What is the treatment for a celiac (coeliac) artery aneurysm?

Treatment of Celiac Artery Aneurysm

Endovascular repair is the first-line treatment for celiac artery aneurysms due to lower perioperative morbidity and mortality compared to open surgical repair. 1

Diagnosis and Assessment

• CT angiography is the preferred initial imaging modality to:
  • Confirm presence and size of the aneurysm
  • Assess collateral circulation
  • Evaluate for associated conditions
  • Plan intervention 1

Treatment Algorithm

1. Size-based Management

• Aneurysms ≥2 cm should be treated in appropriate-risk patients 2
• Smaller aneurysms may be monitored with serial imaging

2. Treatment Options (in order of preference)

First-line: Endovascular Approach

• Endovascular coiling or stent grafting 1, 3
• Benefits:
  • Lower perioperative morbidity and mortality
  • Shorter hospital stay
  • Faster recovery
  • Particularly beneficial for high-risk surgical patients

Second-line: Open Surgical Repair

• Indicated when:
  • Endovascular approach is not feasible
  • Complex anatomy prevents endovascular treatment
  • Presence of infection
• Surgical options:
  • Aneurysm resection with prosthetic graft reconstruction (preferred conduit) 2
  • Primary arterioarterial anastomosis when feasible
  • Celiac artery replantation onto the aorta 4

3. Special Considerations

• Before covering the celiac artery, confirm adequate collateralization between celiac and superior mesenteric artery 5
• In emergency situations with rupture, endovascular coverage may be considered even if celiac artery coverage is necessary 5

Monitoring and Follow-up

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

Outcomes and Prognosis

• Elective repair mortality: 0-5%
• Emergency repair mortality (for rupture): 38-100% 1
• Untreated rupture mortality: up to 100% 1
• No patients who underwent elective intervention in published series developed intestinal ischemia 1

Important Considerations and Pitfalls

• Celiac artery aneurysms are rare but potentially devastating if ruptured
• Approximately 67% of patients may have concomitant aneurysms elsewhere (aortic, renal, peripheral) 2
• Prosthetic grafts have shown excellent long-term results for open repair and should be the conduit of choice for non-infected aneurysms 2
• Saphenous vein grafts have shown higher occlusion rates (documented occlusions at 1 and 6 months in one series) 2
• Late distal migration of endografts can encroach on the superior mesenteric artery, creating stenosis and compromising flow 5
• Despite preoperative evaluation with CTA or angiography to confirm adequate collateralization, a small percentage of patients (3.2% in the largest clinical series) may still develop postoperative visceral ischemia 5

The decision between endovascular and open surgical repair should consider the patient's surgical risk, aneurysm anatomy, and the availability of endovascular expertise, with endovascular approaches being preferred when feasible due to their lower perioperative risks.