Treatment options for visceral artery aneurysms: ten years’ experience

Open surgical repair (OSR) and endovascular techniques (ET) are both described in the literature for treating visceral artery aneurysms (VAAs). Aim of this work is to report a two-center experience (Division of Vascular Surgery, San Carlo Borromeo Hospital, Milan, and Ist Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese) of patients treated for a VAA using either OSR or ET, analyzing perioperative outcomes. Method Clinical data of 32 VAAs in 32 patients treated between January 2001 and May 2011 were retrospectively reviewed. Outcomes were analyzed using log-rank test, chi2 and Wilcoxon. Eighteen patients were men (56,3%). Median age was 64 years (range 26-79). Median sac diameter was 2,7 cm (range 1,6-9 cm). Sixteen aneurysms were asymptomatic, while another 16 were symptomatic: half of them were ruptured causing hemoperitoneum or gastrointestinal bleeding. The artery involved was the splenic artery in fifteen cases (46,9%), in 7 the hepatic (21,8%), in 2 the gastroepiploic and the superior mesenteric artery (both 6,3%), in 5 gastroduodenal or pancreaticoduodenal artery (15,6%) and in 1 the celiac trunk (3,1%). Two patients with hepatic aneurysms were affected by Ehlers-Danlos Syndrome and polyarteritis nodosa; an alpha-1 antitrypsin deficiency was found in a patient with a gastroduodenal aneurysm. Results ET was performed in 19 cases (59%) using covered stents (7 patients), coil embolization (5), plug placement (1), thrombin injection (2) and multiple associated techniques (4). OSR consisted in aneurysmectomy with end to end anastomoses (5 patients) or interposition graft (1), aneurysm ligation (4), splenectomy (2). One patient died during exploration for hemoperitoneum due to VAA rupture (3%). After ET, 3 patients experienced respectively a temporary increase of pancreatic amylase and serum creatinine and one splenic infarction (covered stent placed for splenic artery aneurysm). Among OSR one patient experienced a transient raising of pancreatic amylase; a pancreatic abscess after a splenic aneurysm ligation (which led to death in POD 72) was found in one; a third patient had a pancreatic fistula after right gastroepiploic aneurysm resection. OSR and ET had similar perioperative complication rates (38,4% vs 26,3%, p=0.54). OSR had a longer inhospital stay than ET(8 vs 4 days, p=0,07). Conclusions Clinical presentation, location of the aneurysm, as well as patients' operative risk are the factors that mainly influence surgical strategy. Both OSR and ET offered a safe way to treat VAAs in our experience. ET was associated with shorter in-hospital stay compared to OSR.