Celiac Artery Aneurysm
A celiac artery aneurysm is a localized enlargement of the celiac trunk, the first major branch of the abdominal aorta that supplies blood to the liver, stomach, spleen, and parts of the pancreas. Celiac artery aneurysms are uncommon but clinically important, since they can grow over time and—although less likely to rupture than aortic aneurysms—are associated with potentially serious complications. They are usually discovered incidentally on abdominal imaging. CT angiography and MR angiography are the primary tools for diagnosis and surveillance, and treatment is individualized to the size, shape, cause, and patient factors.
What is it?
The celiac trunk (also called the celiac artery or celiac axis) is the first major branch of the abdominal aorta. It arises just below the diaphragm and quickly divides into three main branches: the splenic artery (which supplies the spleen and parts of the stomach and pancreas), the common hepatic artery (which supplies the liver, gallbladder, and parts of the stomach and pancreas), and the left gastric artery (which supplies the upper stomach and lower esophagus). A celiac artery aneurysm is a localized enlargement (typically defined as a diameter at least 1.5 times the normal size of the vessel) involving the main trunk or its immediate origin. Aneurysms of the individual branches—such as the splenic or hepatic artery—are categorized separately.
Several factors contribute to the development of celiac artery aneurysms. Atherosclerosis is a common cause, particularly in older adults with widespread vascular disease. Connective tissue disorders—such as Marfan syndrome, Loeys-Dietz syndrome, and vascular Ehlers-Danlos syndrome—weaken artery walls and predispose to aneurysms throughout the arterial tree. Fibromuscular dysplasia and certain inflammatory or vasculitic conditions can also affect the celiac artery. Less common causes include infection (mycotic aneurysm), pancreatitis (which can produce pseudoaneurysms), trauma, and complications of prior surgery or radiation. Pseudoaneurysms—contained vascular injuries—differ from true aneurysms and are managed somewhat differently.
The celiac artery is often involved in median arcuate ligament compression, in which a fibrous band from the diaphragm presses on the artery; this is a separate condition but can be associated with post-stenotic dilation that may resemble a true aneurysm on imaging.
Most celiac artery aneurysms cause no symptoms and are discovered incidentally on abdominal imaging done for other reasons. When symptoms do occur, they are often vague and can include upper abdominal pain, back pain, a sensation of upper abdominal pulsation, or early fullness with meals. Large aneurysms occasionally compress nearby structures, producing additional symptoms. The most serious complication is rupture, in which the wall of the aneurysm breaks open and causes major internal bleeding. Celiac artery aneurysm rupture typically presents with sudden, severe upper abdominal or back pain and signs of shock and is a surgical emergency. Pseudoaneurysms, particularly those related to pancreatitis or trauma, carry a higher risk of rupture than typical true aneurysms.
CT angiography of the abdomen and pelvis is the primary imaging test for evaluating celiac artery aneurysms because it provides detailed three-dimensional information about size, shape, location, calcification, and the relationship to surrounding structures, including the aorta, pancreas, liver, and stomach. MR angiography is a useful alternative, particularly when avoiding radiation or iodinated contrast is preferred. Ultrasound may identify some aneurysms but is often limited by overlying bowel gas. Catheter-based angiography is typically reserved for selected patients at the time of planned intervention. Imaging may also reveal coexisting aneurysms in other vascular territories—important because patients with celiac artery aneurysms are at increased risk of having additional aneurysms elsewhere.
Important to Know
Management of a celiac artery aneurysm is individualized and depends on the size, shape, location, growth rate, suspected cause, and patient-specific factors such as age, anatomy, surgical risk, and overall health. For small, asymptomatic, stable aneurysms with low rupture risk, periodic imaging surveillance and aggressive cardiovascular risk reduction are typically recommended.
Important measures include smoking cessation, control of blood pressure, statins and other lipid-lowering therapies in patients with significant atherosclerosis, treatment of diabetes when present, healthy diet, regular physical activity, weight management, and limited alcohol. While these measures may not directly shrink an established aneurysm, they reduce overall cardiovascular risk and may slow progression.
Treatment is generally considered for celiac artery aneurysms that are larger than certain size thresholds (often around 2 centimeters, although thresholds vary based on patient factors), growing on follow-up imaging, causing symptoms, suspected to be mycotic or pseudoaneurysmal, occurring in patients with connective tissue disorders or other high-risk conditions, or that have ruptured.
Endovascular treatment is now the most common approach for elective management of many celiac artery aneurysms. Options include catheter-based coil embolization, placement of covered stents (stent grafts) across the aneurysm, and other newer endovascular techniques. The choice depends on the size, shape, and location of the aneurysm and on the anatomy of the celiac trunk and its branches—particularly whether the hepatic and splenic arterial supply can be preserved. Open surgical repair remains an important option, particularly for complex anatomy, certain aneurysm locations, or when endovascular treatment is not feasible. Ruptured celiac artery aneurysms require emergency treatment.
Care is typically coordinated by primary care clinicians, vascular surgeons, interventional radiologists, vascular medicine specialists, and other relevant providers. Imaging findings are interpreted alongside symptoms, examination, and the patient’s overall health. Comprehensive imaging often evaluates the rest of the aorta and visceral and peripheral arteries to identify additional aneurysms or vascular disease.
Patients with known celiac artery aneurysms benefit from understanding the warning signs of rupture or other complications and seeking immediate care if these develop. First-degree relatives of patients with familial aortic and visceral aneurysmal disease may benefit from screening in selected circumstances.
Red flag symptoms include sudden severe upper abdominal or back pain; lightheadedness or fainting; rapid heart rate; cool, clammy skin or signs of shock; severe vomiting with abdominal pain; or any other sudden severe abdominal symptoms. These warrant immediate emergency evaluation, as they may indicate rupture of the aneurysm.