Visceral Artery Aneurysm: Symptoms, Types, Causes and Treatment

Visceral artery aneurysms (VAAs) are rare but potentially life-threatening vascular conditions involving the arteries that supply blood to the abdominal organs. Although often discovered incidentally, VAAs can have serious consequences if they rupture, making early recognition and management critical. This comprehensive guide explores the symptoms, types, causes, and treatment strategies for visceral artery aneurysms, synthesizing the latest evidence from clinical research.

Symptoms of Visceral Artery Aneurysm

A visceral artery aneurysm often lurks silently, causing no symptoms until its size or complications draw clinical attention. However, when symptoms do occur, they can be subtle or dramatic, ranging from vague abdominal discomfort to life-threatening emergencies. Recognizing these signs early is crucial for timely intervention and improved outcomes.

Symptom	Description	Frequency/Notes	Sources
Abdominal Pain	Sudden or persistent, various sites	Most common presenting symptom	1 2 3 4 5 6 9
GI Bleeding	Vomiting blood, melena, hematochezia	May occur with rupture/erosion	1 5 9
Hemodynamic Instability	Hypotension, shock	Suggests rupture/emergency	1 5 6 9
Malaise/Fever	Low-grade, nonspecific	More common in mycotic aneurysms	2
Weight Loss	Unintentional loss	Seen in chronic or mycotic cases	2
Nausea/Vomiting	With or without pain	Sometimes present	2

Table 1: Key Symptoms

Abdominal Pain: The Most Telling Symptom

Abdominal pain is the most frequent symptom of a visceral artery aneurysm, but its character varies based on the artery involved and the presence of complications. The pain may be sudden and severe, especially in the case of a rupture, or it may be a dull, persistent ache that prompts further investigation. In pregnant women, sudden unexplained abdominal pain should always raise suspicion, as VAAs, though rare, are a known cause of maternal and fetal morbidity 3.

Gastrointestinal Bleeding

In some cases, especially when the aneurysm erodes into adjacent organs like the duodenum or bile duct, patients may present with gastrointestinal bleeding. This can manifest as vomiting blood, black tarry stools (melena), or bright red blood per rectum. Sometimes, repeated but unexplained GI bleeding may be the only clue to a ruptured aneurysm 1 5.

Hemodynamic Instability: A Red Flag

The most serious presentation is hemodynamic instability—manifested by low blood pressure, rapid heart rate, and shock—which typically accompanies aneurysm rupture. This is a life-threatening emergency and requires immediate intervention 1 5 6 9.

Systemic Symptoms

Some patients, particularly those with mycotic (infectious) aneurysms, may have systemic symptoms like low-grade fever, malaise, or weight loss. These are less specific but, when combined with abdominal pain, should heighten clinical suspicion 2.

Types of Visceral Artery Aneurysm

Visceral artery aneurysms come in several forms, each with distinct features, risk profiles, and implications for treatment. Understanding these types is central to making the right diagnostic and management decisions.

Type	Description	Rupture Risk	Sources
True Aneurysm	Involves all vessel wall layers	Lower than pseudoaneurysm	4 8 13
Pseudoaneurysm	Disruption of wall, contained leak	Much higher risk	4 6 8
Mycotic	Infectious origin, often pseudo	High, treat urgently	2 3 4 8
Common Locations	Splenic, hepatic, celiac, mesenteric	Varies by site	1 3 4 5 10 13

Table 2: Types of Visceral Artery Aneurysm

True Aneurysm

A true aneurysm involves all three layers of the arterial wall. These are most often degenerative in nature and may be associated with risk factors like atherosclerosis or connective tissue diseases. True aneurysms generally grow slowly and have a lower risk of rupture compared to pseudoaneurysms, but large sizes (>2 cm) or symptomatic aneurysms warrant treatment 3 4 8 13.

