Treatment Of Visceral Artery Aneurysms Research Articles

Early results of endovascular treatment of visceral artery aneurysms and pseudoaneurysms

Early results of endovascular treatment of visceral artery aneurysms and pseudoaneurysms

Comparative Efficacy and Safety of Self-Expandable vs. Balloon-Expandable Stent Grafts in Visceral Artery Aneurysm Management.

This study assesses the efficacy and safety of self-expandable (SE) versus balloon-expandable (BE) stent grafts for managing visceral artery aneurysms (VAAs), focusing on procedural success and complication rates. We conducted a retrospective analysis of VAA patients treated at our institution from April 2006 to September 2021. The study reviewed patient demographics, aneurysm characteristics, treatment details, and outcomes, including endoleaks. Among the 23 patients analyzed, splenic artery aneurysms represented 44% of cases. Fifteen patients were treated with balloon-expandable stent grafts (BE SGs), and eight patients were treated with self-expandable stent grafts (SE SGs). For saccular aneurysms, the average neck size was 10.10 ± 8.70 mm in the BE group versus 18.50 ± 3.40 mm in the SE group (p = 0.23), with an average sac size of 20.10 ± 18.9 mm in the BE group versus 15.60 ± 12.7 mm in the SE group (p = 0.16). The average sac-to-neck ratio was 1.69 ± 2.23 in the BE group versus 1.38 ± 0.33 in the SE group (p = 0.63). The BE group exhibited a significantly higher endoleak rate (60%) compared to the SE group (12.5%; p = 0.03). While further investigation is needed to fully assess the outcomes of stent graft treatment for VAAs, initial data show a significantly higher endoleak rate with BE SGs compared to SE SGs. The SE SGs may offer better outcomes due to their superior ability to conform to tortuous and mobile visceral arteries.

Robotic Surgery for Elective Repair of Visceral and Renal Artery Aneurysms: A Systematic Review.

Background: The treatment choice of visceral artery aneurysms in an elective setting is debated. The durability and the risk of reintervention with endovascular treatment are still reasons for concern, whereas open surgery is invasive and burdened by major complications. In anecdotal reports and isolated studies, robotic-assisted surgery seems to provide the possibility of a minimally invasive treatment and the durability of traditional open surgery, but the literature supporting this view is scarce. This review aims to collect the results of robotic-assisted surgery in the treatment of visceral artery aneurysms. Methods: A systematic search of the main research databases was performed: the study endpoints were mortality and conversion rates, perioperative morbidity, and freedom from late complications and reinterventions. Results: We identified 16 studies on 53 patients. All cases underwent successful resection, with three conversions to laparoscopy. Perioperative and aneurysm-related mortality were nil. Over a median follow-up of 9 months, two reinterventions were reported (3.6%). Conclusion: The robotic technique is safe and effective in treating splenic and renal artery aneurysms, and it should be considered as a valuable alternative to endovascular and open repair, although larger sample sizes and a longer-term follow-up are necessary to confirm such results.

Use of selective visceral angiography in surgical strategy planning for celiac artery aneurysm in the celiacomesenteric trunk

BackgroundThe celiacomesenteric trunk (CMT) is a common duct of the celiac artery (CA) and the superior mesenteric artery originating from the aorta, which is an uncommon anatomical variant of visceral artery circulation. Because of the variety of visceral circulation in those with CMT, the visceral circulation associated with each branch should be evaluated prior to surgical treatment of visceral artery aneurysm in the CMT.Case presentationA 64-year-old woman was diagnosed with a CA aneurysm in the CMT. Aneurysmectomy of the aneurysm was performed successfully. On preoperative selective visceral angiography, the CA was seen to bifurcate into the common hepatic and splenic artery. The left gastric artery was directly isolated from the aorta and perfused to the common hepatic and splenic artery through collateral circulation. These findings showed that celiac artery embolization is anatomically feasible, even in cases of celiac artery aneurysm rupture.ConclusionsSelective visceral angiography can contribute to surgical strategy planning for CA aneurysm with CMT.

