Nonoperative management of unruptured visceral artery aneurysms: treatment by transcatheter coil embolization

PURPOSE: To describe our experiences with the treatment of visceral artery aneurysms (VAA) by transcatheter coil embolization and to propose indications for treating VAA by this method. METHODS: We treated 22 patients with VAA by coil embolization; 9 had splenic-, 7 renal-, 4 pancreaticoduodenal arcade-, and 2 proper hepatic artery aneurysms. All nine splenic artery aneurysms patients presented with chronic hepatitis-C; four had hepatocellular carcinoma. Of the seven renal artery aneurysms patients, four were hypertensive and three had rheumatoid arthritis. Both pancreaticoduodenal arcade artery aneurysms patients manifested severe stenosis of the celiac axis. Our transcatheter coil embolization procedure includes coil embolization and coil-packing of the aneurysmal sac, preserving the native arterial circulation. RESULTS: Transcatheter coil embolization with aneurysm packing was technically successful in 16 (72.7%) of the 22 patients and the native arterial circulation was preserved. Postprocedure angiograms confirmed complete disappearance of the VAA. In four of the nine splenic artery aneurysm patients, the native arterial circulation was not preserved. In one renal artery aneurysm patient, stenosis at the aneurysmal neck necessitated placement of a stent before transcatheter coil embolization. Magnetic resonance angiographs obtained during the follow-up period (mean 27 months) demonstrated complete thrombosis of the VAA in all 22 patients. Infarction occurred in one splenic- and two renal artery aneurysms patients; the latter developed flank pain and fever after the procedure. CONCLUSIONS: Transcatheter coil embolization is an effective alternative treatment for patients with saccular and proximal VAA. In particular, the isolation technique using coil embolization is advantageous in splenic artery aneurysm patients.     

Transcatheter arterial embolization of splenic artery aneurysms and pseudoaneurysms: short- and long-term results

We evaluated outcomes of endovascular treatment of splenic artery aneurysms and pseudoaneurysms. From April 2002 to May 2007, 17 patients (mean age 55.2 years, range 17-82) with splenic artery aneurysms (n = 7) or pseudoaneurysms (n = 10) underwent endovascular treatment. Six patients were asymptomatic, three had symptomatic nonruptured aneurysms, and eight had ruptured aneurysms. Lesions were in the proximal splenic artery (n = 5), intermediate splenic artery (n = 3), splenic hilum (n = 6), or parenchyma (n = 3). Embolization was with microcoils by sac packing (n = 8), sandwich occlusion of the main splenic artery (n = 4), or cyanoacrylate glue into the feeding artery (n = 4). Computed angiotomography was done within the first month and magnetic resonance angiography after 6 and 12 months, then yearly. Mean follow-up was 29 months (range 1-62). Exclusion of the aneurysm was achieved in 16 (94.1%) patients. One patient with an intraparenchymal pseudoaneurysm underwent splenectomy after failed distal catheterization. No major complications occurred. Postembolization syndrome developed in four patients, who had radiographic evidence of splenic microinfarcts. Transcatheter embolization of splenic artery aneurysms/pseudoaneurysms is safe and effective and may induce less morbidity than open surgery, in particular by preserving the spleen. Coil artifacts may make magnetic resonance angiography preferable over computed tomography for follow-up.     

Traumatisme de la rate : facteurs prédictifs d’échec du traitement non-opératoire

Introduction

Non-operative management of blunt splenic injury in adults has been applied with increasing frequency. However, predictive criteria for successful non-operative management are still a matter of debate.

Methods

we retrospectively reviewed all cases of blunt splenic injury in adult patients from 1997 to 2006.

