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. 1996 Sep;78(5):412–419.

Aneurysms of the visceral and renal arteries.

Y P Panayiotopoulos 1, R Assadourian 1, P R Taylor 1
PMCID: PMC2502914  PMID: 8881722

Abstract

Visceral aneurysms represent a rare clinical entity; however, 10-20% will rupture and this is accompanied by a significant mortality rate of 20-70%, depending on the location of the aneurysm. The incidence, pathogenesis and clinical aspects of splanchnic and renal artery aneurysms are reviewed from the available literature and the problems of diagnosis and treatment are discussed. Their incidence is increasing and controversy still exists regarding their treatment. The decision for intervention has to take into account the size and the natural history of the lesion, the risk of rupture, which is high during pregnancy, and the relative risk of surgical or radiological intervention. For most asymptomatic aneurysms, expectant treatment is acceptable. For large, symptomatic or aneurysms with a high risk of rupture, surgery is advisable. An alternative treatment is the use of endovascular techniques, ie embolisation, or graft stent insertion.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Achkar A. A., Stanson A. W., Johnson C. M., Srivatsa S. S., Dale L. C., Weyand C. M. Rheumatoid vasculitis manifesting as intra-abdominal hemorrhage. Mayo Clin Proc. 1995 Jun;70(6):565–569. doi: 10.4065/70.6.565. [DOI] [PubMed] [Google Scholar]
  2. Athey P. A., Sax S. L., Lamki N., Cadavid G. Sonography in the diagnosis of hepatic artery aneurysms. AJR Am J Roentgenol. 1986 Oct;147(4):725–727. doi: 10.2214/ajr.147.4.725. [DOI] [PubMed] [Google Scholar]
  3. Ayalon A., Wiesner R. H., Perkins J. D., Tominaga S., Hayes D. H., Krom R. A. Splenic artery aneurysms in liver transplant patients. Transplantation. 1988 Feb;45(2):386–389. doi: 10.1097/00007890-198802000-00028. [DOI] [PubMed] [Google Scholar]
  4. BEDFORD P. D., LODGE B. Aneurysm of the splenic artery. Gut. 1960 Dec;1:312–320. doi: 10.1136/gut.1.4.312. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Baker K. S., Tisnado J., Cho S. R., Beachley M. C. Splanchnic artery aneurysms and pseudoaneurysms: transcatheter embolization. Radiology. 1987 Apr;163(1):135–139. doi: 10.1148/radiology.163.1.3823426. [DOI] [PubMed] [Google Scholar]
  6. Barrett J. M., Van Hooydonk J. E., Boehm F. H. Pregnancy-related rupture of arterial aneurysms. Obstet Gynecol Surv. 1982 Sep;37(9):557–566. doi: 10.1097/00006254-198209000-00001. [DOI] [PubMed] [Google Scholar]
  7. Bleichrodt R. P., Smulders T. A., Schreuder F., Tinbergen W., Müller W. F. Aneurysms of the jejunal artery. J Cardiovasc Surg (Torino) 1984 Jul-Aug;25(4):376–377. [PubMed] [Google Scholar]
  8. Bronsther O., Merhav H., Van Thiel D., Starzl T. E. Splenic artery aneurysms occurring in liver transplant recipients. Transplantation. 1991 Oct;52(4):723–724. doi: 10.1097/00007890-199110000-00026. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Bui B. T., Oliva V. L., Leclerc G., Courteau M., Harel C., Plante R., Giroux D., Carignan L. Renal artery aneurysm: treatment with percutaneous placement of a stent-graft. Radiology. 1995 Apr;195(1):181–182. doi: 10.1148/radiology.195.1.7892464. [DOI] [PubMed] [Google Scholar]