Results of current endovascular treatments for visceral artery aneurysms

ObjectiveThis single-center retrospective cohort study aimed to analyze the early and long-term results of endovascular treatment for true visceral artery aneurysms (VAAs). Moreover, a comparison with the results of our previously published historical series of open surgical procedures was performed. MethodsFrom January 2008 to December 2021, 78 consecutive patients were treated at our institution for true VAAs. All demographic data, procedural details, perioperative outcomes, and follow-up data were collected prospectively from a dedicated database. A retrospective analysis identified 72 patients who underwent endovascular surgery. Early results were analyzed in terms of technical success, conversion to open surgery, mortality, and local and systemic morbidities. Follow-up results were analyzed in terms of survival, need for open or endovascular reintervention, and freedom from complications at the level of the treated visceral artery. These results were then compared with those of our historical open surgical group (1982-2007), which included 54 interventions. ResultsIn four cases, the planned endovascular procedure could not be completed, and the overall technical success rate was 94.5%. No deaths occurred during the hospital stay or within 30 days after surgery. Overall, the 30-day perioperative complication rate was 5.8%, with an early reintervention rate of 2.9%. The median follow-up time was 29 months (range, 1–132 months). The estimated 7-year survival rate was 88% (standard error [SE]. 0.05). The estimated 7-year aneurysm-related complication-free rate was 85.5% (SE, 0.06), with reintervention-free and aneurysm-related complication-free survival rates of 93.3% (SE, 0.04) and 75.6% (SE, 0.07), respectively. At the 7-year follow-up, the survival rate was similar between the endovascular and open groups. There was a trend toward a higher aneurysm-related complication rate in the endovascular group than in the open group (14.5% vs 6.4%; P = .07). However, no significant differences in reintervention-free and overall estimated aneurysm-related complication-free survival rates were found between the two groups. ConclusionsEndovascular repair is safe and effective in patients with VAAs, with low perioperative complication rates. The long-term outcomes were satisfactory and comparable with those of the historical series of open surgical repairs. Even if there is a trend toward a higher risk of late aneurysm-related complications among endovascular patients, it does not imply an increased need for late reinterventions.

Complicated visceral artery aneurysms in chronic pancreatitis

Visceral artery aneurysms are rare and occur only in 0.01-0.2% of people. According to various authors, incidence of aneurysm rupture is 10-20% with mortality rate of 20-70% depending on localization and dimensions. One of the causes of visceral artery aneurysms, in particular common hepatic artery aneurysm, is chronic pancreatitis. Incidence of this complication is 2-10%. The first clinical manifestation is often hemorrhagic shock following false aneurysm rupture and bleeding into abdominal cavity, gastrointestinal tract or retroperitoneal space. Common hepatic artery aneurysm is complicated by bleeding in 35% of cases, and mortality may be up to 75%. Treatment of visceral artery aneurysm following chronic pancreatitis and post-necrotic parapancreatic cyst includes several stages. Endovascular methods are the first stage of treatment. The second stage is elimination of the cause of visceral artery false aneurysm (surgery for chronic pancreatitis). We present 3 patients with visceral artery aneurysms and chronic pancreatitis.

Abstract No. 75 Endovascular treatment of visceral artery aneurysms and pseudoaneurysms: comparing outcomes of self-expandable vs balloon-expandable stent grafts

Endovascular treatment of visceral aneurysms is effective and successful with low rates of complications. Depending on location and anatomy, endovascular treatment is either embolization or stent graft exclusion. This single-center retrospective study compares the outcomes of Self Expandable (SE) vs. Balloon Expandable (BE) stent grafts (SGs) in the treatment of visceral artery aneurysms (VAAs) and pseudoaneurysms (VAPAs).

Covered Stents for Treatment of Visceral Artery Aneurysms: A Multicenter Study

PurposeTo evaluate the safety and efficacy of covered stents for treatment of visceral artery aneurysms (VAA). MethodsThis multicenter retrospective study included patients with VAAs who were treated with covered stents between January 2015 and December 2020. A total of 65 patients (mean age, 58 years; range, 27–89 years) with 70 VAAs (60 true aneurysms [86%], 10 pseudoaneurysms [14%]) were included. Of the 65, 48 patients (74%) were asymptomatic. Patient demographics, endovascular treatments, and follow-up results were analyzed. ResultsAll patients received covered stents. The mean diameter was 2.9 cm (range, 1.0–7.6 cm) for symptomatic aneurysms and 2.5 cm (range, 1.0–9.0 cm) for asymptomatic aneurysms. Of the asymptomatic aneurysms, 89% had a saccular shape. The mean distance between the ostium of the artery in which the aneurysm occurred and the aneurysm was 3.9 cm (median, 3.0 cm; range, 0.5–10 cm). Additional coil embolization was used in 7 aneurysms (10%). During the procedure, 68 (97%) aneurysms were completely excluded, while 2 (3%) had a Type Ib endoleak. After a mean follow-up of 20 months (range, 1–75 months), all patients were asymptomatic. Four endoleaks were recorded and left for close observation. Four stents (7%) had mild restenosis, while the rest of the stents were patent. ConclusionsPlacement of covered stents in patients with VAAs excluded aneurysms and maintained artery patency.

