Hepatic and Splenic Artery Aneurysms

Accounting for 80% of all visceral artery aneurysms, splenic and hepatic artery lesions are rare but potentially life threatening. Although their natural history has not been well-defined, the high mortality associated with emergent repair suggests an aggressive approach is indicated. While repair is clearly mandated in patients with a symptomatic aneurysm or contained rupture, the following asymptomatic lesions also warrant intervention: (1) splenic artery aneurysms in patients with the potential to become pregnant or requiring liver transplantation, (2) hepatic aneurysms in patients with polyarteritis nodosa or fibromuscular dysplasia, (3) splenic or hepatic artery aneurysms greater than 2.0 cm in diameter, and (4) splenic or hepatic pseudoaneurysms. Although open surgical interventions have traditionally been the mainstay of therapy, endovascular techniques have increasingly been applied to this problem. Dictated predominately by the need to maintain distal end-organ perfusion, potential therapies include open surgical ligation, autogenous reconstruction, endovascular coil embolization, or percutaneous endograft placement. While offering alternative approaches, endovascular techniques have not dramatically altered the risk-to-benefit ratio in asymptomatic lesions, and both open and percutaneous approaches present viable options for elective repair. Although explored in only a limited number of patients, the application of endovascular techniques to the symptomatic patient offers the greatest potential for significant improvements in morbidity and mortality.