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Visceral artery aneurysms (VAA) are rare, and data on their occurrence and treatment are often outdated or heterogeneous.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; DOI 10.1055/a-2513-1135

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

• References

• 1 Chiesa R, Astore D, Guzzo G. et al. Visceral Artery Aneurysms. Ann Vasc Surg 2005; 19: 42-48
• 2 Juntermanns B, Bernheim J, Karaindros K. et al. Visceral artery aneurysms. Gefässchirurgie 2018; 23: 19-22
• 3 Venturini M, Piacentino F, Coppola A. et al. Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives. J Clin Med 2021; 10: 2520
• 4 Ruffino MA, Rabbia C. Endovascular repair of peripheral and visceral aneurysms with the Cardiatis multilayer flow modulator: One-year results from the Italian Multicenter Registry. J Endovasc Ther 2012; 19: 599-610
• 5 Barrionuevo P, Malas MB, Nejim B. et al. A systematic review and meta-analysis of the management of visceral artery aneurysms. J Vasc Surg 2019; 70: 1694-1699
• 6 Rossi M, Rebonato A, Greco L. et al. Endovascular exclusion of visceral artery aneurysms with stent-grafts: Technique and long-term follow-up. Cardiovasc Intervent Radiol 2008; 31: 36-42
• 7 Rossi UG, Petrocelli F. Hepatic artery aneurysms: Endovascular therapeutic techniques. Ann Hepatobiliary Pancreat Surg 2021; 25: 167-170
• 8 Colombi D, Bodini FC, Bossalini M. et al. Extracranial Visceral Artery Aneurysms/Pseudoaneurysms Repaired with Flow Diverter Device Developed for Cerebral Aneurysms: Preliminary Results. Ann Vasc Surg 2018; 53: 272.e271-272.e279
• 9 Giorgakis E, Chong B, Oklu R. et al. Successful treatment of visceral pseudoaneurysm after pancreatectomy using flow-diverting stent device. Ann Hepatobiliary Pancreat Surg 2020; 24: 114-118
• 10 Bücker A, Gross-Fengels W, Haage P. et al. Qualification guideline of the German Roentgen Society and the German Society of Interventional Radiology and Minimal Invasive Therapy for performing interventional radiologic minimal invasive procedures on arteries and veins. Fortschr Röntgenstr 2012; 184: 565-569
• 11 Zensen S, Bücker A, Meetschen M. et al. Current use of percutaneous image-guided tumor ablation for the therapy of liver tumors: Lessons learned from the registry of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) 2018–2022. Eur Radiol 2024; 34: 3322-3330
• 12 Baerlocher MO, Nikolic B, Sze DY. Adverse Event Classification: Clarification and Validation of the Society of Interventional Radiology Specialty-Specific System. J Vasc Interv Radiol 2023; 34: 1-3
• 13 Rueckel J, Ozpeynirci Y, Trumm C. et al. Preliminary results of intracranial aneurysm treatment with derivo2heal embolization device. Neuroradiology 2024; 66: 1747-1759
• 14 Pierot L, Spelle L, Vitry F. Immediate clinical outcome of patients harboring unruptured intracranial aneurysms treated by endovascular approach: Results of the ATENA study. Stroke 2008; 39: 2497-2504
• 15 Khalilzadeh O, Baerlocher MO, Shyn PB. et al. Proposal of a New Adverse Event Classification by the Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol 2017; 28: 1432-1437.e1433
• 16 Rabuffi P, Bruni A, Antonuccio EGM. et al. Treatment of visceral artery aneurysms and pseudoaneurysms with the use of cerebral flow diverting stents: Initial experience. CVIR Endovasc 2020; 3: 48
• 17 Maingard J, Lamanna A, Kok HK. et al. Endovascular treatment of visceral artery and renal aneurysms (VRAA) using a constant mesh density flow diverting stent. CVIR Endovasc 2019; 2: 15
• 18 Chaer RA, Abularrage CJ, Coleman DM. et al. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg 2020; 72: 3s-39s
• 19 Pitton MB, Dappa E, Jungmann F. et al. Visceral artery aneurysms: Incidence, management, and outcome analysis in a tertiary care center over one decade. Eur Radiol 2015; 25: 2004-2014
• 20 Venturini M, Marra P, Colombo M. et al. Endovascular Repair of 40 Visceral Artery Aneurysms and Pseudoaneurysms with the Viabahn Stent-Graft: Technical Aspects, Clinical Outcome and Mid-Term Patency. Cardiovasc Intervent Radiol 2018; 41: 385-397
• 21 DeCarlo C, Mohebali J, Dua A. et al. Morbidity and mortality associated with open repair of visceral aneurysms. J Vasc Surg 2022; 75: 632-640.e632
• 22 Cappucci M, Zarco F, Orgera G. et al. Endovascular Treatment of Visceral Artery Aneurysms and Pseudoaneurysms With Stent-Graft: Analysis of Immediate and Long-Term Results. Cirugía Española (English Edition) 2017; 95: 283-292
• 23 Brownstein AJ, Erben Y, Rajaee S. et al. Natural history and management of renal artery aneurysms in a single tertiary referral center. J Vasc Surg 2018; 68: 137-144
• 24 Hogendoorn W, Lavida A, Hunink MG. et al. Open repair, endovascular repair, and conservative management of true splenic artery aneurysms. J Vasc Surg 2014; 60: 1667-1676.e1661
• 25 Ikeda O, Tamura Y, Nakasone Y. et al. Nonoperative management of unruptured visceral artery aneurysms: Treatment by transcatheter coil embolization. J Vasc Surg 2008; 47: 1212-1219
• 26 Obara H, Kentaro M, Inoue M. et al. Current management strategies for visceral artery aneurysms: An overview. Surg Today 2020; 50: 38-49
• 27 Koziarz A, Kennedy SA, El-Karim GA. et al. The Use of Vascular Closure Devices for Brachial Artery Access: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2023; 34: 677-684.e675
• 28 Hogendoorn W, Lavida A, Hunink MG. et al. Cost-effectiveness of endovascular repair, open repair, and conservative management of splenic artery aneurysms. J Vasc Surg 2015; 61: 1432-1440
• 29 Keschenau PR, Kaisaris N, Jalaie H. et al. Management strategies for true and dissecting visceral artery aneurysms. J Cardiovasc Surg (Torino) 2020; 61: 340-346
• 30 Wang J, He Y, Zhao J. et al. Systematic review and meta-analysis of current evidence in spontaneous isolated celiac and superior mesenteric artery dissection. J Vasc Surg 2018; 68: 1228-1240.e1229
• 31 Untereiner X, Kretz B, Camin-Kretz A. et al. Dissecting aneurysm of the celiac trunk: A case report. Ann Vasc Surg 2014; 28: 1037.e1031-1034
• 32 Schaarschmidt BM, Boos J, Buchbender C. et al. Heparin-bonded stent graft treatment for major visceral arterial injury after upper abdominal surgery. Eur Radiol 2018; 28: 3221-3227
• 33 Vouche M. Large-scale data from real-life practice of percutaneous liver thermal ablation from an international registry: Unconditionally trustful Atlas or colossus with feet of clay?. Eur Radiol 2024; 34: 3320-3321