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Visceral Aneurysms

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  • • Splenic, hepatic, and superior mesenteric artery (SMA) aneurysms

Splenic Artery Aneurysms (SAA)

  • • Rupture < 2%, rarely occurs if < 3cm

    • Rupture during pregnancy occurs during third trimester: 75% maternal death, 90% fetal death

Hepatic Artery Aneurysms (HAA)

  • • 20% rupture frequency

SMA Aneurysm (SMAA)

  • • Aneurysm may involve origin or branches

    • Lesion rarely calcified

Epidemiology

SAA

  • • Second in frequency of abdominal aneurysms after aortoiliac aneurysms

    • 60% of visceral artery aneurysms

    • More women affected than men (4:1); often during childbearing years

    • Arterial fibrodysplasia and portal hypertension predispose to SAA

HAA

  • • 20% of visceral aneurysms

    • More men than women affected (2:1)

SMAA

  • • < 5% of visceral aneurysms

    • 60% are mycotic, rest atherosclerotic

Symptoms and Signs

SAA

  • • Often asymptomatic, occasionally abdominal pain, rupture

HAA

  • • Rupture into peritoneal cavity, viliary tress, or into viscus

    • Hemobilia with rupture into biliary tree

    • 33% of patients have triad

    • -Intermittent abdominal pain

      -GI bleeding

      -Jaundice

SMAA

  • • Nonspecific abdominal pain

    • Mobile pulsatile abdominal mass

    • Abdominal apoplexy with rupture

Imaging Findings

SAA

  • • Abdominal x-ray: Concentric calcification in left upper quadrant

    • CT scan often diagnostic

    • Angiogram often diagnostic

HAA

  • • CT scan helpful

    • Angiogram diagnostic

SMAA

  • • CT scan helpful

    • Angiogram diagnostic

  • • Angiogram often performed prior to any operative intervention

  • • Abdominal x-ray

    • CT scan

    • Angiography

SAA

  • • Aneurysm exclusion with or without splenectomy

    • Laparoscopic ligation feasible

HAA

  • • If common hepatic artery involved, can be ligated

    • If other portions of artery, reconstruct

SMAA

  • • Options include:

    • -Ligation

      -Endoaneurysmorrhaphy

      -Replace with autogenous vessel

    • For branch aneurysm, consider bowel resection

Surgery

Indications

  • • SAA: Symptomatic aneurysms, pregnant women, aneuruysm > 3 cm

    • HAA: Required with ruptures

Prognosis

SAA

  • • Rupture during pregnancy occurs during third trimester: 75% maternal death, 90% fetal death

HAA

  • • 35% mortality with rupture

References

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Carr SC et al. Visceral artery aneurysm rupture. J Vasc Surg. 2001;33:806.  [PubMed: 11296336]
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Pasha SF et al: Splanchnic artery aneurysms. Mayo Clin Proc 2007;82:472. Review.

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