Endovascular Management of Visceral Artery Aneurysms

Visceral artery aneurysms are dilatations of the splanchnic vasculature most commonly affecting the splenic, hepatic and superior mesenteric arteries. While often asymptomatic, they carry a significant risk of rupture with high morbidity and mortality. Endovascular techniques have become first-line where anatomy and patient condition permit. Procedures centre on selective catheterisation and deployment of coils, covered stents or flow-diverting devices to exclude the aneurysmal sac, often supplemented by liquid embolic agents. This approach offers reduced peri-procedural morbidity compared with open repair and allows treatment in patients deemed high risk for surgery. Treatment thresholds are guided by aneurysm size (generally >2 cm), growth rate and symptomatology. Technical challenges include tortuous vessel anatomy, non-target embolisation and access in giant aneurysms. Advances in imaging, three-dimensional roadmapping and novel embolic materials continue to expand the spectrum of lesions amenable to endovascular management. A patient-tailored strategy, integrating aneurysm morphology (true versus pseudoaneurysm), arterial branch involvement and clinical presentation, underpins optimal outcomes.

Research from Nature Portfolio

Recent observational work has compared the outcomes of coil embolisation in symptomatic and asymptomatic visceral aneurysms across two tertiary centres. Although overall event-free survival was similar, symptomatic pseudoaneurysms demonstrated higher early mortality, emphasising the need for rapid aneurysm characterisation and prompt intervention. A risk association with dyslipidaemia was also noted, suggesting systemic factors may influence aneurysm behaviour. In the setting of giant visceral artery aneurysms (those exceeding 5 cm), a single-centre series reported technical and clinical success rates above 90% using a combination of occlusive coils, covered stents and adjunctive embolic materials. Long-term follow-up showed durable exclusion in most cases, though contained rupture at presentation remained a predictor of adverse outcome. These studies reinforce the safety and efficacy of endovascular exclusion for both standard and large-volume lesions when performed by experienced operators.

Endovascular Management of Visceral Artery Aneurysms publication trend

The graph below shows the total number of articles in endovascular management of visceral artery aneurysms across all publications each year (not limited to Nature Index journals).

Technical terms

Visceral artery aneurysm: Localized dilation of a branch of the celiac, superior or inferior mesenteric arteries.

Pseudoaneurysm: A contained arterial rupture in which blood is held by surrounding tissues rather than the native vessel wall.

Coil embolisation: Deployment of metallic coils into an aneurysm sac to promote thrombosis and exclude flow.

Covered stent: A stent graft with an impermeable lining used to seal aneurysmal segments while preserving parent vessel patency.

Flow-diverting stent: A high-metal-coverage stent designed to redirect blood flow away from an aneurysm, promoting sac thrombosis.

References

1. Management of Coeliac and Hepatic Artery Aneurysms: An Experience of 84 Cases. European Journal of Vascular and Endovascular Surgery (2023).
2. Endovascular embolization of visceral artery aneurysm: a retrospective study. Scientific Reports (2023).
3. Endovascular management of giant visceral artery aneurysms. Scientific Reports (2021).
4. Salvage surgeries for splanchnic artery aneurysms after failed endovascular therapy: case series. International Journal of Surgery (2023).
5. Current management strategies for visceral artery aneurysms: an overview. Surgery Today (2019).
6. Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives. Journal of Clinical Medicine (2021).