Visceral artery aneurysms, treatment and controversies – 20 years of single-center experience
Abstract
Introduction/Aim. Visceral artery aneurysms (VAAs) are rare diseases most often diagnosed accidentally during diagnostic workups for other diseases or for abdominal pain of unknown etiology. The aim of this study was to present 20 years of single-center experience from the surgical treatment of VAAs. Methods. A retrospective study analyzed the outcomes of surgical treatment in 15 patients with VAAs, treated between 2004 and 2024. Both endovascular and classic, open surgical techniques were used, with special emphasis on the histopathological causes of aneurysm formation. Special attention is directed towards symptomatology, preoperative diagnostics, open and endovascular treatment techniques, as well as postoperative follow-up and possible secondary interventions. Results. The average age of patients was 56.1 years. There was a total of seven female and eight male patients. The average diameter of the aneurysms was 4.4 cm (ranging from 2.4 to 6 cm). Open surgical operations were performed in 12 patients, while 3 patients underwent endovascular reconstruction. Surgical treatment was performed on 10 patients due to aneurysm of the splenic artery, on 2 patients due to aneurysm of the gastroduodenal artery, on 1 patient due to aneurysm of the common hepatic artery, on 1 patient due to aneurysm of the celiac trunk, and on 1 patient due to aneurysm of the renal artery. Five patients were operated on as emergency cases due to aneurysm rupture and hemorrhagic shock, while the remaining patients were operated on electively. Immediately after surgery, death occurred in three patients, while in the others, the follow-up period lasted from two to ten years. Conclusion. VAAs represent a serious vascular disease, which, if not diagnosed and treated in time, can lead to deadly complications due to aneurysm rupture and bleeding. In the era of endovascular surgery, open surgical reconstruction of visceral aneurysms continues to play an important role.
References
Pulli R, Dorigo W, Troisi N, Pratesi G, Innocenti AA, Pratesi C. Surgical treatment of visceral artery aneurysms: a 25-year ex-perience. J Vasc Surg 2008; 48(2): 334–42.
Fankhauser GT, Stone WM, Naidu SG, Oderich GS, Ricotta JJ, Bjarnason H, et al. The minimally invasive management of vis-ceral artery aneurysms and pseudoaneurysms. J Vasc Surg 2011; 53(4): 966–70.
Corey MR, Ergul EA, Cambria RP, English SJ, Patel VI, Lancas-ter RT, et al. The natural history of splanchnic artery aneu-rysms and outcomes after operative intervention. J Vasc Surg 2016; 63(4): 949–57.
Gehlen JM, Heeren PA, Verhagen PF, Peppelenbosch AG. Visceral artery aneurysms. Vasc Endovascular Surg 2011; 45(8): 681–7.
Berceli SA. Hepatic and splenic artery aneurysms. Semin Vasc Surg 2005; 18(4): 196−201.
Badea R. Splanchnic artery aneurysms: the diagnostic contribu-tion of ultrasonography in correlation with other imaging methods. J Gastrointestin Liver Dis 2008; 17(1): 101–5.
Pitton MB, Dappa E, Jungmann F, Kloeckner R, Schotten S, Wirth GM, et al. Visceral artery aneurysms: Incidence, management, and outcome analysis in a tertiary care center over one decade. Eur Radiol 2015; 25(7): 2004–14.
Abbas MA, Stone WM, Fowl RJ, Gloviczki P, Oldenburg WA, Pairolero PC, et al. Splenic artery aneurysms: two decades expe-rience at Mayo clinic. Ann Vasc Surg 2002; 16(4): 442–9.
Barrionuevo P, Malas MB, Nejim B, Haddad A, Morrow A, Ponce O, et al. A systematic review and meta-analysis of the man-agement of visceral artery aneurysms. J Vasc Surg 2019; 70(5): 1694−9.
Piasek E, Sojka M, Kuczyńska M, Światłowski Ł, Drelich-Zbroja A, Furmaga O, et al. Visceral artery aneurysms – classification, diagnosis and treatment. J Ultrason 2018; 18(73): 148–51.
Obara H, Kentaro M, Inoue M, Kitagawa Y. Current management strategies for visceral artery aneurysms: an overview. Surg To-day 2020; 50(1): 38–49. Erratum in: Surg Today 2020; 50(3): 320.