  10. Bulbul M. A., Farrow G. A. Renal artery aneurysms. Urology. 1992 Aug;40(2):124–126. doi: 10.1016/0090-4295(92)90509-u. [DOI] [PubMed] [Google Scholar]
  11. Busuttil R. W., Brin B. J. The diagnosis and management of visceral artery aneurysms. Surgery. 1980 Nov;88(5):619–624. [PubMed] [Google Scholar]
  12. Caillouette J. C., Merchant E. B. Ruptured splenic artery aneurysm in pregnancy. Twelfth reported case with maternal and fetal survival. Am J Obstet Gynecol. 1993 Jun;168(6 Pt 1):1810–1813. doi: 10.1016/0002-9378(93)90694-e. [DOI] [PubMed] [Google Scholar]
  13. Cerny J. C., Chang C. Y., Fry W. J. Renal artery aneurysms. Arch Surg. 1968 Apr;96(4):653–663. doi: 10.1001/archsurg.1968.01330220169026. [DOI] [PubMed] [Google Scholar]
  14. Chubachi A., Saitoh K., Imai H., Miura A. B., Kotanagi H., Abe T., Matsumoto T. Case report: intestinal infarction after an aneurysmal occlusion of superior mesenteric artery in a patient with Behçet's disease. Am J Med Sci. 1993 Dec;306(6):376–378. doi: 10.1097/00000441-199312000-00004. [DOI] [PubMed] [Google Scholar]
  15. Cohen J. R., Shamash F. S. Ruptured renal artery aneurysms during pregnancy. J Vasc Surg. 1987 Jul;6(1):51–59. doi: 10.1067/mva.1987.avs0060051. [DOI] [PubMed] [Google Scholar]
  16. Dayton B., Helgerson R. B., Sollinger H. W., Acher C. W. Ruptured renal artery aneurysm in a pregnant uninephric patient: successful ex vivo repair and autotransplantation. Surgery. 1990 Jun;107(6):708–711. [PubMed] [Google Scholar]
  17. Diettrich N. A., Cacioppo J. C., Ying D. P. Massive gastrointestinal hemorrhage caused by rupture of a jejunal branch artery aneurysm. J Vasc Surg. 1988 Aug;8(2):187–189. doi: 10.1067/mva.1988.avs0080187. [DOI] [PubMed] [Google Scholar]
  18. Dzsinich C., Gloviczki P., McKusick M. A., Pairolero P. C., Bower T. C., Hallett J. W., Jr, Cherry K. J., Jr Surgical management of renal artery aneurysm. Cardiovasc Surg. 1993 Jun;1(3):243–247. [PubMed] [Google Scholar]
  19. English J. D. Spontaneous rupture of a splenic artery aneurysm in the third trimester. Ir J Med Sci. 1993 May;162(5):169–170. doi: 10.1007/BF02945175. [DOI] [PubMed] [Google Scholar]
  20. Faggioli G. L., Gargiulo M., Bertoni F., Tarantini S., Stella A. Hypertension due to an aneurysm of the left renal artery in a patient with neurofibromatosis. Ann Vasc Surg. 1992 Sep;6(5):456–459. doi: 10.1007/BF02007003. [DOI] [PubMed] [Google Scholar]
  21. Friedman S. G., Pogo G. J., Moccio C. G. Mycotic aneurysm of the superior mesenteric artery. J Vasc Surg. 1987 Jul;6(1):87–90. doi: 10.1067/mva.1987.avs0060087. [DOI] [PubMed] [Google Scholar]
  22. Frikha I., Masmoudi S., Turki H., Gdoura M., Sahnoun Y. Un nouveau cas de faux anévrysme de l'artère mésentérique supérieure. Ann Cardiol Angeiol (Paris) 1993 Mar;42(3):147–150. [PubMed] [Google Scholar]
  23. Gangahar D. M., Carveth S. W., Reese H. E., Buchman R. J., Breiner M. A. True aneurysm of the pancreaticoduodenal artery: a case report and review of the literature. J Vasc Surg. 1985 Sep;2(5):741–742. doi: 10.1067/mva.1985.avs0020741. [DOI] [PubMed] [Google Scholar]
  24. Graham L. M., Hay M. R., Cho K. J., Stanley J. C. Inferior mesenteric artery aneurysms. Surgery. 1985 Feb;97(2):158–163. [PubMed] [Google Scholar]
