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Visceral artery aneurysms—follow-up of 23 patients with 31 aneurysms after surgical or interventional therapy

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Abstract

Purpose

Visceral artery aneurysms (VAA) are rare forms of vascular pathology, with an incidence of 0.1% to 0.2% in routine autopsies [1–4]. They frequently present as a life-threatening, often fatal, emergency, if associated with rupture and intra- or retroperitoneal bleeding. The clinical symptoms, natural history, and mortality of VAAs vary depending on the vessels involved. The mortality rates range from 8.5% up to 25% and, in pregnant women, up to 75% [1, 4, 6, 7]. A retrospective analysis of all VAAs diagnosed at our institution from 1991 to 2006 was performed. The presentation, management, and outcome of therapy was evaluated for each patient.

Materials and methods

Twenty-three patients (12 men, 11 women, mean age 55.8 years) with 31 VAAs were identified. The anatomical involvement concerned seven regions: celiac (CT) nine, superior mesenteric (SMA) seven, splenic (SA) five, hepatic (HA) six, gastroduodenal (GDA) two, pancreatoduodenal (PDA) one, and one branch of the superior mesenteric artery. Fourteen patients presented symptoms attributable to their aneurysms, which included a total of four ruptures. Nine patients had no symptoms. The etiology of VAAs was atherosclerosis (67.8%), mycotic embolization (12.9%), trauma (9.7%), Marfan Syndrome (3.2%), Klippel–Trenaunay–Weber syndrome (3.2%), and giant cell arteritis (3.2%). Open surgery was performed for 29 aneurysm in 21 patients: partial resection and tailoring in 13 cases (41.9%), resection of the aneurysm with additional autologous vein graft interposition in nine cases and prosthetic graft interposition in 2 cases (35.5%), aneurysm exclusion by ligation in three cases (9.6%) and aneurysm ligation combined with additional autologous bypass procedure in two cases (6.5%). Two patients (6.5%) were treated interventionally with embolization, in one case each with a right hepatic artery aneurysm and in the other with splenic artery aneurysm.

Results

No deaths were observed. The morbidity rate associated with surgical treatment was low. After treatment, a total of 17 patients were followed up for a period ranging from 3 to 154 months (mean 54.6 months). Fifteen patients required no additional procedures. The patency rate of the reconstructed visceral arteries was 90.4%. Six patients were lost for follow-up.

Conclusions

Surgical and interventional therapy of VAAs can be life-saving treatments for the patient with a low periprocedural morbidity. The success rate, defined as the exclusion of VAA rupture and the absence of abdominal discomfort, in our material was 88.2% after a mean follow-up of 54.6 months.

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Parts of this study have been presented as a poster titled “Langzeitergebnisse nach operativer und interventioneller Therapie von Visceralarterienaneurysmen,” Duran M, Grotemeyer D, Park EJ, Hoffmann N, and Sandmann W on the 24th annual meeting of the Deutsche Gesellschaft für Gefäßchirurgie in Dresden, Germany in September 10 to 13, 2008.

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Authors and Affiliations

  1. Department of Vascular Surgery and Kidney Transplantation, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany

    Dirk Grotemeyer, Mansur Duran, Eun-Jo Park, Norbert Hoffmann, Franziska Iskandar, Kai M. Balzer & Wilhelm Sandmann

  2. Institute of Radiology, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany

    Dirk Blondin

  3. Klinik für Gefäßchirurgie und Nierentransplantation, Universitätsklinikum der Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Germany

    Dirk Grotemeyer

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  1. Dirk Grotemeyer
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  2. Mansur Duran
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  3. Eun-Jo Park
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  4. Norbert Hoffmann
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  7. Kai M. Balzer
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  8. Wilhelm Sandmann
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Correspondence to Dirk Grotemeyer.

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Both authors Dirk Grotemeyer and Mansur Duran contributed equally to this manuscript.

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Grotemeyer, D., Duran, M., Park, EJ. et al. Visceral artery aneurysms—follow-up of 23 patients with 31 aneurysms after surgical or interventional therapy. Langenbecks Arch Surg 394, 1093–1100 (2009). https://doi.org/10.1007/s00423-009-0482-z

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  • DOI: https://doi.org/10.1007/s00423-009-0482-z

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