artery aneurysms (SAAs) have a definite risk of rupture. The optimal management of these aneurysms remains elusive. A retrospective chart review of all patients treated at our institutions with the diagnosis of SAA from January 1980 until December 1998 was undertaken. Follow-up was obtained via chart review and by direct phone contact of the patient or relative. No specific protocol was followed for management. From analysis of the patient data we concluded that although SAAs may rupture, not all intact aneurysms need intervention. Calcification does not appear to protect against rupture, although beta-blockade may be protective. Growth rates of SAA are slow and growth is infrequent. Selective management of SAAs is safe. Open ligation or transcatheter embolization should be considered for symptomatic aneurysms, for aneurysms > or = 2 cm in size, or for any SAA in women of childbearing years.

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Author and article information

Contributors

Hideaki Obara: obara.z3@keio.jp

Journal

Journal ID (nlm-ta): Surg Today

Journal ID (iso-abbrev): Surg. Today

Title: Surgery Today

Publisher: Springer Singapore (Singapore )

ISSN (Print): 0941-1291

ISSN (Electronic): 1436-2813

Publication date (Electronic): 16 October 2019

Publication date PMC-release: 16 October 2019

Publication date (Print): 2020

Volume: 50

Issue: 1

Pages: 38-49

Affiliations

[1 ]GRID grid.26091.3c, ISNI 0000 0004 1936 9959, Department of Surgery, , Keio University School of Medicine, ; 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan

[2 ]GRID grid.26091.3c, ISNI 0000 0004 1936 9959, Department of Diagnostic Radiology, , Keio University School of Medicine, ; Tokyo, Japan

Article

Publisher ID: 1898

DOI: 10.1007/s00595-019-01898-3

PMC ID: 6949316

PubMed ID: 31620866

SO-VID: e30eeab6-068e-4884-8e7a-c9284ff13351

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Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

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History

Date received : 30 August 2019

Date accepted : 28 September 2019

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ScienceOpen disciplines: Surgery

Keywords: visceral artery aneurysm,pseudoaneurysm,aneurysm rupture,endovascular therapy

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ScienceOpen disciplines: Surgery

Keywords: visceral artery aneurysm, pseudoaneurysm, aneurysm rupture, endovascular therapy

Current management strategies for visceral artery aneurysms: an overview

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Most cited references 75

Surgical treatment of visceral artery aneurysms: A 25-year experience.

Visceral artery aneurysms: Incidence, management, and outcome analysis in a tertiary care center over one decade

Splenic artery aneurysms: two decades experience at Mayo clinic.

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