title: Management of aneurysms involving branches of the celiac and superior mesenteric arteries: a comparison of surgical and endovascular therapy.
abstract: OBJECTIVE
  Aneurysms involving branches of the superior mesenteric and celiac arteries are uncommon and require proper management to prevent rupture and death. This study compares surgical and endovascular treatment of these aneurysms and analyzes outcome.
  
  
  METHODS
  Patients at the Mount Sinai Medical Center in New York who were treated for aneurysms in the branches of the celiac artery and superior mesenteric artery were identified through a search of the institution's medical records and endovascular database. Patient demographics, history, clinical presentation, aneurysm characteristics, treatments, and follow-up outcome were retrospectively recorded. Significant differences between patients treated by surgical or endovascular therapy were determined by using Student's t test and chi2 analysis.
  
  
  RESULTS
  Between January 1, 1991, and July 1, 2005, 59 patients with 61 aneurysms were treated at a single institution. Twenty-four patients had surgical repair, and 35 underwent endovascular treatment, which included coil embolization and stent-graft therapy. Splenic (28) and hepatic (22) artery aneurysms predominated. Eighty-nine percent of splenic artery aneurysms were true aneurysms and were treated by endovascular and surgical procedures in near equal numbers (14 and 11, respectively). Pseudoaneurysms were significantly more likely to be treated by endovascular means (P < .01). The technical success rate of endovascular treatment for aneurysms was 89%, and failures were successfully treated by repeat coil embolization in all patients who presented for retreatment. Patients treated by endovascular techniques had a significantly higher incidence of malignancy than patients treated with open surgical techniques (P = .03). Furthermore, patients treated by endovascular means had a shorter in-hospital length of stay (2.4 vs 6.6 days, P < .001).
  
  
  CONCLUSIONS
  Endovascular management of visceral aneurysms is an effective means of treating aneurysms involving branches of the celiac and superior mesenteric arteries and is particularly useful in patients with comorbidities, including cancer. It is associated with a decreased length of stay in the elective setting, and failure of primary treatment can often be successfully managed percutaneously.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Mount Sinai Medical Center, New York, NY 10029, USA. Sachdevu2@upmc.edu
authors.forename: Ulka
authors.initials: U
authors.lastname: Sachdev
authors.forename: Donald T
authors.initials: DT
authors.lastname: Baril
authors.forename: Sharif H
authors.initials: SH
authors.lastname: Ellozy
authors.forename: Robert A
authors.initials: RA
authors.lastname: Lookstein
authors.forename: Daniel
authors.initials: D
authors.lastname: Silverberg
authors.forename: Tikva S
authors.initials: TS
authors.lastname: Jacobs
authors.forename: Alfio
authors.initials: A
authors.lastname: Carroccio
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Teodorescu
authors.forename: Michael L
authors.initials: ML
authors.lastname: Marin
mesh_terms: D000783:Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D000792:Angiography; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D002445:Celiac Artery; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome