VISCERAL ARTERY ANEURYSMS - 11/09/11

Doi : 10.1016/S0039-6109(05)70559-4

Louis M. Messina, MD ^a, Charles J. Shanley, MD ^b

^a Division of Vascular Surgery, University of California, San Francisco, California (LMM);

^b the Section of Vascular Surgery, University of Michigan Medical Center, Ann Arbor, Michigan (CJS)

Résumé

Visceral artery aneurysms are an uncommon form of vascular disease whose pathogenesis and natural history remain incompletely characterized. Nonetheless, their importance to the practicing vascular surgeon lies in their potential for rupture or erosion into an adjacent viscus, resulting in life-threatening hemorrhage. Nearly 22% of reported visceral artery aneurysms present with rupture, resulting in an 8.5% mortality rate.^{32 Stanley J.C. Abdominal visceral aneurysms Vascular Emergencies New York: Appleton-Century Crofts (1981).
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Cliquez ici pour aller à la section Références} The purpose of this article is to review the etiology, clinical presentation, and treatment of visceral artery aneurysms.

Traditionally, the distribution of aneurysms among the visceral vessels is aneurysms of the splenic artery (60%), hepatic artery (20%), superior mesenteric artery (5.5%), celiac artery (4%), gastric and gastroepiploic arteries (4%), jejunal, ileal, colic (3%), pancreaticoduodenal and pancreatic arteries (2%), gastroduodenal artery (1.5%), and inferior mesenteric artery (<1%).^{35 Stanley J.C., Thompson N.W., Fry W.J. Splanchnic artery aneurysms Arch Surg 1970 ; 101 : 689

Cliquez ici pour aller à la section Références, 36 Stanley J.C., Zelenock G.B. Splanchnic artery aneurysms Vascular Surgery Philadelphia: WB Saunders (1995).
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Cliquez ici pour aller à la section Références} A recent review of the English language literature for a 10-year period (1985 to 1995) for reports of visceral artery aneurysms revealed that aneurysms of the hepatic arteries were the most frequently reported visceral artery aneurysms during that decade.^{30 Shanley C.J., Shah N.L., Messina L.M. Common splanchnic artery aneurysms: Splenic, hepatic, and celiac Ann Vasc Surg 1996 ; 10 : 315 [cross-ref]

Cliquez ici pour aller à la section Références, 31 Shanley C.J., Shah N.L., Messina L.M. Uncommon splanchnic artery aneurysms: Pancreaticoduodenal, gastroduodenal, superior mesenteric, inferior mesenteric, and colic Ann Vasc Surg 1996 ; 10 : 506 [cross-ref]

Cliquez ici pour aller à la section Références} This trend most likely relates to the increasing use of percutaneous diagnostic and therapeutic biliary procedures. A second factor is the increased use of diagnostic CT scanning after blunt liver trauma. These studies have resulted in an increased detection of post-traumatic false aneurysms of the intrahepatic arterial branches. Thus, 50% of all hepatic artery aneurysms reported within that decade are false aneurysms of the intrahepatic arterial branches. Furthermore, the majority of those lesions were managed percutaneously.

A factor contributing to incomplete knowledge of the pathogenesis and natural history of visceral artery aneurysms is that very few series have been reported involving more than 30 cases at a single institution.^{30 Shanley C.J., Shah N.L., Messina L.M. Common splanchnic artery aneurysms: Splenic, hepatic, and celiac Ann Vasc Surg 1996 ; 10 : 315 [cross-ref]

Cliquez ici pour aller à la section Références} Much of the literature concerning visceral artery aneurysms consists of single case reports or small series of several patients. This type of reporting may introduce bias in favor of unusual presentations and positive outcomes. Despite these limitations, these reports do provide an important frame of reference for the diagnosis and management of these unusual aneurysms. In fact, many visceral artery aneurysms still present with rupture, which often results in death of the patient. Thus, an aggressive approach to the diagnosis and management of these aneurysms is warranted.

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