SINGLE-CENTER EXPERIENCE IN THE TREATMENT OF VISCERAL ARTERY ANEURYSMS.

AIMS: Visceral artery aneurysms (VAAs), although rare, represent a life-threatening disease with high mortality rates. With the more frequent use of diagnostic tests, there has been an incidental detection of these lesions which are mostly asymptomatic. It follows that surgeons are increasingly called to decide the most appropriate management of VAAs between an open surgical or endovascular approach and among the different endovascular options currently available. The aim of this retrospective study was to evaluate the results of open surgery and interventional endovascular strategies of visceral artery aneurysms with respect to technical success, therapy-associated complications and post- interventional follow-up in the elective and emergency situation.

METHODS: From January 1992 to January 2017, 125 open surgical or endovascular interventions for VAA were performed at our institution. Once the VAA was diagnosed and the indication for treatment was assessed, the preoperative diagnostic workup consisted of contrast computed tomography (CT) or magnetic resonance imaging (MR) and, in some patients, digital subtraction angiography. Follow-up included clinical and duplex ultrasound scan (DUS) and contrast enhanced ultrasound (CEUS) to assess the treated vessel patency and organ perfusion after 1, 6, and 12 months, and yearly thereafter. CT or MR controls were also performed at 1 year of follow-up and only when DUS was not diagnostic or showed a complication thereafter. After the first 5 years of follow-up, the status of the patient was obtained by a structured telephone survey.

RESULTS: The treatment option was endovascular in 56 out of 125 cases (44.8%). Technical success was 98.3%. In one case the procedure was interrupted for the extensive dissection of the afferent vessel. Twenty-six patients were treated by coils embolization while 29 with covered stenting. The endovascular approach was in emergency in two cases (3.6%). In the endovascular group, mortality was nil. Complications occurred in 5 cases (8.9%): 1 sub-acute intestinal ischemia caused by superior mesenteric artery dissection, 2 aneurysm reperfusion, 1 stent thrombosis and 1 massive splenic hematoma. In 69 (55.2%) surgical treatment was preferred, with 24 VAA resections and 45 arterial reconstructions. In 20 cases (29%), open surgery was performed in emergency conditions. In the surgical group, 8 emergency patients (40%) died intraoperatively. The mortality after elective surgical interventions was nil. Complications after surgery were 4 graft late thrombosis (5.8%): asymptomatic in three cases and requiring splenectomy in one.

CONCLUSIONS: There is no overall consensus regarding the indications for treatment of VAA.