Visceral Artery Aneurysms: Decision Making and Treatment Options in the New Era of Minimally Invasive and Endovascular Surgery

Abstract

The abdominal viscera blood supply is derived from anterior branches of the abdominal aorta. Visceral artery aneurysms (VAAs) include aneurysms of the following arteries and their branches: the celiac artery, the hepatic artery, the splenic artery, the superior mesenteric artery, the inferior mesenteric artery, the pancreaticoduodenal artery, and the gastroduodenal artery. Overall VAAs comprise < 2% of all types of arterial aneurysms. Asymptomatic VAAs are now being encountered more frequently due to the widespread use of advanced diagnostic abdominal imaging. The incidental finding of a VAA frequently leaves clinicians with a dilemma as to the best course of management. The focus of this review is on current treatment options and management guidelines for both symptomatic and asymptomatic VAAs.

Management of a common and proper hepatic artery aneurysm

“…Although outcomes are limited to small studies and individual case reports, the 30-day mortality rate for both urgent and elective open or endovascular procedures ranges between 6% and 14 %. 9 Postintervention complications occur in 24% 9 to 29% 1 of patients and include hemorrhage, graft thrombosis, common bile duct stricture, duodenal perforation, pancreatitis, enterocutaneous fistula, and infection. Despite the risk of thrombosis, 5-year graft patency rates have been reported as 79%, 3 86%, 1 and 100%, 10 demonstrating promising results for HAA repair with synthetic or venous grafting.…”

Rupture of splenic artery aneurysm in a man with polycythemia vera and acquired von Willebrand syndrome

“…Splenic artery aneurysms (SAA) are the most common visceral artery aneurysms, with causes including pregnancy/multiparity, hypertension, portal hypertension, connective tissue disease, fibromuscular dysplasia and atherosclerosis. [1][2][3] While the vast majority of SAA are asymptomatic, the rupture rate is 2%, with mortality as high as 36%. 1 Sudden onset of left upper quadrant pain and hemodynamic instability is a prototypical presentation of rupture.…”

“…[1][2][3] While the vast majority of SAA are asymptomatic, the rupture rate is 2%, with mortality as high as 36%. 1 Sudden onset of left upper quadrant pain and hemodynamic instability is a prototypical presentation of rupture. As was a concern in this patient, the 'doublerupture' phenomenon has been described, where patients transiently stabilize (due to tamponade of hemorrhage in the lesser peritoneal sac), followed by subsequent circulatory collapse (when hemorrhage extends to the peritoneal cavity).…”

“…2 Conventional treatment options include surgical excision or ligation, while transcatheter embolization has gained favour. [1][2][3] Endovascular therapy should be considered for asymptomatic aneurysms of 2 cm or larger.…”