Assessing the aneurysm occlusion efficacy of a shear-thinning biomaterial in a 3D-printed model

Metallic coil embolization is a common method for the endovascular treatment of visceral artery aneurysms (VAA) and visceral artery pseudoaneurysms (VAPA); however, this treatment is suboptimal due to the high cost of coils, incomplete volume occlusion, poor reendothelialization, aneurysm puncture, and coil migration. Several alternative treatment strategies are available, including stent flow diverters, glue embolics, gelfoam slurries, and vascular mesh plugs—each of which have their own disadvantages. Here, we investigated the in vitro capability of a shear-thinning biomaterial (STB), a nanocomposite hydrogel composed of gelatin and silicate nanoplatelets, for the minimally-invasive occlusion of simple necked aneurysm models. We demonstrated the injectability of STB through various clinical catheters, engineered an in vitro testing apparatus to independently manipulate aneurysm neck diameter, fluid flow rate, and flow waveform, and tested the stability of STB within the models under various conditions. Our experiments show that STB is able to withstand at least 1.89 Pa of wall shear stress, as estimated by computational fluid dynamics. STB is also able to withstand up to 10 mL s−1 pulsatile flow with a waveform mimicking blood flow in the human femoral artery and tolerate greater pressure changes than those in the human aorta. We ultimately found that our in vitro system was limited by supraphysiologic pressure changes caused by aneurysm models with low compliance.

Surgical treatment of visceral and renal abdominal artery aneurysms of various etiology

Visceral artery aneurysms are detected when complications occur or accidentally during examination for other diseases gastrointestinal tract, aimed at determining the functional significance. Over the past 10 years, we have observed 31 patients with abdominal visceral artery aneurysms, 10 patients had renal aneurysms, 15 had splenic arteries, hepatic artery and pancreatoduodenal artery aneurysms – in one case. The combination of aneurysms – in 2 cases: in one case – the renal artery with the splenic artery, in the other – the renal artery and the abdominal trunk. The patients ranged in age from 24 to 78 years, the average age is 43±6.5. Previously, infection was considered the most common cause of splenic artery aneurysms in 10 cases, with most patients complaining of fever, abdominal pain and a pulsating mass in the abdomen. And two patients with splenic artery aneurysm noted abdominal trauma. 3 had atherosclerotic changes. The causes of renal artery aneurysms are atherosclerosis in 6 cases, fibromuscular dysplasia in 2 cases, and Nonspecific aortoarteritis in 2 cases. Also, atherosclerotic etiology is present in aneurysms of the external iliac arteries aneurysms. Reconstructions on hepatobiliary aneurysms were performed in 6 (20%) cases, in 5 cases - resection with end-to-end anastomosis and in 2 cases - resection of splenic artery aneurysm, resection of splenic artery aneurysms with autovenous patch, clipping of splenic artery aneurysms – in 2 cases (6.5%), endovascular techniques were applied in 18 cases (58%). In 2 cases, nephroectomy was performed due to the spread of the aneurysm into the kidney gate and the lack of conditions for reconstruction. In the immediate and long-term (after 6 months and 3 years) postoperative period, the preservation of organ function in reconstructive and ligating methods of surgical treatment is the same. Signs of ischemia and impairment in the immediate postoperative period were not observed with reconstructive and ligating methods of surgical treatment. The choice of treatment method depends on the severity of the patient’s condition, clinical manifestations, as well as the localization of the aneurysm and its morphology. Preference is given to endovascular techniques, which are not traumatic enough and provide a good long-term result. However, in each case, the patient’s management tactics are individual, the choice of the optimal method of treatment of visceral artery aneurysms is based on data from the entire spectrum of possible diagnostic manipulations.

Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives.

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.

Endovascular treatment of visceral aneurysms and pseudoaneurysms.

