What is the treatment for a celiac artery aneurysm?

Treatment of Celiac Artery Aneurysm

For celiac artery aneurysms, endovascular repair is recommended as the first-line treatment due to lower perioperative morbidity and mortality compared to open surgical repair. 1, 2

Diagnostic Approach

• CT angiography is the preferred initial imaging modality to:
  • Confirm the presence and size of the aneurysm
  • Assess collateral circulation
  • Evaluate for associated conditions (e.g., celiac artery stenosis)
  • Plan intervention 1, 2

Treatment Algorithm

1. Asymptomatic Celiac Artery Aneurysms

• Indication for repair: All celiac artery aneurysms should be considered for repair regardless of size due to high risk of rupture 3, 4
• First-line treatment: Endovascular coiling/stent grafting 2, 3
• Alternative: Open surgical repair when endovascular approach is not feasible

2. Symptomatic/Ruptured Celiac Artery Aneurysms

• Emergency treatment: Immediate endovascular intervention 2, 5
• Technique: Coil embolization or stent graft placement
• Monitoring: Close post-procedure observation for signs of visceral ischemia

Special Considerations

Associated Celiac Artery Stenosis

• Before covering the celiac artery during endovascular repair, confirm adequate collateralization between celiac and superior mesenteric artery 1
• Initial management may focus on aneurysm exclusion without celiac revascularization 3
• Celiac revascularization may be performed later if symptoms of gastric ischemia develop 5

Follow-up Protocol

• First imaging follow-up within 1 month post-procedure
• Annual imaging for the first 5 years if findings are stable
• CT angiography or duplex ultrasound to assess for:
  • Aneurysm exclusion
  • Patency of visceral vessels
  • Development of endoleaks (if stent graft was used) 1

Potential Complications and Management

• Visceral ischemia: Monitor for abdominal pain, nausea, vomiting post-procedure 5
• Endoleaks: May require secondary intervention
• Rupture: Carries mortality rate up to 100% if untreated 4

Clinical Pearls

• Beta-blockers may reduce risk of aneurysm rupture 1
• Men and patients with non-calcified aneurysms appear to have higher risk for rupture 1
• Elective repair has significantly lower mortality (0-5%) compared to emergency repair for rupture (38-100%) 1, 4
• No patient who underwent elective intervention in published series developed intestinal ischemia 1

The decision between endovascular and open surgical approaches should consider anatomical factors, patient comorbidities, and institutional expertise, but endovascular treatment offers significant advantages in terms of reduced perioperative morbidity and mortality.