Skip to main content
SpringerLink
Log in

Clinical Presentation, Etiology, Diagnostic Considerations, Treatment, and Results

  • Chapter
  • First Online:
Mesenteric Vascular Disease

Abstract

VAAs are a rare entity; however, aneurysm rupture, which is the catastrophic complication, may lead to a mortality rate up to 90 % according to the location of the aneurysm. Timely diagnosis of VAA is the most important, and individualized treatment is tailored based on the symptoms and signs, size, location, anatomy, and etiology of the aneurysm, as well as patient’s surgical risk. Currently, there is no consensus regarding treatment guidelines. Asymptomatic patients with VAA < 2.0 cm in diameter can be observed with close imaging follow-up which includes DUS, CTA, or MRA. In general, interventions are indicated in symptomatic or ruptured VAAs, pseudoaneurysms, asymptomatic patients with aneurysm > 2.0 cm, and aneurysm with rapid increase in size ≥ 0.5 cm/year. Besides, due to the high risk of rupture, regardless of size or symptom, interventions are also recommended in female patient of childbearing age or pregnant and orthotopic liver transplant recipient who harbors an SAA patient with visceral branch aneurysms. Surgical repair includes excision of the VAA with or without revascularization or organ resection; endovascular therapy includes embolization and placement of covered stents. Regardless of the procedure performed, revascularization must be considered when there is inadequate or no collateral flow to maintain end-organ perfusion. Long-term results of open repair of VAAs are durable; endovascular treatment, as a promising alternative to open surgery especially in anatomically suitable and high risk patients, provides good short-term results; however, its long-term results are not yet well known. Follow-up data from randomized controlled trials and prospective studies are required to justify the treatment strategy for VAAs.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Stanley JC, Wakefield TW, Graham LM, Whitehouse Jr WM, Zelenock GB, Lindenauer SM. Clinical importance and management of splanchnic artery aneurysms. J Vasc Surg. 1986;3(5):836–40.

    Article  CAS  PubMed  Google Scholar 

  2. Carr SC, Pearce WH, Vogelzang RL, McCarthy WJ, Nemcek Jr AA, Yao JS. Current management of visceral artery aneurysms. Surgery. 1996;120(4):627–33; discussion 33–4.

    Article  CAS  PubMed  Google Scholar 

  3. Shanley CJ, Shah NL, Messina LM. Common splanchnic artery aneurysms: splenic, hepatic, and celiac. Ann Vasc Surg. 1996;10(3):315–22.

    Article  CAS  PubMed  Google Scholar 

  4. Messina LM, Shanley CJ. Visceral artery aneurysms. Surg Clin North Am. 1997;77(2):425–42.

    Article  CAS  PubMed  Google Scholar 

  5. Cordova AC, Sumpio BE. Visceral artery aneurysms and pseudoaneurysms – should they all be managed by endovascular techniques? Ann Vasc Dis. 2013;6(4):687–93.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Lakin RO, Kashyap VS. Splanchnic Artery Aneurysms. In: Cronenwett JL, Johnston KW, editors. Rutherford's vascular surgery. 8th ed. Philadelphia: Saunders; 2014. p. 2220–35.

    Google Scholar 

  7. Barbaros U, Ozemir IA, Aksakal N, Tukenmez M, Kilic B, Agcaoglu O, et al. Laparoscopic surgery of the splenic artery and vein aneurysm with spontaneous arteriovenous fistula. Surg Laparosc Endosc Percutan Tech. 2013;23(3):e127–30.

    Article  PubMed  Google Scholar 

  8. Takase A, Akuzawa N, Hatori T, Imai K, Kitahara Y, Aoki J, et al. Two patients with ruptured posterior inferior pancreaticoduodenal artery aneurysms associated with compression of the celiac axis by the median arcuate ligament. Ann Vasc Dis. 2014;7(1):87–92.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Sarcina A, Bellosta R, Magnaldi S, Luzzani L. Aneurysm of the middle colic artery–case report and literature review. Eur J Vasc Endovasc Surg. 2000;20(2):198–200.

