The Minimally Invasive Management of Visceral Artery Aneurysms and Pseudoaneurysms

Objective: Minimally invasive methods (endovascular and percutaneous) are now available for the management of visceral artery aneurysms and pseudoaneurysms (VAA). The purpose of this study was to review our ten-year experience with the minimally invasive treatment of VAA.
Methods: All patients evaluated from June 1999 to June 2009 with the diagnosis of aneurysms of the celiac, superior mesenteric, and inferior mesenteric arteries and their branches were included for review. Medical records were reviewed for demographics, therapy, and results.
Results: Minimally invasive management was attempted in 185 aneurysms in 176 patients (mean age 58, 56% male). 182 of 185 (98%) aneurysms in 173 patients had successful intervention. Sixty-three (34%) aneurysms were located in the splenic artery, 56 (30%) in the hepatic artery, 28 (15%) in the gastroduodenal, 16 (8.6%) in the pancreaticoduodenal, 6 (3.2%) in the superior mesenteric, 4 (2.1%) in the gastric, 4 (2.1%) in the celiac, 4 (2.1%) in the gastroepiploic, 2 (1%) in the inferior mesenteric, and 1 (0.5%) in the middle colic artery. Pseudoaneurysms were more common than true aneurysms (64% vs. 36%) Acute bleeding was the indication for intervention in 86 aneurysms (46%). Initial treatment was successful in 177 aneurysms (96%). Additional intervention was required in 5 (3%) aneurysms within 30 days for persistent flow or bleeding. Coiling was the sole technique employed in 139 aneurysms (75%) and was used in combination with at least one other technique in 20 (11%) other aneurysms. Thirty day aneurysm-related mortality was 1% (2 deaths). Nine additional deaths occurred during 30-day follow-up though none were related to complications of the aneurysms (4.8%).
Conclusions: Minimally invasive intervention for visceral artery aneurysms can be used alone or in combination to effectively treat these aneurysms in elective or emergent conditions.