Peripheral Vascular Surgery Society

#17 ENDOVASCULAR MANAGEMENT OF VISCERAL ARTERY ANEURYSMS.

Karthikeshwar Kasirajan, MD, Daniel G. Clair, MD, Roy K. Greenberg, MD, and Kenneth Ouriel, MD

Cleveland Clinic Foundation, Cleveland, OH

Purpose: High-resolution imaging modalities have resulted in improved detection of visceral artery aneurysms (VAA). Endovascular management may prove to be a safe and effective means of treatment, as a stand-alone therapy or an adjunct to open procedures when clinically indicated.

Methods: We retrospectively reviewed our experience in the management of VAA with percutaneous coil embolization techniques between 1988 and 1998.

Results: 9 patients (5 female, 4 male) with 12 (8 false, 4 true) VAA underwent attempted catheter based treatment. The mean age was 60 years (range 39-73). The majority of the patients (67%) presented with symptoms of aneurysm rupture. The aneurysm etiology was iatrogenic in 4, pancreatitis in 4 and non-specific in 4. Selective and superselective catheter techniques were used to obtain access to the VAA. The hepatic artery was involved in 10 cases, and the middle colic and gastroduodenal were each involved in 1 case. Technical success (aneurysm exclusion with coil embolization) was achieved 75% of the time (9 of 12 excluded). All technical failure resulted from the inability to cannulate the aneurysm neck. With only one exception, coil embolization of the aneurysm sac did not produce occlusion of the native vessel. No procedure related complications or deaths were noted. All patients remained symptom free during a mean follow-up of 46 months (range 19-108 months).

Conclusion: Percutaneous transcatheter embolotherapy should be considered for the initial management of VAA. This therapy may dramatically decrease the morbidity and mortality associated with open surgical procedure, in addition to the potential to selectively thrombose the aneurysm while preserving flow in the native vessel.

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Last updated January 1,2000