title: Open versus Endovascular Treatment of Visceral Artery Aneurysms and Pseudoaneurysms.
abstract: BACKGROUND
  Visceral artery aneurysms and pseudoaneurysms (VAAP) represent a rare and potential life-threatening disease with a documented incidence of 0.1-2.0%. Treatment options for VAAP vary from open approach with aneurysm excision, exclusion and revascularization to endovascular techniques. Aneurysm anatomy and pathogenesis dictate treatment choice. The purpose of this study was to compare the perioperative, short- and mid-term outcomes of open and endovascular approaches.
  
  
  METHODS
  Between January 2007 to April 2015, patients with VAAP who underwent surgical treatment, either by endovascular technique (endovascular surgery [EV] group) or by open surgery (OS group), were selected for analysis. Aneurysm's anatomy and pathogenesis dictated treatment choice. Demographic variables, surgical data, and postoperative follow-up were retrospectively analyzed. Preoperative computed tomography scans were evaluated for aneurysm characteristics.
  
  
  RESULTS
  A total of 296 consecutive patients were identified with VAAP. Surveillance without intervention occurred in 183 patients, and 113 underwent surgical treatment: 57 by EV technique and 56 by OS. The VAAP sites were: splenic (50.9/5.4%), renal (7.0/50%), superior mesenteric (7.0/7.1%), celiac (12.3/17.9%), hepatic (14.0/5.4%), gastroduodenal (7.0/7.1%), and pancreaticoduodenal (1.8/7.1%). Eight urgent surgeries occurred in EV and 5 in OS group (P = 0.39). Operative time and estimated blood loss were 122 ± 54 vs. 312 ± 157 min (P < 0.001) and 5 (interquartile range [IR], 0-50) vs. 550 (IR, 200-980) mL (P < 0.001) in groups EV and OS, respectively. The intraoperative and postoperative major complications, including end-organ infarction, and reinterventions were comparable between the groups. Transfusion of blood products was necessary in 12.3% (EV) and 42.9% (OS; P < 0.001). Median hospital length of stay was 1 (IR, 1-3) and 6 (IR, 4-9) days in groups EV and OS, respectively (P < 0.001). Short-term technical success was achieved in 98.2% (EV) and 96.4% (OS). During the median follow-up period of 16 (IR, 7.1-43.9) months, the clinical success was 91.2% and 92.9% (P = 0.74), and the overall survival was 94.7% and 96.4% (P = 1.0) in groups EV and OS, respectively.
  
  
  CONCLUSIONS
  Open and endovascular approaches have similar rates of technical and clinical success, as well as mortality during follow-up. However, periprocedural morbidity was significantly higher in cases treated by OS. Although longer-term follow-up is needed to access the durability of the endovascular treatment, initial successful outcomes and low reintervention rates make it a safe and feasible approach.
authors.affiliation: Vascular Surgery Department, The Cleveland Clinic, Cleveland, OH. Electronic address: nayaracioffi@yahoo.com.
authors.forename: Nayara Cioffi
authors.initials: NC
authors.lastname: Batagini
authors.affiliation: Vascular Surgery Department, The Cleveland Clinic, Cleveland, OH.
authors.forename: Hazem
authors.initials: H
authors.lastname: El-Arousy
authors.affiliation: Vascular Surgery Department, The Cleveland Clinic, Cleveland, OH.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Clair
authors.affiliation: Vascular Surgery Department, The Cleveland Clinic, Cleveland, OH.
authors.forename: Lee
authors.initials: L
authors.lastname: Kirksey
mesh_terms: D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001158:Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D016063:Blood Loss, Surgical; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014781:Viscera / Q000098:blood supply*