Ultra-Long-Term CT Angiography Evaluation of Patients Treated with Covered Stents for Visceral Aneurysms: A Single Center Case Series

Abstract

Objective: Endovascular repair of visceral artery aneurysms (VAAs) and visceral artery pseudoaneurysms (VAPAs) using covered stent grafts is a novel technique that preserves efferent vessel patency and prevents end-organ ischemia; however, long-term results are lacking in the literature. This study aims to evaluate ultra-long-term outcomes (>5 years) using CT angiography (CTA) and technical aspects of covered stents in treating VAAs and VAPAs. Methods: A single-center retrospective study was conducted on patients with VAAs and VAPAs treated with stent grafts between 2004 and 2023. The study included an ultra-long-term follow-up using CTA. Stent graft patency, aneurysm characteristics, technical success, 30-day and long-term follow-up clinical success, and mortality were assessed. Results: Among 23 patients presenting with VAAs and VAPAs treated exclusively with covered stents implantation, 7 (mean age: 68 years, SD 14), including 5 with VAAs and 2 with VAPAs, met the inclusion criteria for the study. Six of the seven patients underwent elective procedures with no significant periprocedural complications. Both technical and 30-day clinical success rates were 100%. The mean follow-up period was 10 years (125 months SD 53). At the 5-year follow-up, 71% of stent grafts remained patent. No patient experienced aneurysm sac revascularization or rupture. Stent obstruction did not affect survival. Conclusions: This study demonstrates that endovascular covered stenting is a durable and effective treatment for VAAs and VAPAs, even in the ultra-long term, with a patency rate of 71% at a mean CTA follow-up of 125 months, the longest reported to date and no cases of sac revascularization. Stent thrombosis was significantly associated with VAPAs.

Keywords: CT angiography; covered stent; endovascular; pseudoaneurysm; stent graft; visceral aneurysm.

Figure 1

Study population selection flowchart.

Figure 2

Multimodal imaging and long-term follow-up of a hepatic pseudoaneurysm. (a) Angio CT shows a pseudoaneurysm of the hepatic artery origin with dissection and obstruction of the artery; (b) dynamic CT angiography used for pre-treatment planning; (c) angiogram of the superior mesenteric artery demonstrating collateral flow to the distal hepatic artery; (d) intraoperative image of Viabahn stent graft deployment in the coeliac trunk and in the splenic artery to exclude the aneurismatic origin of the hepatic artery; (e) CT at 5 years with patency of the implanted stent graft; (f) occluded stent graft at 139 months follow-up.