Open, Hybrid and Endovascular Repair of Visceral Artery Aneurysms: State of the Art and Clinical Perspectives

Dear Colleagues,

Visceral artery aneurysms represent a rare but clinically significant challenge, often characterized by heterogeneous presentations and complex anatomical variations. Their management has evolved substantially over the past decades, moving beyond traditional open repair toward hybrid and fully endovascular strategies that have reshaped the therapeutic landscape.

Open surgical reconstruction remains a durable and reliable option, particularly in the context of rupture, infection, or unfavorable anatomy. However, its invasiveness and associated morbidity have prompted the search for less traumatic alternatives. Hybrid approaches, combining targeted surgical exposure with endovascular exclusion, have emerged as an effective bridge between durability and minimal invasiveness, especially for anatomically demanding aneurysms involving the hepatic, splenic, superior mesenteric, or renal arteries.

Endovascular treatments have gained increasing traction, offering a wide range of tools, including covered stents, coils, plugs, and flow-modifying devices. These techniques have expanded our ability to treat visceral aneurysms in high-risk patients or in anatomies traditionally considered prohibitive for open surgery. Nonetheless, important challenges remain, from the risk of end-organ ischemia to uncertainties about long-term durability, device selection, and the optimal management of branch-preserving reconstructions.

Despite these advances, several pressing issues continue to demand attention. Precise preoperative imaging and intraoperative navigation remain essential to minimize complications and ensure technical success. The potential impact of radiation exposure, contrast-induced renal injury, and the off-label use of endovascular devices highlights the need for continuous improvements in procedural safety. Moreover, as the use of complex hybrid and endovascular repairs expands, so too do the ethical and regulatory questions surrounding device modification, long-term surveillance, and outcome reporting.

The future of visceral artery aneurysm management lies in refining patient selection, optimizing technique, and generating robust evidence to guide clinical decision-making across the spectrum of open, hybrid, and endovascular interventions.

We look forward to receiving your valuable contributions.

Dr. Andrea Xodo
Dr. Francesco Squizzato
Dr. Vincenzo Vento
Guest Editors

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• visceral artery aneurysms
• endovascular treatment
• open surgical repair
• hybrid approach
• covered stents
• end-organ ischemia
• long-term durability
• patient selection