Celiac, Hepatic, and Splenic Artery Aneurysms

Clinical Presentation

Celiac artery aneurysms account for 4% of all splanchnic artery aneurysms. The mean age at the time of diagnosis is 56 years. Men and women appear to be equally affected. Aortic aneurysms affect nearly 20% of these patients, and approximately 40% have other splanchnic aneurysms. Half the celiac artery aneurysms reported before 1950 were mycotic, although infectious lesions have been uncommonly encountered in recent years.

Most celiac artery aneurysms appear secondary to medial degeneration. Arteriosclerosis is a frequent finding, but, as in the case of other splanchnic artery aneurysms, it is considered a secondary process. Celiac artery aneurysms are usually saccular and involve the distal trunk of the artery. Some evolve from poststenotic dilatations caused by intrinsic occlusive disease or median arcuate ligament compression of the proximal celiac artery.

Currently, most celiac artery aneurysms are asymptomatic or are associated with vague abdominal discomfort. They are often first recognized as incidental findings on computed tomography or other imaging for nonvascular diseases ( Figure 1 ). Some patients, however, have symptoms, with abdominal or back pain being the most common manifestation in these cases. Less common presentations are early satiety, jaundice, and gastrointestinal bleeding. Rupture reportedly occurs in 13% of these celiac artery aneurysms, is usually intraperitoneal, and carries a mortality of 50%. Intervention is warranted for all symptomatic celiac artery aneurysms and for bland aneurysms exceeding 2 cm in diameter.

Management

Open surgical procedures are the most common intervention for celiac artery aneurysms unless a prohibitive operative risk exists. Most nonruptured aneurysms can be treated through an abdominal approach, although in the presence of acute expansion or rupture, a thoracoabdominal incision may be favored. Arterial reconstruction of the celiac trunk is preferred following aneurysmectomy, although simple aneurysmal exclusion with ligation of entering and exiting branches may be performed in selected patients. If the latter is undertaken, the foregut collateral blood flow to the liver must be sufficient to prevent severe hepatic ischemia. When such is not the case, an aortoceliac or aortohepatic artery bypass should be undertaken. Successful outcomes of open surgical therapy are greater than 90%.

Endovascular treatment of celiac artery aneurysms is not often performed because of the need to occlude the hepatic, splenic, and left gastric arteries, as well as the inferior phrenic arteries in some cases. Nevertheless, successful endovascular therapy of these aneurysms has been reported and has a role, especially in patients at high risk for open surgery.