Results

Of 190 patients with blunt splenic trauma (median age: 33 years, range 16-98), 43.7% (n=83) underwent emergency surgical intervention (Group I), and 56.3% (n=105) of patients were admitted for conservative treatment of splenic trauma. Conservative treatment was successful in 76.6% (n=82) (Group II), while 23.4% (n=25) of patients required a laparotomy (Group III). Ultimately, 43.2% of patients were successfully managed non-operatively, and 56.9% underwent laparotomy. Mechanism of injury was not significantly different among three groups. Group I patients presented significantly more frequently with hypovolemic shock (p<0.01), associated injuries (p<0.01), and high grade of splenic injury (p<0.01). All patients with active bleeding as evidenced by extravasation on CT scan, underwent exploratory laparotomy. Failure of non-operative management increased significantly with splenic trauma grade (grade I (0%), grade II (22.6%), grade III (27.6%) and grade IV (40%), (p<0.01) and with quantity of hemoperitoneum (10.4% of patients with small, 22.2% of patient with moderate, and 47.8% with large hemoperitoneum). The median interval for conservative treatment failure was 3 days (range: 1-15).Splenic injuries were operatively controlled by splenectomy (91.6%) and splenorrhaphy (8.4%).

Conclusion

Suitability of adult patients with blunt splenic injury for non-operative management may be predicted at initial presentation, based on hemodynamic status and associated injuries. The quantity of hemoperitoneum and magnitude of splenic injury are predictive factors for failure of conservative treatment. Early definition of these factors may help identify those patients likely to be successfully treated without laparotomy.     

The endovascular management of splenic artery aneurysms and pseudoaneurysms

The purpose of this study was to evaluate outcomes of the endovascular treatment of splenic artery aneurysms (SAAs) and pseudoaneurysms (SAPAs). From April 2003 to December 2009, 12 patients (mean age 46.8 years, range 29-58) with SAAs (n = 9) or SAPAs (n = 3) underwent endovascular treatment. Four patients were asymptomatic and three had ruptured aneurysms. Lesions were in the proximal splenic artery (n = 3), intermediate splenic artery (n = 3) and distal splenic artery (n = 6). Endovascular procedures included embolization by sac packing (n = 5), sandwich occlusion of the splenic artery (n = 4) or stent graft deployment (n = 3). Computed tomography (CT) was done before the operation, 3 and 12 months after the operation, then yearly. Endovascular treatment was successful at the first attempt in all 12 (100%) patients, with complete angiographic exclusion of the aneurysm at the end of the operation. The mean amount of contrast medium used was 165 mL (range 100-230), and the mean total procedure time was 92 minutes (range 55-160). No major complications occurred. Postoperational CT scans showed splenic multisegmental infarcts in eight patients (66.7%, 8/12) and among them postembolization syndrome developed in six patients, manifesting as abdominal pain and fever. The mean follow-up was 32 months (range 9-51). No patient demonstrated gross evidence of aneurysm sac growth, and no significant decrease in aneurysm sac size postintervention was noted on follow-up. The endovascular management of SAAs and SAPAs is safe and effective and may induce less mortality than open surgery. Regardless of the etiology, endovascular treatment can provide excellent mid-term results.     

脾动脉瘤的诊断和治疗

目的：总结16例脾动脉瘤的外科诊治经验。方法：回顾性分析收治的16例脾动脉瘤患者的临床资料。其中男4例,女12例,经超声多普勒、CT血管造影（CTA）等检查发现脾动脉瘤15例,另1例术中探查发现。手术治疗11例,其中脾动脉瘤破裂行急诊手术4例,择期性手术7例,手术包括脾动脉瘤及脾切除9例,同时切除胰尾3例,脾动脉瘤切除、脾动脉重建1例,脾动脉瘤切除、近远端脾动脉结扎1例。另外行脾动脉瘤介入栓塞3例,非手术治疗2例。结果：手术及介入治疗的14例患者治疗后未发生严重的并发症,无死亡,均康复出院。术后随访0.5~19.0年,平均8.4年。11例手术及介入治疗者中,2例分别手术后3,7年死于其他疾病,另9例情况良好。2例非手术治疗者已分别随访3,5年,脾动脉瘤无变化。结论：脾动脉瘤女性多发;CT血管造影和多普勒超声等可明确诊断;早期切除动脉瘤或介入栓塞术是防止破裂出血导致死亡的有效方法。     

