Visceral artery aneurysm surgery involves complex vascular reconstruction for rare yet clinically significant lesions that represent less than 2% of all arterial aneurysms. Although endovascular therapies have gained prominence recently, open surgical repair remains a vital treatment modality for patients with unsuitable anatomy. This case series highlights the outcomes of patients treated for celiac trunk aneurysms (CTAAs) and hepatic artery aneurysms (HAAs) at a specialized institution.

Individualized Strategies in Visceral Artery Aneurysm Surgery

Surgical teams must tailor their approach to each patient's unique anatomy and underlying comorbidities. In this series, surgeons utilized various reconstruction techniques, such as splenic artery interposition and saphenous vein grafts. Consequently, they achieved a 100% graft patency rate at the one-year follow-up. This success demonstrates that traditional surgery provides durable results for complex visceral lesions that may not be amenable to stenting. Moreover, preoperative imaging remains crucial for precise operative planning in these rare cases.

Managing Risks and Complications

While technical success was high, these procedures carry inherent risks due to the vital organs served by the celiac and hepatic vessels. For instance, one patient required a total gastrectomy following postoperative gastric ischemia. Another patient needed surgical re-exploration to manage a hematoma. Therefore, careful perioperative monitoring and immediate intervention are essential for optimal recovery. However, the study recorded zero perioperative mortality, reinforcing the safety of elective open repair when performed by experienced vascular teams.

Benefits of Visceral Artery Aneurysm Surgery

The primary benefit of open repair is its long-term durability and the ability to maintain blood flow in complex branch involvements. Modern surgeons often prefer endovascular-first approaches for many visceral aneurysms because they are less invasive. Nevertheless, open surgery remains the gold standard when preservation of collateral flow is technically difficult via catheters. Specifically, this series confirms that elective surgery offers satisfactory mid-term outcomes for celiac and hepatic vessels. Furthermore, tailored reconstruction ensures preserved end-organ perfusion over time.

FAQs

When is surgery recommended for visceral artery aneurysms?

Current clinical guidelines suggest repair for celiac artery aneurysms larger than 2 cm or if the patient becomes symptomatic. For hepatic artery aneurysms, intervention is typically advised at the 2 cm threshold or if the growth exceeds 0.5 cm per year, especially in patients with associated vasculopathy.

What are the common grafts used in open repair?

Surgeons frequently use the great saphenous vein, the superficial femoral artery, or prosthetic interposition grafts for reconstruction. The choice depends on the specific arterial involvement, the length of the required bypass, and the availability of the patient's own venous conduits.

What is the risk of rupture for these aneurysms?

Visceral artery aneurysms often follow a silent course but carry a significant risk of catastrophic rupture. Rupture rates for celiac trunk aneurysms vary but are clinically concerning enough to warrant elective intervention once the diameter exceeds recommended safety thresholds.

Disclaimer: This content is for informational and educational purposes only and does not constitute medical advice or a professional relationship. Always seek the advice of a qualified healthcare provider for any medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Todorov A et al. Open Surgical Management of Celiac Trunk and Hepatic Artery Aneurysms: A Case Series. Vasc Endovascular Surg. 2026 Apr 26. doi: 10.1177/15385744261447882. PMID: 42035302.

Chaer RA, et al. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg. 2020 Jul;72(1S):3S-39S. doi: 10.1016/j.jvs.2020.01.039.

Huo H, et al. Management of Coeliac and Hepatic Artery Aneurysms: An Experience of 84 Cases. Eur J Vasc Endovasc Surg. 2023 Sep;66(3):396-403.