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Visceral artery aneurysms

What's new

The European Society for Vascular Surgery (ESVS) has published updated guidelines on the management of mesenteric artery and vein diseases, including visceral artery aneurysms and dissections. Computed tomography angiography (CTA) is recommended for diagnosis, anatomical assessment, and procedural planning in patients with suspected visceral artery aneurysms. For asymptomatic visceral artery aneurysms <30 mm and pancreaticoduodenal artery aneurysms <15 mm, annual surveillance for the first 3 years is advised, followed by individualized follow-up, preferably with duplex ultrasound or, if not feasible, CTA. Urgent repair is recommended for all symptomatic visceral artery aneurysms, regardless of size and location. Endovascular repair is preferred over open surgery in anatomically suitable patients. Endovascular or open repair is suggested for asymptomatic splenic, hepatic, celiac, superior mesenteric, or renal artery aneurysms ≥30 mm, and for pancreaticoduodenal artery aneurysms ≥15 mm. .

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of visceral artery aneurysms are prepared by our editorial team based on guidelines from the European Society for Vascular Surgery (ESVS 2025).
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Diagnostic investigations

Diagnostic imaging: as per ESVS 2025 guidelines, obtain CTA for diagnosis, anatomical characterization, and procedure planning in patients with suspected visceral artery aneurysm.
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Therapeutic procedures

Indications for repair: as per ESVS 2025 guidelines, perform urgent repair in patients with a symptomatic visceral artery aneurysm, regardless of size and location.
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  • Choice of repair

Specific circumstances

Pregnant patients
As per ESVS 2025 guidelines:
Consider performing endovascular or open surgical treatment in female patients of childbearing age
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and in pregnant patients with an asymptomatic splenic artery aneurysm, regardless of aneurysm size.
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Consider performing endovascular or open treatment in pregnant patients with a renal artery aneurysm, regardless of aneurysm size.
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  • Patients with mycotic aneurysms

  • Patients with visceral artery dissection (conservative management)

  • Patients with visceral artery dissection (indications for repair)

  • Patients with visceral artery dissection (imaging surveillance)

Follow-up and surveillance

Surveillance imaging: as per ESVS 2025 guidelines, consider obtaining annual surveillance for the first 3 years and individualized thereafter, preferably with duplex ultrasound and otherwise CTA, in patients with an asymptomatic visceral artery aneurysm with a diameter < 30 mm and for pancreaticoduodenal artery aneurysms with a diameter < 15 mm.
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