CURRENT MANAGEMENT OF VISCERAL ARTERY ANEURYSMS

Background. Visceral artery aneurysms are an uncommon but important fo rm of abdominal vascular disease. This study reviews a contemporary ex perience with special emphasis on newer methods of diagnosis and treat ment. Methods. From 1980 to 1994, 37 patients were diagnosed with 46 v isceral artery aneurysms. These consisted of 22 splenic, 10 hepatic, 4 superior mesenteric 2 gastroduodenal, 3 celiac, 2 left gastric, 1 pan creatoduodenal, 1 jejunal-ileal, and 1 inferior mesenteric artery aneu rysms. Follow-up was complete for 28 patients, average of 37.7 months. There were 17 asymptomatic and 29 symptomatic aneurysms, including 11 presenting with rupture. Results. Seventeen patients were treated sur gically, with no surgical deaths. Surgical complications included sple nic abscess (two) and failure to thrombose (one). Transcatheter emboli zation was used in 12 patients. Complications included splenic infarct ion (one) and recurrence (two), successfully treated with repeat embol ization. Nine patients were treated with observation. Eight experience d no complications during follow-up; one died of a ruptured splenic ar tery aneurysm before treatment was initiated. Conclusions. The widespr ead use of computed tomography has led to increased detection of asymp tomatic visceral artery aneurysms. Although surgery remains necessary in many patients, transcatheter embolization is effective in the treat ment of selected visceral artery aneurysms with few complications and low recurrence.