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.
Highlights
Visceral artery aneurysms (VAAs) are rare and usually asymptomatic, but can prove fatal if they rupture
In 1770, Beaussier reported a case of VAA in a 60-year-old woman from France, whose autopsy led to the discovery of a splenic aneurysm [1]
In 1953, Debakey and Cooley [3] reported a case of an infected superior mesenteric artery aneurysm (SMAA), since when VAA has appeared in the literature
Summary
Visceral artery aneurysms (VAAs) are rare and usually asymptomatic, but can prove fatal if they rupture. Covered stent placement may be effective for iatrogenic pseudoaneurysms in the gastroduodenal artery (GDA), splenic artery, common hepatic artery, or proper hepatic artery after pancreaticoduodenectomy, since simple coil embolization of these arteries carries a high risk of liver failure caused by blood flow disruption (Fig. 5) [40] This technique, even if conceptually feasible, is often limited by the arterial anatomy and location of the aneurysm, since relatively large and rigid delivery devices have to be navigated to the target artery. Occlusion of the celiac artery by coil embolization as treatment for CAA is effective, with less risk of organ ischemia, and may be indicated, especially for patients at high risk for open surgery [63, 64]. The most common therapeutic strategy is open surgery, there is a report stating that EVT was effective for rupture [79]
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