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Visceral Aneurysms

1. Splenic Artery Aneurysms:

  • Most common visceral aneurysm (60% of cases).
  • Prevalence: 0.1-10.4%, with a higher incidence in females (F:M = 4:1).
  • Most common in the 5th decade of life.
  • 17% associated with portal hypertension (PHTN).
  • Size: Usually <3 cm (average 2.1 cm).
  • Location: 75% occur in the distal 1/3 of the artery.
  • 80% asymptomatic, but a double rupture phenomenon can occur in symptomatic patients.
  • Rupture occurs in 13% of cases, often into the GI tract causing bleeding or hemobilia.

  • Ruptured splenic artery aneurysms are most common in pregnant women, accounting for 95% of cases.

    Management:

    • Asymptomatic aneurysms > 2 cm: Treatment is recommended.
    • In pregnant women, intervene even if aneurysm is < 2 cm.
    • Proximal and mid-splenic artery aneurysms: Managed with endovascular embolization.
    • Distal aneurysms: Managed with splenectomy.
    • Complication: Post-embolization syndrome is the most common issue after coil embolization.

2. Superior Mesenteric Artery (SMA) Aneurysm:

  • Incidence: 5.5%, affects males and females equally.
  • Most common location: First 5 cm of the SMA.
  • Most common cause: Mycotic origin from septic emboli.
  • Symptoms: 90% symptomatic with abdominal pain and a pulsatile mass.
  • Intervention: Recommended for asymptomatic, noninfected aneurysms > 2.5 cm.

3. Celiac Artery Aneurysm:

  • Incidence: 4%, most common in the 5th decade of life.
  • Symptoms: Most are asymptomatic, but epigastric pain is the most common symptom.
  • Rupture risk: 13%.
  • Imaging: Curvilinear calcification in the epigastrium seen on radiographs.

4. Inferior Mesenteric Artery (IMA) Aneurysm:

  • Incidence: 0.5%.
  • Location: Most common in the proximal main trunk.
  • Unique etiology: Often associated with occlusive disease of the celiac and SMA.

5. Gastroduodenal Artery (GDA) Aneurysm:

  • More common in males.
  • High rupture risk: 56%.
  • Jaundice occurs in about 1/3 of patients.
  • Pancreatitis in 47%.
  • Majority are treated with ligation (~72%).

Question:

  1. The most common visceral arterial aneurysm is?

    A) Hepatic artery aneurysm

    B) Splenic artery aneurysm

    C) Left gastric artery aneurysm

    D) SMA aneurysm

    Answer:

    B) Splenic artery aneurysm

  2. All are true regarding splenic artery aneurysm except:

    • A) 80% - asymptomatic
    • B) Associated with PHTN in 17%
    • C) Small, Usually < 3cm
    • D) 25% found in distal 1/3 of artery

    Answer: D) 25% found in distal 1/3 of artery

    (75% are found in the distal 1/3 of the artery)

  3. All are true regarding GDA aneurysm except:

    • A) More common in males
    • B) Rupture chance is 56%
    • C) 1/3 pts develop jaundice
    • D) Pancreatitis found in around 20%

    Answer: D) Pancreatitis found in around 20%

    (Pancreatitis is found in around 47% of patients, not 20%)