Clinical Research
Visceral Artery Aneurysms, an Experience on 32 Cases in a Single Center: Treatment From Surgery to Multilayer Stent

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Between 2000 and 2010, 32 patients (17 males; mean age: 64.7 [range: 18-85] years) with visceral artery aneurysms (VAAs) were treated in our center. The site of aneurysmal disease was: splenic artery (18), hepatic artery (5), superior mesenteric artery (3), pancreaticoduodenal artery (3), celiac axis (2), and gastroduodenal (1). Six patients (18.75%) presented with an aneurysm rupture. Nine cases received an endovascular treatment. Primary technical success was achieved in six patients. Failures included one case of immediate stent occlusion, one stent migration, and one failed attempt of embolization. In 24 cases, the surgical treatment was performed successfully. The total survival rate was 90.6% (in urgency: 75%; in election: 95.8%). A follow-up period of 34.7 months (range: 2-117 months) showed good results. Because of the potential risk of rupture, VAAs should be treated. A new endovascular technology based on a multilayer stent could provide us with a new alternative to VAA treatment, guaranteeing both aneurysmatic sac thrombosis and the correct perfusion of the organs. However, this new technology is not suitable for all aneurysms and requires a specific training and learning curve. In subjects with a low surgical risk, surgery guarantees a definitive and long-lasting repair with a good organ perfusion.

Introduction

The incidence rate of visceral artery aneurysms (VAAs) ranges from 0.1% to 2%.1, 2 These lesions represent a clinical emergency in 22% of cases, with a mortality rate of 8.5%.3 In order of decreasing incident frequency of VAA, the arteries involved are splenic (60%), hepatic (20%), superior mesenteric (5.5%), celiac (4%), gastric and gastroepiploic (4%), intestinal (jejunal, ileal, colic) (3%), pancreaticoduodenal and pancreatic (2%), gastroduodenal (1.5%), and inferior mesenteric arteries (rare).4 In general, the VAAs are asymptomatic. However, they are clinically important because of the high incidence of rupture and life-threatening hemorrhage.5, 6 Generally, indications for intervention include a VAA of diameter equal to or greater than 1.5-2 cm, rapid growth of the aneurysm, symptomatic aneurysm, and the childbearing age.7 The primary end point of this retrospective study is to evaluate the efficacy of the surgical and endovascular treatment of VAA in a single center.

Section snippets

Methods

Between January 2000 and December 2010, we treated 32 VAAs in 32 patients. We retrospectively collected the data concerning preoperative assessment (demographic data, risk factors, comorbid conditions, clinical and anatomic features), intraoperative procedure (surgical approach, type of reconstruction, endovascular treatment and associated procedures), and postoperative outcomes (mortality, major complications, aneurysm-related treatment complications, reintervention, hospital length of stay,

Results

During the study period, 32 patients (17 males; mean age: 64.7 [range: 18-85] years) underwent VAA treatment. In 18 patients, the VAA diagnosis was occasional during the imaging assessment for unrelated visceral arteries diseases. Five VAAs were diagnosed during invasive examinations for aortic and iliac aneurysms. Three cases were detected during CT scan as a result of abdominal pain. In six patients, an urgent CT scan detected a VAA rupture. The VAAs were associated with other aneurysms in

Discussion

VAA is a rare pathology, but is a potentially lethal one. In the literature, mortality rate after VAA rupture has been reported to be in the range of 10-36%1,9-12, whereas a rate of 5% has been reported during elective treatment.9 Even if the history of untreated VAA remains unclear,13, 14 the indications for treatment of asymptomatic VAA remain controversial because of the lack of prospective studies providing evaluative evidence of the natural history of these lesions. Universally accepted

Conclusion

The high mortality rate in the emergency group and the good results in the elective one suggest that these lesions should be treated as soon as possible. The surgical approach remains the first choice of treatment in patients with a low surgical risk because it ensures a long-lasting patency and a good organ perfusion. Despite the fact that endovascular treatments do not represent a standard option and require both a specific training and a learning curve, the development of new technologies,

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    Copyright © 2011 Annals of Vascular Surgery Inc. Published by Elsevier B.V. All rights reserved.