介入治疗内脏动脉瘤的远期疗效

目的观察介入治疗内脏动脉瘤(VAA)的远期疗效。方法回顾性分析30例接受介入治疗VAA患者(41个瘤灶),术后随访时间均12个月,观察治疗效果及并发症。结果对12个肾动脉瘤、8个脾动脉瘤行动脉瘤填塞术,其中5个脾动脉瘤、5个肾动脉瘤采用裸支架辅助填塞;对13个脾动脉瘤、1个肝动脉瘤行动脉瘤栓塞术;对4个肾动脉瘤行载瘤动脉支架植入术,其中3个采用多层裸支架植入术、1个采用覆膜支架植入术;对2个肾动脉瘤、1个腹腔干动脉瘤行保守治疗;均获得成功。1个脾动脉瘤栓塞术后出现部分脾梗死,1个左肾多发动脉瘤植入支架后瘤腔小部分显影。术后随访12～55个月,平均(23.44±12.48)个月,期间脾梗死者梗死面积未增大、未见脓肿形成,瘤腔部分显影病变显影面积未增大。30例患者中,1例因心力衰竭死亡,余均存活,无VAA复发及其他并发症。结论介入治疗VAA远期疗效较好,且安全性较高。     

内脏动脉瘤的外科治疗

目的 总结腔内技术和外科手段治疗内脏动脉瘤的疗效.方法 回顾性分析10例内脏动脉瘤患者的临床资料.男4例,女6例,年龄28～74岁,平均(56 ±13)岁.其中脾动脉真性动脉瘤5例,脾动脉假性动脉瘤1例,肠系膜上动脉瘤2例,腹腔干结核性假性动脉瘤1例,肾动脉瘤1例.结果 1例腹腔干假性动脉瘤行支架型人工血管腔内修复术,1例脾动脉瘤行支架型人工血管腔内修复术失败,改为开腹手术治疗,另外8例直接行开腹手术治疗.手术均获成功,康复出院.术后住院时间7～18 d,平均(10±5)d,本组所有患者获随访,随访时间3个月至6年,平均(27 ±12)个月.无死亡病例,无动脉瘤复发,无胃肠道、肝脏、脾脏、肾脏缺血梗死及其他严重并发症发生.结论 内脏动脉瘤开放手术治疗疗效可靠,而腔内治疗则是一种有前途的微创治疗手段.

Abstract：

Objective To analyse the management of splanchnic artery aneurysms by open surgery and endoluminal therapy. Methods The clinical data of 10 splanchnic artery aneurysm patients (four male, six female) hospitalised from January 2002 were analysed retrospectively. The average age was (56 ± 13) years (28 - 74). Surgical or endoluminal treatment for six cases of splenic artery aneurysms or pseudoaneurysms were applied, among which multiple splenic artery aneurysms was found in one, and aberrant aneurysms at the proximal section of the splenic artery originating from a spleno-mesenteric trunk was found in three, splenic artery pseudoaneurysm in one and single aneurysm with normal splenic artery in anatomy in one. Besides, there were two superior mesenteric artery aneurysm, one of tuberculous celiac artery pseudoaneurysm and one renal artery aneurysm. Results The tuberculous celiac artery pseudoaneurysm was successfully managed by deploying a stent-graft endoluminally. One case was converted to open surgery after the splenic artery aneurysm was only paitially covered by a stent-graft. The other 8 cases were successfully treated by open surgery. All of the operations are successful. All patients were followed up from three months to six years, during which no death or other severe complications occurs. Conclusions The splanchnic artery varies from one to another anatomically. Preoperative CT scan or digital substraction angiology are helpful for the diagnosis of the splanchnic arterial aneurysms and choosing an appropriate management. Conventional open surgery is effective and reliable, while endoluminal therapy is a minimally invasive alternative.     

