Visceral Artery Aneurysms: A Complex and Unresolved Issue

Aims: The lack of prospective studies on abdominal non-aortic true or false aneurysms results in insufficient data to predict their natural history and propose a treatment of choice. The experience provided by case reports is important to discuss their management and prevention. This is relevant because abnormal enlargements in superior mesenteric artery are relatively uncommon but associated with specific symptoms and a high incidence of rupture and/or ischemic bowel complications.

Presentation of Case: Open surgery was preferred in a giant true aneurysm with an associated arteriovenous fistula, due to the likely need for revascularization and probable lack of stability for a stent graft. Contrarily in a pseudoaneurysm with a similar size we performed coil embolization. Incidentally, this procedure required a subsequent deployment of a covered stent graft to resolve bleeding.

Discussion: We discuss the outcomes of true and false aneurysms in the superior mesenteric artery, which required urgent treatment due to their high diameter. Their extremely large size also suggests a protracted course and a considerable period of time without proper surveillance through imaging techniques. Endovascular techniques seem to be favored in the elective setting and open surgery in the emergent setting but the challenge for the vascular surgeon to choose a treatment is considerable. Patient’s clinical state, perceived risk of rupture, the size of the lesion and expected quality of life conditioned the choice.

Conclusion: The described cases illustrate the urgent requirement of treatment guidelines and/or screening programs to detect abdominal non-aortic aneurysms at an early stage.