Visceral artery aneurysms: a single center experience

Aneurysms of the splanchnic arteries are among the rarest affecting the arterial circulation. Although in most instances these aneurysms are asymptomatic, their propensity for catastrophic exsanguinating rupture has long been recognized. Surgical intervention has paralleled advances in angiography and vascular surgical technique. In 1949 DeBakey and Cooley [1] reported the first successfully resected aneurysm of the superior mesenteric artery. Since that time 18 additional splanchnic artery aneurysms have been surgically resected, including 5 cases involving the superior mesenteric artery and 2 involving the celiac trunk. The clinical observations, surgical technique and follow-up are described.

Journal of Vascular Surgery, 2016

Objective: Splanchnic artery aneurysms (SAAs) are uncommon, and standards for surveillance and intervention are lacking. The goal of this study was to review our 20-year experience with managing SAAs. Methods: The Research Patient Data Registry at the Massachusetts General Hospital was queried, and all patients with SAAs identified by axial imaging from 1994 to 2014 were included. Aneurysms were stratified into two cohorts: those that underwent early intervention (<6 months after lesion discovery) and those that received surveillance. Primary study end points included aneurysm growth or rupture during surveillance and patient 30-day morbidity or mortality after aneurysm repair. Results: There were 264 SAAs identified in 250 patients. In 166 patients, 176 SAAs (66.6%) were placed into the surveillance cohort; 38 SAAs (21.6%) did not have subsequent axial imaging and were considered lost to follow-up. Mean aneurysm size in the surveillance cohort at first imaging study was 16.28 mm (8-41 mm), and mean surveillance time was 36.1 months (2-155 months); 126 SAAs (91.3%) remained stable in size over time, and 8 SAAs (5.8%) required intervention for aneurysm growth after a mean of 24 months. There were no ruptures in the surveillance cohort. There were 88 SAAs (33.3%) repaired early. Mean size of SAAs that were repaired early was 31.1 mm (10-140 mm). For intact SAAs, 30-day morbidity and mortality rates after repair were 13% and 3%, respectively. In the early repair cohort, 13 SAAs (14.7%) were ruptured at presentation. The 30-day morbidity and mortality rates after rupture were 54% and 8%, respectively. Five ruptured SAAs (38%) were anatomically located in the pancreaticoduodenal arcade. On univariate analysis, pancreaticoduodenal aneurysms were strongly associated with rupture (P [ .0002). Conclusions: Small SAAs (#25 mm) are not prone to significant expansion and do not require frequent surveillance imaging. Imaging every 3 years for small SAAs is adequate. Aneurysms of the pancreaticoduodenal arcade and gastroduodenal aneurysms are more likely to rupture and therefore warrant a more aggressive interventional approach.

Annals of Vascular Surgery, 1996

Aneurysms involving the splanchnic arteries represent an uncommon and potentially lethal form of vascular disease. Because they frequently present as life-threatening clinical emergencies, a clear understanding of the presentation and management of these aneurysms is essential for the practicing vascular surgeon. The purpose of this review was to document recent changes in the diagnosis and management of common splanchnic artery aneurysms. Traditionally the most commonly reported splanchnic artery aneurysms have involved, in decreasing order of frequency, the splenic, hepatic, and celiac arteries.~ We reviewed the English language literature for the past 10 years (1985 to 1995) for reports of these lesions. Interestingly, in contrast to previously published series, aneurysms of the hepatic arteries were the most frequently reported splanchnic artery aneurysms in the past decade. This trend probably relates to the increasing use of percutaneous diagnostic and therapeutic biliary tract procedures. During these procedures, injury to the intrahepatic branches of the hepatic artery can lead to the development of false aneurysms of these vessels. In addition to these iatrogenic false aneurysms, the increased use of diagnostic CT scanning following blunt liver trauma has also led to increased detection of posttraumatic false aneurysms of the intrahepatic arterial

Annals of Vascular Surgery, 1996

Annals of Vascular Surgery, 2021

Objective: Splanchnic artery aneurysms (SAAs) are uncommon, and standards for surveillance and intervention are lacking. The goal of this study was to review our 20-year experience with managing SAAs. Methods: The Research Patient Data Registry at the Massachusetts General Hospital was queried, and all patients with SAAs identified by axial imaging from 1994 to 2014 were included. Aneurysms were stratified into two cohorts: those that underwent early intervention (<6 months after lesion discovery) and those that received surveillance. Primary study end points included aneurysm growth or rupture during surveillance and patient 30-day morbidity or mortality after aneurysm repair. Results: There were 264 SAAs identified in 250 patients. In 166 patients, 176 SAAs (66.6%) were placed into the surveillance cohort; 38 SAAs (21.6%) did not have subsequent axial imaging and were considered lost to follow-up. Mean aneurysm size in the surveillance cohort at first imaging study was 16.28 mm (8-41 mm), and mean surveillance time was 36.1 months (2-155 months); 126 SAAs (91.3%) remained stable in size over time, and 8 SAAs (5.8%) required intervention for aneurysm growth after a mean of 24 months. There were no ruptures in the surveillance cohort. There were 88 SAAs (33.3%) repaired early. Mean size of SAAs that were repaired early was 31.1 mm (10-140 mm). For intact SAAs, 30-day morbidity and mortality rates after repair were 13% and 3%, respectively. In the early repair cohort, 13 SAAs (14.7%) were ruptured at presentation. The 30-day morbidity and mortality rates after rupture were 54% and 8%, respectively. Five ruptured SAAs (38%) were anatomically located in the pancreaticoduodenal arcade. On univariate analysis, pancreaticoduodenal aneurysms were strongly associated with rupture (P [ .0002). Conclusions: Small SAAs (#25 mm) are not prone to significant expansion and do not require frequent surveillance imaging. Imaging every 3 years for small SAAs is adequate. Aneurysms of the pancreaticoduodenal arcade and gastroduodenal aneurysms are more likely to rupture and therefore warrant a more aggressive interventional approach.

