title: Visceral artery aneurysms--follow-up of 23 patients with 31 aneurysms after surgical or interventional therapy.
abstract: OBJECTIVE
  Visceral artery aneurysms (VAA) are rare forms of vascular pathology, with an incidence of 0.1% to 0.2% in routine autopsies. They frequently present as a life-threatening, often fatal, emergency, if associated with rupture and intra- or retroperitoneal bleeding. The clinical symptoms, natural history, and mortality of VAAs vary depending on the vessels involved. The mortality rates range from 8.5% up to 25% and, in pregnant women, up to 75%. A retrospective analysis of all VAAs diagnosed at our institution from 1991 to 2006 was performed. The presentation, management, and outcome of therapy was evaluated for each patient.
  
  
  METHODS
  Twenty-three patients (12 men, 11 women, mean age 55.8 years) with 31 VAAs were identified. The anatomical involvement concerned seven regions: celiac (CT) nine, superior mesenteric (SMA) seven, splenic (SA) five, hepatic (HA) six, gastroduodenal (GDA) two, pancreatoduodenal (PDA) one, and one branch of the superior mesenteric artery. Fourteen patients presented symptoms attributable to their aneurysms, which included a total of four ruptures. Nine patients had no symptoms. The etiology of VAAs was atherosclerosis (67.8%), mycotic embolization (12.9%), trauma (9.7%), Marfan Syndrome (3.2%), Klippel-Trenaunay-Weber syndrome (3.2%), and giant cell arteritis (3.2%). Open surgery was performed for 29 aneurysm in 21 patients: partial resection and tailoring in 13 cases (41.9%), resection of the aneurysm with additional autologous vein graft interposition in nine cases and prosthetic graft interposition in 2 cases (35.5%), aneurysm exclusion by ligation in three cases (9.6%) and aneurysm ligation combined with additional autologous bypass procedure in two cases (6.5%). Two patients (6.5%) were treated interventionally with embolization, in one case each with a right hepatic artery aneurysm and in the other with splenic artery aneurysm.
  
  
  RESULTS
  No deaths were observed. The morbidity rate associated with surgical treatment was low. After treatment, a total of 17 patients were followed up for a period ranging from 3 to 154 months (mean 54.6 months). Fifteen patients required no additional procedures. The patency rate of the reconstructed visceral arteries was 90.4%. Six patients were lost for follow-up.
  
  
  CONCLUSIONS
  Surgical and interventional therapy of VAAs can be life-saving treatments for the patient with a low periprocedural morbidity. The success rate, defined as the exclusion of VAA rupture and the absence of abdominal discomfort, in our material was 88.2% after a mean follow-up of 54.6 months.
authors.affiliation: Department of Vascular Surgery and Kidney Transplantation, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany. grotemeyer@uni-duesseldorf.de
authors.forename: Dirk
authors.initials: D
authors.lastname: Grotemeyer
authors.forename: Mansur
authors.initials: M
authors.lastname: Duran
authors.forename: Eun-Jo
authors.initials: EJ
authors.lastname: Park
authors.forename: Norbert
authors.initials: N
authors.lastname: Hoffmann
authors.forename: Dirk
authors.initials: D
authors.lastname: Blondin
authors.forename: Franziska
authors.initials: F
authors.lastname: Iskandar
authors.forename: Kai M
authors.initials: KM
authors.lastname: Balzer
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Sandmann
mesh_terms: D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D015331:Cohort Studies; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013152:Splanchnic Circulation; D016896:Treatment Outcome; D014781:Viscera / Q000098:blood supply*