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Other Visceral Artery Interventions
Franklin Nwoke, MD; Raymond W. Liu, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Outcomes

          TERMINOLOGY

          • Definitions

            • Visceral artery aneurysms: Relatively infrequent
              • Incidence of 0.1-2.0% in general population
                • Reported rupture rates of 20-70%
                  • 50% present with rupture
                  • 8.5-75.0% mortality rate (location dependent)
              • Various etiologies
                • Atherosclerosis (most common)
                • Infection (mycotic)
                • Trauma
                • Genetic
                  • Marfan syndrome
                  • Klippel-Trenaunay-Weber syndrome
                  • Ehlers-Danlos syndrome
                  • Behçet syndrome
                • Vasculitis
                • Iatrogenic intervention
              • Visceral artery aneurysm distribution
                • Splenic artery: 60-80%
                • Hepatic artery: 20%
                • Superior mesenteric artery (SMA): 5%
                • Gastroduodenal/gastroepiploic artery: 4%
              • True aneurysm: Contains all 3 layers of arterial wall
                • Degenerative process involving arterial wall
                • Rupture risk increases when size ≥ 2 cm
              • Pseudoaneurysm (false aneurysm): Arterial wall disruption with focal contained hemorrhage
                • Does not contain all 3 layers of arterial wall
                • Typically associated perivascular inflammation
                  • Etiologies include trauma, infection, vasculitis
                • High risk of rupture
                  • Usually require treatment, regardless of size
                • Increasing incidence from iatrogenic injury
                  • Endoscopic/percutaneous biliary interventions
                  • Laparoscopic interventions
                  • Transarterial chemo-/radioembolization
                  • Transplantation related
            • Fibromuscular dysplasia (FMD): Noninflammatory arteriopathy typified by abnormal cellular growth in walls of medium to large arteries
            • Segmental arterial mediolysis (SAM): Nonatherosclerotic, noninflammatory arteriopathy
              • Histology shows vacuolar degeneration of smooth muscle in outer media of arterial wall
              • Clinical symptoms include acute abdominal pain and hemorrhage in late middle-aged & elderly patients
              • Responds poorly to angioplasty & other interventions

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Procedure Steps

                      • Alternative Procedures/Therapies

                        POST PROCEDURE

                        • Things to Do

                          OUTCOMES

                          • Complications

                            • Expected Outcomes

                              Selected References

                              1. Kok HK et al: Systematic review and single-center experience for endovascular management of visceral and renal artery aneurysms. J Vasc Interv Radiol. 27(11):1630-1641, 2016
                              2. Balderi A et al: Endovascular treatment of visceral artery aneurysms and pseudoaneurysms: our experience. Radiol Med. 117(5):815-830, 2012
                              3. Spiliopoulos S et al: Endovascular treatment of visceral aneurysms and pseudoaneurysms: long-term outcomes from a multicenter European study. Cardiovasc Intervent Radiol. 35(6):1315-25, 2012
                              4. Etezadi V et al: Endovascular treatment of visceral and renal artery aneurysms. J Vasc Interv Radiol. 22(9):1246-53, 2011
                              5. Gehlen JM et al: Visceral artery aneurysms. Vasc Endovascular Surg. 45(8):681-7, 2011
                              6. Saba L et al: The multidetector computed tomography angiography (MDCTA) in the diagnosis of splenic artery aneurysm and pseudoaneurysm. Acta Radiol. 52(5):488-98, 2011
                              7. Takao H et al: Natural history of true pancreaticoduodenal artery aneurysms. Br J Radiol. 83(993):744-6, 2010
                              8. Chao CP: Segmental arterial mediolysis. Semin Intervent Radiol. 26(3):224-32, 2009
                              9. Michael M et al: Segmental arterial mediolysis: CTA findings at presentation and follow-up. AJR Am J Roentgenol. 187(6):1463-9, 2006
                              10. Nosher JL et al: Visceral and renal artery aneurysms: a pictorial essay on endovascular therapy. Radiographics. 26(6):1687-704; quiz 1687, 2006
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Preprocedure

