Visceral Artery Aneurysms and Pseudoaneurysms—Should They All be Managed by Endovascular Techniques?

Abstract

Visceral artery aneurysms (VAA) and pseudoaneurysms (VAPA) can be life-threatening conditions with high incidence of rupture and hemorrhage. Greater availability and increased use of advanced imaging technology has led to the increased incidental detection of asymptomatic visceral aneurysms. In addition, increased percutaneous endovascular interventions have raised the incidence of iatrogenic pseudoaneurysms. Due to this, both VAA and VAPA have become an increasingly frequent diagnosis confronting the vascular surgeon. Over the past decade, there has been steady increase in the utilization of minimally invasive, non-operative interventions, for vascular occlusive and aneurysmal disease. All VAA and VAPA can technically be fixed by endovascular techniques but that does not mean they should. These catheter-based techniques constitute an excellent approach in the elective setting, particularly in patients who are poor surgical candidates due to their comorbidities or who present a hostile abdomen. However, in the emergent setting it may carry a higher morbidity and mortality. We review the literature about open and endovascular approach for the treatment of VAA and VAPA both in the elective and emergent setting.

Keywords: endovascular; pseudoaneurysm; splanchnic; visceral artery aneurysm.

Fig. 1

Traditional open surgical management. (a) Splenic artery aneurysm, (b) Ligation and exclusion of splenic artery aneurysm.

Fig. 2

(a) Celiac artery aneurysm, (b) Resection and revascularization of celiac artery aneurysm.

Fig. 3

Endovascular management. (a) Coil embolization of arterial inflow and outflow, (b) Coil embolization of aneurysm, (c) Stent graft exclusion of aneurysm.