Management of visceral artery aneurysms

Objective: Visceral artery aneurysms, despite being uncommon, are important vascular diseases, since they frequently are life-threatening, and often fatal emergencies. The purpose of this study is to review our experience with treatments of visceral artery aneurysms. Method: Between 1988 and June, 2004, 37 visceral artery aneurysms were treated in 35 patients (17 male and 18 female) with average age of 56 ± 14 years. The most common locations were the splenic artery (18), the hepatic artery (10) and the superior mesenteric artery (four). 22 patients were asymptomatic, 13 patients were symptomatic. Emergency surgery was performed on three patients, elective open surgery on 29 patients, and endovascular treatment on seven patients. Results: Perioperative mortality rate was 3.1% in the surgical group. The perioperative morbidity rate was 5.7%: one case of respiratory distress and one case of bilious fistula were manifested in the immediate postoperative period. None of the patients died in the endovascular group; perioperative morbidity rate was 14.3% (one case of hepatic artery thrombosis after failure of gastroduodenal artery aneurysm embolization). Failure of the procedure was 42.9% (three cases of aneurysm recanalization). Conclusions: We believe that an aggressive surgical approach is justified even in case of asymptomatic visceral artery aneurysms, due to the low morbidity/mortality rates. Endovascular treatment should be reserved to selected cases.