Visceral artery aneurysms
With different clinical manifestations and a more characteristic pathology, the renal artery aneurysms are discussed separately.
The reported incidence of VAA is approximately 0.01% to 2% in autopsy and angiographic studies 2 and more than a half are related to splenic artery aneurysms. Multiple aneurysms are present in approximately one third of patients 3. The proportion of aneurysm between visceral arteries are 1:
- splenic artery aneurysm: ~60% to 80%
- hepatic artery aneurysm: ~20%
- superior mesenteric artery aneurysm: ~5.5%
- coeliac artery aneurysm: ~4%
- gastric and gastroepiploic artery aneurysm: ~4%
- gastroduodenal artery and pancreatic branches: ~6%
- jejunal and ileocolic arteries: ~3%
- inferior mesenteric artery aneurysm: <1%
VAAs are usually degenerative and related to a deficiency of the arterial media with loss of elastic fibers and reduced smooth muscle. Other possible causes are atherosclerosis, fibromuscular dysplasia, collagen disorders, trauma, inflammation, infection, or vasculitis 1.
Pancreatitis may promote destruction of the arterial wall resulting in pseudoaneurysms of related visceral arteries.
Most patients are asymptomatic and these aneurysms are usually discovered incidentally. Less frequently they are associated with abdominal pain or could be palpable as a pulsatile mass in the abdomen.
Up to 25% may be complicated by rupture 3. In these cases, patients present with acute abdominal pain and bleeding that is associated with a high rate of morbidity and mortality 4.
Treatment and prognosis
Follow-up and treatment recommendations vary somewhat for different types of visceral artery aneurysms, and are discussed in more detail in their respective articles.
In general, treatment for VAAs is generally recommended when they are >2 cm in size.
Follow-up recommendations some types of VAAs is not established. Patients with pancreaticoduodenal aneurysms (e.g. post-Whipple procedure patients) are thought to be at higher risk of rupture than other VAAs. If the VAA is thought to be a pseudoaneurysm, then it would probably be prudent to have a shorter follow up interval.
- 1. Nosher JL, Chung J, Brevetti LS et-al. Visceral and renal artery aneurysms: a pictorial essay on endovascular therapy. Radiographics. 2006;26 (6): 1687-704. doi:10.1148/rg.266055732 - Pubmed citation
- 2. Belli AM, Markose G, Morgan R. The role of interventional radiology in the management of abdominal visceral artery aneurysms. Cardiovasc Intervent Radiol. 2012;35 (2): 234-43. doi:10.1007/s00270-011-0201-3 - Pubmed citation
- 3. Pasha SF, Gloviczki P, Stanson AW et-al. Splanchnic artery aneurysms. Mayo Clin. Proc. 2007;82 (4): 472-9. doi:10.4065/82.4.472 - Pubmed citation
- 4. Horton KM, Smith C, Fishman EK. MDCT and 3D CT angiography of splanchnic artery aneurysms. AJR Am J Roentgenol. 2007;189 (3): 641-7. doi:10.2214/AJR.07.2210 - Pubmed citation
- 5. Henke PK, Cardneau JD, Welling TH et-al. Renal artery aneurysms: a 35-year clinical experience with 252 aneurysms in 168 patients. Ann. Surg. 2001;234 (4): 454-62. Free text at pubmed - Pubmed citation