Overview of visceral artery aneurysm and pseudoaneurysm
- Bauer Sumpio, MD, PhD
Bauer Sumpio, MD, PhD
- Professor of Surgery and Radiology
- Yale University
- Section Editors
- John F Eidt, MD
John F Eidt, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor of Surgery, Texas A&M Health Sciences Center - Dallas Campus
- Vice Chair of Vascular Surgical Services, Baylor Heart and Vascular Hospital at Dallas
- Joseph L Mills, Sr, MD
Joseph L Mills, Sr, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor and Chief
- Division of Vascular Surgery and Endovascular Therapy
- Baylor College of Medicine
Visceral artery aneurysms (VAAs) and visceral artery pseudoaneurysms (VAPA) are defined as aneurysms affecting the celiac, superior, or inferior mesenteric arteries and their branches. VAA and VAPA are relatively rare [1,2]. The splenic artery (VAA) and hepatic artery (VAPA) are most commonly involved. VAA and VAPA can be life-threatening conditions with high incidences of rupture and hemorrhage. The clinical features of symptomatic disease differ for each anatomic location; however, clinical symptoms and signs are nevertheless nonspecific. VAA and VAPA are often not suspected initially in patients presenting with abdominal complaints, due to their rarity, which can lead to a delay in diagnosis. Consequently, these often present with life-threatening hemorrhage due to a high incidence of rupture [3,4]. Thus, the general approach to VAA/VAPA is early elective intervention rather than watchful waiting, to minimize the risk of rupture.
The diagnosis and management of visceral artery aneurysms and pseudoaneurysms will be reviewed here. The surgical and endovascular management of VAAs and VAPAs are discussed separately. (See "Treatment of visceral artery aneurysm".)
DEFINITIONS AND ANATOMIC DISTRIBUTION
Visceral artery aneurysms (VAAs) and visceral artery pseudoaneurysms (VAPAs) are defined as those affecting the celiac, superior, or inferior mesenteric arteries and their branches. Aneurysms of the renal artery are usually regarded separately.
True VAA involves all layers of the wall, each of which is thinned but intact. False aneurysms, visceral artery pseudoaneurysm (VAPAs), result from a tear in the vessel wall due to trauma with subsequent periarterial hematoma formation . As with any blood vessel, a given artery is defined as aneurysmal if there is a focal dilation of the artery that has a diameter more than 1.5 times the normal diameter of the artery. As an example, the most common true VAA, splenic artery aneurysm, is usually noted when the diameter of the artery is around 1 cm. VAAs/VAPAs are often not clinically detected until their diameters are well beyond the diameter that is considered aneurysmal.
Average normal diameters of the various visceral vessels are as follows (±standard deviation) [5,6]:
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- DEFINITIONS AND ANATOMIC DISTRIBUTION
- EPIDEMIOLOGY AND ASSOCIATIONS
- CLINICAL FEATURES
- General observations
- Specific aneurysms
- - Hepatic artery aneurysm
- - Splenic artery aneurysm
- - Celiac artery aneurysm
- - Superior mesenteric artery aneurysm
- Differential diagnosis
- Natural history and role of observation
- Indications for treatment
- Evaluation for other aneurysms
- SUMMARY AND RECOMMENDATIONS