AAA and Visceral Aneurysms

  • Jaap Ottevanger
  • Stephen Merrilees
  • Ian CivilEmail author
Part of the Hot Topics in Acute Care Surgery and Trauma book series (HTACST)


An aneurysm is a section of artery which is dilated in comparison to its original vessel diameter. By definition this is generally accepted as dilatation by at least one and a half times the normal vessel diameter. Therefore aneurysms are defined by the artery affected rather than by absolute diameters. Aneurysms can be classified as either true or false. True aneurysms are those which are bound by all three layers of the artery (intima, media, and adventitia), whereas false aneurysms, also known as pseudoaneurysms, are bound only by adventitia. As an aneurysm enlarges, the risk of rupture increases, but for any given size, pseudoaneurysms have a relatively higher rupture risk when compared to true aneurysms of the same size.



A special thanks to associate professor An Tang (University of Montreal) for allowing us to use his previously published illustrative images (Figs. 16.3, 16.4, 16.5, 16.6, 16.7, and 16.8) [39].


  1. 1.
    Ouriel K, Green RM, Donayre C, et al. An evaluation of new methods of expressing aortic aneurysm size: relationship to rupture. J Vasc Surg. 1992;15:12–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Forsdahl SH, Singh K, Solberg S, Jacobsen BK. Risk factors for abdominal aortic aneurysms: a 7-year prospective study: the Tromsø Study, 1994–2001. Circulation. 2009;119:2202–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Landenhed M, Engström G, Gottsäter A, et al. Risk profiles for aortic dissection and ruptured or surgically treated aneurysms: a prospective cohort study. J Am Heart Assoc. 2015;4:e001513. doi: 10.1161/JAHA.114.001513.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    The UK Small Aneurysm Trial Participants. Mortality results for randomized controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. Lancet. 1998;352:1649–55.CrossRefGoogle Scholar
  5. 5.
    Brewster DC, Cronenwett JL, Hallett JW Jr, et al. Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. J Vasc Surg. 2003;37:1106–17.CrossRefPubMedGoogle Scholar
  6. 6.
    Scott SWM, Batchelder AJ, Kirkbride D, Naylor AR, Thompson JP. Late survival in nonoperated patients with infrarenal abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. 2016;52(4):444–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Darling RC III, Brewster DC, Darling RC, LaMuraglia GM, Moncure AC, Cambria RP, et al. Are familial abdominal aortic aneurysms different? J Vasc Surg. 1989;10:39–43.CrossRefPubMedGoogle Scholar
  8. 8.
    ACC/AHA. 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM Jr, White CJ, White J, White RA, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B, American Association for Vascular Surgery, Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, ACC/AHA Task Force on Practice Guidelines Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease, American Association of Cardiovascular and Pulmonary Rehabilitation, National Heart, Lung, and Blood Institute, Society for Vascular Nursing, TransAtlantic Inter-Society Consensus, Vascular Disease Foundation Circulation. 2006; 113(11):e463–654.Google Scholar
  9. 9.
    Mealy K, Salman A. The true incidence of ruptured abdominal aortic aneurysms. Eur J Vasc Surg. 1988;2:405–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Johansen K, Kohler TR, Nicholls SC, et al. Ruptured abdominal aortic aneurysm: the Harborview experience. J Vasc Surg. 1991;13:240–5. discussion 245–7CrossRefPubMedGoogle Scholar
  11. 11.
    Heikkinen M, Salenius J, Zeitlin R, et al. The fate of AAA patients referred electively to vascular surgical unit. Scand J Surg. 2002;91:345–52.CrossRefPubMedGoogle Scholar
  12. 12.
    Dueck AD, Kucey DS, Johnston KW, Alter D, Laupacis A. Survival after ruptured abdominal aortic aneurysm: effect of patient, surgeon, and hospital factors. J Vasc Surg. 2004;39:1253–60. [PubMed]CrossRefPubMedGoogle Scholar
  13. 13.
    Heikkinen M, Salenius JP, Auvinen O. Ruptured abdominal aortic aneurysm in a well-defined geographic area. J Vasc Surg. 2002;36:291–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Starnes BW, Quiroga E, Hutter C, Tran NT, Hatsukami T, Meissner M, et al. Management of ruptured abdominal aortic aneurysm in the endovascular era. J Vasc Surg. 2010;51:9–17. discussion: 18CrossRefPubMedGoogle Scholar
  15. 15.
    Johnson PT, Fishman EK. IV contrast selection for MDCT:current thoughts and practice. Am J Roentgenol. 2006;186(2):406–15.CrossRefGoogle Scholar
  16. 16.
    Siegel CL, Cohan RH, Korobkin M, Alpern MB, Courneya DL, Leder RA. Abdominal aortic aneurysm morphology: CT features in patients with ruptured and nonruptured aneurysms. Am J Roentgenol. 1994;163:1123–9.CrossRefGoogle Scholar
  17. 17.
