Natural History of Visceral Artery Aneurysms in Patients with End Stage Liver Disease
Michael A. Antiporda, M.D, Tariq Almerey, M.D, Mahmoud Selim, M.D, Houssam Farres, M.D, Albert G. Hakaim, M.D, Justin H. Nguyen, M.D, Houssam Farres, M.D.
Mayo Clinic, Jacksonville, FL, USA.
Natural History of Visceral Artery Aneurysms in Patients with End Stage Liver Disease
Objective
The purpose of this study was to characterize the incidence and natural history of visceral artery aneurysms (VAAs) in patients with end stage liver disease (ESLD) whose extensive pre-transplantation work-up included routine magnetic resonance imaging (MRI).
Methods
We retrospectively reviewed the medical records of 72 adult patients evaluated for liver transplantation at our institution, from 2005 to 2015, who were incidentally found to have VAAs via MRI. Data collected included demographics, underlying liver disease and co-morbidities, VAA characteristics, and outcomes of interventions related to the VAA and liver transplant.
Results
VAAs were detected in 72 ESLD patients who underwent routine MRI as part of their pre-transplant work-up. 46 of these went on to undergo transplantation. 68% had splenic aneurysms, 5.6% celiac, 2.8% superior mesenteric artery (SMA), 1.4% inferior mesenteric artery (IMA), 13.9% common or proper hepatic or branch thereof, 5.6% gastroduodenal artery (GDA), and 6.9% renal artery. Only five patients required intervention for their aneurysm and this was performed via endovascular means. None of those patients suffered complications of their treatment. None of the patients suffered mortality related to their visceral aneurysm while they were followed. The percentage of male patients was 51.4%. The mean BMI was 28.6. Underlying liver disease was viral hepatitis in 38.9%, alcoholic cirrhosis in 12.5%, primary biliary cirrhosis in 9.7%, and cryptogenic cirrhosis or other in 38.9%.
Conclusion
The incidence of VAAs in ESLD patients is elevated in comparison to the general population but despite higher detection rates, there does not appear to be a heightened risk of mortality specifically related to these. Screening for VAAs should be emphasized in patients undergoing evaluation for liver transplantation but there does not seem to be a need to lower the threshold for intervention solely because of the presence of hepatic dysfunction. Further analysis is in progress to assess the apparent susceptibility to aneurysmal disease occurrence in patients with hepatic disorder in the setting of cirrhosis.
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