Combination of aortic stent-graft and arterial embolization for ruptured bronchial artery aneurysm

Bronchial artery aneurysm is a rare condition. Rupture of bronchial artery aneurysm can cause a critical hemorrhage. We report a case of ruptured bronchial artery aneurysm mimicking a clinical picture of aortic dissection with right hemothorax. The patient was treated with a combination of an aortic stent-graft and arterial embolization. Recovery was uneventful and the patient's follow-up result in 1 year was well. Combination treatment is feasible and accurate for ruptured bronchial artery aneurysm. The present study is among the few in which an aortic stent-graft has been used for a bronchial artery aneurysm.     

Splenic artery aneurysm rupture in late pregnancy: a case report and review of the literature

Haemorrhages during pregnancy may have a non-obstetrical origin, the pregnancy itself favoring some specific aetiologies because of pregnancy-related physiological modifications. These non-obstetrical haemorrhages are rare but are associated with a high maternal and foetal mortality. The prognosis depends on an early diagnosis and a multidisciplinary approach. We report the case of a patient who had a caesarean section for suspicion of acute foetal distress during which was found a large intraperitoneal bleeding due to rupture of an unknown splenic artery aneurysm. We discuss the principal causes of non-obstetrical intra-abdominal bleeding, including subcapsular liver haematoma, rupture of uterine vessels and rupture of splenic artery aneurysm, with a specific focus on this last aetiology.     

Arterial Infections in the New Millenium: An Old Problem Revisited

The natural history of infected aneurysms or arterial infections is characterized by rapid expansion leading to rupture, pseudoaneurysm formation, and sepsis. Treatment options include in situ grafting either with prosthetic or autogenous grafts or with cryopreserved allografts (CPAs), resection of the aneurysm with remote bypass grafting, and ligation. The purpose of this study was to review our recent experience with these infections and to present long-term follow-up with in situ CPAs. From January 2000 through June 2005, we treated nine patients with infected aneurysms and one patient with an infection without aneurysm formation. The infection involved the infrarenal abdominal aorta in six patients and the femoral artery in three patients. One patient had an infected splenic artery aneurysm. Aortic rupture occurred in five of the six patients with infected aortas. Two of the three patients with infected femoral aneurysms presented with recurrent hemorrhage. Of the six patients with aortic infections, five were treated with in situ CPAs. One patient was treated with aortic resection and axillofemoral grafting. Two patients with femoral aneurysms were treated with in situ CPAs, and the third patient underwent aneurysm resection and prosthetic grafting through the obturator foramen. The patient with the splenic aneurysm underwent combined valve replacement, aneurysm resection, and splenectomy. Three of the six patients with aortic infections died postoperatively, all of whom were septic at presentation. The cause of death in these three patients was multiple organ failure in two and overwhelming sepsis in one. The three survivors are alive and well with up to 5-year follow-up. The three patients with infected femoral aneurysms are alive and well with follow-up extending to 44 months. The patient with the splenic aneurysm is doing well. No recurrent infections have been noted among the survivors. The CPAs have remained structurally intact in all. The mortality rate among patients with abdominal aortic infections remains high and is likely related to their preoperative septic state. In situ grafting with CPAs appears to be a reasonable treatment option for arterial infections. CPAs appear to maintain their structural integrity and to be resistant to recurrent infection.     

Aneurysms of the visceral arteries: report of 5 cases

Visceral artery aneurysms are uncommon and usually result from atherosclerosis, periarteritis nodosa and fibromuscular dysplasia. Hepatic artery aneurysms were detected in two patient, splenic artery aneurysms in three. In four patients rupture occurred. In the two patients with hepatic artery aneurysm hemobilia from arterial rupture into the common bile duct and intraperitoneal bleeding in lesser sac was assessed. Ruptured aneurysms of the splenic artery with free intraperitoneal bleeding occurred in two patients, one patient had an asymptomatic splenic artery aneurysm. In four patients the diagnosis was made by contrast-TC and/or celiac and mesenteric angiography. In four patients excision of the aneurysm was successfully performed. One patient with ruptured hepatic artery aneurysm and in which resection and revascularization was made died.     