                                  • Procedure

                                    • Outcomes

                                      TERMINOLOGY

                                      • Definitions

                                        • Visceral artery aneurysms: Relatively infrequent
                                          • Incidence of 0.1-2.0% in general population
                                            • Reported rupture rates of 20-70%
                                              • 50% present with rupture
                                              • 8.5-75.0% mortality rate (location dependent)
                                          • Various etiologies
                                            • Atherosclerosis (most common)
                                            • Infection (mycotic)
                                            • Trauma
                                            • Genetic
                                              • Marfan syndrome
                                              • Klippel-Trenaunay-Weber syndrome
                                              • Ehlers-Danlos syndrome
                                              • Behçet syndrome
                                            • Vasculitis
                                            • Iatrogenic intervention
                                          • Visceral artery aneurysm distribution
                                            • Splenic artery: 60-80%
                                            • Hepatic artery: 20%
                                            • Superior mesenteric artery (SMA): 5%
                                            • Gastroduodenal/gastroepiploic artery: 4%
                                          • True aneurysm: Contains all 3 layers of arterial wall
                                            • Degenerative process involving arterial wall
                                            • Rupture risk increases when size ≥ 2 cm
                                          • Pseudoaneurysm (false aneurysm): Arterial wall disruption with focal contained hemorrhage
                                            • Does not contain all 3 layers of arterial wall
                                            • Typically associated perivascular inflammation
                                              • Etiologies include trauma, infection, vasculitis
                                            • High risk of rupture
                                              • Usually require treatment, regardless of size
                                            • Increasing incidence from iatrogenic injury
                                              • Endoscopic/percutaneous biliary interventions
                                              • Laparoscopic interventions
                                              • Transarterial chemo-/radioembolization
                                              • Transplantation related
                                        • Fibromuscular dysplasia (FMD): Noninflammatory arteriopathy typified by abnormal cellular growth in walls of medium to large arteries
                                        • Segmental arterial mediolysis (SAM): Nonatherosclerotic, noninflammatory arteriopathy
                                          • Histology shows vacuolar degeneration of smooth muscle in outer media of arterial wall
                                          • Clinical symptoms include acute abdominal pain and hemorrhage in late middle-aged & elderly patients
                                          • Responds poorly to angioplasty & other interventions

                                      PREPROCEDURE

                                      • Indications

                                        • Contraindications

                                          • Preprocedure Imaging

                                            • Getting Started

                                              PROCEDURE

                                              • Patient Position/Location

                                                • Procedure Steps

                                                  • Alternative Procedures/Therapies

                                                    POST PROCEDURE

                                                    • Things to Do

                                                      OUTCOMES

                                                      • Complications

                                                        • Expected Outcomes

                                                          Selected References

                                                          1. Kok HK et al: Systematic review and single-center experience for endovascular management of visceral and renal artery aneurysms. J Vasc Interv Radiol. 27(11):1630-1641, 2016
                                                          2. Balderi A et al: Endovascular treatment of visceral artery aneurysms and pseudoaneurysms: our experience. Radiol Med. 117(5):815-830, 2012
                                                          3. Spiliopoulos S et al: Endovascular treatment of visceral aneurysms and pseudoaneurysms: long-term outcomes from a multicenter European study. Cardiovasc Intervent Radiol. 35(6):1315-25, 2012
                                                          4. Etezadi V et al: Endovascular treatment of visceral and renal artery aneurysms. J Vasc Interv Radiol. 22(9):1246-53, 2011
                                                          5. Gehlen JM et al: Visceral artery aneurysms. Vasc Endovascular Surg. 45(8):681-7, 2011
                                                          6. Saba L et al: The multidetector computed tomography angiography (MDCTA) in the diagnosis of splenic artery aneurysm and pseudoaneurysm. Acta Radiol. 52(5):488-98, 2011
                                                          7. Takao H et al: Natural history of true pancreaticoduodenal artery aneurysms. Br J Radiol. 83(993):744-6, 2010
                                                          8. Chao CP: Segmental arterial mediolysis. Semin Intervent Radiol. 26(3):224-32, 2009
                                                          9. Michael M et al: Segmental arterial mediolysis: CTA findings at presentation and follow-up. AJR Am J Roentgenol. 187(6):1463-9, 2006
                                                          10. Nosher JL et al: Visceral and renal artery aneurysms: a pictorial essay on endovascular therapy. Radiographics. 26(6):1687-704; quiz 1687, 2006