WARNING! The Hidden Killer – Visceral Aneurysm

The incidence of vascular diseases is increasing year by year with the changes in lifestyle and dietary habits of the clinic. Visceral aneurysm is an important vascular disease that seriously threatens human health, and its incidence is about 2% of the normal population, among which splenic aneurysm is the most common, accounting for about 60% and commonly found in women. ), gastroduodenal aneurysms (1.5%), submesenteric aneurysms and renal aneurysms (<1%). The onset of visceral aneurysms is relatively insidious, and most patients have no obvious symptoms and are detected by routine abdominal ultrasound or arteriography. In larger cases, a pulsating abdominal mass can be detected. Once abdominal pain occurs, it often indicates that the aneurysm has ruptured or is about to rupture. Most patients with visceral aneurysms who present with sudden abdominal pain are often first seen by emergency, general, or urologic surgeons, and are easily misdiagnosed as acute appendicitis, gallbladder stones, pancreatitis, or urinary stones. However, due to the gradual increase in vigilance of physicians in various departments and the advancement of various examination methods, the diagnosis rate of visceral aneurysm is getting higher and higher, and CT angiography can quickly clarify the diagnosis. The possibility of visceral aneurysm should be immediately thought of for abdominal pain that cannot be explained by common causes. Once a visceral aneurysm is suspected, the receiving physician should control the patient's blood pressure and heart rate, advise him or her not to engage in strenuous activity or emotional excitement, and perform enhanced CT or DSA angiography as soon as possible, and promptly consult a vascular surgeon. The main causes of visceral aneurysm include atherosclerosis, hypertension, infection, pregnancy, congenital abnormalities, trauma, nodular arteritis, and portal hypertension. The main risk of visceral aneurysm is rupture of the aneurysm causing hemorrhage with mortality rate as high as 35-50%; or formation of thrombus inside the aneurysm, and dislodgement of the thrombus leading to embolism of the distal artery, which may cause necrosis of the tissues and organs in the corresponding artery supply area, which may cause disability or death in severe cases. Therefore, once diagnosed, most visceral aneurysms require active treatment. In terms of treatment, for small aneurysms, close follow-up and blood pressure control can be performed; if the aneurysm is large or has a tendency to increase in size, surgical treatment should be performed decisively. Surgical treatment mainly includes the traditional open surgery and the emerging endovascular treatment techniques. For example, the most common treatment for splenic aneurysm is abdominoplasty, revascularization, or removal of the aneurysm together with the spleen, which often requires general anesthesia, great trauma, complications, and high risk and mortality. This traditional treatment method is gradually being replaced by endovascular techniques. Endovascular treatment requires only a puncture in the groin under local anesthesia and the use of catheters and guidewire technology to implant a stent in the splenic artery to repair the vessel or to deliver a spring coil to embolize the tumor, which can preserve the spleen with minimal trauma, few complications, and fast recovery, This method is suitable for most patients, even if they are old, have poor general condition, have many underlying diseases, and cannot tolerate traditional open surgery.