Visceral Artery Aneurysms
What is a visceral artery aneurysm?
An aneurysm is a bulging or ballooning in the wall of a blood vessel. It is caused when a portion of the artery wall weakens. As the aneurysm expands (like a balloon), the artery wall grows progressively thinner, increasing the likelihood that the aneurysm will burst.
Peripheral aneurysms affect arteries other than the aorta. A visceral artery aneurysm is a peripheral aneurysm found in the arteries feeding the kidneys, intestines or other intra-abdominal organs.
What are the treatment options for visceral artery aneurysms?
The goals of treatment are to reduce symptoms and reduce the risk of complications. Although the possibility of rupture is there, visceral aneurysms do not rupture as often as aortic aneurysms.
Visceral aneurysms may form clots that block blood flow, or they can compress a nearby nerve or vein and cause pain, numbness or swelling. If this occurs, or in order to prevent this from occurring, treatment may be warranted.
Each patient will be evaluated and treatment will be individualized for the patient’s circumstances. Your healthcare provider will refer you to a vascular surgeon who can recommend the treatment option that is right for you. Before choosing any treatment, it is important to discuss the potential benefits, risks and side effects with your healthcare provider. You will receive specific guidelines to help you prepare for your procedure, as well as specific instructions to help your recovery.
If the aneurysm is small and not causing any symptoms, your physician may recommend “watchful waiting.” By closely monitoring your condition with ultrasound, CT or MRI scans every six to 12 months, the aneurysm will be watched for signs of changes.
If you have high blood pressure, your physician may prescribe blood pressure medication to lower your overall blood pressure and the pressure on the weakened area of the aneurysm. Additionally, your physician may prescribe a statin (or cholesterol-lowering medication) to maintain the health of your blood vessels.
Thrombolysis may be used to eliminate clots that are blocking blood flow. Thrombolytic therapy uses drugs designed to dissolve clots and restore normal blood flow. Your physician will inject a clot-dissolving medication into a blood vessel. A catheter (a long, thin tube) may also be used to deliver the medication or to break up the clot.
Surgical Treatment with Aneurysm Resection and Bypass (also known as Visceral Arterial Reconstruction)
A visceral aneurysm may be treated with resection of the aneurysm and bypass from one normal segment of artery to the next. This is done with a graft that is made from a portion of one of your veins or a man-made synthetic tube.
Minimally Invasive Repair
Your surgeon may consider a newer procedure called an endovascular, or stent-graft, repair of the aneurysm. Endovascular means that surgery is performed inside your artery using thin, long tubes called catheters. You may be eligible for endovascular repair of your visceral aneurysm depending on the location and size of the aneurysm.
Your surgeon will enter through arterial punctures in the groin or arm, using catheters to guide and deliver a stent-graft through the blood vessels to the site of the aneurysm. X-ray guidance is used to position a graft made of artificial material to the area of the aneurysm. The graft is then expanded inside the artery and held in place with metallic hooks rather than sutures.
In some instances, if the aneurysm is in a branch artery that is not vital for organ perfusion, the aneurysm will simply be occluded by the placement of metal coils or glue within the arteries feeding the aneurysm or arising from the aneurysm. This stops all of the blood flow in the aneurysm and prevents it from rupturing or embolizing.
Outcomes for Aneurysm Repair
The Department of Vascular Surgery at Cleveland Clinic is recognized internationally for its leadership in the repair of complex aneurysms and has published many reports concerning the early and late results of management.
With more than 1,500 patients now treated with minimally invasive aneurysm repair, the experience we offer patients requiring aneurysm surgery is increasingly important. Patients undergoing this approach experience reduced operative morbidity and mortality when the procedure is performed by a skilled team. Increasingly, the minimally invasive approach is becoming the preferred approach, as it reduces complications.
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