Validity of Therapeutic Approaches for Visceral Artery Aneurysms: Outcome after Surgery (Surgical Treatment or Endovascular Treatment) or Conservative Treatment

• Published in: Japanese Journal of Vascular Surgery Vol. 22; no. 3; pp. 633 - 639
• Main Authors: Murakami, Masanori, Samura, Makoto, Yamashita, Osamu, Hamano, Kimikazu, Morikage, Noriyasu, Suehiro, Kotaro
• Format: Journal Article
• Language: Japanese
• Published: JAPANESE SOCIETY FOR VASCULAR SURGERY 25.04.2013; 特定非営利活動法人 日本血管外科学会
• Subjects: endovascular treatment; EVT; open surgery; visceral artery aneurysm; 内臓動脈瘤; 外科的手術; 血管内治療
• ISSN: 0918-6778; 1881-767X
• DOI: 10.11401/jsvs.22.633

Objective: The aim of this study was to evaluate the results of treatment for visceral artery aneurysms in our institution and examine the validity of therapeutic approaches. Subjects and Methods: This study included 43 patients with 48 aneurysms (17 renal artery aneurysms; RAAs, 20 splenic artery aneurysms; SAAs, 3 celiac artery aneurysms; CAAs, 6 superior mesenteric artery aneurysms; SMAAs, 1 inferior pancreaticoduodenal artery aneurysm; IPDA, and 1 hepatic artery aneurysm; HAA) treated between 2001 and June 2012. Aneurysms with a diameter ≥20 mm, symptomatic aneurysms, false aneurysms, and superior mesenteric artery branch aneurysms were treated, and other aneurysms were followed-up. As an exceptional measure, 2 RAAs and 1 SAA of 20 to 21 mm in diameter with an eggshell appearance were also followed-up. Endovascular treatment was chosen as the first-line treatment, and surgical treatment were performed when arterial reconstruction was necessary or endovascular treatment was anatomically impossible. Results: Of the 48 aneurysms, 17 required therapeutic intervention: 8 surgical treatments and 9 endovascular treatments. The surgical treatments performed were: resection and arterial reconstruction for 2 RAAs; aneurysmectomy, aneurysmectomy with arterial reconstruction, or aneurysmectomy with splenectomy for 3 SAAs; aneurysmectomy with arterial reconstruction for 2 SMAAs; and aneurysmectomy for 1 IPDA. Endovascular coil embolization was performed for 3 RAAs, 5 SAAs, and 1 HAA. None of the patients who underwent surgical or endovascular treatments developed late complications, but all of them returned to their social activities. The diameter of the 31 aneurysms that were followed-up for a mean period of 43±19 months did not significantly increase (13.1±3.3 mm at the first examination and 13.5±3.7 mm at the final examination, p=0.12), and none of the patients with these aneurysms developed aneurysm rupture or converted to surgery. The 5- and 8-year cumulative survival rates of patients treated by surgical or endovascular treatments were 100 and 75%, respectively. No patients died of aneurysm-related causes. Conclusion: The outcome of patients treated by surgical or endovascular treatments or followed-up was favorable, suggesting that our current therapeutic approaches are appropriate.