Abstract
Visceral artery aneurysms (VAAs) are rare, usually asymptomatic and incidentally discovered during a routine radiological examination. Shared guidelines suggest their treatment in the following conditions: VAAs with diameter larger than 2 cm, or 3 times exceeding the target artery; VAAs with a progressive growth of at least 0.5 cm per year; symptomatic or ruptured VAAs. Endovascular treatment, less burdened by morbidity and mortality than surgery, is generally the preferred option. Selection of the best strategy depends on the visceral artery involved, aneurysm characteristics, the clinical scenario and the operator’s experience. Tortuosity of VAAs almost always makes embolization the only technically feasible option. The present narrative review reports state of the art and new perspectives on the main endovascular and other interventional options in the treatment of VAAs. Embolization techniques and materials, use of covered and flow-diverting stents and percutaneous approaches are accurately analyzed based on the current literature. Visceral artery-related considerations and targeted approaches are also provided and discussed.
Highlights
Visceral artery aneurysms (VAAs), or true aneurysms, are an uncommon entity, with a variable incidence at autopsy finding from 0.01 to 0.2% [1,2]
A double antiplatelet therapy is recommended to prevent stent-thrombosis as in the case of all VAAs treated with covered stent
For exand characterized by a peculiar lack of shape memory, was successfully used in 40 patients ample, the Viabahn covered stent (Gore, Flagstaff, AZ, USA), which is PTFE coated, highly flexible and characterized by a peculiar lack of shape memory, was successfully used in 40 patients affected by VAAs with permanent aneurysm exclusion and good stent patency rates at follow-up [87]
Summary
Visceral artery aneurysms (VAAs), or true aneurysms, are an uncommon entity, with a variable incidence at autopsy finding from 0.01 to 0.2% [1,2]. Conditions associated with a higher risk of rupture are pregnancy due to hormonal changes and increased blood flow [13], and the presence of visceral artery pseudoaneurysms or false aneurysms that can be caused by pancreatitis [14], trauma [15], previous surgical or interventional procedures [16,17,18]. The choice between conservative versus interventional management of VAAs is influenced by different factors, such as patient age, aneurysm size and the involved visceral artery and associated comorbidities. The aim of the present review is to analyze state of the art and new perspectives of the different embolization techniques, including the other endovascular and interventional options for the treatment of visceral and renal artery aneurysms
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