What is the most common visceral aneurysm?

Splenic Artery Aneurysms Are the Most Common Visceral Aneurysms

The splenic artery aneurysm is the most common visceral aneurysm, accounting for approximately 60% of all visceral artery aneurysms. 1, 2

Epidemiology and Classification of Visceral Aneurysms

• Splenic artery aneurysms historically have been considered the most common visceral artery aneurysms, representing approximately 60% of all visceral aneurysms 1
• Hepatic artery aneurysms are the second most common, accounting for about 20% of visceral aneurysms 1
• Superior mesenteric artery aneurysms represent only 6-7% of all visceral aneurysms 1
• Celiac artery aneurysms account for approximately 4% of visceral aneurysms 1
• Other visceral aneurysms make up the remaining 10% 1

Clinical Presentation and Risk Factors for Splenic Artery Aneurysms

• Most splenic artery aneurysms are asymptomatic at the time of discovery, typically found incidentally during abdominal imaging 1
• Approximately 20% of patients present with either chronic upper abdominal pain or acute rupture 1
• Women of childbearing age are at particularly high risk for rupture, with maternal mortality rates as high as 70% and fetal mortality exceeding 90% 1, 3
• Risk factors associated with splenic artery aneurysms include:
  • Portal hypertension 4
  • Essential hypertension 4
  • Female gender (more common in women) 1
  • Pregnancy (especially multiparous women) 1

Mortality and Complications

• The mortality rate for ruptured splenic artery aneurysms in non-pregnant patients ranges from 10% to 25% 1
• Rupture during pregnancy carries significantly higher risks with maternal mortality up to 70% 1
• Aneurysms measuring at least 2.0 cm in diameter have been reported to rupture during pregnancy 1
• The overall mortality rate for all visceral aneurysms can reach up to 70% in cases of rupture 5

Diagnostic Approaches

• Diagnosis is typically made using various imaging modalities:
  • Computed tomography (CT) angiography 6, 4
  • Ultrasound imaging 4
  • Conventional angiography 4
• An increasing number of splenic artery aneurysms are being discovered in women undergoing ultrasound evaluations during pregnancy 1

Management Considerations

• Treatment options include:
  • Open surgical repair (may include splenectomy) 4
  • Endovascular treatment with coil embolization or stent grafts 2
  • Laparoscopic approaches 3
• The technical success rate for catheter-based interventions ranges from 67% to 100% 1
• Patients undergoing catheter-based intervention should be monitored closely for development of abdominal pain, which may indicate complications 1
• Elective intervention is generally recommended for splenic artery aneurysms in women of childbearing age due to the high risk of rupture during pregnancy 3

In summary, based on the ACC/AHA 2005 practice guidelines and supporting research evidence, splenic artery aneurysms are definitively the most common visceral aneurysm, representing approximately 60% of all visceral artery aneurysms. The correct answer to the question is (c) splenic.