Evolution of the therapeutic approach of visceral artery aneurysms

Abstract

Introduction: Visceral artery aneurysms are an infrequent entity. Most of them are asymptomatic, but when they present as a rupture, a high mortality is associated. Material and Methods: We review our experience of 18 cases between 1988 and 2006. Results: 9 males and 9 females with a mean age of 66,5 years are analyzed. Aneurysms were located in splenic artery (9), hepatic artery (2), superior mesenteric artery (2), celiac trunk (3), inferior mesenteric artery (1) and gastroduodenal artery (1). Three of them were associated with abdominal aorta aneurysms. Fourteen patients were asymptomatic, three presented abdominal pain and one case presented with rupture and intraperitoneal bleeding. Surgical treatment was performed in thirteen of the patients and endovascular in five. Two cases of endovascular treatment failed and surgery was necessary. Postsurgical mortality was 0 and complications appeared in 2 patients. Mean hospital stay after surgical treatment was 11 days and 3 days after endovascular one. None of the patients presented recurrences, and one has chronic mesenteric ischemia as sequelae of surgical treatment of a superior mesenteric artery aneurysm. Conclusion: Visceral artery aneurysms must be treated if it is feasible, due to the potential risk of rupture. Endovascular treatment associates lower morbimortality rates and shorter hospital stay than surgical one, but nowadays many aneurysms are not suitable for this management. Endovascular treatment is a technically difficult approach, that requires a specific training and the first cases represent a learning curve.