Natural History Of Incidentally Noted Celiac Artery Aneurysms
Charlotte Austen Hartwell, MD, William Johnson, MD, Chukwuma Nwachukwu, MD, Karan Garg, MD, Mikel Sadek, MD, Thomas S. Maldonado, MD, Glenn R. Jacobowitz, MD, Danny Kim, MD, Caron Rockman, MD.
New York University Langone Medical Center, New York, NY, USA.
OBJECTIVES: Aneurysms of the celiac artery (CAA) are unusual. Existing literature is skewed towards those that underwent operative or endovascular intervention. The goal of this study was to study the natural history of untreated CAA.
METHODS: This is a single institution retrospective analysis of patients with CAA diagnosed by CT imaging during years 2015-2019. Patients were identified by searching our institutional radiology database. Radiologic, demographic and follow up clinical and imaging data was obtained via the EMR.
RESULTS: The analyzed cohort consists of 76 patients; 86.8% were male. Mean age was 69.8 years (range, 29-93). Medical comorbidities included hypertension (64.5%), diabetes (9.2%), coronary disease (18.4%), and hypercholesterolemia (46.1%). Concomitant vascular disease was noted: AAA (13.2%), additional visceral aneurysm (10.5%), and visceral artery anomaly (11.8%). Mean CAA diameter on the index study was 15.4 mm (range, 7-30 mm). The majority (97.3%) were felt to be true aneurysms. Additional characteristics included thrombus (9.2%), calcification (26.3%), and dissection (11.8%). 45 (59.2%) patients had follow up imaging available for analysis. Mean clinical follow up time was 31.2 months. Follow up time including only those with subsequent imaging was 25.2 months. Over this period, 16 (21.1%) enlarged in size, while 29 (79.9%) remained stable. No patient developed symptoms or rupture. One patient (1.3%) underwent intervention for increasing size in the setting of chronic dissection. On univariate analysis, the only factor which was significantly associated with increased risk of growth was younger age (mean age at diagnosis: 63.4 years vs. 74.3 years, p = .005). We could not identify any other factor which was significantly predictive of or protective against aneurysm growth. For patients with follow up imaging, freedom from aneurysm growth or intervention was 63% at 37 months. For the entire cohort, freedom from aneurysm rupture or need for intervention was 90% at 59 months. CONCLUSIONS: This large study of patients with untreated CAA reveals that very few lesions either enlarged to a clinically meaningful degree, became symptomatic, or required intervention over a 31.2 month follow up period. Guidelines that suggest repair of CAA ≥2 cm in diameter may be overly aggressive. Close follow up with serial imaging, particularly in patients who are younger at the time of diagnosis, may be preferred in most patients with incidentally noted true CAA.
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