Pseudoaneurysm (False Aneurysm)

Pseudoaneurysms, or false aneurysms, result from a breach in the vessel wall, with blood contained by surrounding tissues or the outer vessel layer. They carry a dramatically higher risk of rupture and are often caused by trauma, inflammation, or medical interventions. Immediate treatment is recommended, regardless of size 4 6 8.

Mycotic Aneurysm

These are infectious aneurysms, often pseudoaneurysms in nature, typically caused by bacterial infection (commonly Streptococcus or Staphylococcus). Mycotic aneurysms present with a combination of abdominal pain, fever, malaise, and sometimes weight loss. They require urgent antimicrobial therapy and surgical or endovascular intervention 2 3 4 8.

Common Locations

• Splenic artery: The most commonly affected site.
• Hepatic artery: Second most frequent.
• Celiac, superior mesenteric, and renal arteries: Also frequently involved.
• Other sites: Gastroduodenal, pancreaticoduodenal, inferior mesenteric, and more rarely, branch arteries 1 3 4 5 10 13.

The risk of rupture and the urgency of treatment can vary by location, with splenic and hepatic artery aneurysms more prone to rupture, particularly in pregnancy 3 4 5 9.

Causes of Visceral Artery Aneurysm

Understanding what leads to the formation of visceral artery aneurysms is key to prevention and risk assessment. Causes range from degenerative changes to infections and trauma.

Cause	Mechanism	Notes / Risk Factors	Sources
Atherosclerosis	Degeneration of vessel wall	Most common in older adults	1 4 10
Fibromuscular Dysplasia	Abnormal vessel wall growth	Younger patients, rare	1 4
Connective Tissue Disorders	Inherited wall weakness	e.g., Marfan, Ehlers-Danlos	4 10
Infection (Mycotic)	Bacterial infiltration of wall	High rupture risk	2 3 8
Trauma	Blunt, penetrating, or iatrogenic	Post-procedural, accidents	4 8
Iatrogenic	Medical/surgical intervention	Angiography, surgery	4 8
Pregnancy	Hormonal and hemodynamic changes	Increased rupture risk	3 4 9

Table 3: Causes of Visceral Artery Aneurysm

Degenerative and Atherosclerotic Changes

Atherosclerosis is the leading cause of true visceral artery aneurysms, particularly in older adults. The build-up of atherosclerotic plaque weakens the vessel wall, making it prone to dilation and aneurysm formation 1 4 10.

Connective Tissue Disorders

Certain inherited conditions, such as Marfan syndrome or Ehlers-Danlos syndrome, are associated with weakened arterial walls, predisposing individuals to aneurysm formation, often at a younger age 4 10.

Fibromuscular Dysplasia

This non-atherosclerotic, non-inflammatory vascular disease leads to abnormal cellular growth in the artery wall, resulting in aneurysms, stenoses, or dissections. It is a less common cause but important, especially in younger patients 1 4.

Mycotic (Infectious) Aneurysms

Infectious, or mycotic, aneurysms arise when bacteria infiltrate the arterial wall, leading to rapid destruction and pseudoaneurysm formation. They are most often due to Streptococcus or Staphylococcus species and carry a high risk of rupture 2 3 8.

Traumatic and Iatrogenic Causes

Trauma—whether from blunt injury, penetrating wounds, or medical procedures such as angiography or surgery—can disrupt the vessel wall and lead to pseudoaneurysm formation. Iatrogenic pseudoaneurysms are increasingly recognized as a complication of medical interventions 4 8.

Pregnancy

Pregnancy is a unique risk factor, particularly for splenic artery aneurysms. Hormonal and hemodynamic changes, increased blood volume, and vessel wall remodeling can predispose women to aneurysm formation and rupture, especially in the third trimester 3 4 9.

Treatment of Visceral Artery Aneurysm

The management of visceral artery aneurysms has evolved rapidly, with minimally invasive endovascular techniques now at the forefront. Treatment decisions depend on the aneurysm’s type, size, location, symptoms, and the patient's overall health.

