Discussion
Celiac artery aneurysms are rare vascular lesions with an estimated
incidence in the overall population ranging from 0.005% to 0.2% (1).
They make up about 4% of visceral artery aneurysms and less than 0.01%
of all aneurysms (2). Like all other splanchnic artery aneurysms, they
are defined as a localized dilation of the mesenteric vasculature
greater than 1.5 times the normal diameter of an artery (3). Patients
with these lesions often present with associated aneurysms.
Approximately 18% to 20% will have an aortic aneurysm, and 18% to
38% will have a second visceral artery aneurysm. 18% to 67% of
patients have aneurysms in their peripheral arteries. Our patient
doesn’t have aneurysms in the aorta or the abdominal visceral vessels.
Celiac artery aneurysms are frequently asymptomatic. Patients may
present with vague epigastric or back pain. Other areas of pain, such as
the left lower quadrant (4, 5), can also occur. Worsening abdominal pain
usually indicates either a rapidly expanding aneurysm or rupture. Food
ingestion can aggravate abdominal pain in some cases, suggesting
intestinal angina. Nausea and vomiting occur in 21% of patients (1, 6).
Occasionally, symptoms may arise as a result of compressing adjacent
structures, such as dysphagia from esophageal compression (7, 8).
A rupture is the most serious complication of celiac artery aneurysms.
Reports indicate a low risk of rupture, approximately 13%. The
mortality rate reaches 100% (1, 7). The factors that might stratify
that risk have not been identified. A study by Stone et al. showed that
comorbid conditions, aneurysm calcification, presence of thrombus,
aneurysm size, and sex did not correlate with the risk for rupture (10).
On the other hand, Vasconcelos et al. suggest that pregnancy and
increasing diameter may be considered aggravating factors. However,
there are no established predictors of rupture (1). Other documented
complications include thromboembolic complications (7).
Graham et al. did a literature review on patients with celiac artery
aneurysm. They proposed a distinction between cases that occurred before
the historical period and those that occurred after 1950 (the
contemporary period), taking into account factors such as etiology and
clinical importance. Among 60 celiac artery aneurysms encountered before
1950, representing the historic era, 40% were infectious, 7% were
traumatic, and 52% were of undetermined cause. The majority exhibited
symptoms, 87% experienced ruptures, and 95% received their diagnosis
during postmortem examinations. Since 1950, the contemporary era has
consisted of 48 cases. Congenital or developmental medial defects of the
arterial wall and atherosclerosis were the most common causes of
aneurysms (9). Saliou et al. propose that tuberculosis, syphilis,
Takayasu’s arteries, fibromuscular dysplasia, trauma, and mycotic
bacterial infection are complications of infective endocarditis,
frequently associated with a mesenteric artery aneurysm (8). We found no
evidence in the literature that benign or malignant liver lesions cause
CAAs. Most aneurysms in the contemporary period were either asymptomatic
or accompanied by vague abdominal discomfort. Reports indicated a low
risk of rupture (8, 9). The demographic analysis revealed that
historically, the male-to-female ratio was 9:1, and the mean age of
affected patients was 39.7 years. More recent reports showed no
difference in the male-to-female ratio, with an average age at
presentation of 52.3 years (1, 9).
Given that the majority of patients remain asymptomatic, the diagnosis
of celiac artery aneurysm typically occurs incidentally during imaging
procedures conducted for unrelated conditions. As CT imaging becomes
more prevalent in the emergency room, we can anticipate a rise in the
incidence of CAAs. Abdominal radiographs may show calcification on the
aneurysm’s wall, but celiac artery aneurysm diagnosis necessitates other
diagnostic modalities such as ultrasonography, CT scanning, or magnetic
resonance angiography. Angiography should be part of the preoperative
evaluation to get a better idea of the aneurysm’s shape and to find out
more about the distal vasculature and collateral circulation so that the
best treatment can be chosen (1, 5).
Stone et al. recommended elective repair in good-risk patients with
aneurysms of greater than 2 cm (10). Vecchia and Blazar recommended
surgical repair for symptomatic aneurysms larger than two cm, those
expanding more than 0.5 cm annually, and asymptomatic women of
childbearing age (5).