Early and Long-Term Results of Open and Endovascular Treatment of Visceral Artery Aneurysms

Objectives
This study retrospectively analyzed early and follow-up results of open and endovascular management of visceral artery aneurysms in two Italian teaching hospitals.
Methods
From January 1982 to December 2014, 144 consecutive elective interventions for visceral artery aneurysms were performed in 144 patients; in 76 cases an endovascular intervention was performed (group 1), while in the remaining 68, an open procedure was carried out. Pre-, intra-, and postoperative data were prospectively collected in a dedicated database. Early (<30 days) and follow-up results were evaluated and compared with χ2 test and Kaplan-Meier curves.
Results
The site of aneurysm was the splenic artery in 43 patients in group 1 and in 34 patients in group 2, the common hepatic artery in 6 and 7 patients, and the renal artery in 8 cases for each group. Perigastric and peripancreatic aneurysms were present in 20 patients (11 and 9, respectively), while the celiac trunk was involved in 6 cases (5 and 1, respectively). Colic and mesenteric aneurysms were found in three cases in group 1 and in two cases in group 2. Finally, seven patients in group had multiple vessel involvement; 10 patients (6.9%) had rupture. In group 1 interventions consisted in coiling in 59 cases; in 17 patients, a covered or a multilayer stent was placed. In group 2, 58 patients had aneurysmectomy with reconstitution of the arterial patency in different fashions; nine patients with distal splenic aneurysm had splenectomy and arterial ligature, and one patient had aneurysmal wrapping. Technical success in group 1 was 96%. There were three perioperative deaths, two in group 1 (2.6%) and one in group 1 (1.4%; P = .6). Local and systemic complications occurred in nine patients in group 1 (11.8%) and in seven patients in group 2 (10.2%; P = .7). Three patients in group 1 underwent early reintervention (3.9%), while in group 2, no early reintervention was required (P = .08). Median duration of follow-up was 48 months (range, 1-324). Estimated 7-year survival was 83.4% in group 1 and 85.2% in group 2 (P = .2, log-rank 1.2). Also the rates of freedom from aneurysm-related complications and of reinterventions were similar between the two groups (P = .3 and P = .7, respectively).
Conclusions
Elective open and endovascular treatment of visceral artery aneurysm provided excellent early results, with low mortality and reinterventions rates, even in the presence of a not negligible rate of perioperative complications. Also long-term results were equally satisfactory, suggesting the effectiveness of a single patient-based therapeutic choice.