Visceral Artery Aneurysms: A Complex and Unresolved Issue
Bahaa Arefai
Servei d'Angiologia, Cirurgia Vascular i Endovascular, Hospital Universitari Joan XXIII, Tarragona, Spain.
Mariam Perea-Ribis
Unitat de Recerca Biomèdica, Universitat Rovira i Virgili, Reus, Tarragona, Spain.
Benet Gómez
Servei d'Angiologia, Cirurgia Vascular i Endovascular, Hospital Universitari Joan XXIII, Tarragona, Spain.
Natalia Rodríguez
Servei d'Angiologia, Cirurgia Vascular i Endovascular, Hospital Universitari Joan XXIII, Tarragona, Spain.
Patricia Hernández
Servei de Radiologia i Medicina Nuclear, Hospital Universitari Joan XXIII, Tarragona, Spain.
Jordi Camps
Unitat de Recerca Biomèdica, Universitat Rovira i Virgili, Reus, Tarragona, Spain.
Jorge Joven
Unitat de Recerca Biomèdica, Universitat Rovira i Virgili, Reus, Tarragona, Spain.
Anna Hernández-Aguilera *
Unitat de Recerca Biomèdica, Universitat Rovira i Virgili, Reus, Tarragona, Spain.
Vicente Martín-Paredero
Servei d'Angiologia, Cirurgia Vascular i Endovascular, Hospital Universitari Joan XXIII, Tarragona, Spain.
*Author to whom correspondence should be addressed.
Abstract
Aims: The lack of prospective studies on abdominal non-aortic true or false aneurysms results in insufficient data to predict their natural history and propose a treatment of choice. The experience provided by case reports is important to discuss their management and prevention. This is relevant because abnormal enlargements in superior mesenteric artery are relatively uncommon but associated with specific symptoms and a high incidence of rupture and/or ischemic bowel complications.
Presentation of Case: Open surgery was preferred in a giant true aneurysm with an associated arteriovenous fistula, due to the likely need for revascularization and probable lack of stability for a stent graft. Contrarily in a pseudoaneurysm with a similar size we performed coil embolization. Incidentally, this procedure required a subsequent deployment of a covered stent graft to resolve bleeding.
Discussion: We discuss the outcomes of true and false aneurysms in the superior mesenteric artery, which required urgent treatment due to their high diameter. Their extremely large size also suggests a protracted course and a considerable period of time without proper surveillance through imaging techniques. Endovascular techniques seem to be favored in the elective setting and open surgery in the emergent setting but the challenge for the vascular surgeon to choose a treatment is considerable. Patient’s clinical state, perceived risk of rupture, the size of the lesion and expected quality of life conditioned the choice.
Conclusion: The described cases illustrate the urgent requirement of treatment guidelines and/or screening programs to detect abdominal non-aortic aneurysms at an early stage.
Keywords: Visceral artery aneurysms, pseudoaneurysms, risk assessment, screening, superior mesenteric artery.