Infected splenic artery aneurysm with associated splenic abscess formation secondary to bacterial endocarditis: case report and review of the literature

Infected aneurysms are rare and may present with rupture or sepsis. Surgical treatment is often required to prevent catastrophic sequelae. Bacterial endocarditis is one of the classic causes of infected aneurysm. We present a case of a 6.1-cm infected splenic artery aneurysm secondary to endocarditis. Surgical treatment consisted of aortic and mitral valve replacements, splenic artery aneurysm resection, and splenectomy. We reviewed five other reported infected splenic artery aneurysms in which documented ruptured had occurred in three patients. Because the rate of rupture in these patients appears to be quite high, infected splenic artery aneurysms require prompt treatment.     

脾动脉起始部动脉瘤的切除及血管重建的手术探讨

目的探讨脾动脉起始部动脉瘤的切除及脾动脉重建的手术方法。方法回顾性分析1996年1月~2007年3月收治的8例脾动脉起始部动脉瘤患者的临床资料,经彩色超声、CT和血管造影检查证实脾动脉起始部真性动脉瘤;均在全身麻醉下首先阻断腹腔干起始部,远端脾动脉阻断后切除动脉瘤,1例行腹腔干-脾动脉自体静脉移植,4例行肾下主动脉-脾动脉人工血管转流,3例同时切除动脉瘤和脾脏。结果均于手术后10~14 d治愈出院。随访0.5~10年;其中1例人工血管转流术后2年死于急性心肌梗塞,余7例均健康生活,无动脉瘤复发。结论动脉瘤切除、脾动脉重建是一种较好的脾动脉起始部真性动脉瘤的治疗方案。     

经导管弹簧圈栓塞治疗脾动脉瘤

目的探讨经导管弹簧圈栓塞治疗脾动脉瘤的临床应用价值。方法回顾性分析接受经导管弹簧圈栓塞治疗的18例脾动脉瘤患者的资料,其中真性脾动脉瘤14例,假性脾动脉瘤4例;近端型6例,中间型4例,脾门型8例。根据患者脾动脉造影情况,选择普通弹簧圈、微弹簧圈或机械可脱式弹簧圈进行栓塞。术后1周及1、3、9个月行CT增强或CTA复查,随后每月行电话随访。结果对18例均顺利完成手术,11例采用隔绝旷置术,4例采用瘤腔填塞术,3例采用隔绝旷置术+瘤腔填塞术。术后12例出现栓塞后综合征,其中8例出现不同程度的脾梗死,梗死体积约10%~35%;余4例为轻微并发症。随访中无瘤体增大、破裂或复发及相关并发症。结论经导管弹簧圈栓塞治疗脾动脉瘤简单可行、安全有效。     

Foregut revascularization via retrograde splenic artery perfusion after resection of a juxtaceliac mycotic aneurysm: Complicated by pancreatic infarction because of cholesterol emboli

A 66-year-old woman had development of a rapidly enlarging juxtaceliac mycotic aneurysm after therapy for lumbar osteomyelitis and a psoas abscess. The aneurysm was repaired through a thoracoabdominal approach with a Dacron aortic graft sewn end to end to the thoracic aorta and end to side to the infrarenal aorta. Perfusion was restored after oversewing the abdominal aorta above the superior mesenteric artery and oversewing the celiac trunk. After reperfusion the foregut remained critically ischemic despite a patent superior mesenteric artery. Foregut reperfusion was achieved by removing the spleen and anastomosing the distal splenic artery to the aortic graft. Recovery was complicated by infarction of the body of the pancreas because of cholesterol emboli, resulting in a large pleural effusion. After undergoing a subtotal pancreatectomy that preserved the splenic artery, the patient recovered without additional complications. During 8 years of follow-up, the patient has normoglycemia and has had no further infections complications. The distal splenic artery offers an excellent inflow for foregut revascularization; however, the pancreas is intolerant of atheromatous emboli. (J VASC SURG 1995;21:530-6.)     

