Treatment 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 Science Center
- 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
The indications for treating specific visceral artery aneurysms depend upon the natural history of disease for the specific site. In general, all visceral artery pseudoaneurysms (VAPAs), symptomatic visceral artery aneurysms (VAAs), and many asymptomatic VAAs (those meeting criteria) require treatment to reduce the risk of death associated with rupture . (See "Overview of visceral artery aneurysm and pseudoaneurysm", section on 'Management'.)
There has been a steady increase in the use of an endovascular approach for aneurysmal disease at other sites, and although all VAAs/VAPAs can technically be treated using endovascular techniques, an open approach may remain the optimal strategy, particularly among those who require emergency repair. Endovascular intervention is an excellent approach in the elective setting, particularly for patients who are poor risk surgical candidates.
The specific treatment of VAAs (open or endovascular) will be reviewed here. The clinical features, diagnosis, and management of VAA is reviewed separately. (See "Overview of visceral artery aneurysm and pseudoaneurysm".)
APPROACH TO TREATMENT
The goal of treatment of visceral artery aneurysms (VAAs) and visceral artery pseudoaneurysms (VAPAs) consists of excluding the aneurysm sac from the systemic circulation while ideally preserving distal blood flow. If this cannot be accomplished, the aneurysm can be occluded. Either can be accomplished using an open surgical or endovascular approach. The choice for an individual patient needs to take into account the clinical presentation, site of the aneurysm (vascular bed), location within the affected artery (proximal versus distal, main trunk branch vessel), clinical presentation, associated risk factors, and local expertise . (See 'Endovascular intervention' below and 'Open surgery' below.)
For either approach, it is necessary to evaluate the specific anatomy of involved visceral vessel before determining the appropriate treatment. (See 'Specific aneurysm sites' below and 'Endovascular intervention' below and 'Open surgery' below.)
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