Visceral artery aneurysm (VAA) is a rare and potentially life-threatening condition, defined as true artery aneurysms and pseudoaneurysms of splanchnic circulation and renal artery. This study reports our experience in the diagnosis and endovascular treatment of visceral artery aneurysms (VAAs) over a 10-year period. Between 2008 and 2018, a total of 24 VAAs in 21 patients were diagnosed by clinical symptoms and a combination of imaging techniques, such as Doppler ultrasound, computed tomography angiogram, and catheter angiogram. All patients underwent endovascular treatment to exclude aneurysms. Oral antiplatelet medicine was administered, and imaging examination was performed during follow-up. Technical success was achieved in all 21 patients, and no periprocedural complications occurred. Endovascular coiling alone was employed in 10 aneurysms. Coiling was combined with gelfoam in 2 aneurysms. Coiling was assisted by stent in 4 aneurysms. Covered stents were deployed in 8 aneurysms individually. Clinical symptoms disappeared or highly improved in all patients after treatment. None of the patients showed recurrent symptoms after discharge. However, two cases with new aneurysms after 6 and 8 months, respectively, and one case with in-stent thrombosis after 12 months were reported during follow-up. This study may justify the efficacy of percutaneous endovascular coil embolization and stent deployment. It also provides beneficial experience about how to choose appropriate various endovascular strategies based on both clinical symptoms and aneurysm anatomy condition.

Endovascular treatment of wide-neck saccular renal artery aneurysm with waffle-cone technique.

In the past, treatment of visceral artery aneurysms (VAAs) was exclusively surgical. These aneurysms were rarely diagnosed in elective or emergency cases. Development of imaging techniques and endovascular procedures has changed the history of the therapeutic options for this pathology. Endovascular management of VAAs has arisen to advances in endovascular techniques and has achieved high efficacy.

Treatment of visceral artery aneurysms and pseudoaneurysms with the use of cerebral flow diverting stents: initial experience

BackgroundFlow-diverter stents (FDS) are designed to maintain laminar flow in the parent artery and sidebranches and to promote thrombosis of the aneurysm. Although these devices were developed for use in intracranial circulation, FDS could be employed to treat aneurysms regardless of their location, when anatomic factors may limit the efficacy of classic endovascular techniques. The objective of this study is to describe the initial experience of a single center in the treatment of visceral artery aneurysms and pseudoaneurysms (VAA-VAP) with cerebral FDS, analyzing safety, efficacy and 1-year outcome. Between 2016 and 2018 six patients (4 women, mean age 57.6) underwent treatment with FDS of 4 VAA and 2 VAP located in renal (4), hepatic (1) and splenic arteries (1). Mean aneurysm diameter was 14.3 mm (range 8–22). All the aneurysms had sidebranches arising from the neck or had an unfavorable dome-to-neck ratio. Technical success, safety, efficacy and 1-year outcome were analyzed. Follow-ups (FU) with Color-Doppler US and CTA ranged from 12 to 36 (mean 20) months.ResultsTechnical success was achieved in all cases. There were no aneurysm rupture nor reperfusion after exclusion. Five out of six (83.3%) FDS were patent at each FU; all the aneurysms showed shrinkage with a mean dimensional reduction rate of 55.8%. Sac thrombosis was observed in 4 aneurysms at 1 (n = 3) and at 12-month FUs. There was one sidebranch occlusion with evidence of a small area of kidney hypoperfusion at the 12-month FU, which was asymptomatic. In one patient, a reintervention was needed because CTA showed a severe in-stent stenosis, which was symptomatic. Mean hospitalization was 4.1 days.ConclusionsTreatment of morphologically complex VAA and VAP with cerebral FDS proved to be safe and efficient. Stronger evidence from larger populations are required.

Ten-Year Experience with Repair of Visceral Artery Aneurysms

The aim of this study is to evaluate midterm Results obtained with surgical and endovascular treatment of visceral artery aneurysms (VAA) and to describe the open and endovascular techniques used to repair these aneurysms. A retrospective review of patients undergoing VAA repair at a single academic tertiary medical center was performed from 2008 to 2017. Patient demographics, aneurysm characteristics, surgical management, and patient outcomes were evaluated. Twenty-seven patients (13 males, 14 females) with a median age of 61 ± 12.9 years underwent a total of 28 surgical or endovascular repairs of VAAs. The pathology of VAAs included 11 splenic artery aneurysms (39.3%), 6 renal artery aneurysms (21.4%), 5 hepatic artery aneurysms (17.9%), as well as 2 aneurysms of the pancreaticoduodenal artery, celiac artery, and superior mesenteric artery, respectively (7.1%). Four patients (14.8%) presented with symptoms of back pain or abdominal pain, while the majority aneurysms were incidentally found (85.2%). Seventeen aneurysms were repaired by open surgical techniques with ligation, primary repair, or bypass, while 11 aneurysms were treated with endovascular techniques with stent grafts and coiling. All aneurysms were intact at the time of repair with a median size of 2.3 ± 2.2 cm. One-year survival was 100% for patients undergoing open or endovascular repair. Only one patient among the endovascular repair group required reintervention for aneurysmal growth noted on surveillance imaging. The surgical and endovascular techniques used are described. Excellent midterm survival is feasible with open or endovascular repair of VAAs. Due to the potential need for reintervention, long term follow-up imaging is suggested.