  25. Graham L. M., Stanley J. C., Whitehouse W. M., Jr, Zelenock G. B., Wakefield T. W., Cronenwett J. L., Lindenauer S. M. Celiac artery aneurysms: historic (1745-1949) versus contemporary (1950-1984) differences in etiology and clinical importance. J Vasc Surg. 1985 Sep;2(5):757–764. doi: 10.1067/mva.1985.avs0020757. [DOI] [PubMed] [Google Scholar]
  26. Granke K., Hollier L. H., Bowen J. C. Pancreaticoduodenal artery aneurysms: changing patterns. South Med J. 1990 Aug;83(8):918–921. doi: 10.1097/00007611-199008000-00016. [DOI] [PubMed] [Google Scholar]
  27. Guida P. M., Moore S. W. Aneurysm of the hepatic artery. Report of five cases with a brief review of the previously reported cases. Surgery. 1966 Aug;60(2):299–310. [PubMed] [Google Scholar]
  28. Haddad M., Barral X., Boissier C., Bouilloc X., Beraud A. M. Extracorporeal repair of renal artery branch lesions. Eur J Vasc Surg. 1989 Oct;3(5):435–441. doi: 10.1016/s0950-821x(89)80052-0. [DOI] [PubMed] [Google Scholar]
  29. Hageman J. H., Smith R. F., Szilagyi E., Elliott J. P. Aneurysms of the renal artery: problems of prognosis and surgical management. Surgery. 1978 Oct;84(4):563–572. [PubMed] [Google Scholar]
  30. Harlaftis N. N., Akin J. T. Hemobilia from ruptured hepatic artery aneurysm. Report of a case and review of the literature. Am J Surg. 1977 Feb;133(2):229–232. doi: 10.1016/0002-9610(77)90087-3. [DOI] [PubMed] [Google Scholar]
  31. Henriksson C., Lukes P., Nilson A. E., Pettersson S. Angiographically discovered, non-operated renal artery aneurysms. Scand J Urol Nephrol. 1984;18(1):59–62. doi: 10.3109/00365598409182164. [DOI] [PubMed] [Google Scholar]
  32. Holdsworth R. J., Gunn A. Ruptured splenic artery aneurysm in pregnancy. A review. Br J Obstet Gynaecol. 1992 Jul;99(7):595–597. doi: 10.1111/j.1471-0528.1992.tb13828.x. [DOI] [PubMed] [Google Scholar]
  33. Hubert J. P., Jr, Pairolero P. C., Kazmier F. J. Solitary renal artery aneurysm. Surgery. 1980 Oct;88(4):557–565. [PubMed] [Google Scholar]
  34. Hupp T., Allenberg J. R., Post K., Roeren T., Meier M., Clorius J. H. Renal artery aneurysm: surgical indications and results. Eur J Vasc Surg. 1992 Sep;6(5):477–486. doi: 10.1016/s0950-821x(05)80620-6. [DOI] [PubMed] [Google Scholar]
  35. Jeans P. L. Hepatic artery aneurysms and biliary surgery: two cases and a literature review. Aust N Z J Surg. 1988 Nov;58(11):889–894. doi: 10.1111/j.1445-2197.1988.tb00998.x. [DOI] [PubMed] [Google Scholar]
  36. Kibbler C. C., Cohen D. L., Cruicshank J. K., Kushwaha S. S., Morgan M. Y., Dick R. D. Use of CAT scanning in the diagnosis and management of hepatic artery aneurysm. Gut. 1985 Jul;26(7):752–756. doi: 10.1136/gut.26.7.752. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Lal R. B., Strohl J. A., Piazza S., Aslam M., Ball D., Patel K. Hepatic artery aneurysm. J Cardiovasc Surg (Torino) 1989 May-Jun;30(3):509–513. [PubMed] [Google Scholar]
  38. Langlois N. E., Miller I. D. Intramural gastric hematoma originating from an atherosclerotic aneurysm of a gastric artery. Am J Gastroenterol. 1993 Apr;88(4):613–614. [PubMed] [Google Scholar]
