Visceral Artery Aneurysms: Diagnosis and Percutaneous Management

 

 Buy Article Permissions and Reprints

ABSTRACT

Visceral artery aneurysms (VAAs) and visceral artery pseudoaneurysms (VAPAs) frequently present as life-threatening emergencies. VAAs are now being diagnosed with increasing frequency, related to routine use of magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound. Both surgery as well as endovascular techniques are well established in their management. Endovascular management includes transarterial deployment of coils, N-butyl cyanoacrylate, or stent grafts. Direct percutaneous embolization of visceral aneurysms and pseudoaneurysms may also be performed. Special attention to aneurysmal etiology—congenital, atherosclerotic, infectious, and inflammatory is outlined. Advances in endovascular management with various aneurysmal isolation techniques are discussed. It is concluded that percutaneous endovascular management, now offers a safe and effective alternative to conventional surgery with lower procedural morbidity and mortality and high technical success rates.

REFERENCES

• 1 Huang Y-K, Hsieh H-C, Tsai F-C, Chang S H, Lu M S, Ko P J. Visceral artery aneurysm: risk factor analysis and therapeutic opinion.  Eur J Vasc Endovasc Surg. 2007;  33(3) 293-301
  CrossrefPubMedGoogle Scholar
• 2 Nosher J L, Chung J, Brevetti L S, Graham A M, Siegel R L. Visceral and renal artery aneurysms: a pictorial essay on endovascular therapy.  Radiographics. 2006;  26(6) 1687-1704, quiz 1687
  CrossrefPubMedGoogle Scholar
• 3 Sachdev U, Baril D T, Ellozy S H et al.. Management of aneurysms involving branches of the celiac and superior mesenteric arteries: a comparison of surgical and endovascular therapy.  J Vasc Surg. 2006;  44(4) 718-724
  CrossrefPubMedGoogle Scholar
• 4 Chiesa R, Astore D, Guzzo G et al.. Visceral artery aneurysms.  Ann Vasc Surg. 2005;  19(1) 42-48
  CrossrefPubMedGoogle Scholar
• 5 Ikeda O, Tamura Y, Nakasone Y, Iryou Y, Yamashita Y. Nonoperative management of unruptured visceral artery aneurysms: treatment by transcatheter coil embolization.  J Vasc Surg. 2008;  47(6) 1212-1219
  CrossrefPubMedGoogle Scholar
• 6 Pulli R, Dorigo W, Troisi N, Pratesi G, Innocenti A A, Pratesi C. Surgical treatment of visceral artery aneurysms: A 25-year experience.  J Vasc Surg. 2008;  48(2) 334-342
  CrossrefPubMedGoogle Scholar
• 7 Tulsyan N, Kashyap V S, Greenberg R K et al.. The endovascular management of visceral artery aneurysms and pseudoaneurysms.  J Vasc Surg. 2007;  45(2) 276-283, discussion 283
  CrossrefPubMedGoogle Scholar
• 8 Friedman S G, Pogo G J, Moccio C G. Mycotic aneurysm of the superior mesenteric artery.  J Vasc Surg. 1987;  6(1) 87-90
  CrossrefPubMedGoogle Scholar
• 9 McCready R A, Bryant M A, Fehrenbacher J W, Rowe M G. Infected splenic artery aneurysm with associated splenic abscess formation secondary to bacterial endocarditis: case report and review of the literature.  J Vasc Surg. 2007;  45(5) 1066-1068
  CrossrefPubMedGoogle Scholar
• 10 Hyare H, Desigan S, Brookes J A, Guiney M J, Lees W R. Endovascular management of major arterial hemorrhage as a complication of inflammatory pancreatic disease.  J Vasc Interv Radiol. 2007;  18(5) 591-596
  CrossrefPubMedGoogle Scholar
• 11 Hassen-Khodja R, Declemy S, Batt M et al.. Visceral artery aneurysms in Von Recklinghausen's neurofibromatosis.  J Vasc Surg. 1997;  25(3) 572-575
  CrossrefPubMedGoogle Scholar
• 12 Parfitt J, Chalmers R TA, Wolfe J HN. Visceral aneurysms in Ehlers-Danlos syndrome: case report and review of the literature.  J Vasc Surg. 2000;  31(6) 1248-1251
  CrossrefPubMedGoogle Scholar
• 13 Sellke F W, Williams G B, Donovan D L, Clarke R E. Management of intra-abdominal aneurysms associated with periarteritis nodosa.  J Vasc Surg. 1986;  4(3) 294-298
  CrossrefPubMedGoogle Scholar
• 14 Bailey R W, Riles T S, Rosen R J, Sullivan L P. Celiomesenteric anomaly and aneurysm: clinical and etiologic features.  J Vasc Surg. 1991;  14(2) 229-234
  CrossrefPubMedGoogle Scholar
• 15 Settembrini P G, Jausseran J-M, Roveri S et al.. Aneurysms of anomalous splenomesenteric trunk: clinical features and surgical management in two cases.  J Vasc Surg. 1996;  24(4) 687-692
  CrossrefPubMedGoogle Scholar
• 16 Mitchell M B, McAnena O J, Rutherford R B. Ruptured mesenteric artery aneurysm in a patient with alpha 1-antitrypsin deficiency: etiologic implications.  J Vasc Surg. 1993;  17(2) 420-424
  CrossrefPubMedGoogle Scholar
• 17 O'Hara P J, Ratliff N B, Graor R A, Novick A, Beven E G. Medial agenesis associated with multiple extracranial peripheral and visceral arterial aneurysms.  J Vasc Surg. 1985;  2(2) 298-306
  CrossrefPubMedGoogle Scholar
• 18 Kim B S, Do H M, Razavi M. N-butyl cyanoacrylate glue embolization of splenic artery aneurysms.  J Vasc Interv Radiol. 2004;  15(1 Pt 1) 91-94
  PubMedGoogle Scholar
• 19 Carr S C, Mahvi D M, Hoch J R, Archer C W, Turnipseed W D. Visceral artery aneurysm rupture.  J Vasc Surg. 2001;  33(4) 806-811
  CrossrefPubMedGoogle Scholar
• 20 Boudghene F, L'Hermine C, Bigot J M. Arterial complications of pancreatitis: diagnostic and therapeutic aspects in 104 cases.  J Vasc Interv Radiol. 1993;  4(4) 551-558
  CrossrefPubMedGoogle Scholar
• 21 Arepally A, Dagli M, Hofmann L V, Kim H S, Cooper M, Klein A. Treatment of splenic artery aneurysm with use of a stent-graft.  J Vasc Interv Radiol. 2002;  13(6) 631-633
  CrossrefPubMedGoogle Scholar
• 22 Sallou C, Cron J, Julia P, Fabiani J N. Aneurysm of the inferior mesenteric artery: case report and review of the literature.  Eur J Vasc Endovasc Surg. 1997;  14(1) 71-74
  PubMedGoogle Scholar
• 23 Mandeville K LD, Bicknell C, Narula S, Renton S. Inferior mesenteric artery aneurysm with occlusion of the superior mesenteric artery, coeliac trunk and right renal artery.  Eur J Vasc Endovasc Surg. 2008;  35(3) 312-313
  CrossrefPubMedGoogle Scholar

Meghna ChadhaM.D. 

Department of Radiology, Detroit Medical Center

3737 Beaubien Street, # 902, Detroit, MI 48201

Email: chadha.meghna@gmail.com