Visceral Artery Aneurysms: Diagnosis and Percutaneous Management

ABSTRACT

Visceral artery aneurysms (VAAs) and visceral artery pseudoaneurysms (VAPAs) frequently present as life-threatening emergencies. VAAs are now being diagnosed with increasing frequency, related to routine use of magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound. Both surgery as well as endovascular techniques are well established in their management. Endovascular management includes transarterial deployment of coils, N-butyl cyanoacrylate, or stent grafts. Direct percutaneous embolization of visceral aneurysms and pseudoaneurysms may also be performed. Special attention to aneurysmal etiology—congenital, atherosclerotic, infectious, and inflammatory is outlined. Advances in endovascular management with various aneurysmal isolation techniques are discussed. It is concluded that percutaneous endovascular management, now offers a safe and effective alternative to conventional surgery with lower procedural morbidity and mortality and high technical success rates.

Visceral artery aneurysms - endovascular - surgery - aneurysmal rupture

REFERENCES

• 1 Huang Y-K, Hsieh H-C, Tsai F-C, Chang S H, Lu M S, Ko P J. Visceral artery aneurysm: risk factor analysis and therapeutic opinion.  Eur J Vasc Endovasc Surg. 2007;  33(3) 293-301
• 2 Nosher J L, Chung J, Brevetti L S, Graham A M, Siegel R L. Visceral and renal artery aneurysms: a pictorial essay on endovascular therapy.  Radiographics. 2006;  26(6) 1687-1704, quiz 1687
• 3 Sachdev U, Baril D T, Ellozy S H et al.. Management of aneurysms involving branches of the celiac and superior mesenteric arteries: a comparison of surgical and endovascular therapy.  J Vasc Surg. 2006;  44(4) 718-724
• 4 Chiesa R, Astore D, Guzzo G et al.. Visceral artery aneurysms.  Ann Vasc Surg. 2005;  19(1) 42-48
• 5 Ikeda O, Tamura Y, Nakasone Y, Iryou Y, Yamashita Y. Nonoperative management of unruptured visceral artery aneurysms: treatment by transcatheter coil embolization.  J Vasc Surg. 2008;  47(6) 1212-1219
• 6 Pulli R, Dorigo W, Troisi N, Pratesi G, Innocenti A A, Pratesi C. Surgical treatment of visceral artery aneurysms: A 25-year experience.  J Vasc Surg. 2008;  48(2) 334-342
• 7 Tulsyan N, Kashyap V S, Greenberg R K et al.. The endovascular management of visceral artery aneurysms and pseudoaneurysms.  J Vasc Surg. 2007;  45(2) 276-283, discussion 283
• 8 Friedman S G, Pogo G J, Moccio C G. Mycotic aneurysm of the superior mesenteric artery.  J Vasc Surg. 1987;  6(1) 87-90
• 9 McCready R A, Bryant M A, Fehrenbacher J W, Rowe M G. Infected splenic artery aneurysm with associated splenic abscess formation secondary to bacterial endocarditis: case report and review of the literature.  J Vasc Surg. 2007;  45(5) 1066-1068
• 10 Hyare H, Desigan S, Brookes J A, Guiney M J, Lees W R. Endovascular management of major arterial hemorrhage as a complication of inflammatory pancreatic disease.  J Vasc Interv Radiol. 2007;  18(5) 591-596
• 11 Hassen-Khodja R, Declemy S, Batt M et al.. Visceral artery aneurysms in Von Recklinghausen's neurofibromatosis.  J Vasc Surg. 1997;  25(3) 572-575
• 12 Parfitt J, Chalmers R TA, Wolfe J HN. Visceral aneurysms in Ehlers-Danlos syndrome: case report and review of the literature.  J Vasc Surg. 2000;  31(6) 1248-1251
• 13 Sellke F W, Williams G B, Donovan D L, Clarke R E. Management of intra-abdominal aneurysms associated with periarteritis nodosa.  J Vasc Surg. 1986;  4(3) 294-298
• 14 Bailey R W, Riles T S, Rosen R J, Sullivan L P. Celiomesenteric anomaly and aneurysm: clinical and etiologic features.  J Vasc Surg. 1991;  14(2) 229-234
• 15 Settembrini P G, Jausseran J-M, Roveri S et al.. Aneurysms of anomalous splenomesenteric trunk: clinical features and surgical management in two cases.  J Vasc Surg. 1996;  24(4) 687-692
• 16 Mitchell M B, McAnena O J, Rutherford R B. Ruptured mesenteric artery aneurysm in a patient with alpha 1-antitrypsin deficiency: etiologic implications.  J Vasc Surg. 1993;  17(2) 420-424
• 17 O'Hara P J, Ratliff N B, Graor R A, Novick A, Beven E G. Medial agenesis associated with multiple extracranial peripheral and visceral arterial aneurysms.  J Vasc Surg. 1985;  2(2) 298-306
• 18 Kim B S, Do H M, Razavi M. N-butyl cyanoacrylate glue embolization of splenic artery aneurysms.  J Vasc Interv Radiol. 2004;  15(1 Pt 1) 91-94
• 19 Carr S C, Mahvi D M, Hoch J R, Archer C W, Turnipseed W D. Visceral artery aneurysm rupture.  J Vasc Surg. 2001;  33(4) 806-811
• 20 Boudghene F, L'Hermine C, Bigot J M. Arterial complications of pancreatitis: diagnostic and therapeutic aspects in 104 cases.  J Vasc Interv Radiol. 1993;  4(4) 551-558
• 21 Arepally A, Dagli M, Hofmann L V, Kim H S, Cooper M, Klein A. Treatment of splenic artery aneurysm with use of a stent-graft.  J Vasc Interv Radiol. 2002;  13(6) 631-633
• 22 Sallou C, Cron J, Julia P, Fabiani J N. Aneurysm of the inferior mesenteric artery: case report and review of the literature.  Eur J Vasc Endovasc Surg. 1997;  14(1) 71-74
• 23 Mandeville K LD, Bicknell C, Narula S, Renton S. Inferior mesenteric artery aneurysm with occlusion of the superior mesenteric artery, coeliac trunk and right renal artery.  Eur J Vasc Endovasc Surg. 2008;  35(3) 312-313