E xcellent success rates have been achieved with differ-ent endovascular techniques in the treatment of splanchnic aneu-rysms. This pictorial essay describes the endovascular management of dif-ferent splanchnic aneurysms. METHOD This was a retrospective study that included all aneurysms involving the splanchnic arteries that were referred to our department for endovascular treatment over a period of more than 10 years (from June 2002 to December 2012). RESULTS 63 patients were included in this study. Males were more common than females (4.7:1) and more than half of the patients were in the 30 to 60 year age group. The most common symp-toms were abdominal pain, melena, and hematemesis (Figure 1A). Pancreatitis (29%), surgery (22%), infection (14%), and trauma (12%) were the most com-mon causes (Figure 1B). The most com-mon locations were the hepatic artery (39%) and the splenic artery (31%; Fig-ure 1C). The most common endovascu-lar techniques used were proximal coil embolization (51...

Digestive Diseases and Sciences, 2004

Journal of Vascular Surgery, 2011

The management of patients with splenic artery aneurysms (SAAs) is variable since the natural history of these aneurysms is poorly delineated. The objective of this study was to review our experience with open repair, endovascular therapy, and observation of SAAs over a 14-year interval. Methods: Between January 1, 1996 and December 31, 2009, 128 patients with SAAs were evaluated. Sixty-two patients underwent surgical repair (n ‫؍‬ 13) or endovascular coil/glue ablation (n ‫؍‬ 49), while 66 patients underwent serial observation. The original medical records and computed tomography (CT) imaging were reviewed. Statistical analyses were performed using 2 or Fisher's exact test for categorical patient characteristics and t-test for continuous variables. Kaplan-Meier estimates for survival were calculated. Mortality was verified via the Social Security Death Index. Results: Patients (61 ؎ 11 years, 69% female) were investigated for abdominal symptoms (49%) or had the incidental finding of SAA (mean size, 2.4 ؎ 1.4 cm). Seven patients (5.5%) presented with rupture and were treated emergently with two perioperative mortalities (29%). Patients requiring surgical or endovascular treatment were more likely male (40% vs 21%, P ‫؍‬ .031), younger (58 vs 64 years; P ‫؍‬ .004), and current smokers (18% vs 5%; P ‫؍‬ .035). Increased aneurysm calcification was associated with decreased SAA size (P ‫؍‬ .013). The mean aneurysm size at initial diagnosis was 1.67 cm for patients undergoing observation and 3.13 cm for the treated group (P < .001). Endovascular repair was safe and durable with a mean 1.5-mm regression in SAA size over 2 years. The mean rate of growth for observed SAA was 0.2 mm/y. Ten-year survival was 89.4% (95% confidence interval: 82.0, 97.4) for all patients (observed group, 94.9%; treated group, 85.1%; P ‫؍‬ .18). No late aneurysm-related mortality was identified. Conclusions: Ruptured SAAs are lethal. Large SAAs can undergo endovascular ablation safely with durable SAA regression. Smaller SAAs (<2 cm) grow slowly and carry a negligible rupture risk.

Journal of Vascular Surgery, 2008

Objective: The aim of this study was to analyze our 25-year experience with surgical treatment of visceral artery aneurysms (VAAs), with particular attention paid to early and long-term results. Materials and Methods: From January 1982 to September 2007, 55 patients (32 males, 58%, and 23 females, 42%) underwent surgical treatment of 59 VAAs. Only one patient was treated with an endovascular procedure. Mean patient age was 59.3 years (range, 36-78 years). The site of aneurysmal disease was splenic artery in 30 (50.8%) cases, renal artery in nine (15.2%) cases, common hepatic artery in seven (11.9%) cases, pancreaticoduodenal artery in four (6.8%) cases, celiac trunk in three (5.1%) cases, superior mesenteric artery in two (3.4%) cases, and gastroduodenal, inferior mesenteric, middle colic and right gastroepiploic in one (1.7%) case for each artery. Two (3.6%) patients had multiple VAAs. In five (9.1%) patients, an abdominal aortic aneurysm coexisted. Early results in terms of mortality and major complications were assessed. Follow-up consisted of clinical and ultrasound examinations at 1 and 12 months, and yearly thereafter.

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2009

patients with SAA underwent laparoscopic surgery. Among these patients, 4 had splenectomy alone and 2 had splenectomy with distal pancreatectomy. The mean size of the aneurysm was 3.1 cm (range: 2 to 4 cm).