Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content + • 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 ++Carr SC et al. Visceral artery aneurysm rupture. J Vasc Surg. 2001;33:806. [PubMed: 11296336] ++Pasha SF et al: Splanchnic artery aneurysms. Mayo Clin Proc 2007;82:472. Review. GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessSurgery 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessSurgery Full Site: One-Year Individual Subscription $995 USD Buy Now View All Subscription Options