    Article  CAS  PubMed  Google Scholar 

  10. Edogawa S, Shibuya T, Kurose K, Sasaki K, Tomita H. Inferior mesenteric artery aneurysm: case report and literature review. Ann Vasc Dis. 2013;6(1):98–101.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Moskowitz R, Rundback J. Middle colic artery branch aneurysm presenting as spontaneous hemoperitoneum. Ann Vasc Surg. 2014;28(7):1797.e15-7. doi:10.1016/j.avsg.2014.05.001.

  12. Cron DC, Coleman DM, Sheetz KH, Englesbe MJ, Waits SA. Aneurysms in abdominal organ transplant recipients. J Vasc Surg. 2014;59(3):594–8.

    Article  PubMed  Google Scholar 

  13. Lagana D, Carrafiello G, Mangini M, Dionigi G, Caronno R, Castelli P, et al. Multimodal approach to endovascular treatment of visceral artery aneurysms and pseudoaneurysms. Eur J Radiol. 2006;59(1):104–11.

    Article  PubMed  Google Scholar 

  14. Wiegering A, Ritter CO, Allolio B, Buck AK, Germer CT, Lorenz U. Early development of a celiac trunk aneurysm during anti-vascular endothelial growth factor receptor therapy. Surgery. 2014;155(4):729–30.

    Article  PubMed  Google Scholar 

  15. 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(1):41–5.

    Article  PubMed  Google Scholar 

  16. Sgroi MD, Kabutey NK, Krishnam M, Fujitani RM. Pancreaticoduodenal artery aneurysms secondary to median arcuate ligament syndrome may not need celiac artery revascularization or ligament release. Ann Vasc Surg. 2014. doi:10.1016/j.avsg.2014.05.020. [Ahead of print]

    Google Scholar 

  17. Armstrong MB, Stadtlander KS, Grove MK. Pancreaticoduodenal artery aneurysm associated with median arcuate ligament syndrome. Ann Vasc Surg. 2014;28(3):741 e1–5 e1.

    Article  Google Scholar 

  18. Habib N, Hassan S, Abdou R, Torbey E, Alkaied H, Maniatis T, et al. Gastroduodenal artery aneurysm, diagnosis, clinical presentation and management: a concise review. Ann Surg Innov Res. 2013;7(1):4.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Bergert H, Hinterseher I, Kersting S, Leonhardt J, Bloomenthal A, Saeger HD. Management and outcome of hemorrhage due to arterial pseudoaneurysms in pancreatitis. Surgery. 2005;137(3):323–8.

    Article  PubMed  Google Scholar 

  20. Tessier DJ, Abbas MA, Fowl RJ, Stone WM, Bower TC, McKusick MA, et al. Management of rare mesenteric arterial branch aneurysms. Ann Vasc Surg. 2002;16(5):586–90.

    Article  PubMed  Google Scholar 

  21. Sadat U, Dar O, Walsh S, Varty K. Splenic artery aneurysms in pregnancy – a systematic review. Int J Surg. 2008;6(3):261–5.

    Article  PubMed  Google Scholar 

  22. Lee PC, Rhee RY, Gordon RY, Fung JJ, Webster MW. Management of splenic artery aneurysms: the significance of portal and essential hypertension. J Am Coll Surg. 1999;189(5):483–90.

    Article  CAS  PubMed  Google Scholar 

  23. Jackson HT, Diaconu SC, Maluso PJ, Abell B, Lee J. Ruptured splenic artery aneurysms and the use of an adapted fast protocol in reproductive age women with hemodynamic collapse: case series. Case Rep Emerg Med. 2014;2014:454923.

    PubMed Central  PubMed  Google Scholar 

  24. Abbas MA, Stone WM, Fowl RJ, Gloviczki P, Oldenburg WA, Pairolero PC, et al. Splenic artery aneurysms: two decades experience at Mayo clinic. Ann Vasc Surg. 2002;16(4):442–9.

