Endovascular treatment of true visceral artery aneurysms: a decade of experience and key outcomes from a high-volume single center

Background: Endovascular approach has emerged as the first-choice treatment of visceral artery aneurysms (VAAs). However, most published series include heterogeneous populations combining true aneurysms and pseudoaneurysms. Our single-center retrospective study aimed to evaluate a large and homogenous series of true VAAs treated endovascularly. Demographic, clinical and procedural details of patients with VAAs treated at our Interventional Radiology unit from January 2014 to January 2025 were collected in a dedicated database. Intraprocedural and perioperative outcomes included technical success, complications, mortality and need for reintervention. At long-term follow-up, overall survival, aneurysm-related complications, freedom from reintervention, and aneurysmal sac reperfusion were evaluated. Results: Ninety-four consecutive patients (41 men; median age: 67.3 years; range 29–98 years) with 97 VAAs were included in the study. VAAs had a median diameter of 2.93 cm (range 6–9.2 cm). Treatment strategies included sac packing in 45 VAAs, sandwich technique in 35, covered stent placement in 13, afferent artery occlusion in 5 and stent-assisted coiling in 4 cases. Technical success rate was 100% with no perioperative deaths. Perioperative major complication and reintervention rates were 5.2% and 2.1%, respectively. At a mean follow-up of 44.7 ± 28.9 months, overall survival, freedom from aneurysm-related complications, and freedom from reintervention were 89.4%, 92.8%, and 93.8%, respectively. Aneurysm sac reperfusion was observed in 8(8.2%) cases. No aneurysm-related deaths occurred. Conclusion: Endovascular approach is a safe and effective first-line option in patients with true VAAs, with notable results in terms of complication and freedom from reintervention rates and an excellent long-term overall survival.