Celiac arterial aneurysms: A critical reappraisal of a rare entity

Hypothesis: We hypothesize that although rare true aneurysms of the celiac artery carry a definite risk for rupture, current indications for elective intervention remain elusive and management has varied. To assess indications, the risks of surgical repair, and the morbidity of rupture, we reviewed our experience. Design: We undertook a retrospective medical chart review of all patients with true celiac arterial aneurysms from our institutions from January 1, 1980, through December 31, 1998. We excluded patients with thoraco-abdominal aneurysms and pseudoaneurysms. We followed up patients via medical records and/or telephone calls to the patient or a relative. Results: Of 306 patients with visceral arterial aneurysms, true celiac arterial aneurysms were identified in 18 (5.9%), including 12 men (67%) and 6 women (33%) with a mean age of 64.2 years. Twelve patients (67%) had concomitant associated aneurysms at the time of presentation (8 aortic, 2 renal, 1 popliteal, and 1 femoral). Aneurysm size ranged from 1.5 to 4.0 cm. Only 1 patient (6%) in our series presented with a ruptured aneurysm. Of the 17 patients with intact aneurysms, 9 (53%) underwent intervention, including revascularization in 8 (4 prosthetic, 2 saphenous vein, and 2 primary arterioarterial anastomoses). There was no operative mortality. In follow-up, both saphenous vein grafts were found to be occluded at 1 and 6 months after operation. Among the 9 patients treated nonoperatively, 1 late rupture resulted in death. Eight patients (44%) were alive without symptoms after a mean follow-up of 91 months (range, 1-371 months). Conclusions: Celiac arterial aneurysms are rare, but rupture occurs, and elective repair should be considered in good-risk patients with aneurysms of greater than 2 cm. An association with nonvisceral arterial aneurysms is frequent. Long-term results with prosthetic grafts have been excellent and should be the conduit of choice for non-infected aneurysms.