Endovascular Treatment of Visceral Artery Aneurysms: Data Analysis of the DeGIR/DGNR Quality Management System

Abstract

Purpose

Visceral artery aneurysms (VAA) are rare, and data on their occurrence and treatment are often outdated or heterogeneous. The objective of this study is to provide a comprehensive overview of features and interventional treatment options for VAA.

Materials and Methods

We analyzed demographic, procedural, and clinical data on VAA from 2018 to 2022 based on data derived from the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) registry regarding demographic details, aneurysm characteristics, treatment processes, and outcomes such as technical success, complication rates, and radiation exposure. Group comparisons between aneurysm locations and types were calculated as dependent variables as well as occurrence of incomplete embolization, complication rates, technical success, duration of intervention, and dose-area-product (DAP).

Results

In total 647 patients were enrolled. The mean age was 66 years, with 68.5% male. The most affected arteries were splenic (27.5%) and renal (21.3%). True aneurysms were most common (56.7%). Technical success was 91.2%, while primary incomplete embolization occurred in 47.3%. Complications were observed in 4.8%, with a 0.2% mortality. Mean intervention duration was 67 min, mean fluoroscopic time was 36 min and mean DAP was 9560 cGycm². There were no significant differences in primary incomplete embolization, complication rate, correct placement of embolization material, duration, and DAP based on aneurysm location. Aneurysm types showed a significant difference in incomplete embolization, with dissections having the highest rates and longest durations of intervention and highest DAP.

Conclusion

The analysis of DeGIR quality management data reveals consistently high technical success and low complication rates in endovascular treatment of VAA. Dissecting aneurysms exhibit the highest rates in incomplete embolization, requiring the longest interventions and increased radiation. Enhancing the DeGIR registry with follow-up features would benefit assessing VAA occlusion rates. The data provide a comprehensive nationwide overview of how interventional radiology can impact treatment strategy.

Key Points

• Visceral artery aneurysms represent a rare entity

• The DeGIR registry provides extensive data about rare endovascular treatments of visceral artery aneurysms

• Endovascular treatment of visceral aneurysms is feasible and safe

• Dissecting aneurysms are associated with the highest rates of primary incomplete embolization and the longest interventional durations

Citation Format

• Weiss D, Jannusch K, Wilms LM et al. Endovascular Treatment of Visceral Artery Aneurysms: Data Analysis of the DeGIR/DGNR Quality Management System. Rofo 2025; 197: 1291–1299

Zusammenfassung

Ziel

Viszeralarterienaneurysmen (VAA) sind selten, und die Daten zu ihrem Auftreten und ihrer Behandlung sind oft veraltet oder heterogen. Das Ziel dieser Analyse ist es, einen umfassenden Überblick über interventionelle Behandlungsoptionen und Eigenschaften der VAA zu bieten.

Material und Methoden

Es wurden prozedurale und klinische Daten zu VAA von 2018 bis 2022 analysiert. Die Daten stammen aus dem Deutschen Register für Interventionelle Radiologie und Minimalinvasive Therapie (DeGIR) und umfassen demografische Details, Merkmale der Aneurysmen, Behandlungsprozesse und Ergebnisse wie dem technischen Erfolg, Komplikationsraten und die Strahlenexposition. Gruppenvergleiche zwischen Aneurysmalokalisationen und -typen als abhängige Variablen sowie dem Auftreten von einer primären unvollständigen Embolisation, Komplikationsraten, technischem Erfolg, Interventionsdauer und Dosisflächenprodukt (DFP) wurden berechnet.

Ergebnisse

Es wurden 647 Patienten eingeschlossen. Das Durchschnittsalter betrug 66 Jahre, mit 68,5% Männern. Am häufigsten betroffen waren die Milz- (27,5%) und die Nierenarterien (21,3%). Wahre Aneurysmen waren am häufigsten (56,7%). Der technische Erfolg betrug 91,2%, während eine primäre unvollständige Embolisation bei 47,3% auftraten. Komplikationen traten bei 4,8% auf, mit einer Mortalitätsrate von 0,2%. Die durchschnittliche Interventionsdauer betrug 67 Minuten, die durchschnittliche Fluoroskopiezeit 36 Minuten und das DFP durchschnittlich 9560 cGycm². Es gab keine signifikanten Unterschiede in primärer unvollständiger Embolisation, Komplikationsrate, korrekter Platzierung von Embolisationsmaterial, Dauer und DFP basierend auf der Aneurysmalokalisation. Aneurysmatypen zeigten einen signifikanten Unterschied im Auftreten einer primären unvollständigen Embolisation, wobei Dissektionen die höchste Rate und die längsten Interventionen sowie das höchste DFP aufwiesen.

Schlussfolgerung

Die endovaskuläre Behandlung von VAA zeigt hohe technische Erfolgs- und niedrige Komplikationsraten. Dissezierende Aneurysmen zeigten insgesamt die höchste Rate an einer primären unvollständigen Embolisation, erforderten längere Interventionen und dadurch eine erhöhte Strahlenbelastung. Die Erweiterung des DeGIR-Registers um Follow-up-Daten würde dazu beitragen, die Okklusionsraten von VAA besser zu beurteilen. Die Daten zeigen einen umfassenden nationalen Überblick darüber, wie die interventionelle Radiologie die Behandlungsstrategie beeinflussen kann.

Kernaussagen

• Viszeralarterienaneurysmen sind eine seltene Entität.

• Das DeGIR-Register liefert umfangreiche Daten zu seltenen endovaskulären Behandlungen von viszeralen Arterienaneurysmen.

• Die endovaskuläre Behandlung von viszeralen Aneurysmen ist machbar und sicher.

• Dissezierende Aneurysmen haben die höchste Rate an einer primären unvollständigen Embolisation und längste Interventionsdauern.

Keywords

DeGIR registry data - module b - aneurysm - endovascular treatment - stent - coil

Publication History

Received: 10 June 2024

Accepted after revision: 04 January 2025

Article published online:
20 February 2025

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