Treatment	Indication	Advantages/Notes	Sources
Endovascular	Most VAAs, especially elective cases	Minimally invasive, lower morbidity, shorter recovery	3 7 8 11 12 13
Open Surgery	Rupture, failed endovascular, anatomic constraints	Still essential in emergencies	3 4 6 8 10 13
Embolization	Selective occlusion of aneurysm	Highly effective, first-line	7 11 12 13
Covered Stents	Preserves flow in parent vessel	Used selectively	7
Surveillance	Small, asymptomatic true aneurysms	Only in low-risk patients	11 13
Antimicrobial Therapy	Mycotic aneurysm	Must precede intervention	2 8

Table 4: Treatment Options

Endovascular Approaches: The Gold Standard

Endovascular therapy has become the first-line treatment for most visceral artery aneurysms, especially those detected before rupture. Techniques include:

• Coil Embolization: Small coils are inserted via catheter to occlude the aneurysm and prevent blood flow into it. This is highly effective for most locations 7 11 12 13.
• Liquid Embolic Agents: Materials like N-butyl-2-cyanoacrylate (glue) are sometimes used for complex or high-flow aneurysms 11.
• Covered Stents: These stents maintain vessel patency while excluding the aneurysm; useful when preserving blood flow is critical 7.

Benefits include lower procedural morbidity, faster recovery, and, in elective cases, lower mortality compared to open surgery. However, endovascular repair may require reintervention, especially in pseudoaneurysms 7 11 12 13.

Open Surgery: Still Vital for Emergencies

While endovascular treatment is preferred, open surgery remains necessary in certain scenarios:

• Ruptured aneurysms: Immediate open repair may be needed if endovascular access is not feasible or fails 3 6 10.
• Complex anatomy or failed endovascular attempts: Open surgical techniques include aneurysm resection, arterial ligation, or bypass grafting 1 3 4 6 10 13.

Open surgery is associated with higher morbidity and longer recovery, but outcomes can be excellent in stable, elective cases 10 13.

Embolization and Technique Selection

• Embolization is particularly effective for splenic, hepatic, and gastroduodenal artery aneurysms.
• Post-embolization syndrome (fever, pain) can occur, more commonly with splenic artery embolization, but is usually self-limited 13.
• Selection of technique depends on aneurysm size, location, vessel anatomy, and presence of rupture 7 8 11 12.

Special Considerations

• Pseudoaneurysms: Due to the high risk of rupture, these require urgent treatment at diagnosis, regardless of size 4 6 8.
• Mycotic aneurysms: Require prompt initiation of antibiotics, followed by surgical or endovascular intervention 2 8.
• Pregnancy: Lower threshold for intervention due to high risk of rupture and maternal-fetal morbidity 3 4.

Surveillance and Follow-Up

Small, asymptomatic true aneurysms may be monitored with serial imaging, but close follow-up is essential. Intervention thresholds vary, but most guidelines recommend treatment for aneurysms >2 cm, symptomatic lesions, or any pseudoaneurysm 3 11 13.

Conclusion

Visceral artery aneurysms, though rare, represent a critical vascular emergency when they rupture. Rapid advances in diagnostic imaging and endovascular techniques have improved management and outcomes, but high suspicion and prompt action remain vital.

Key points covered:

• Symptoms are often nonspecific but can include abdominal pain, GI bleeding, and shock—especially in rupture.
• Types include true aneurysms, pseudoaneurysms, and mycotic aneurysms, with differing risks and management needs.
• Causes range from atherosclerosis and connective tissue disorders to infection, trauma, and pregnancy-related changes.
• Treatment is increasingly endovascular, with coil embolization and stenting as first-line options, while open surgery remains crucial in emergencies or complex cases.

Early diagnosis, aggressive management of high-risk lesions (especially pseudoaneurysms), and individualized treatment strategies are essential to reduce morbidity and mortality in patients with visceral artery aneurysms.