title: Endovascular management of visceral artery aneurysms: When to watch, when to intervene?
abstract: Visceral artery aneurysms (VAA) include splanchnic and renal artery aneurysms. They represent a rare clinical entity, although their detection is rising due to an increased use of cross-sectional imaging. Rupture is the most devastating complication, and is associated with a high morbidity and mortality. In addition, increased percutaneous endovascular interventions have raised the incidence of iatrogenic visceral artery pseudoaneurysms (VAPAs). For this reason, elective repair is preferable in the appropriately chosen patient. Controversy still exists regarding their treatment. Over the past decade, there has been steady increase in the utilization of minimally invasive, non-operative interventions, for vascular aneurysmal disease. All VAAs and VAPAs can technically be fixed by endovascular techniques but that does not mean they should. These catheter-based techniques constitute an excellent approach in the elective setting. However, in the emergent setting it may carry a higher morbidity and mortality. The decision for intervention has to take into account the size and the natural history of the lesion, the risk of rupture, which is high during pregnancy, and the relative risk of surgical or radiological intervention. For splanchnic artery aneurysms, we should recognize that we are not, in reality, well informed about their natural history. For most asymptomatic aneurysms, expectant treatment is acceptable. For large, symptomatic or aneurysms with a high risk of rupture, endovascular treatment has become the first-line therapy. Treatment of VAPAs is always mandatory because of the high risk of rupture. We present our point of view on interventional radiology in the splanchnic arteries, focusing on what has been achieved and the remaining challenges.
authors.affiliation: Romaric Loffroy, Sylvain Favelier, Pierre Pottecher, Pierre-Yves Genson, Louis Estivalet, Sophie Gehin, Jean-Pierre Cercueil, Denis Krausé, Department of Vascular, Oncologic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 21079 Dijon Cedex, France.
authors.forename: Romaric
authors.initials: R
authors.lastname: Loffroy
authors.affiliation: Romaric Loffroy, Sylvain Favelier, Pierre Pottecher, Pierre-Yves Genson, Louis Estivalet, Sophie Gehin, Jean-Pierre Cercueil, Denis Krausé, Department of Vascular, Oncologic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 21079 Dijon Cedex, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Favelier
authors.affiliation: Romaric Loffroy, Sylvain Favelier, Pierre Pottecher, Pierre-Yves Genson, Louis Estivalet, Sophie Gehin, Jean-Pierre Cercueil, Denis Krausé, Department of Vascular, Oncologic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 21079 Dijon Cedex, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Pottecher
authors.affiliation: Romaric Loffroy, Sylvain Favelier, Pierre Pottecher, Pierre-Yves Genson, Louis Estivalet, Sophie Gehin, Jean-Pierre Cercueil, Denis Krausé, Department of Vascular, Oncologic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 21079 Dijon Cedex, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Genson
authors.affiliation: Romaric Loffroy, Sylvain Favelier, Pierre Pottecher, Pierre-Yves Genson, Louis Estivalet, Sophie Gehin, Jean-Pierre Cercueil, Denis Krausé, Department of Vascular, Oncologic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 21079 Dijon Cedex, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Estivalet
authors.affiliation: Romaric Loffroy, Sylvain Favelier, Pierre Pottecher, Pierre-Yves Genson, Louis Estivalet, Sophie Gehin, Jean-Pierre Cercueil, Denis Krausé, Department of Vascular, Oncologic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 21079 Dijon Cedex, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Gehin
authors.affiliation: Romaric Loffroy, Sylvain Favelier, Pierre Pottecher, Pierre-Yves Genson, Louis Estivalet, Sophie Gehin, Jean-Pierre Cercueil, Denis Krausé, Department of Vascular, Oncologic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 21079 Dijon Cedex, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Cercueil
authors.affiliation: Romaric Loffroy, Sylvain Favelier, Pierre Pottecher, Pierre-Yves Genson, Louis Estivalet, Sophie Gehin, Jean-Pierre Cercueil, Denis Krausé, Department of Vascular, Oncologic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 21079 Dijon Cedex, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Krausé
keywords: Aneurysm; Angiography; Embolization; False aneurysm; Stent-graft; Visceral artery