Double-Lumen Balloons, Are They Only Useful in Neurointerventions? Preliminary Outcomes of Double-Lumen Balloon-Assisted Embolization of Visceral Artery Aneurysms.

This study aimed to assess the feasibility and results of double-lumen balloon-assisted embolization of visceral artery aneurysms (VAAs). Nine patients (mean age, 55.3 ± 10.8 years) diagnosed with VAA (superior mesenteric, n = 5; splenic, n = 2; renal, n = 2) and undergoing double-lumen balloon-assisted embolization were included in this study. Magnetic resonance angiogram (MRA) was used in the 6-month follow-up to assess the aneurysms and patency of the parent arteries. All patients were successfully treated with no reports of morbidity or mortality. Residual filling of the aneurysm neck was detected in 2 patients at the end of the procedure, but those parts were found to be stable in the sixth-month MRA. In 1 patient with renal aneurysm, a stent had to be deployed using a double-lumen balloon catheter because of the prolapse of the coil into the main artery. In another patient with a very large-necked superior mesenteric artery aneurysm, additional coils could be used at the same time thanks to the double-lumen balloon as the coils were not stabilized enough during embolization with the microcatheter coils. Liquid embolic agent was also used in this patient from the same lumen because of the large diameter of the aneurysm. Double-lumen balloons, which are mostly used in neurointerventional procedures, can be efficiently used as in the treatment of VAAs due to their ability to deploy stent and perform coil-liquid embolization through 1 lumen.

PC172. Visceral Artery Aneurysms—Management and Outcomes

Visceral artery aneurysms (VAAs) are rare and can be challenging to manage. The goal of this study was to detail the evolution of management of VAAs and to compare outcomes of open and endovascular repair. Using the Nationwide Inpatient Sample data from 1998 to 2014, all admissions with a diagnosis of VAA and intervention were identified. Patients were stratified by aneurysm type (splenic artery aneurysm or non-splenic VAA [NSVAA]) and by procedure type (open, endovascular, combined). Years studied were then divided between procedures performed before and after January 2005. Primary outcomes included in-hospital mortality, length of stay (LOS), postoperative complications (POCs), and total hospital charges. There were 9363 patients who underwent an intervention for a VAA. There was a significant increase in VAA procedures overall as well as in endovascular procedures during the 14 years studied (P < .001 and P < .001). The Table details the cohort demographic and outcomes studied stratified by time frame (before and after 2005). After 2005, there were significant increases in endovascular treatment, POCs, and total hospital charges. After 2005, there were significant decreases in open repair, elective procedures, LOS, non-home discharge, and in-hospital mortality. Overall, the in-hospital mortality rate was 5.4% (n = 506). Significant predictors of in-hospital mortality included preoperative aneurysm rupture (odds ratio [OR], 4.7; P < .001), increased Charlson comorbidity score (OR, 1.2; P < .001), and open repair (OR, 1.61; P = .005). The average LOS was 9.5 ± 11 days, and the only factor that significantly reduced LOS was having an endovascular procedure (−3.2 days; P < .001). Having an NSVAA, preoperative aneurysm rupture, and teaching hospital status significantly increased LOS (+1.7 days [P < .001], +3.5 days [P < .001], and +1.5 [P < .001], respectively). There were 3880 patients (41%) who had any POC, and significant predictors of POC included open procedure (OR, 1.45; P < .001), NSVAA (OR, 1.3; P = .001), surgery after 2005 (OR, 1.3; P < .001), and preoperative rupture (OR, 1.9; P < .001). Endovascular procedures had significantly reduced total hospital charges (−$22,903; P < .001) compared with open repair. Combined procedures, NSVAAs, and preoperative rupture significantly increased total charges (+$26,226 [P = .014], +$16,558 [P < .001], and +$17,965 [P = .007], respectively). Treatment, particularly endovascular management, of VAAs has significantly increased in contemporary practice. Endovascular interventions have a lower mortality, reduced LOS, fewer POCs, and decreased costs compared with open surgery. These data support an endovascular-first approach to VAAs.TableDemographics and outcomes for the treatment of visceral artery aneurysms (VAAs) before and after 2005Demographic and outcomeBefore 2005After 2005P valueDemographicNo. (%) or average (±SD)No. (%) or average (±SD) Patients30166347 Age, years60 (±16)59 (±16)<.001 Female sex1316 (44)2878 (45).128 Splenic artery aneurysm1230 (41)2545 (40).528 NSVAA1828 (61)3893 (61).501 Splenic and VAA42 (1.4)91 (1.4).875 Ruptured VAA496 (16)1020 (16).645 Open repair1388 (46)1441 (23)<.001 Endovascular repair1200 (40)4588 (72)<.001 Combined open and endovascular repair428 (14)318 (5)<.001 Elective procedure652 (43)2058 (32)<.001Outcome Length of stay10.4 days (±14)9 days (±10)<.001 Any postoperative complication1156 (38)2724 (43)<.001 Nonhome discharge348 (14)82 (9)<.001 Total charges$78,753 (±$105,732)$118,589 (±$150,347)<.001 In-hospital mortality202 (7)304 (5)<.001NSVAA, Non-splenic visceral artery aneurysm; SD, standard deviation.Boldface entries indicate statistical significance. Open table in a new tab

