Part 2 · Visceral artery aneurysms
What are visceral artery aneurysms?
Visceral artery aneurysms involve the arteries supplying the abdominal organs — most commonly the splenic artery (about 60% of cases), followed by the hepatic, celiac, superior mesenteric, renal, gastroduodenal, and pancreaticoduodenal arteries. Many are now found incidentally on CT scans done for unrelated reasons. The lifetime rupture risk varies by location and size, but mortality after rupture remains high — approaching 25–70% for some splenic and hepatic aneurysms.5
It’s important to distinguish true aneurysms (atherosclerotic, congenital, or related to fibromuscular dysplasia and segmental arterial mediolysis) from pseudoaneurysms (contained vessel ruptures from trauma, pancreatitis, infection, or prior procedures). Pseudoaneurysms carry a far higher rupture risk and warrant treatment regardless of size.
When to treat
Modern Society for Vascular Surgery (SVS) guidelines have shifted toward earlier intervention than in the past:5
- Splenic artery aneurysm — repair at 3 cm or larger; smaller in pregnancy, women of childbearing age, portal hypertension, or transplant candidates
- Hepatic, celiac, and superior mesenteric artery aneurysms — generally repair at 2 cm or larger
- Pancreaticoduodenal and gastroduodenal aneurysms — repair regardless of size, given high rupture risk
- Renal artery aneurysm — repair at 2 cm or larger, with smaller thresholds in pregnancy or uncontrolled hypertension
- Any pseudoaneurysm — treat regardless of size
Embolization approach
The embolic strategy depends on the aneurysm’s geometry and the importance of preserving the parent vessel. Sac packing with detachable coils is straightforward when the aneurysm has a narrow neck. The isolation technique (sometimes called front-and-back-door embolization) closes the inflow and outflow vessels and is appropriate when the parent artery has good collateral circulation — the spleen, for example, tolerates splenic artery occlusion well. When the parent vessel must be preserved (renal, hepatic, mesenteric arteries), a covered stent excludes the aneurysm while maintaining flow. Liquid embolics (n-BCA glue, Onyx) are useful for irregular geometry. Modern series report technical success above 95% with major complication rates under 5%.6
Who performs embolization
Embolization is performed by interventional radiologists and, for many visceral lesions, by vascular surgeons working in hybrid operating rooms. The common thread is image-guided technique: detailed pre-procedure mapping, precise catheter navigation, and selective embolization. At Florida Interventional Specialists, every embolization is performed under live imaging guidance and integrated with the patient’s broader specialty care — pulmonology and HHT specialty teams for PAVMs, vascular surgery and hepatology for visceral aneurysms.
Frequently asked questions
When should a splenic artery aneurysm be repaired?
SVS guidelines recommend repair at 3 cm or larger, and at smaller sizes during pregnancy, in women of childbearing age, portal hypertension, transplant candidates, or any pseudoaneurysm.
Is embolization painful?
The procedure is performed under sedation or general anesthesia. Post-embolization syndrome — mild fever, fatigue, and discomfort over the treated organ for several days — is common after splenic, hepatic, or renal embolization and is managed with anti-inflammatory medication.
References
- Kjeldsen AD, Vase P, Green A. Hereditary haemorrhagic telangiectasia: a population-based study of prevalence and mortality in Danish patients. J Intern Med. 1999;245(1):31–39.
- Shovlin CL. Pulmonary arteriovenous malformations. Am J Respir Crit Care Med. 2014;190(11):1217–1228.
- Faughnan ME, Mager JJ, Hetts SW, et al. Second International Guidelines for the Diagnosis and Management of Hereditary Hemorrhagic Telangiectasia. Ann Intern Med. 2020;173(12):989–1001.
- Hsu CC, Kwak GH, Pierce DB, et al. Long-term outcomes of pulmonary arteriovenous malformation embolization in adults: a systematic review and meta-analysis. J Vasc Interv Radiol. 2020;31(11):1746–1759.e2.
- Chaer RA, Abularrage CJ, Coleman DM, et al. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg. 2020;72(1S):3S–39S.
- Barrionuevo P, Malas MB, Nejim B, et al. A systematic review and meta-analysis of the management of visceral artery aneurysms. J Vasc Surg. 2019;70(5):1694–1699.
