Visceral artery aneurysms and pseudoaneurysms are rare lesions arising from the splanchnic or renal arterial circulation. Their clinical significance is disproportionate to their incidence because rupture may present as upper gastrointestinal bleeding, hematuria, abdominal pain, retroperitoneal hemorrhage, or sudden hemodynamic collapse.^[1-3] Increasing use of cross-sectional imaging has improved incidental detection, but a substantial number of patients still present only after bleeding or mass effect has occurred.

Management decisions are shaped by lesion size, location, morphology, rupture status, and the physiological reserve of the patient. Contemporary reviews and guideline documents increasingly favor endovascular therapy for many lesions because it can control bleeding quickly, avoid laparotomy, shorten hospital stay, and permit treatment in patients who carry significant operative risk.^[1,3-5] Coil embolization, sandwich embolization, sac packing, liquid embolics, and covered stent techniques have all expanded the therapeutic armamentarium.

Even so, the pattern of disease remains heterogeneous. Splenic, gastroduodenal, hepatic, renal, celiac, and superior mesenteric artery lesions do not behave identically, and pseudoaneurysms in particular may be more unstable because they often arise in the setting of pancreatitis, surgery, or iatrogenic injury.^[2,6-10] Outcome data from single-centre experiences therefore remain valuable, especially when they describe real-world combinations of lesion types and embolization strategies.

The present study was undertaken to analyze the demographic profile, anatomical distribution, procedural details, and early as well as long-term outcomes of endovascular treatment for visceral artery aneurysms and pseudoaneurysms in a retrospective hospital-based cohort.

Study Design and Setting

This was a retrospective review of patients who underwent endovascular treatment for visceral artery aneurysms/pseudoaneurysms at tertiary care hospital, Mysore, from 2006 to 2021.

Study Population

The final study cohort comprised 48 patients. A total of 50 aneurysms were treated, with more than one aneurysm identified in 2 patients. Patients were referred by surgeons and gastroenterologists. All were hospitalized, underwent the necessary investigations, received standard medical management, and were assessed for surgical options before endovascular treatment.

Data Collection and Outcome Measures

Demographic profile, presenting symptoms, associated conditions, aneurysm location, aneurysm type, embolization strategy, embolic material, and follow-up outcomes were reviewed. Follow-up assessment was performed at 24 hours, 4 weeks, 3 months, and 1 year. Successful treatment was defined as cessation of hemorrhage or symptom control, hemodynamic and hematologic stabilization where relevant, and absence of persistent aneurysmal flow on follow-up imaging.

Procedure Details

Conscious sedation with local anesthesia was preferred. Endovascular access for all procedures was obtained through the common femoral artery using a 6F or 7F femoral sheath. Selective angiography was performed with appropriate visceral catheters. The commonly used catheters were Cobra, SIM, RDC, and microcatheters. Embolic materials included coils, glue, polyvinyl alcohol particles, and gelfoam. Depending on aneurysm morphology and parent vessel anatomy, sac embolization, proximal embolization alone, or combined proximal and distal embolization was performed.

Statistical Analysis

Data were summarized descriptively. Patient-based variables were expressed as counts and percentages for categorical data and as mean with standard deviation and range for age. Lesion-related procedural data were analyzed at aneurysm level.

The study included 48 patients with 50 treated aneurysms. Males predominated (32/48, 66.7%), and the mean age was 32.1 ± 10.9 years, with a range of 12 to 57 years. Two patients harbored more than one aneurysm. The study flow is illustrated in Figure 1.

Pain was the commonest presenting symptom, followed by gastrointestinal bleeding and hematuria. Chronic pancreatitis was the leading associated condition. The baseline demographic and clinical profile is summarized in Table 1, and the age-group distribution is shown in Figure 2.

At aneurysm level, splenic artery lesions were the most frequent (15/50, 30.0%), followed by gastroduodenal artery lesions (14/50, 28.0%). True aneurysms (29/50, 58.0%) slightly outnumbered pseudoaneurysms (21/50, 42.0%). The anatomical distribution and lesion type are detailed in Table 2 and Figure 3.

