Results of current endovascular treatments for visceral artery aneurysms

Objective: This single-centre retrospective cohort study was aimed to analyse the early and long-term results of endovascular treatment for true visceral artery aneurysms. Moreover, a comparison with the results of our previously published historical series of open surgical procedures was performed. Materials and methods: From January 2008 to December 2021, 78 consecutive patients were treated at our institution for true visceral artery aneurysms. All demographic data, procedural details, perioperative outcomes, and follow-up data were prospectively collected from a dedicated database. A retrospective analysis identified 72 patients who underwent endovascular surgery. Early results were analysed in terms of technical success, conversion to open surgery, mortality, and local and systemic morbidities. Follow-up results were analysed in terms of survival, need for open or endovascular reintervention, and freedom from complications at the level of the treated visceral artery. These results were then compared with those of our historical open surgical group (1982-2007), which included 54 interventions. Results: In four cases, the planned endovascular procedure could not be completed, and the overall technical success rate was 94.5%. No deaths occurred during the hospital stay or 30 days after surgery. Overall, the 30-day perioperative complication rate was 5.8%, with an early reintervention rate of 2.9%. The median follow-up time was 29 months (1-132 months). The estimated 7-year survival rate was 88% (standard error, SE 0.05). The estimated 7-year aneurysm-related complication-free rate was 85.5% (SE 0.06), with reintervention-free and aneurysm-related complication-free survival rates of 93.3% (SE 0.04) and 75.6% (SE 0.07), respectively. At the 7-year follow-up, the survival rate was similar between the endovascular and open groups. There was a trend towards a higher aneurysm-related complication rate in the endovascular group than in the open group (14.5% vs. 6.4%, p=0.07). However, no significant differences in reintervention-free and overall estimated aneurysm-related complication-free survival rates were found between the two groups. Conclusions: Endovascular repair is safe and effective in patients with visceral artery aneurysms, with low perioperative complication rates. The long-term outcomes were satisfactory and comparable with those of the historical series of open surgical repairs. Even if there is a trend towards a higher risk of late aneurysm-related complications among endovascular patients, it does not imply an increased need for late reinterventions.