    Article  PubMed  Google Scholar 

  25. Lakin RO, Bena JF, Sarac TP, Shah S, Krajewski LP, Srivastava SD, et al. The contemporary management of splenic artery aneurysms. J Vasc Surg. 2011;53(4):958–64; discussion 65.

    Article  PubMed  Google Scholar 

  26. Ruddy JM, Dodson TF, Duwayri Y. Open repair of superior mesenteric artery mycotic aneurysm in an adolescent girl. Ann Vasc Surg. 2014;28(4):1032 e21–4 e21.

    Article  Google Scholar 

  27. Oderich GS, Panneton JM, Macedo TA, Noel AA, Bower TC, Lee RA, et al. Intraoperative duplex ultrasound of visceral revascularizations: optimizing technical success and outcome. J Vasc Surg. 2003;38(4):684–91.

    Article  PubMed  Google Scholar 

  28. Stella N, Palombo G, Taddeo C, Rizzo L, Taurino M. Stent-assisted coil embolization of a complex wide-neck splenic artery aneurysm. Ann Vasc Surg. 2013;27(8):1187 e5–8 e5.

    Article  Google Scholar 

  29. Plaza-Martinez A, Genoves-Gasco B, Cester-Ves D, Gomez-Palones FJ. Endograft-assisted coil embolization of a celiac trunk aneurysm. Ann Vasc Surg. 2014;28(1):263 e1–5 e1.

    Article  Google Scholar 

  30. Sfyroeras GS, Dalainas I, Giannakopoulos TG, Antonopoulos K, Kakisis JD, Liapis CD. Flow-diverting stents for the treatment of arterial aneurysms. J Vasc Surg. 2012;56(3):839–46.

    Article  PubMed  Google Scholar 

  31. Balderi A, Antonietti A, Pedrazzini F, Sortino D, Vinay C, Grosso M. Treatment of visceral aneurysm using multilayer stent: two-year follow-up results in five consecutive patients. Cardiovasc Intervent Radiol. 2013;36(5):1256–61.

    Article  PubMed  Google Scholar 

  32. Sfyroeras GS, Liapis CD. Endovascular management of visceral artery aneurysms with flow-diverting stents. Ann Vasc Surg. 2014;28(4):1080.

    Article  PubMed  Google Scholar 

  33. Wong SS, Lindsay TF, Roche-Nagle G. Anomalous splenic artery aneurysm. Vascular. 2013;21(2):105–8.

    Article  PubMed  Google Scholar 

  34. Verzini F, Biello A, Marucchini A, Parente B, Parlani G, Cao P. Total endovascular solution for complex visceral aneurysms. J Vasc Surg. 2013;58(5):1412–6.

    Article  PubMed  Google Scholar 

  35. Naito A, Toyota N, Ito K. Embolization of a ruptured middle colic artery aneurysm. Cardiovasc Intervent Radiol. 1995;18(1):56–8.

    Article  CAS  PubMed  Google Scholar 

  36. Ham EM, Cho BS, Ye JB, Mun YS, Choi YJ, Kwon OS. The endovascular treatment of a ruptured aneurysm of the middle colic artery combined with an isolated dissection of superior mesenteric artery: report of a case. Vasc Endovascular Surg. 2014;48(4):352–5.

    Article  PubMed  Google Scholar 

  37. Pulli R, Dorigo W, Troisi N, Pratesi G, Innocenti AA, Pratesi C. Surgical treatment of visceral artery aneurysms: A 25-year experience. J Vasc Surg. 2008;48(2):334–42.

    Article  PubMed  Google Scholar 

  38. Marone EM, Mascia D, Kahlberg A, Brioschi C, Tshomba Y, Chiesa R. Is open repair still the gold standard in visceral artery aneurysm management? Ann Vasc Surg. 2011;25(7):936–46.