  39. Lawrie G. M., Morris G. C., Jr, Glaeser D. H., DeBakey M. E. Renovascular reconstruction: factors affecting long-term prognosis in 919 patients followed up to 31 years. Am J Cardiol. 1989 May 1;63(15):1085–1092. doi: 10.1016/0002-9149(89)90083-0. [DOI] [PubMed] [Google Scholar]
  40. Long C. D., Bakshi K. R., Kahn M. B., Roberts A. B. Giant splenic artery aneurysm. Ann Vasc Surg. 1993 Sep;7(5):474–478. doi: 10.1007/BF02002133. [DOI] [PubMed] [Google Scholar]
  41. Martin R. S., 3rd, Meacham P. W., Ditesheim J. A., Mulherin J. L., Jr, Edwards W. H. Renal artery aneurysm: selective treatment for hypertension and prevention of rupture. J Vasc Surg. 1989 Jan;9(1):26–34. [PubMed] [Google Scholar]
  42. Marzelle J., Gigou F., Cormier F., Carlet J., Farkas J. C., Lazareth I., Fermand M., Marteau V., Cormier J. M. Dissection isolée de l'artère mésentérique supérieure. La dysplasie, une cause rare d'ischémie mésentérique. Une observation. Presse Med. 1992 Jul 4;21(25):1157–1159. [PubMed] [Google Scholar]
  43. Matano R., Gennaro M., Mohan C., Ascer E. Association of intra-abdominal pathologies and vascular anomalies with infrarenal aortic aneurysm: a computed tomographic study. Cardiovasc Surg. 1993 Feb;1(1):27–29. [PubMed] [Google Scholar]
  44. Mattar S. G., Lumsden A. B. The management of splenic artery aneurysms: experience with 23 cases. Am J Surg. 1995 Jun;169(6):580–584. doi: 10.1016/s0002-9610(99)80225-6. [DOI] [PubMed] [Google Scholar]
  45. McDermott V. G., Shlansky-Goldberg R., Cope C. Endovascular management of splenic artery aneurysms and pseudoaneurysms. Cardiovasc Intervent Radiol. 1994 Jul-Aug;17(4):179–184. doi: 10.1007/BF00571531. [DOI] [PubMed] [Google Scholar]
  46. McNamara M. F., Griska L. B. Superior mesenteric artery branch aneurysms. Surgery. 1980 Nov;88(5):625–630. [PubMed] [Google Scholar]
  47. Men S., Ozmen M. N., Balkanci F., Boyacigil S., Akbari H. Superior mesenteric artery aneurysm in Behçet's disease. Abdom Imaging. 1994 Jul-Aug;19(4):333–334. doi: 10.1007/BF00198191. [DOI] [PubMed] [Google Scholar]
  48. Moore S. W., Guida P. M., Schumacher H. W. Splénic artery aneurysm. Bull Soc Int Chir. 1970 Jul-Aug;29(4):210–218. [PubMed] [Google Scholar]
  49. Naito A., Toyota N., Ito K. Embolization of a ruptured middle colic artery aneurysm. Cardiovasc Intervent Radiol. 1995 Jan-Feb;18(1):56–58. doi: 10.1007/BF02807359. [DOI] [PubMed] [Google Scholar]
  50. Ohta M., Hashizume M., Tanoue K., Kitano S., Sugimachi K., Yasumori K. Splenic hyperkinetic state and splenic artery aneurysm in portal hypertension. Hepatogastroenterology. 1992 Dec;39(6):529–532. [PubMed] [Google Scholar]
  51. Papalambros E., Felekuras E., Bastounis E., Panayotopoulos J., Balas P. Polyarteritis nodosa. An unusual cause of acute abdomen. Int Angiol. 1989 Oct-Dec;8(4):229–233. [PubMed] [Google Scholar]
  52. Parangi S., Oz M. C., Blume R. S., Bixon R., Laffey K. J., Perzin K. H., Buda J. A., Markowitz A. M., Nowygrod R. Hepatobiliary complications of polyarteritis nodosa. Arch Surg. 1991 Jul;126(7):909–912. doi: 10.1001/archsurg.1991.01410310119019. [DOI] [PubMed] [Google Scholar]
  53. Pitkäranta P., Haapiainen R., Kivisaari L., Schröder T. Diagnostic evaluation and aggressive surgical approach in bleeding pseudoaneurysms associated with pancreatic pseudocysts. Scand J Gastroenterol. 1991 Jan;26(1):58–64. doi: 10.3109/00365529108996484. [DOI] [PubMed] [Google Scholar]
