Dear Emanuele Ferrero,

At this moment we prefer endovascular treatment.

Dear colleague, that depends...if this visceral artery can be treated with endovascular procedures it will be preffered of course....but this is not always the case...

Best Regards

Generally speaking almost all of the uncomplicated visceral artery aneurysms can be treated by interventional radiology. However a complicated ones are more likely to require surgery due to urgent presentation and failure/no applicability/unavailability of interventional radiology techniques.

many thanks to all colleagues . Have any of you had experience with the multilayer stent of flow diverting stent in the treatment of visceral aneurysms ?

I `ve no experience with multilayer, but some do  in my country with good results for small arteries as visceral arteries.

i prefer coils with ballon or stent tecnics.

I have some experience with multilayer stent in the treatment of renal aneurysms interesting the ilar segment of the artery.Have you similar experience?

We never treated renal artery aneurysm with multilayer stent , only hepatic artery aneurysm and splenic one.

i preffer endovascular, after previous pancreatic surgery above all, it should be solved in time of sentinel bleeding, surgery is more complicated and after head resection sometimes pancreatectomy necessary

If treatment is indicated, currently endovascular approach is the first option. It is les invasive and procedure related morbi-mortality is lower tan with surgery.

How about mycotic visceral aneurysm? If you encountered a rapid-growing mycotic visceral aneurysm in a patient with obvious abdominal pain and fever, would you treat this patient  endovascularly or surgically?

I'd rather suggest the evaluation of laparoscopy, robotic if possible. It is possible to treat a wide range of visceral artery aneurisms by resection-anastomosis or aneurismectomy + ligature

 Most of the visceral artery is possible to ligate. In such situation laparoscopic ligation appears to be less risky and preferable

ak pujahari

prof surg  Gastroenterology

I have very limited experience with VAAs. It is a rare condition and for that reason comparative studies of treatment modalities will not be possible. Next best thing is to set up a registry. In literature some series have been presented and from what I've read I would both in acute and in elective cases prefer transcatheter embolization of the aneurysms, which even proved to be safe in some cases of SMA VVA. Of course diligent clinical surveillance for the first 48 hours seems warranted in such cases. 

According to our experience the majority of the cases can be treated using minimally invasive, percutaneous, endovascular methods and avoid surgery. Endovascular methods demonstrate high technical success rates and low complication/recurrence rates. Please see:

Spiliopoulos S, Sabharwal T, Karnabatidis D, Brountzos E, Katsanos K, Krokidis M, Gkoutzios P, Siablis D, Adam A.Endovascular treatment of visceral aneurysms and pseudoaneurysms: long-term outcomes from a multicenter European study.

Cardiovasc Intervent Radiol. 2012 Dec;35(6):1315-25 .

Like most arterial lesions, it is not one method versus the other. If the lesion is suitable for an endovascular approach then use it with appropriate expertise. For example in an  arterial segment that can be readily treated with ablation or a covered stent. If not then seek the alternatives with an eye on minimal invasion.

What visceral aneurysm are we talking about? If it is a terminal branch one in a minor artery then it is seldom easy to embolize. However, if it is a major artery main branch you'll have to keep flow with either a covered stent, a stent/coiling or open surgery. Also you'll have to see if there is collateral flow because that can help you to decide whether to embolize or to do a revascularization.

See Dr Spiliopoulos answer above.

Endovascular Surgery, either exclusion or covered stent insertion according to the case, is our preferred option. it is usually neither easy nor a quick procedure and the adequate resolution of the case has to be surveyed over time.

I agree with all of you, when possible endovascular approach is a good therapeutic options, even if surgery remain also a good option. What about this article? "Long-term results of surgical treatment of aneurysms of digestive arteries"

I totally agree with Hugo Rodrigues. You also can take in consideration the implantation of  a flow-diverter.

in the most of cases endovascular approach is preferable. Open surgical reconstruction is advised in ilar renal or hepatic aneurysms

The question cannot be answered categorically. The treatment of choice needs to be identified considering the location of the aneurysm (A. hepatica? A. lienalis? A. gastroduodenalis? A. renalis? A. mesenterica superior? A. mesenterica inferior? location proximal or distal), age, gender, the clinical situation of the patient, symptoms, concomitant diseases, renal function,, prior abdominal or vascular surgical procedures, diameter of the vessel, tortuosity, avialable endovascular techniques, and this is probably not all. We decide on treatment in an interdisciplinary conference.