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Vascular: Visceral Artery Aneurysms Treatable Via Minimally Invasive Methods

Combining these methods with other tools may be especially effective

Visceral artery aneurysms (VAAs) and pseudoaneurysms can be treated effectively with minimally invasive methods, both alone or in combination with other techniques, according to a study published in the Journal of Vascular Surgery.

For many years, surgical intervention—often aneurysm ligation with or without end-organ resection—was the gold standard of care for VAAs. There are now a variety of endovascular options that have been described in the medical literature. However, data on efficacy and outcomes were lacking. The authors of the current study therefore decided to conduct a retrospective review of patients diagnosed with aneurysms or pseudoaneurysms of the celiac, superior mesenteric, and inferior mesenteric arteries, or their branches. Participants were treated between June 1999 and June 2009. Any degree of bleeding was considered an indication for intervention; type and means of intervention was determined by the managing physician. Patient records were reviewed for overall 30-day mortality, aneurysm-related 30-day mortality, morbidity, and cause of death. To assess recurrence, subsequent treatment, and complications, a three-question survey was also sent to all patients.

One hundred seventy-six patients with 185 aneurysms were identified for analysis. Fifty-six percent (99) were male and mean age was 58 (range 18 to 89 years). Coil embolization was by far the most common minimally invasive method (it was the sole interventional technique used in 78 percent of patients), followed by aneurysm exclusion via covered stent deployment. Treatment was successful in 98 percent of aneurysms and the overall 30-day mortality rate was 6.2 percent. Only two patients, or 1.1 percent, reported long-term complications (one case of bile duct ischemia and one case of sepsis).

In the authors’ review, both endovascular and transabdominal techniques were used, sometimes together. Ultrasound-guided percutaneous aneurysm access was found to be an especially valuable addition to these methods. “The wide variety of endovascular and percutaneous techniques employed and the willingness to combine these techniques afforded a very high success rate with low recurrence and morbidity. As technology grows and the experience with these and emerging techniques increases, even more VAAs will become amenable to minimally invasive treatment,” the authors write.

Source: Fankhauser GT, Stone WM, Naidu SG, et al. 2011. The minimally invasive management of visceral artery aneurysms and pseudoaneurysms. Journal of Vascular Surgery 53:966-970.