Visceral Artery Aneurysm

What is a visceral artery aneurysm?

An aneurysm occurs when the wall of an artery is weak and expands like a balloon. If your artery wall expands too much, it can rupture or burst. This is called a hemorrhage and is a life-threatening event.

Visceral arteries are blood vessels that branch off the main artery in your body called the aorta. Visceral arteries carry blood to the organs inside your abdomen, including your:

• Intestines.
• Kidneys.
• Liver.
• Pancreas.
• Spleen.
• Stomach.

Visceral artery aneurysms most often occur in the arteries that carry blood to your spleen, kidneys and liver.

What are the types of visceral artery aneurysms?

The two types are pseudoaneurysms (fake aneurysms) and true aneurysms:

• Pseudoaneurysms occur when there is a hole in your artery wall and blood pools in the tissue outside your artery. The clotting action of the blood forms a weak wall around the pooled blood. Because this wall may be unstable, pseudoaneurysms are more likely to rupture.
• True aneurysms are when a weakened section of an artery wall expands.

How common are visceral artery aneurysms?

Visceral artery aneurysms are rare. But since many people do not have symptoms, it’s not clear how often they occur.

The frequency of some types of visceral artery aneurysms varies by sex. For example, people assigned female at birth are more likely to have aneurysms in the artery leading to their spleen.

What are the symptoms of a visceral artery aneurysm?

Usually, people don’t have symptoms. Providers often find visceral artery aneurysms during medical imaging tests they order for other conditions.

The main signs of a ruptured visceral artery aneurysm are anemia and pain in your abdomen or back. The severity of the pain can range from mild to severe, making the condition difficult to diagnose in some cases. Other symptoms depend on the location of the aneurysm but can include vomiting blood or blood in your stool.

What causes visceral artery aneurysms?

The main causes of true aneurysms include:

• Atherosclerosis.
• Connective tissue diseases such as fibromuscular dysplasia, Marfan syndrome and Ehlers-Danlos syndrome.
• Trauma, such as an injury or accident.

Pseudoaneurysms usually occur due to:

• Injury from liver or pancreatic surgery.
• Pancreatitis.
• Trauma, caused by an injury or an accident.
• Vasculitis.

How are visceral artery aneurysms diagnosed?

Providers diagnose visceral artery aneurysms using medical imaging tests such as CT scans and MRIs. These tests measure the size of the aneurysm, which is important for guiding treatment options.

Angiography is a minimally invasive test. It can help your provider assess your blood vessels if other imaging tests show a problem. During angiography, your provider inserts a thin tube called a catheter into one of your veins. They thread the catheter to the affected visceral artery and inject a contrast dye. X-rays or CT images of the artery pick up the contrast and highlight any abnormal areas. In some cases, your provider can provide treatment right away during the angiography.

In some conditions, especially connective tissue diseases, it’s common to have aneurysms in multiple visceral arteries. In these cases, your provider may examine all the arteries in your abdomen.

What is monitoring for visceral artery aneurysms?

Treatment often depends on the size and type of the aneurysm. In general, watchful waiting may be the best option for a true aneurysm that is less than 2 centimeters.

Your provider will monitor the aneurysm routinely to check if it is growing. You may also receive medication to lower your blood pressure. In some cases, this can help prevent aneurysm growth.

When is treatment needed for a visceral artery aneurysm?

Treatment is the best option for any aneurysm with the potential to burst. This includes:

• Pseudoaneurysms of any size.
• True aneurysms larger than 2 centimeters (except for splenic artery aneurysms, which providers recommend repairing when larger than 3 centimeters).

You may also need treatment regardless of aneurysm size if you are at a higher risk of a rupture. Your risk may be higher if you:

• Are pregnant or of childbearing age.
• Experience ongoing symptoms such as anemia or abdominal or back pain.
• Need a liver transplant or other procedure for the treatment of cirrhosis.

Certain visceral artery aneurysms also require immediate treatment regardless of size. This is because they’re more likely to rupture. These include aneurysms located in your:

• Gastroduodenal artery that carries blood to your stomach, the upper part of your small intestine and the top of your pancreas.
• Pancreaticoduodenal artery that supplies blood to your pancreas and the upper part of your small intestine.
• Superior mesenteric artery that supplies blood to your small intestine.

What are the types of treatment for visceral artery aneurysms?

The main treatment options are open surgery and minimally invasive endovascular procedures. Factors that providers consider to decide which of these treatments is right for you include:

• Anatomy of your blood vessels, including their shape and size.
• Location of the aneurysm.
• Risk of open surgery, based on your age and overall health.

Open surgery requires a relatively large incision to give the surgeon direct access to the aneurysm. The surgeon removes the damaged area of the artery and replaces or repairs it.

Minimally invasive treatment uses a catheter inserted into an artery, usually in your groin, to access the aneurysm. Through the catheter, your provider may use one or more techniques to provide support and prevent rupture, including:

• Coil or plug embolization, or packing the aneurysm with a wire coil or mechanical plug.
• Liquid embolization, or injection of a glue, gel or another liquid agent to plug the aneurysm.
• Stenting, or fitting a fabric-covered, metal mesh tube (stent) inside your artery.

If you’re having an angiography to diagnose a visceral artery aneurysm, you may receive minimally invasive treatment right away through the same catheter.

How do open surgery and endovascular treatments compare?

Studies have compared patient outcomes between open and minimally invasive treatments. In general, both are equally safe and effective. Minimally invasive techniques lead to faster recovery and shorter hospital stays but may require a second treatment.

How can I prevent a visceral artery aneurysm?

Many types of visceral artery aneurysms are unavoidable. But you can prevent those related to atherosclerosis, which is often due to an unhealthy lifestyle. Changes you can make to reduce your chance of developing atherosclerosis include:

• Controlling your cholesterol and blood pressure.
• Exercising regularly.
• Following a heart-healthy diet.
• Getting enough sleep.
• Limiting alcohol use.
• Managing stress.
• Quitting smoking and tobacco use.

What is the outlook for visceral artery aneurysms?

Visceral artery aneurysms often lead to rupture and, in some cases, death. Studies show that about 25% of people with visceral artery aneurysms who seek emergency care have a rupture. At least 10% of these people die. The risk of death is higher in pregnant people with ruptured aneurysms.

In general, outcomes tend to be better in people who don’t have any symptoms (pain or internal bleeding) before treatment. Ruptures and death occur more often in people with pseudoaneurysms compared to true aneurysms.

When should I see my healthcare provider?

Seek medical attention immediately if you experience sudden pain in your abdomen or back.

A note from Cleveland Clinic

Visceral artery aneurysms are weak areas in the walls of the arteries in your abdomen. If the wall ruptures, internal bleeding can occur. Because not all people with this condition experience severe symptoms, diagnosis may be delayed. The widespread use of medical imaging tests for other conditions often leads to discovery of visceral artery aneurysms before they rupture. This allows for early treatment and reduced mortality. Though you can’t prevent all visceral artery aneurysms, you can reduce your risk of atherosclerosis-related aneurysms with a healthy lifestyle. Talk to your healthcare provider about steps you can take to reduce your risk of atherosclerosis.