    Schwartz SA, Taljanovic MS, Smyth S, O’Brien MJ, Rogers LF. CT findings of rupture, impending rupture, and contained rupture of abdominal aortic aneurysms. Am J Roentgenol. 2007;188:W57–62.CrossRefGoogle Scholar
  18. 18.
    Wadgaonkar AD, Black JH, Weihe EK, Zimmerman SL, Fishman EK, Johnson PT. Abdominal aortic aneurysms revisited: MDCT with multiplanar reconstructions for identifying indicators of instability in the pre- and postoperative patient. Radiographics. 2015;35(1):254–68. doi: 10.1148/rg.351130137.CrossRefPubMedGoogle Scholar
  19. 19.
    Mehard W, Heiken J, Sicard G. High-attenuating crescent in abdominal aortic aneurysm wall at CT: a sign of acute or impending rupture. Radiology. 1994;192(2):359–62.CrossRefPubMedGoogle Scholar
  20. 20.
    Halliday KE, Al-Kutoubi A. Draped aorta: CT sign of contained leak of aortic aneurysms. Radiology. 1996;199:41–3.CrossRefPubMedGoogle Scholar
  21. 21.
    Huang YK, Hsieh HC, Tsai FC, et al. Visceral artery aneurysm: risk factor analysis and therapeutic opinion. Eur J Vasc Endovasc Surg. 2007;33:293–301.CrossRefPubMedGoogle Scholar
  22. 22.
    Carr SC, Pearce WH, Vogelzang RL, McCarthy WJ, Nemcek AA Jr, Yao JST. Current management of visceral artery aneurysms. Surgery. 1996;120(4):627–34. doi: 10.1016/s0039-6060(96)80009-2.CrossRefPubMedGoogle Scholar
  23. 23.
    Berceli SA. Hepatic and splenic artery aneurysms. Semin Vasc Surg. 2005;18(4):196–201.CrossRefPubMedGoogle Scholar
  24. 24.
    Abbas MA, Stone WM, Fowl RJ, et al. Splenic artery aneurysms: two decades experience at Mayo clinic. Ann Vasc Surg. 2002;16:442–9.CrossRefPubMedGoogle Scholar
  25. 25.
    O’Arend P, Douillez V. Hepatic artery aneurysm: case report. Acta Chir Belg. 2007;107(4):409–11.CrossRefGoogle Scholar
  26. 26.
    Abbas MA, Fowl RJ, Stone WM, Panneton JM, Oldenburg WA, Bower TC, et al. Hepatic artery aneurysm: factors that predict complications. J Vasc Surg. 2003;38:41–5.CrossRefPubMedGoogle Scholar
  27. 27.
    Nathan DP, Wang GJ, Woo EY, Fairman RM, Jackson BM. Open and endovascular repair of hepatic artery aneurysm: two case reports and review of the literature. Vascular. 2011;19:42–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Vultaggio F, Morère P-H, Constantin C, Christodoulou M, Roulin D. Gastrointestinal bleeding and obstructive jaundice: Think of hepatic artery aneurysm. World J Gastrointest Surg. 2016;8(6):467–71.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Henke PK, Cardneua JD, Welling TH, et al. Renal artery aneurysms: a 35-year clinical experience with 252 aneurysms in 168 patients. Ann Surg. 2001;234:454–62. discussion 462–3CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Reiher L, Grabitz K, Sandmann W. Reconstruction for renal artery aneurysm and its effect on hypertension. Eur J Vasc Endovasc Surg. 2000;20:454–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Cohen JR, Shamash FS. Ruptured renal artery aneurysms during pregnancy. J Vasc Surg. 1986;6:51–9.CrossRefGoogle Scholar
  32. 32.
    Connell JM. Han DC Celiac artery aneurysms: a case report and review of the literature. Am Surg. 2006;72(8):746–9.PubMedGoogle Scholar
  33. 33.
    Stone WM, Abbas M, Cherry KJ, et al. Superior mesenteric artery aneurysms: Is presence an indication for intervention? J Vasc Surg. 2002;36:234–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Sun J, Li DL, Wu ZH, He YY, Zhu QQ, Zhang HK. Morphologic findings and management strategy of spontaneous isolated dissection of the celiac artery. J Vasc Surg. 2016;64(2):389–94.CrossRefPubMedGoogle Scholar
  35. 35.
    Corey MR, Ergul EA, Cambria RP, English SJ, Patel VI, Lancaster RT, Kwolek CJ, Conrad MF. The natural history of splanchnic artery aneurysms and outcomes after operative intervention. J Vasc Surg. 2016;63(4):949–57.CrossRefPubMedGoogle Scholar
  36. 36.
    Lorelli DR, Cambria RA, Seabrook GR, Towne JB. Diagnosis and management of aneurysms involving the superior mesenteric artery and its branches: a report of four cases. Vasc Endovasc Surg. 2003;37(1):59–66.CrossRefGoogle Scholar
  37. 37.
    Kordzadeh A, Watson J, Panayiotopolous YP. Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg. 2016;63(6):1638–46.CrossRefPubMedGoogle Scholar
  38. 38.
    Moore E, Matthews MR, Minion DJ, et al. Surgical management of peripancreatic arterial aneurysms. J Vasc Surg. 2004;40(2):247–53.CrossRefPubMedGoogle Scholar
  39. 39.
    Vu KN, Kaitoukov Y, Morin-Roy F, Kauffmann C, Giroux MF, Thérasse E, Soulez G, Tang A. Rupture signs on computed tomography, treatment, and outcome of abdominal aortic aneurysms. Insights Imaging. 2014;5(3):281–93.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Interventional Radiology FellowAuckland City HospitalAucklandNew Zealand
  2. 2.Interventional RadiologistAuckland City HospitalAucklandNew Zealand
  3. 3.Auckland City HospitalAucklandNew Zealand

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