The Endovascular Treatment of Visceral Aneurysms: Single-Center Experience

Abstract

Visceral artery aneurysms (VAAs) represent a pathologic condition with high mortality rates because of their high frequency of rupture and consequent fatal bleeding (22%-70%). The increased incidental detection related to frequent use of advanced imaging technology lets vascular surgeons choose between endovascular and open surgical treatment. The primary end points of this retrospective study are evaluation of technical success and periprocedural mortality rate; the first is defined as the successful exclusion of the true aneurysm from the main stream of the blood flow as confirmed by completion angiography, and the second is the mortality incidence within the first 30 days after treatment. From January 1992 to December 2015, 122 open and endovascular interventions for VAA were performed. The preoperative diagnostic workup consisted of computed tomography scan. The treatment option was endovascular in 52 of 122 (42.6%) cases, of which 25 were treated by embolization and 27 with covered stent deployment. In more than half of the cases (69/122 [56.5%]), open surgical treatment was preferred, with 24 resections and 45 reconstructions. In one case, the endovascular treatment failed because of superior mesenteric artery dissection during the procedure. In 20 cases (29%), surgery was performed in emergency conditions. Follow-up consisted of clinical and ultrasound examination at 1 month, 6 months, and 12 months and yearly thereafter, covering a period of 60 months. All patients had at least one computed tomography scan during follow-up. In the endovascular group, the intraoperative and postoperative mortality was nil. In this group, major complications were intestinal ischemia from superior mesenteric artery dissection and a massive splenic hematoma. In the surgical group, eight patients, treated in emergency, died (40% mortality). There is no standardized consensus regarding the indications for treatment of VAAs. In general, these should always be treated if they are symptomatic, are larger than 2 cm in a good-risk surgical candidate, have a rapid growth of >0.5 cm/y, and are present in a pregnant women or those of childbearing age and in patients undergoing an orthotopic liver transplantation. In the emergent setting, the endovascular approach should be considered first choice. When it is electively performed, endovascular treatment has shown good results in the short term and midterm, and so it represents the first option in our experience.