  54. Puttini M., Aseni P., Brambilla G., Belli L. Splenic artery aneurysms in portal hypertension. J Cardiovasc Surg (Torino) 1982 Nov-Dec;23(6):490–493. [PubMed] [Google Scholar]
  55. Quandalle P., Chambon J. P., Marache P., Saudemont A., Maes B. Pancreaticoduodenal artery aneurysms associated with celiac axis stenosis: report of two cases and review of the literature. Ann Vasc Surg. 1990 Nov;4(6):540–545. doi: 10.1016/S0890-5096(06)60835-2. [DOI] [PubMed] [Google Scholar]
  56. Reidy J. F., Rowe P. H., Ellis F. G. Splenic artery aneurysm embolisation--the preferred technique to surgery. Clin Radiol. 1990 Apr;41(4):281–282. doi: 10.1016/s0009-9260(05)81667-8. [DOI] [PubMed] [Google Scholar]
  57. Rijbroek A., van Dijk H. A., Roex A. J. Rupture of renal artery aneurysm during pregnancy. Eur J Vasc Surg. 1994 May;8(3):375–376. doi: 10.1016/s0950-821x(05)80162-8. [DOI] [PubMed] [Google Scholar]
  58. Robinson L., Gedroyc W., Reidy J., Saxton H. M. Renal artery stenosis in children. Clin Radiol. 1991 Dec;44(6):376–382. doi: 10.1016/s0009-9260(05)80653-1. [DOI] [PubMed] [Google Scholar]
  59. Salam T. A., Lumsden A. B., Martin L. G., Smith R. B., 3rd Nonoperative management of visceral aneurysms and pseudoaneurysms. Am J Surg. 1992 Sep;164(3):215–219. doi: 10.1016/s0002-9610(05)81073-6. [DOI] [PubMed] [Google Scholar]
  60. Sellke F. W., Williams G. B., Donovan D. L., Clarke R. E. Management of intra-abdominal aneurysms associated with periarteritis nodosa. J Vasc Surg. 1986 Sep;4(3):294–298. doi: 10.1067/mva.1986.avs0040294. [DOI] [PubMed] [Google Scholar]
  61. Sharma A. K. Renal artery aneurysm, hypertension and neurofibromatosis. J R Soc Med. 1991 Jun;84(6):373–374. doi: 10.1177/014107689108400625. [DOI] [PMC free article] [PubMed] [Google Scholar]
  62. Shaw J. F. Hepatic artery aneurysms. Br J Hosp Med. 1982 Oct;28(4):404, 407-9. [PubMed] [Google Scholar]
  63. Smith D. L., Wernick R. Spontaneous rupture of a renal artery aneurysm in polyarteritis nodosa: critical review of the literature and report of a case. Am J Med. 1989 Oct;87(4):464–467. doi: 10.1016/s0002-9343(89)80835-6. [DOI] [PubMed] [Google Scholar]
  64. Solis M. M., Ranval T. J., McFarland D. R., Eidt J. F. Surgical treatment of superior mesenteric artery dissecting aneurysm and simultaneous celiac artery compression. Ann Vasc Surg. 1993 Sep;7(5):457–462. doi: 10.1007/BF02002130. [DOI] [PubMed] [Google Scholar]
  65. Stabile B. E., Wilson S. E., Debas H. T. Reduced mortality from bleeding pseudocysts and pseudoaneurysms caused by pancreatitis. Arch Surg. 1983 Jan;118(1):45–51. doi: 10.1001/archsurg.1983.01390010035009. [DOI] [PubMed] [Google Scholar]
  66. Stabile B. E., Wilson S. E., Debas H. T. Reduced mortality from bleeding pseudocysts and pseudoaneurysms caused by pancreatitis. Arch Surg. 1983 Jan;118(1):45–51. doi: 10.1001/archsurg.1983.01390010035009. [DOI] [PubMed] [Google Scholar]
  67. Stanley J. C., Fry W. J. Pathogenesis and clinical significance of splenic artery aneurysms. Surgery. 1974 Dec;76(6):898–909. [PubMed] [Google Scholar]
