Management of Coeliac and Hepatic Artery Aneurysms: An Experience of 84 Cases

Eur J Vasc Endovasc Surg. 2023 Dec;66(6):814-820. doi: 10.1016/j.ejvs.2023.09.032. Epub 2023 Sep 16.

Abstract

Objective: To report outcomes following open or endovascular treatment of true hepatic and coeliac artery aneurysms at a single referral centre.

Methods: This was a retrospective cohort study of consecutive patients treated for true hepatic and coeliac artery aneurysms between May 2002 and December 2021. Outcome measures included complications, graft patency, and survival rate.

Results: Overall, 84 patients were included with a median age of 63 years (interquartile range 55, 79). The majority (76%) of the patients were men. Frequent comorbidities included a history of tobacco (69%), hypertension (65%), hyperlipidaemia (32%), and diabetes (15%). Multiple synchronous aneurysms were detected in 22 patients (26%). There were 33 (39%) symptomatic aneurysms (abdominal pain without rupture [n = 18], rupture [n = 10], and sepsis [n = 5]). Seventeen patients (20%) had mycotic aetiology. Fifty patients (60%) underwent endovascular treatment with either covered stent placement (n = 29) or coil embolisation (n = 21), and 34 patients (40%) were treated with open surgery using allogenic iliac artery (n = 15), autologous saphenous vein (n = 15), GoreTex graft (n = 2), or ligation (n = 2). The complication rate was 32% in the open group and 18% in the endovascular group (p = .048). The overall 90 day post-operative mortality rate was 1.2%, five year primary patency was 90.0%, five year survival rate was 81.2%, and mean follow up was 6.9 ± 4.2 years.

Conclusion: Endovascular treatment is the preferred approach whenever technically possible. Despite higher post-operative morbidity, an open approach with vascular reconstruction using autologous or allogenic vascular grafts yields acceptable long term results.

Keywords: Coeliac artery aneurysm; Hepatic artery aneurysm; Mesenteric artery aneurysm; Visceral artery aneurysm.

MeSH terms

  • Aneurysm* / diagnostic imaging
  • Aneurysm* / etiology
  • Aneurysm* / surgery
  • Blood Vessel Prosthesis Implantation* / adverse effects
  • Endovascular Procedures* / adverse effects
  • Female
  • Hepatic Artery / diagnostic imaging
  • Hepatic Artery / surgery
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stents
  • Treatment Outcome