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
- University of South Carolina School of Medicine Greenville
- 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]:
- Pulli R, Dorigo W, Troisi N, et al. Surgical treatment of visceral artery aneurysms: A 25-year experience. J Vasc Surg 2008; 48:334.
- Cordova AC, Sumpio BE. [Not Available]. Ann Vasc Dis 2013; 6:687.
- Ferrero E, Viazzo A, Ferri M, et al. Management and urgent repair of ruptured visceral artery aneurysms. Ann Vasc Surg 2011; 25:981.e7.
- Etezadi V, Gandhi RT, Benenati JF, et al. Endovascular treatment of visceral and renal artery aneurysms. J Vasc Interv Radiol 2011; 22:1246.
- Silveira LA, Silveira FB, Fazan VP. Arterial diameter of the celiac trunk and its branches. Anatomical study. Acta Cir Bras 2009; 24:43.
- Zeng DB, Dai CZ, Lu SC, et al. Abnormal splenic artery diameter/hepatic artery diameter ratio in cirrhosis-induced portal hypertension. World J Gastroenterol 2013; 19:1292.
- Stanley JC, Wakefield TW, Graham LM, et al. Clinical importance and management of splanchnic artery aneurysms. J Vasc Surg 1986; 3:836.
- Dave SP, Reis ED, Hossain A, et al. Splenic artery aneurysm in the 1990s. Ann Vasc Surg 2000; 14:223.
- Pilleul F, Beuf O. Diagnosis of splanchnic artery aneurysms and pseudoaneurysms, with special reference to contrast enhanced 3D magnetic resonance angiography: a review. Acta Radiol 2004; 45:702.
- Gehlen JM, Heeren PA, Verhagen PF, Peppelenbosch AG. Visceral artery aneurysms. Vasc Endovascular Surg 2011; 45:681.
- Ehtuish EF, Mishra A. Multiple visceral aneurysms in antiphospholipid antibody syndrome - an unusual presentation. Br J Radiol 2008; 81:e184.
- Berceli SA. Hepatic and splenic artery aneurysms. Semin Vasc Surg 2005; 18:196.
- Chiesa R, Astore D, Guzzo G, et al. Visceral artery aneurysms. Ann Vasc Surg 2005; 19:42.
- Huang YK, Hsieh HC, Tsai FC, et al. Visceral artery aneurysm: risk factor analysis and therapeutic opinion. Eur J Vasc Endovasc Surg 2007; 33:293.
- Pasha SF, Gloviczki P, Stanson AW, Kamath PS. Splanchnic artery aneurysms. Mayo Clin Proc 2007; 82:472.
- Sachdev U, Baril DT, Ellozy SH, et al. Management of aneurysms involving branches of the celiac and superior mesenteric arteries: a comparison of surgical and endovascular therapy. J Vasc Surg 2006; 44:718.
- Tulsyan N, Kashyap VS, Greenberg RK, et al. The endovascular management of visceral artery aneurysms and pseudoaneurysms. J Vasc Surg 2007; 45:276.
- Salcuni PF, Spaggiari L, Tecchio T, et al. Hepatic artery aneurysm: an ever present danger. J Cardiovasc Surg (Torino) 1995; 36:595.
- Abbas MA, Fowl RJ, Stone WM, et al. Hepatic artery aneurysm: factors that predict complications. J Vasc Surg 2003; 38:41.
- Carr SC, Pearce WH, Vogelzang RL, et al. Current management of visceral artery aneurysms. Surgery 1996; 120:627.
- Shanley CJ, Shah NL, Messina LM. Common splanchnic artery aneurysms: splenic, hepatic, and celiac. Ann Vasc Surg 1996; 10:315.
- Hogendoorn W, Lavida A, Hunink MG, et al. Open repair, endovascular repair, and conservative management of true splenic artery aneurysms. J Vasc Surg 2014; 60:1667.
- Trastek VF, Pairolero PC, Joyce JW, et al. Splenic artery aneurysms. Surgery 1982; 91:694.
- Abbas MA, Stone WM, Fowl RJ, et al. Splenic artery aneurysms: two decades experience at Mayo clinic. Ann Vasc Surg 2002; 16:442.
- Yadav R, Tiwari MK, Mathur RM, Verma AK. Unusually giant splenic artery and vein aneurysm with arteriovenous fistula with hypersplenism in a nulliparous woman. Interact Cardiovasc Thorac Surg 2009; 8:384.
- Agrawal A, Whitehouse R, Johnson RW, Augustine T. Giant splenic artery aneurysm associated with arteriovenous malformation. J Vasc Surg 2006; 44:1345.
- Lowry SM, O'Dea TP, Gallagher DI, Mozenter R. Splenic artery aneurysm rupture: the seventh instance of maternal and fetal survival. Obstet Gynecol 1986; 67:291.
- McMahon DP, Ward WH, Harwood JL, Moore EM. An institutional review of splenic artery aneurysm in childbearing-aged females and splenic artery aneurysm rupture during pregnancy. Is screening justified? Mil Med 2012; 177:96.
- Ayalon A, Wiesner RH, Perkins JD, et al. Splenic artery aneurysms in liver transplant patients. Transplantation 1988; 45:386.
- Nishida O, Moriyasu F, Nakamura T, et al. Hemodynamics of splenic artery aneurysm. Gastroenterology 1986; 90:1042.
- Graham LM, Stanley JC, Whitehouse WM Jr, et al. Celiac artery aneurysms: historic (1745-1949) versus contemporary (1950-1984) differences in etiology and clinical importance. J Vasc Surg 1985; 2:757.
- Jimenez JC, Rafidi F, Morris L. True celiac artery aneurysm secondary to median arcuate ligament syndrome. Vasc Endovascular Surg 2011; 45:288.
- Stone WM, Abbas MA, Gloviczki P, et al. Celiac arterial aneurysms: a critical reappraisal of a rare entity. Arch Surg 2002; 137:670.
- RO Lakin, VS Kashyap. Splanchnic artery aneurysms. In: Vascular Surgery, R. Rutherford (Ed), Saunders, Philadephia 2014. p.2220.
- Schick C, Ritter RG, Balzer JO, et al. Hepatic artery aneurysm: treatment options. Eur Radiol 2004; 14:157.
- Schweigert M, Adamus R, Stadlhuber RJ, Stein HJ. Endovascular stent--graft repair of a symptomatic superior mesenteric artery aneurysm. Ann Vasc Surg 2011; 25:841.e5.
- Stone WM, Abbas M, Cherry KJ, et al. Superior mesenteric artery aneurysms: is presence an indication for intervention? J Vasc Surg 2002; 36:234.
- Ha JF, Phillips M, Faulkner K. Splenic artery aneurysm rupture in pregnancy. Eur J Obstet Gynecol Reprod Biol 2009; 146:133.
- 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