From the Guidelines
Management of celiac artery aneurysms should prioritize a tailored approach based on aneurysm size, symptoms, and patient factors, with intervention generally recommended for aneurysms larger than 2 cm, symptomatic aneurysms, or those showing rapid growth. For high-risk surgical candidates, endovascular repair with coil embolization or stent grafting is preferred due to its minimally invasive nature 1. Open surgical repair, involving aneurysmectomy with direct reconstruction, bypass grafting, or ligation with revascularization of distal branches, remains the gold standard for younger, healthier patients. Asymptomatic aneurysms smaller than 2 cm can be managed conservatively with regular imaging surveillance every 6-12 months using CT angiography or MR angiography.
Key Considerations
- Aneurysm size and symptoms are critical factors in determining the management approach
- Patient factors, such as age and overall health, influence the choice between endovascular and open surgical repair
- Regular imaging surveillance is essential for monitoring aneurysm growth and detecting potential complications
- Blood pressure control and risk factor modification are crucial in reducing the risk of rupture and improving outcomes
Treatment Options
- Endovascular repair with coil embolization or stent grafting for high-risk surgical candidates
- Open surgical repair for younger, healthier patients
- Conservative management with regular imaging surveillance for asymptomatic aneurysms smaller than 2 cm
- Surgical release of the median arcuate ligament (MAL) may be beneficial in patients with MAL syndrome, with subsequent reconstruction of the celiac artery as needed 1
Surveillance and Follow-up
- Regular imaging surveillance every 6-12 months using CT angiography or MR angiography
- Blood pressure control using antihypertensive medications like ACE inhibitors or beta-blockers
- Risk factor modification, including quitting smoking, controlling diabetes, and managing hyperlipidemia
- Close monitoring for potential complications, such as abdominal pain or flank pain, after catheter-based intervention 1
From the Research
Management of Celiac Artery Aneurysm
The management of celiac artery aneurysm can be approached through various methods, including surgical and endovascular techniques.
- Surgical repair is a traditional method, which has been used to treat celiac artery aneurysms, with a reported mortality rate of 5% 2.
- Endovascular treatment is being increasingly used, with a technical success rate of 89% and is particularly useful in patients with comorbidities, including cancer 3.
- A novel classification system for celiac artery aneurysms has been proposed, which categorizes aneurysms into two types (Type I and Type II) based on their location and morphology, and this classification can guide endovascular treatment strategies 4.
- Endovascular repair using a combination of coil embolization and aortic cuff stent graft has been successfully used to treat concomitant celiac and splenic artery aneurysms 5.
- Elective repair is recommended for celiac artery aneurysms greater than 2 cm in good-risk patients, with long-term results using prosthetic grafts being excellent 6.
Treatment Outcomes
- The outcomes of surgical and endovascular treatment of celiac artery aneurysms have been compared, with endovascular treatment being associated with a shorter in-hospital length of stay and a higher incidence of malignancy 3.
- Technical success rates for endovascular treatment have been reported to be high, with low rates of complications and mortality 4, 3.
- Open surgical repair has also been reported to be effective, with a mortality rate of 5% and no operative mortality in some series 6, 2.
Indications for Treatment
- Indications for elective intervention for celiac artery aneurysms include aneurysm size greater than 2 cm, with rupture being a serious complication that can occur in these aneurysms 6, 2.
- The presence of concomitant aneurysms in other locations, such as the aorta or renal arteries, may also influence the decision to intervene 6.