Treatment of three pancreaticoduodenal artery aneurysms associated with coeliac artery occlusion and splenic artery aneurysm: a case report and review of the literature.

A case of three pancreaticoduodenal artery (PDA) aneurysms associated with coeliac artery occlusion and a concomitant splenic arterial aneurysm is described. Surgical treatment was used because it was anticipated that the hepatic blood supply would be obstructed completely if percutaneous transluminal embolization for three PDA aneurysms were performed. Splenectomy in continuity with the splenic artery aneurysm and PDA aneurysmectomies were performed, and infrarenal abdominal aorto-splenic artery bypass was accomplished using a 6mm ringed expanded polytetrafluoroethylene graft. The postoperative course was uneventful. Graft patency and successful aneurysm ablation were confirmed using MRA and intravenous DSA. Arterial histology revealed segmental arterial mediolysis. At 2-year follow-up, the patient was well and asymptomatic. A literature review of PDA aneurysms is presented.     

Splenic artery aneurysms: postembolization syndrome and surgical complications

BACKGROUND: This study assessed the endovascular embolization of splenic artery aneurysms and false aneurysms with special consideration given to postoperative complications. METHODS: Fifteen patients (11 women; mean age, 56 y; range, 39-80 y) with splenic artery aneurysm (n = 13) or false aneurysm (n = 2) were treated with coil embolization. The lesion was asymptomatic in 9 patients, symptomatic in 5 patients, and ruptured in 1 patient. The mean aneurysm diameter was 33 +/- 23 mm (range, 15-80 mm). Postoperative follow-up evaluation included a clinical visit and spiral computed tomography at 1, 4, and 12 months, and yearly thereafter. RESULTS: Endovascular treatment was possible in 14 patients (93%) (1 failure: neck cannulation). Perioperative mortality was not observed. Morbidity included postembolization syndrome in 5 patients (30%). Neither pancreatitis nor spleen abscess occurred. The mean follow-up period was 36 months (range, 3-60 mo). During follow-up evaluation we detected 1 sac reperfusion that was sealed successfully with additional coils. Surgical conversion or open repair were never required. CONCLUSIONS: At our institute, endovascular treatment represents the first-line treatment for splenic artery aneurysms. Postembolization syndrome and infarcts are common events but generally resolve without sequelae.     

Expanding retrograde saphenous vein graft aneurysm treated with endovascular coiling

Saphenous vein graft aneurysm is a potentially fatal complication of coronary artery bypass grafting and usually requires surgery. This report describes endovascular coiling of a saphenous vein graft aneurysm that developed after redo coronary artery bypass grafting. The aneurysm occurred in a proximally occluded saphenous vein graft after revascularization of the same target vessel. The procedure required a retrograde approach through a patent left internal mammary and left anterior descending artery to reach and successfully thrombose the aneurysm.     

Growth of asymptomatic unruptured aneurysms in follow-up study: report of three cases

The natural history of asymptomatic unruptured aneurysms that have not been subjected to surgery was studied radiologically using MRA and MRI and 3D-CT angiography (3D-CTA) commencing in 1993. We report on the growth of documented asymptomatic unruptured aneurysms in three patients. Growth of the aneurysms was followed by repeated MRA, MRI and 3D-CTA. In Case 1, a 71-year-old woman had been diagnosed as having a 3 mm unruptured anterior communicating artery aneurysm. The size of the aneurysm had expanded to 4 mm, 2 years later. This was detected during a follow-up MRA and confirmed by angiography. After this follow-up MRA, the aneurysm showed no change in size or shape for 8 years. Case 2 was that of a 75-year-old woman who had a 4.5 mm aneurysm involving the basilar artery and the superior cerebellar artery. 12 months later, an MRA was carried out as a follow-up study. This MRA revealed that the aneurysm had developed a bleb and was expanding. 8 months later the patient bled from the aneurysm and underwent surgery, but died. Before surgery, the diameter of the aneurysm, confirmed by angiogram, was 5.5 mm including the bleb. The third patient was a 66-year-old woman who had a 7 mm internal aneurysm involving the carotid artery and the posterior communicating artery. 3 years later a 3D-CTA detected the expansion of the aneurysm and development of an aneurysm bleb. 6 years later more expansion occurred and 3 months after that the patient bled from the aneurysm and underwent clipping. At that time, the diameter of the aneurysm, confirmed by angiography, was 13 mm including the bleb. In this follow-up study, patients with diagnosed asymptomatic unruptured aneurysms were followed up by MRA and MRI and 3D-CTA to determine risk factors for aneurysm rupture. We emphasize the fact that growth of an unruptured aneurysm and formation of blebs are important risk factors of aneurysm rupture.     

