December 23, 2005

Management of Aneurysms of the Superior Mesenteric Artery (SMA) and Celiac Arteries (CA): Surgery and Endovascular Therapy

Ulka Sachdev, MD, Donald Baril, MD, Sharif Ellozy, MD, Robert Lookstein, Daniel Silverberg, MD, Tikva Jacobs, MD, Alfio Carroccio, MD, Victoria Teodorescu, MD, Michael Marin, MD.
Mt. Sinai Medical Center, New York, NY, USA.

Objective: Aneurysms of the superior mesenteric (SMA) and celiac arteries (CA) are uncommon, and require proper management to prevent rupture and death. This study compares surgical and endovascular treatment of these aneurysms, and analyzes outcome.
Methods: Patients treated for aneurysms of the CA and SMA were identified. Patient demographics, history, presentation, aneurysm characteristics, treatments, follow-up and outcome were retrospectively recorded. Significant differences between patients treated by surgical or endovascular therapy was determined using χ ² analysis and t-test.
Results: Between 1/1/1991 and 7/1/2005, 59 patients with 62 aneurysms were treated at a single institution. Twenty-five patients underwent surgical repair, and 34 underwent endovascular treatment, which included coil embolization and stent graft therapy. Splenic (26) and hepatic (22) artery aneurysms predominated. Ninety-two percent of splenic artery aneurysms were true aneurysms, and were treated by endovascular and surgical procedures in near equal numbers (13 and 11, respectively). Only 34% of hepatic artery aneurysms were true. Endovascular management of hepatic artery aneurysms was more commonly employed to treat pseudoaneurysms. No ruptures occurred after either procedure.


	Endovascular n=34	Open n=25	p
Mean age	58	52
Females	13	8
Mean co-morbidities/patient	1.2	1.0
Previous abdominal surgery	15	7
Patients with pseudoaneurysms	17	4	0.01
Presentation:
Incidental	16	10
Symptomatic (non-ruptured)	7	10
Ruptured	11	4
Mean F/U, months Range	8.3 0-63	11.5 0-127
Complications	6	7
Re-interventions Open Percutaneous	3 1 2	4 2 1
Deaths	2	1

Conclusions: Both surgical and endovascular therapies are effective modalities in preventing rupture of aneurysms involving the SMA and CA. Morphology of the aneurysm did not affect short-term outcome. While patients were not randomized to receive one treatment group or the other, the techniques for repair did not appear to affect peri-procedural morbidity and mortality.

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