With respect to technique, combined proximal and distal embolization was the commonest approach (26/50, 52.0%), followed by proximal embolization alone (15/50, 30.0%) and sac embolization (9/50, 18.0%). Coils were the dominant embolic material (39/50, 78.0%), whereas glue, gelfoam, and combined coil plus particulate or gelfoam techniques were used selectively. These procedural details are summarized in Table 3 and Figure 4.

Clinical success was high across follow-up. Immediate successful hemorrhage control or lesion exclusion was achieved in 47 of 48 patients (97.9%), with one early recurrent bleed. By 4 weeks, all 48 patients demonstrated stable exclusion. At 3 months, stable exclusion persisted in 44 patients (91.7%), while 2 patients required surgery and 2 had died. At 1 year, durable exclusion was documented in 44 patients, and a further 2 aneurysms had been excluded surgically. Follow-up outcomes are shown in Table 4 and Figure 5.

This retrospective series demonstrates that endovascular treatment was effective across a broad spectrum of visceral artery aneurysms and pseudoaneurysms. The cohort combined rupture-related presentations, pain syndromes, hematuria, and lesions associated with pancreatitis or prior intervention, which reflects the real-world heterogeneity described in contemporary reviews.^[1,2,6,11] Even within that mixed case-mix, immediate clinical success approached 98%, and stable exclusion was maintained in the majority of patients through 1 year.

The anatomical distribution in this study was led by splenic and gastroduodenal artery lesions. That pattern is clinically plausible. Splenic artery aneurysms remain the commonest true visceral aneurysms in most modern series, whereas pseudoaneurysms are frequently linked to pancreatitis, surgery, or inflammatory processes involving the gastroduodenal and peripancreatic circulation.^[1,7,10] The burden of chronic pancreatitis in the present cohort supports that association.

Technique selection was individualized according to aneurysm morphology and parent-vessel anatomy. Proximal and distal embolization was the commonest strategy, followed by proximal embolization alone and sac packing. Coils were the dominant embolic material. This preference is in line with contemporary endovascular practice, where coil-based exclusion remains widely used because of its versatility, controllability, and suitability for both true aneurysms and pseudoaneurysms.^{[3-5,9,11-14]} The selective use of glue, gelfoam, and combination therapy in the present series suggests a pragmatic lesion-specific approach rather than dependence on a single device platform.

When the present findings are interpreted against recent literature, the overall message is consistent. Contemporary guideline and observational data support endovascular therapy as a first-line option for many visceral artery aneurysms, particularly when rapid hemorrhage control or organ-preserving minimally invasive management is desired.^[2-5,12,13] The high early success observed here and the durable one-year exclusion in most patients align with those broader reports, even though direct comparison must remain cautious because lesion anatomy, rupture status, and follow-up definitions vary between studies.

The study has limitations. It was retrospective, single-centre, and based on treatment-era practice over several years. Follow-up outcomes were primarily descriptive, and the available case records did not support formal comparative modeling across aneurysm subtypes or embolic platforms. In addition, two deaths were recorded during follow-up, but causality could not be explored in detail from the available records. These limitations matter. Still, the study retains practical value because it documents outcome patterns from routine endovascular practice across multiple arterial territories.

Overall, the data support endovascular treatment as a dependable therapeutic option for visceral artery aneurysms and pseudoaneurysms in appropriately selected patients, with high immediate success and durable exclusion in most cases.

Endovascular treatment achieved high immediate success and favorable one-year durability in this retrospective cohort of visceral artery aneurysms and pseudoaneurysms. Splenic and gastroduodenal artery lesions predominated, coils were the principal embolic agent, and combined proximal-distal exclusion was the most frequently used strategy. These findings support endovascular therapy as an effective and practical treatment option for a wide range of visceral arterial aneurysmal lesions.

Source of Funding

Nil.

Conflict of Interest

None declared.

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