The endovascular management of visceral artery aneurysms and pseudoaneurysms

OBJECTIVE: Visceral artery aneurysms may be treated by aneurysm exclusion, excision, revascularization, and endovascular techniques. The purpose of this study was to review the outcomes of the management of visceral artery aneurysms with catheter-based techniques. METHODS: Between 1997 and 2005, 90 patients were identified with a diagnosis of visceral artery aneurysm. This was inclusive of aneurysmal disease of the celiac axis, superior mesenteric artery (SMA), inferior mesenteric artery, and their branches. Surveillance without intervention occurred in 23 patients, and 19 patients underwent open aneurysm repair (4 ruptures). The endovascular treatment of 48 consecutive patients (mean age 58, 60% men) with 20 visceral artery aneurysms (VAA) and 28 visceral artery pseudoaneurysms (VAPA) was the basis for this study. Electronic and hardcopy medical records were reviewed for demographic data and clinical variables. Original computed tomography (CT) scans and fluoroscopic imaging were evaluated. RESULTS: The endovascular treatment of visceral artery aneurysms was technically successful in 98% of 48 procedures, consisting of 3 celiac axis repairs, 2 left gastric arteries, 1 SMA, 12 hepatic arteries, 20 splenic arteries, 7 gastroduodenal arteries, 1 middle colic artery, and 2 pancreaticoduodenal arteries. Of these, 29 (60%) were performed for symptomatic disease (5 ruptured aneurysms). Procedures were performed in the endovascular suite under local anesthesia with conscious sedation (94%). The femoral artery was used as the preferential access site (90%). Coil embolization was used for aneurysm exclusion in 96%. N-butyl-2-cyanoacrylate (glue) was used selectively (19%) using a triaxial system with a 3F microcatheter for persistent flow or multiple branches. The 30-day mortality was 8.3% (n = 4). One patient died from recurrent gastrointestinal bleeding after gastroduodenal embolization, and the remaining died of unrelated causes. All perioperative deaths occurred in patients requiring urgent or emergent intervention in the setting of hemodynamic instability. No patients undergoing elective intervention died in the periprocedural period. Postprocedural imaging was performed after 77% of interventions at a mean of 16 months. Complete exclusion of flow within the aneurysm sac occurred in 97% interventions with follow-up imaging, but coil and glue artifact complicated CT evaluation. Postembolization syndrome developed in three patients (6%) after splenic artery embolization. There was no evidence of hepatic insufficiency or bowel ischemia after either hepatic or mesenteric artery aneurysm treatment. Three patients required secondary interventions for persistent flow (n = 1) and recurrent bleeding from previously embolized aneurysms (n = 2). CONCLUSION: Visceral artery aneurysms and pseudoaneurysms can be successfully treated with endovascular means with low periprocedural morbidity; however, the urgent repair of these lesions is still associated with elevated mortality rates. Aneurysm exclusion can be accomplished with coil embolization and the selective use of N-butyl-2-cyanoacrylate. Current catheter-based techniques extend our ability to exclude visceral artery aneurysms, but imaging artifact hampers postoperative CT surveillance.