Visceral Aneurysms

• • 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