Consider Using Endovascular Repair for Splanchnic Aneurysms

By Kerri Wachter  

NEW YORK -- Splanchnic artery aneurysms can be successfully treated with endovascular repair, said Dr. Daniel G. Clair at the Veith symposium on vascular medicine sponsored by the Cleveland Clinic.

"Increasingly, we're seeing patients who have serendipitously noted aneurysms in the splanchnic circulation," according to Dr. Clair, who is the chairman of the department of vascular surgery at the Cleveland Clinic.

Treatment of these patients is complex because of poor available information regarding the natural history of the condition.

The majority of splanchnic aneurysms occur in the celiac distribution vessels, with aneurysms in the celiac, splenic, hepatic, and gastric arteries accounting for 90% of them.

"Aneurysm exclusion can be accomplished with high technical success with endovascular therapy," according to Dr. Clair, who presented his data on the treatment of splanchnic artery aneurysms at the Cleveland Clinic over an 8-year period.

He and his colleagues looked at endovascular repair in 48 patients with both vascular artery aneurysms (20) and vascular artery pseudoaneurysms (28).

Patients were mostly male (60%) with an average age of 58 years. Most aneurysms or pseudoaneurysms occurred in celiac distribution vessels: 20 in the splenic artery and 12 in the hepatic.

"Most of these patients initially were treated with coils, but ultimately our practice has [shifted] to coils in combination with glue to fill branches as needed," said Dr. Clair.

Coil embolization was used for aneurysm exclusion in 96% of the cases. Glue was used selectively. Technical success was 95% for aneurysms and 100% for pseudoaneurysms. Complete exclusion of flow within the aneurysm sac occurred in 97% of interventions with follow-up imaging.

One aneurysm patient died from intracerebral hemorrhage several days post procedure, but this appeared to be unrelated to the procedure itself. Three pseudoaneurysm patients also died periprocedurally.

Open repair is recommended when there is inadequate collateral circulation. Open-treatment options include ligation, exclusion with bypass, and aneurysmectomy.

Repair should be considered when symptoms are present; when size is greater than 2 cm; in women who are pregnant or of child-bearing potential; or when the aneurysm is located in high-risk vessels (celiac, hepatic, and gastric) or in small vessels.

Dr. Clair noted that he had potential conflicts of interest with several device manufacturers.