  68. Stanley J. C., Rhodes E. L., Gewertz B. L., Chang C. Y., Walter J. F., Fry W. J. Renal artery aneurysms. Significance of macroaneurysms exclusive of dissections and fibrodysplastic mural dilations. Arch Surg. 1975 Nov;110(11):1327–1333. doi: 10.1001/archsurg.1975.01360170067009. [DOI] [PubMed] [Google Scholar]
  69. Stanley J. C., Thompson N. W., Fry W. J. Splanchnic artery aneurysms. Arch Surg. 1970 Dec;101(6):689–697. doi: 10.1001/archsurg.1970.01340300045009. [DOI] [PubMed] [Google Scholar]
  70. Stewart B., Mannell A. Superior mesenteric artery aneurysms: a case report. Aust N Z J Surg. 1991 Feb;61(2):153–155. doi: 10.1111/j.1445-2197.1991.tb00194.x. [DOI] [PubMed] [Google Scholar]
  71. Taylor J. L., Woodward D. A. Splenic conservation and the management of splenic artery aneurysm. Ann R Coll Surg Engl. 1987 Jul;69(4):179–180. [PMC free article] [PubMed] [Google Scholar]
  72. Tham G., Ekelund L., Herrlin K., Lindstedt E. L., Olin T., Bergentz S. E. Renal artery aneurysms. Natural history and prognosis. Ann Surg. 1983 Mar;197(3):348–352. doi: 10.1097/00000658-198303000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  73. Trastek V. F., Pairolero P. C., Joyce J. W., Hollier L. H., Bernatz P. E. Splenic artery aneurysms. Surgery. 1982 Jun;91(6):694–699. [PubMed] [Google Scholar]
  74. Trevisani M. F., Ricci M. A., Michaels R. M., Meyer K. K. Multiple mesenteric aneurysms complicating subacute bacterial endocarditis. Arch Surg. 1987 Jul;122(7):823–824. doi: 10.1001/archsurg.1987.01400190089018. [DOI] [PubMed] [Google Scholar]
  75. Verma B. S., Bose A. K., Bhatia H. C., Katoch R. Superior mesenteric artery branch aneurysm diagnosed by ultrasound. Br J Radiol. 1991 Feb;64(758):169–171. doi: 10.1259/0007-1285-64-758-169. [DOI] [PubMed] [Google Scholar]
  76. Verta M. J., Jr, Dean R. H., Yao J. S., Conn J., Jr, Mehn W. H., Bergan J. J. Pancreaticoduodenal arterial aneurysms. Ann Surg. 1977 Jul;186(1):111–114. doi: 10.1097/00000658-197707000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  77. Wagner W. H., Cossman D. V., Treiman R. L., Foran R. F., Levin P. M., Cohen J. L. Hemosuccus pancreaticus from intraductal rupture of a primary splenic artery aneurysm. J Vasc Surg. 1994 Jan;19(1):158–164. doi: 10.1016/s0741-5214(94)70130-x. [DOI] [PubMed] [Google Scholar]
  78. Weaver D. H., Fleming R. J., Barnes W. A. Aneurysm of the hepatic artery: the value of arteriography in surgical management. Surgery. 1968 Nov;64(5):891–896. [PubMed] [Google Scholar]
  79. Werner K., Tarasoutchi F., Lunardi W., Mariño J. C., Grinberg M., Bellotti G., Jatene A. D. Mycotic aneurysm of the celiac trunk and superior mesenteric artery in a case of infective endocarditis. J Cardiovasc Surg (Torino) 1991 May-Jun;32(3):380–383. [PubMed] [Google Scholar]
  80. Whiteley M. S., Katoch R., Kennedy R. H., Bidgood K. A., Baird R. N. Ruptured renal artery aneurysm in the first trimester of pregnancy. Eur J Vasc Surg. 1994 Mar;8(2):238–239. doi: 10.1016/s0950-821x(05)80469-4. [DOI] [PubMed] [Google Scholar]
  81. Yuasa H., Hiraiwa T., Tanaka K., Mizutani T., Yada I., Kusagawa M. Aneurysm of the inferior mesenteric artery. Cardiovasc Surg. 1993 Apr;1(2):143–145. [PubMed] [Google Scholar]

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