Discussion
There is strong evidence that symtomatic and pseudo-VAA are to be treated irrespectivly aneurysm size (8,
9).
There exist different treatment indications for asymtomatic aneurysms to avoid complications e.g.
rupture,
thrombosis,
and embolism.
Some authors advise treatment when aneurysma size exceeds 2-3 times the diameter of the normal arterial vessel (4).
Other authors recommend treatment for VAA ≧2 cm in size with exceptions concerning hepatic and splenic artery aneurysm (5,
6).
Regular controls for VAA <2 cm are suggested because rapid increase in size may be predictive for rupture.
The long-term-results in our retrospective analysis confirm findings in the literature: conservative management in patients with VAA size ≦1.5 cm seems to be reasonable.
Endovascular therapy with coil embolization or stent placement is suggested in patients with high surgical risk,
or aneurysms with difficult surgical approach (4).
Endovascular treatment is shown to be a safe alternative to surgery in shrot-term,
but the risk of aneurysm reperfusion is feared (3,
7).
A recent publication by Marone et al.
(7) reported 4 out of 20 endovascular treated patients with the need of late surgical conversion.
None of our patients suffered from severe complications after treatment or underwent second intervention.
Our long-term-outcome indicates that endovascular treatment is effective and durable.
Conclusion
Visceral artery aneurysms are very rare.
Small aneurysms are stable.
Endovascular treatment of visceral aneurysms is feasible showing good long-term results.
Considering its minimally invasive character this is the preferred method compared to open surgical repair.
Follow-up of patients with untreated small (<1.5 cm) VAA is safe and should be the strategy of choice.