Visceral Artery Aneurysms - An Indian Gastroenterologist's Perspective

Introduction: To evaluate the etiology, presentation, risk factors for rupture, management and outcomes at 1 month in a tertiary care center for mesenteric aneurysms and pseudoaneurysms. Methods: We performed retrospective analysis of data from 2017-2021 at a tertiary care centre in Western India of all the patients who were diagnosed with mesenteric aneurysms and pseudoaneurysms. Results: Fifty-seven aneurysms and 48 pseudoaneurysms in 74 patients were studied. The most commonly involved vessels were splenic artery (69.5%) & gastroduodenal artery (GDA) (17.1%). About 75.6% patients were symptomatic, 51.3% had gastrointestinal bleeding (GI bleeding) & 24.3% abdominal pain. The most common etiologies noted were - Chronic Pancreatitis (35.1%) & decompensated cirrhosis (20.1%). Almost all patients with pseudoaneurysms were symptomatic (p< 0.0001). True aneurysms were more likely to be multiple, as compared to pseudoaneurysms (1.84+1.93 v/s 1.12+0.32; p=0.009). There was no significant difference in mortality and rebleed at one month between aneurysms and pseudoaneurysms (p=0.4887 & p=0.873). Male patients were found to have a higher risk of GI bleeding, irrespective of etiology (p=0.006), whereas female patients were more likely to have complications post intervention (p=0.04). Conservative treatment was given to 32.4% of patients who had a mean size of aneurysm being 1.2+0.77cm. Three out of 24 patients who were managed conservatively bled within a month. Interventional radiology guided treatment was offered in the form of angiographic coiling (40.5%), angiographic glue injection (17.6%) and angiographic glue+coiling respectively (5.4%). There was no significant difference between the risk of rebleeding or mortality amongst the modes of interventional therapy. One patient underwent surgical management for aneurysmal rupture. The mean amount of N-cyanoacrylate & coils used was 1.45+0.72mL & 3.89+1.87 respectively. Around 8.1% patients had complications post intervention, most common being Gram negative septicemia; all managed medically with no mortality & were commonly seen with interventions relating to the splenic artery. Three patients rebled, 2 of those bled post intervention. 4% patients died due to aneurysm rupture or rebled post intervention. Size >2cm did not correlate with GI bleeding or hemodynamic instability. Conclusion: Pseudoaneurysms have a high risk of rupture, regardless of the size and hence must be treated. Radiological intervention in form of coil or glue is safe and effective.