Management of true visceral artery aneurysms in 31 cases.
BACKGROUND
True visceral artery aneurysms (VAA) should be treated under elective conditions in dependency on maximum diameter. In this respect, the traditional accepted threshold is 2cm, whereas VAA sizing less than 2cm should conservatively be observed without invasive treatment. The aim of this study was to review differences in the treatment outcome over three decades.


METHODS
This was a retrospective review of all treated VAAs at one institution from 1985 to 2015. Patients demographics, aneurysm characteristics, management and outcome were recorded with special regard to differences in the course of time.


RESULTS
Thirty-one true VAA in 29 patients (74% female) were repaired (5 ruptured, 26 intact). Mean diameter was 30.27±11mm for intact and 38.0±8.5mm for ruptured VAA (rVAA) (P=NS). Most patients were asymptomatic (67.8% asymptomatic, 16.1% symptomatic without rupture and 16.1% with rupture). There was a vice-versa situation in chosen treatment techniques between the first (1985-2000) and the second (2001-2015) time period [first period: 75% open repair (OR) and 25% endovascular repair (ER); second period: 27% OR and 73% ER; P=0.009]. OR included aneurysm ligation and resection with (end-to-end-anastomosis, graft interposition or without blood flow reconstruction), while ER was exclusively coil embolization with sacrifice of all parent afferent and efferent arteries. Immediate technical success was 81% for all procedures. There was a trend toward higher technical success rate of VAA being treated in second time period, but we found no significant differences (69% in the first, 93% in the second; P=0.101). Conversion to OR due to technical failures was necessary after 3 endovascular repairs (20%). The overall 30-day-mortality rate decreases in the course of time (25% in the first and 0% in the second period; P=0.038). Furthermore, there was a lower 30-day mortaliy rate after ER of all VAA (elective and urgent repair) (20% after OR, 0% after ER; P=0.038). There was no decrease in 30-day mortality rate of rVAA (100% in the first and 20% in the second period; P=NS).


CONCLUSIONS
In the fact of medical progress and a growing number of endovascular procedures, this study presents a decrease in mortality rate after elective aneurysm repair over three decades. This might become an argument to reduce the 2-cm threshold in highly selected individuals.
Department of Vascular Surgery, University Hospital, Krankenhausstrasse 12, 91054 Erlangen, Germany. Electronic address: Susanne.regus@uk-erlangen.de.
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Regus
Department of Vascular Surgery, University Hospital, Krankenhausstrasse 12, 91054 Erlangen, Germany.
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000628:therapy*; D001158:Arteries; D000072226:Computed Tomography Angiography; D019468:Disease Management; D017558:Elective Surgical Procedures / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation / Q000379:methods; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014781:Viscera / Q000098:blood supply*; D055815:Young Adult
Chronic pancreatitis; Coil embolization; False aneurysm; Indications; Visceral artery aneurysm