Owing to different clinical manifestations and a unique, specific, pathology, renal artery aneurysms are discussed separately.
The reported incidence of visceral artery aneurysms is approximately 0.01% to 2% on autopsy and angiographic studies 2, with over half the cases involving splenic artery aneurysms.
Most patients are asymptomatic and these aneurysms are usually discovered incidentally. Less frequently they are associated with abdominal pain or are 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.
Visceral artery aneurysms 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. Segmental arterial mediolysis is also an increasingly recognized cause.
Multiple aneurysms are present in approximately one-third of the cases 3. The distribution among visceral arteries is 1:
- splenic artery aneurysm: ~70% (range 60-80%)
- hepatic artery aneurysm: ~20%
- superior mesenteric artery aneurysm: ~6%
- gastroduodenal artery and pancreatic branches: ~6%
- coeliac artery aneurysm: ~4%
- gastric and gastroepiploic artery aneurysm: ~4%
- jejunal and ileocolic arteries: ~3%
- inferior mesenteric artery aneurysm: <1%
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 visceral artery aneurysms is generally recommended when they are greater than 2 cm in diameter.
Follow-up recommendations some types of visceral artery aneurysms is not established. Patients with pancreaticoduodenal aneurysms (e.g. post-Whipple procedure patients) are thought to be at higher risk of rupture than other visceral artery aneurysms. If the aneurysm is thought to be a pseudoaneurysm, 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