Visceral artery aneurysms

Abstract

Visceral artery aneurysms are rare with an incidence of only 0.01–0.1% of the population. Open surgical or endovascular elimination should be performed for aneurysms greater than 2 cm in size. The risk of aneurysm rupture is then approximately 25–40%. If the aneurysm ruptures the mortality can be as high as 76%. For mycotic aneurysms or spurious aneurysms there is no lower limit to the diameter size for the need of treatment. Sudden abdominal pain during pregnancy can be caused by visceral artery aneurysms and must be further clarified. The indications for surgery during pregnancy should be made generously. The clinical symptoms (abdominal complaints) of visceral artery aneurysms are manifold. The treatment can be either an open surgical approach or endovascular treatment. In the emergency setting, if endovascular treatment is no longer possible, an open surgical treatment needs to be performed. There are so far no randomized studies which could identify one of the procedures (open surgery vs. endovascular surgery) as clearly being superior. The prognosis after treatment is satisfactory with a 5–10 year survival rate of approximately 90%.

Cesarean section following idiopathic rupture of renal artery aneurysm leading to fetal dysfunction

“…The prevalence of visceral artery aneurysm (VAA) has been reported as 0.01-2% of the population [1,2]. However, the number of undetected VAAs may be much larger, as VAAs are usually asymptomatic.…”

“…However, the number of undetected VAAs may be much larger, as VAAs are usually asymptomatic. VAAs can be found in the following locations: splenic artery, 60%; hepatic artery, 20-50%; superior mesenteric artery, 5.5-6%; celiac artery, 4%; gastric and gastroepiploic arteries, 4%; jejunal, ileal, and colic arteries, 3%; pancreaticoduodenal and pancreatic arteries, 2%; gastroduodenal artery, 1.5%; inferior mesenteric artery, < 1%; and renal artery, 0.01-0.09% [2,3,6]. Risk factors for rupture include hypertension, aneurysm size ≥ 2 cm, non-calcified aneurysm, and pregnancy [3].…”

“…The mortality rates for maternal and fetal death due to VAA rupture are 70-75% and 90-95%, respectively. Since 24-45% of VAAs rupture during the last trimester and the early phase after delivery, these periods are particularly hazardous [2]. Although RAA comprises approximately 0.01% of VAAs and only 32 cases have been reported over the past 20 years [4], over 50% of ruptured RAAs in patients under 40 years old are reportedly related to pregnancy [5].…”

“…Some previous studies have referred to possibilities including increased outflow resistance of arteries due to the increase in circulating blood and compression by the gravid uterus, vasodilation induced by estrogen or nitric oxide (NO) [7], histological changes in reticulin fibers or elastic fibers, and changes in smooth muscle cells [8,9]. Underlying diseases related to the formation of VAA include vasculitis, fibromuscular dysplasia, syphilis, hypertension, atherosclerosis, and trauma [2,10]. Sjögren syndrome, as seen in this case, is not typically associated with VAA.…”

“…Renal artery aneurysms (RAAs) in pregnancy are uncommon, with most found after rupturing. It has been reported that the prevalence of visceral artery aneurysm (VAA) is 0.01-2% of the population [1,2]. However, the number of undetected VAAs may be much larger, as VAAs are usually asymptomatic.…”