Giant aneurysms are notable because they rarely present without having ruptured. The traditional approach to a giant aneurysm has been surgical, although an endovascular approach is becoming more popluar. VDM has published a few cases of giant aneurysms presenting in various settings. Most recently, Vishesh Kumar, MD, James Balcom, MD, Neha Patel, MD, and Neeraj Saini, MD report a case of a giant abdominal aortic aneurysm in the June issue of Vascular Disease Management. The 70-year-old male patient presented 3 weeks after coronary artery bypass grafting. He was completely asymptomatic but on examination a pulsatile mass and bruit were detected. Computed tomographic angiography showed a giant juxtarenal abdominal aortic aneurysm (AAA) measuring 14 cm in diameter with no evidence of rupture. He received urgent repair of the aortic aneurysm with a 22 mm collagen-impregnated knitted Dacron graft. The patient had an uneventful recovery, but the authors point out that the risk of rupture was high, especially because he had coronary bypass graft surgery.
In 2011, Daniel Wildes, DO, Richard Kovach, MD, and Jon C. George, MD presented a case of endovascular repair of a giant popliteal artery aneurysm. An 80-year-old patient with multiple comorbidities presented with progressive pain in his left lower extremity. Selective angiography revealed a giant saccular aneurysm involving the distal segment of the left superficial femoral artery extending into the distal popliteal artery. The aneurysm was treated successfully with overlapping covered stents.
And in 2008, Muhammad Asad, MD, FRCS, and Mahalingam Sivakumar, MD, FRCS, FACS presented a case of a giant splenic artery aneurysm that was also treated endovascularly. The 57-year-old male patient also had multiple comorbidities and presented with pain in the epigastrium and left flank. The authors elected to treat the aneurysm with angioembolization because of his acute pancreatitis and other comorbidities. The aneurysm was occluded by embolization through a tracker catheter using multiple detachable metallic coils. CT scans 6 months and 1 year after discharge showed complete thromboses of the aneurysm.
These three cases were treated in three different ways, and all had successful outcomes. Have you seen a giant aneurysm in your practice? How did you approach treatment?