Visceral artery aneurysms: a literature review of etiology, natural history, diagnosis and treatment paradigms.

BACKGROUND AND OBJECTIVE: Visceral artery aneurysms (VAAs) are rare but clinically significant vascular lesions associated with high mortality following rupture, estimated at 25-75%. Increased use of modern imaging has improved incidental detection of asymptomatic aneurysms. This review summarizes the etiology, natural history, diagnosis, and evolving management strategies of VAAs, with emphasis on territory-specific endovascular and surgical approaches. METHODS: A structured literature review was conducted using PubMed/MEDLINE, EBSCO, and the Cochrane Library to identify studies published between 2010 and 2025 on the diagnosis and management of VAAs. Original studies, systematic reviews, meta-analyses, and selected case reports were reviewed and synthesized. KEY CONTENT AND FINDINGS: VAAs often remain asymptomatic until rupture, whereas pseudoaneurysms carry significantly higher rupture risk and require urgent treatment regardless of size. Diagnosis relies primarily on computed tomography angiography (CTA), magnetic resonance imaging (MRI), ultrasound (US), and catheter angiography. Management depends on aneurysm morphology, location, rupture status, symptoms, and patient-specific risk factors. Endovascular therapy has become the preferred treatment modality in most anatomically suitable cases because of its minimally invasive nature and high technical success. Common techniques include coil embolization, stent-assisted and balloon-assisted embolization, liquid embolic agents, covered stents, and flow-diverting stents. Surgical and hybrid approaches remain important in cases of rupture, complex anatomy, or failed endovascular therapy. CONCLUSIONS: Advances in imaging and interventional radiology have transformed VAA management, with endovascular approaches increasingly favored over open surgery in appropriately selected patients. Individualized, multidisciplinary management remains essential for optimizing outcomes.