Preliminary Results of Stent-Assisted Coiling of Wide-Necked Visceral Artery Aneurysms via Self-Expandable Neurointerventional Stents

PurposeTo determine technical feasibility and results of stent-assisted coiling of visceral artery aneurysms (VAAs) with self-expandable LEO PLUS neurointerventional stent. Materials and MethodsIn this retrospective study, 11 consecutive patients (mean age 61.9 y ± 8.9; range, 45–76 y) with VAAs (splenic, n = 3; common hepatic, n = 2; renal, n = 5; celiac, n = 1) treated with neurointerventional stents were included. MR angiography was evaluated for aneurysmal occlusion and patency of the parent arteries. ResultsTechnical success was 90.9%. A minor technical complication developed in 1 patient (9%), and thrombosis of the distal part of the stent was seen just after deployment in another patient, but it resolved after tirofiban injection. Complete occlusion was determined in all patients on MR angiography at 6-month follow-up. ConclusionsSelf-expandable LEO PLUS neurointerventional stents could become a useful tool in the treatment of VAAs. Studies with larger groups of patients, including control groups, are needed to assess the true outcome of this treatment method.

Visceral Artery Aneurysms: Diagnosis, Surveillance, and Treatment.

Visceral artery aneurysms (VAAs) are a rare, but serious clinical entity as rupture confers a high rate of mortality. Data regarding the prevalence, treatment, and prognosis of VAAs is largely from case series, as true randomized trials are lacking. The incidence of VAAs has risen over the decades with advances in imaging technology, availability, and utilization. Even in the presence of symptoms, the prompt diagnosis of VAAs may be challenging as symptoms are often nonspecific and varied. Although there are no definitive treatment guidelines, asymptomatic VAAs require treatment in the following scenarios: when the aneurysm diameter is greater than 2cm, when identified during pregnancy, when multiple aneurysms are present, and in the case of hepatic transplant. Similar to therapeutic trends in other vascular beds, advances in endovascular devices and techniques have driven an "endovascular first" approach for the treatment of VAAs. However, although the success rates of endovascular repair are impressive, surgical intervention is still necessary in treating centers. This paper reviews the pathophysiology, clinical features, anatomic characteristics, and management strategies required for the effective diagnosis and treatment of VAAs.

Covered stenting and transcatheter embolization of splenic artery aneurysms in diabetic patients: A review of endovascular treatment of visceral artery aneurysms in the current era.

Diabetes mellitus is associated with both microvascular and macrovascular complications, which can result in visceral aneurysms as for example splenic artery aneurysms: in their management, an endovascular treatment, less invasive than surgery, is generally preferred. Endovascular treatment of splenic artery aneurysms can be based either on covered stenting (CS) or transcatheter embolization (TE). CS generally allows aneurysm exclusion with vessel preservation, while TE usually determines target artery occlusion with potential risk of distal ischemia. We performed a review of the existing literature on endovascular treatment of visceral artery aneurysms (VAAs) and psudoaneurysms (VAPAs) in the current era.