Visceral Artery Aneurysms between Intervention and Watchful Waiting: Retrospective Analysis of Multimodal Management in a Single Center

Purpose: Visceral artery aneurysms (VAA) are rare, potentially life-threatening lesions, with a reported incidence of 0.01%–0.2%. Widespread use of cross-sectional imaging led to an increase in incidental detection. Management varies according to aneurysm type, size, location, and etiology. This study evaluates outcomes of VAAs with up to 1-year follow-up, managed by different approaches at a tertiary care center. Methods: A retrospective observational study was conducted on 14 patients diagnosed with VAAs between January 2023 and March 2024. Demographic characteristics, clinical presentation, aneurysm morphology (true vs. pseudoaneurysm; saccular vs. fusiform), etiology, treatment strategies, and outcomes were analyzed. Follow-up data were obtained from hospital records and outpatient documentation. Results: Mean age was 53.6 ± 16.7 years, with 71.4% males. Splenic and superior mesenteric artery aneurysms were the most frequent (4 each; 28.6%). True aneurysms formed nine cases (64.3%). Abdominal pain was the most common symptom (71.4%), and two patients presented with rupture. The largest diameter recorded was 42 mm. Etiologies included degenerative atherosclerosis (35.7%), inflammatory (35.7%), vasculitis (21.4%), and infective (7.1%). Seven patients underwent intervention (three open, one hybrid, three endovascular), whereas seven were managed conservatively with medical therapy and imaging surveillance. Upon follow-up upto 1-year, five intervened patients were asymptomatic with patent graft or successful aneurysm exclusion. Two postoperative deaths occurred in patients who presented with ruptured pseudoaneurysms. In the conservatively managed group, five were clinically stable, whereas two were lost to follow-up. Conclusion: While pseudo-aneurysms and symptomatic aneurysms warrant prompt intervention, management of incidentally detected asymptomatic aneurysms is complex. In this small retrospective cohort, pseudoaneurysms were associated with emergency presentation and higher mortality. Selected asymptomatic true aneurysms remained stable under surveillance during the short-term 1-year follow-up. Given the limited sample size and retrospective observational design, conclusions should be interpreted cautiously, Society of Vascular Surgery and European Society of Vascular Surgery guidelines aid in individualized decision-making, and high vigilance and structured follow-up remain essential.