    Article  PubMed  Google Scholar 

  39. Ghariani MZ, Georg Y, Ramirez C, Lebied E, Gaudric J, Chiche L, et al. Long-term results of surgical treatment of aneurysms of digestive arteries. Ann Vasc Surg. 2013;27(7):954–8.

    Article  PubMed  Google Scholar 

  40. Tiberio GA, Bonardelli S, Gheza F, Arru L, Cervi E, Giulini SM. Prospective randomized comparison of open versus laparoscopic management of splenic artery aneurysms: a 10-year study. Surg Endosc. 2012 Jun 30. [Ahead of print].

    Google Scholar 

  41. Koganemaru M, Abe T, Nonoshita M, Iwamoto R, Kusumoto M, Kuhara A, et al. Follow-up of true visceral artery aneurysm after coil embolization by three-dimensional contrast-enhanced MR angiography. Diagn Interv Radiol. 2014;20(2):129–35.

    PubMed  Google Scholar 

  42. Tulsyan N, Kashyap VS, Greenberg RK, Sarac TP, Clair DG, Pierce G, et al. The endovascular management of visceral artery aneurysms and pseudoaneurysms. J Vasc Surg. 2007;45(2):276–83; discussion 83.

    Article  PubMed  Google Scholar 

  43. Fankhauser GT, Stone WM, Naidu SG, Oderich GS, Ricotta JJ, Bjarnason H, et al. The minimally invasive management of visceral artery aneurysms and pseudoaneurysms. J Vasc Surg. 2011;53(4):966–70.

    Article  PubMed  Google Scholar 

  44. Yasumoto T, Osuga K, Yamamoto H, Ono Y, Masada M, Mikami K, et al. Long-term outcomes of coil packing for visceral aneurysms: correlation between packing density and incidence of coil compaction or recanalization. J Vasc Interv Radiol. 2013;24(12):1798–807.

    Article  PubMed  Google Scholar 

  45. Kunzle S, Glenck M, Puippe G, Schadde E, Mayer D, Pfammatter T. Stent-graft repairs of visceral and renal artery aneurysms are effective and result in long-term patency. J Vasc Interv Radiol. 2013;24(7):989–96.

    Article  PubMed  Google Scholar 

  46. Sachdev U, Baril DT, Ellozy SH, Lookstein RA, Silverberg D, Jacobs TS, et al. Management of aneurysms involving branches of the celiac and superior mesenteric arteries: a comparison of surgical and endovascular therapy. J Vasc Surg. 2006;44(4):718–24.

    Article  PubMed  Google Scholar 

  47. Cochennec F, Riga CV, Allaire E, Cheshire NJ, Hamady M, Jenkins MP, et al. Contemporary management of splanchnic and renal artery aneurysms: results of endovascular compared with open surgery from two European vascular centers. Eur J Vasc Endovasc Surg. 2011;42(3):340–6.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA

    Ying Huang MD, PhD & Leonardo Reis de Souza MD

  2. Masters Degree Program from the Department of Surgery, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Leonardo Reis de Souza MD

  3. Division of Vascular Surgery, Mayo Clinic, Rochester, MN, USA

    Gustavo S. Oderich MD, FACS

  4. Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA

    Gustavo S. Oderich MD, FACS

  5. Department of SurgeryDepartment of Surgery, Mayo Clinic, Scottsdale, AZ, USA

    William M. Stone MD

Authors
  1. Ying Huang MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leonardo Reis de Souza MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gustavo S. Oderich MD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. William M. Stone MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gustavo S. Oderich MD, FACS .

Editor information

Editors and Affiliations

  1. Division of Vascular and Endovascular Therapy, Mayo Clinic Gonda Vascular Center, Rochester, Minnesota, USA

    Gustavo S. Oderich

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Huang, Y., de Souza, L.R., Oderich, G.S., Stone, W.M. (2015). Clinical Presentation, Etiology, Diagnostic Considerations, Treatment, and Results. In: Oderich, G. (eds) Mesenteric Vascular Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1847-8_34

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1847-8_34

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1846-1

  • Online ISBN: 978-1-4939-1847-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation