Visceral Artery Aneurysms

Although rare, visceral artery aneurysms are being increasingly identified with the widespread use of advanced imaging techniques. Their incidence, based on routine autopsies, has been estimated at 0.01 to 0.2% but is thought to be increasing with the rise in percutaneous biliary procedures, endovascular chemoembolization therapies, liver transplantation, arterial trauma secondary to laparoscopic manipulation of vessels, and a trend toward nonoperative management of blunt liver trauma. The morbidity and mortality associated with visceral aneurysms remain high—up to 22% in some reports. Therefore, early recognition and treatment prior to rupture are a priority. Management is evolving and includes open repair, laparoscopic and robotic-assisted repair, and a more important role for endovascular therapies. This review covers splenic artery aneurysms, hepatic artery aneurysms, superior mesenteric artery aneurysms, celiac artery aneurysms, and gastroduodenal and pancreaticoduodenal artery aneurysms. Tables highlight the estimated frequency of aneurysms by anatomic distribution, current management options, etiology of splanchnic artery aneurysms, average visceral artery diameters, and preoperative imaging options. Angiographic images and intraoperative photos are provided. This review contains 12 figures, 5 tables, and 25 references.