Aortic branch aneurysms

Aneurysms can develop in any main branch of the aorta. These aneurysms are much less common than abdominal or thoracic aortic aneurysms. Risk factors include atherosclerosis, hypertension, smoking, and older age. Localized infection can cause mycotic aneurysms.

Subclavian artery aneurysms are sometimes associated with the presence of cervical ribs or thoracic outlet syndrome.

Aneurysms of organ arteries are rare. Approximately 60% develop in the splenic artery, 20% in the hepatic arteries, 5.5% in the ascending mesenteric artery. Splenic artery aneurysms develop mainly in women (4:1).

[ 1 ], [ 2 ], [ 3 ]

Causes of aortic branch aneurysms

Causes include fibromuscular dysplasia of the media, portal hypertension, multiple pregnancies, penetrating or blunt abdominal trauma, pancreatitis, and infection. Hepatic artery aneurysms occur predominantly in men (2:1). They may result from previous abdominal trauma, intravenous drug use, medial degeneration, or periarterial inflammation. Renal artery aneurysms may dissect or rupture, causing acute occlusion.

[ 4 ], [ 5 ]

Symptoms of aortic branch aneurysms

Symptoms vary. Subclavian artery aneurysms may cause local pain, throbbing, venous thrombosis or swelling (due to compression of adjacent veins), signs of distal ischemia, symptoms of transient ischemic attacks, stroke, hoarseness, or motor or sensory impairment (due to compression of the recurrent laryngeal nerve or brachial plexus). Superior mesenteric artery aneurysms may cause abdominal pain and ischemic colitis.

Regardless of location, mycotic or inflammatory aneurysms can cause local pain and complications of systemic infection (eg, fever, severe general weakness, weight loss).

Diagnosis of aortic branch aneurysms

Most aortic branch aneurysms are not diagnosed until they rupture, although calcified asymptomatic aneurysms may be seen on radiographs or other imaging studies performed for other reasons. Ultrasound or CT is usually used to detect or confirm aortic branch aneurysms. Angiography is helpful when it is necessary to determine whether peripheral vascular or tissue symptoms are due to aneurysm or embolic complications.

[ 6 ], [ 7 ], [ 8 ], [ 9 ]

Treatment of aortic branch aneurysms

Treatment includes surgical removal of the aneurysm and replacement of the aneurysm. For asymptomatic aneurysms, the decision to replace the aneurysm is made taking into account the risk of rupture, the size, location of the aneurysm, and perioperative risks.

Surgical treatment of aortic branch aneurysms subclavian aneurysms may include removal of cervical ribs (if present) prior to replacement.

For organ artery aneurysms, the risk of rupture and death is about 10% and is especially high in women of childbearing age and patients with hepatic artery aneurysms (> 35%). Absolute indications for surgical treatment of organ artery aneurysms are defined for women of childbearing age, patients of other age groups with aneurysms with clinical symptoms, and hepatic artery aneurysms. For splenic artery aneurysm, surgery may consist of ligation without arterial reconstruction or excision of the aneurysm. Depending on the location of the aneurysm, splenectomy may be necessary.

In mycotic aneurysms, intensive antibiotic treatment directed at the specific pathogen is indicated. In general, aneurysms of this type require surgical treatment.