Stent graft repair of visceral artery aneurysms

Abstract

Endovascular techniques with coil embolization have been used in certain visceral aneurysm cases, often resulting in sacrifice of the involved visceral vessel and end-organ thrombosis. We describe two cases in which stent grafts were used to treat these aneurysms, allowing preservation of visceral artery and end-organ flow while completely excluding the aneurysm. Case 1 was a 50-year-old morbidly obese woman with a history of multiple abdominal operations for renal cell carcinoma who was found to have a large splenic artery aneurysm. A 12-mm x 50-mm Wallgraft endoprosthesis (Boston Scientific, Watertown, Mass) was placed across the aneurysm from a femoral approach. The aneurysm was completely excluded, and splenic artery flow was preserved. A subsequent computed tomographic scan showed complete aneurysm exclusion and preserved flow to the spleen. Case 2 was a 73-year-old man with hypertension with back pain who was found with computed tomographic scan to have an 8-cm hepatic artery aneurysm. Arteriography showed a large saccular aneurysm arising from the mid portion of the common hepatic artery. Two 5-mm x 26-mm Jostent stent grafts (Jomed, Alpharetta, Ga) were placed across the aneurysm neck, completely excluding the aneurysm and preserving hepatic artery flow. The patient became pain free, and subsequent duplex ultrasound scan showed a thrombosed aneurysm with normal hepatic artery flow. Stent graft techniques show early promise as a safe and effective treatment of visceral artery aneurysms in selected patients at high risk. Endografts, unlike coil embolization, exclude the aneurysm and preserve end organ perfusion. Determining the durability of this type of therapy will require further study.