A systematic review and meta-analysis of the management of visceral artery aneurysms

Patricia Barrionuevo, Mahmoud B. Malas, Besma Nejim, Abdullah Haddad, Allison Morrow, Oscar Ponce, Bashar Hasan, Mohamed Seisa, Rabih Chaer, Mohammad H Murad

Research output: Contribution to journalReview article

Abstract

Background: The evidence supporting management decisions of visceral artery aneurysms (VAAs) is sparse. Practice guidelines are needed to help patients and surgeons choose between endovascular and open surgery approaches. Methods: We searched MEDLINE, EMBASE, Cochrane databases, and Scopus for studies of patients with VAAs. Studies were selected and appraised by pairs of independent reviewers. Meta-analysis was performed when appropriate. Results: We included 80 observational studies that were mostly noncomparative. Data were available for 2845 aneurysms, comprising 1279 renal artery, 775 splenic artery, 359 hepatic artery, 226 pancreaticoduodenal and gastroduodenal arteries, 95 superior mesenteric artery, 87 celiac artery, 15 jejunal, ileal and colic arteries, and 9 gastric and gastroepiploic arteries. Differences in mortality between open and endovascular approaches were not statistically significant. The endovascular approach was used more often by surgeons. The endovascular approach was associated with shorter hospital stay and lower rates of cardiovascular complications but higher rates of reintervention. Postembolization syndrome rates ranged from 9% (renal) to 38% (splenic). Coil migration ranged from 8% (splenic) to 29% (renal). Otherwise, access site complication were low (<5%). Pseudoaneurysms tended to have higher mortality and reintervention rates. Conclusion: This systematic review provides event rates for outcomes important to patients with VAAs. Despite the low certainty warranted by the evidence, these rates along, with surgical expertise and anatomic feasibility, can help patients and surgeons in shared-decision making.

Original languageEnglish (US)
JournalJournal of vascular surgery
DOIs
StatePublished - Jan 1 2019

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Aneurysm
Meta-Analysis
Arteries
Gastroepiploic Artery
Celiac Artery
Kidney
Splenic Artery
Superior Mesenteric Artery
Colic
Mortality
Hepatic Artery
False Aneurysm
Renal Artery
Practice Guidelines
MEDLINE
Observational Studies
Length of Stay
Stomach
Decision Making
Databases

Keywords

  • Aneurysm
  • Guideline
  • Meta-analysis
  • Visceral

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

A systematic review and meta-analysis of the management of visceral artery aneurysms. / Barrionuevo, Patricia; Malas, Mahmoud B.; Nejim, Besma; Haddad, Abdullah; Morrow, Allison; Ponce, Oscar; Hasan, Bashar; Seisa, Mohamed; Chaer, Rabih; Murad, Mohammad H.

In: Journal of vascular surgery, 01.01.2019.

Research output: Contribution to journalReview article

Barrionuevo, P, Malas, MB, Nejim, B, Haddad, A, Morrow, A, Ponce, O, Hasan, B, Seisa, M, Chaer, R & Murad, MH 2019, 'A systematic review and meta-analysis of the management of visceral artery aneurysms', Journal of vascular surgery. https://doi.org/10.1016/j.jvs.2019.02.024
Barrionuevo, Patricia ; Malas, Mahmoud B. ; Nejim, Besma ; Haddad, Abdullah ; Morrow, Allison ; Ponce, Oscar ; Hasan, Bashar ; Seisa, Mohamed ; Chaer, Rabih ; Murad, Mohammad H. / A systematic review and meta-analysis of the management of visceral artery aneurysms. In: Journal of vascular surgery. 2019.
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AU - Morrow, Allison

AU - Ponce, Oscar

AU - Hasan, Bashar

AU - Seisa, Mohamed

AU - Chaer, Rabih

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AB - Background: The evidence supporting management decisions of visceral artery aneurysms (VAAs) is sparse. Practice guidelines are needed to help patients and surgeons choose between endovascular and open surgery approaches. Methods: We searched MEDLINE, EMBASE, Cochrane databases, and Scopus for studies of patients with VAAs. Studies were selected and appraised by pairs of independent reviewers. Meta-analysis was performed when appropriate. Results: We included 80 observational studies that were mostly noncomparative. Data were available for 2845 aneurysms, comprising 1279 renal artery, 775 splenic artery, 359 hepatic artery, 226 pancreaticoduodenal and gastroduodenal arteries, 95 superior mesenteric artery, 87 celiac artery, 15 jejunal, ileal and colic arteries, and 9 gastric and gastroepiploic arteries. Differences in mortality between open and endovascular approaches were not statistically significant. The endovascular approach was used more often by surgeons. The endovascular approach was associated with shorter hospital stay and lower rates of cardiovascular complications but higher rates of reintervention. Postembolization syndrome rates ranged from 9% (renal) to 38% (splenic). Coil migration ranged from 8% (splenic) to 29% (renal). Otherwise, access site complication were low (<5%). Pseudoaneurysms tended to have higher mortality and reintervention rates. Conclusion: This systematic review provides event rates for outcomes important to patients with VAAs. Despite the low certainty warranted by the evidence, these rates along, with surgical expertise and anatomic feasibility, can help patients and surgeons in shared-decision making.

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