The treatment of challenging visceral and peripheral arterial aneurysms with flow diversion – a German multicentric observational study

Stefan Schob^1*Joerg Ukkat^2*Gregor Scharf³Yvonne Maybaum⁴Lea Tauber⁴Clara Lüdeke⁴Endres John²Karl Julius Büchner⁵Robert Fiedler⁶Christian Frahm⁷Mathias Wieprecht⁸Silvio Brandt⁹Mohamed Alsabbagh⁹Ararat Minasyan⁹Andreas Simgen¹⁰Richard Brill⁴Jakob Albrecht¹¹Walter Alexander Wohlgemuth⁴Maximilian De Bucourt¹¹Marie-Sophie Schüngel⁴

• ¹University Clinic and Polyclinic for Radiology, University Hospital in Halle, Halle, Germany
• ²Universitäts- und Poliklinik für Viszerale, Gefäß- und Endokrine Chirurgie, Universitätsmedizin Halle / Saale, Halle/Saale, Germany
• ³Universitätsklinikum Regensburg, Interdisziplinäres Zentrum für pädiatrisch-interventionelle Radiologie, Regensburg, Regensburg, Germany
• ⁴Universitäts- und Poliklinik für Radiologie Universitätsmedizin Halle / Saale, Halle (Saale), Germany
• ⁵Evangelisches Krankenhaus Konigin Elisabeth Herzberge gGmbH, Berlin, Germany
• ⁶Klinikum Wernigerode, Wernigerode, Germany
• ⁷Radiologisches Institut, Alexianer St. Josephs Krankenhaus Potsdam, Potsdam, Potsdam, Germany
• ⁸Institut für Radiologie, Asklepios Klinikum Weißenfels, Weißenfels, Weißenfels, Germany
• ⁹Institut für Radiologie und Neuroradiologie, Klinikum Chemnitz, Chemnitz, Chemnitz, Germany
• ¹⁰Klinik für Neuroradiologie, Westpfalz Klinikum Kaiserslautern, Kaiserslautern, Kaiserslautern, Germany
• ¹¹Charite - Universitatsmedizin Berlin, Berlin, Germany

Purpose: Endovascular treatment has become the preferred modality for managing visceral and peripheral aneurysms. Various techniques are applied, including deconstructive approaches such as parent vessel occlusion with coils or liquid embolic agents and reconstructive methods like stent-grafting, stent-assisted, or balloon-assisted coiling. Reconstruction is generally favored to avoid ischemia in dependent territories; however, conventional reconstructive options may fail in tortuous arteries or at bifurcations. Flow diversion using densely braided stents is well established for cerebral aneurysms, allowing safe treatment of complex or bifurcation lesions without compromising non-collateralized side branches under adequate platelet inhibition. Only few reports describe its use in visceral or peripheral aneurysms. This multicenter study summarizes the experience of several vascular centers using flow diversion in the peripheral vasculature. Materials and Methods: This retrospective multicenter analysis included data from 10 vascular centers with treatments performed between 2022 and 2025. Safety, feasibility, procedural aspects, antiplatelet management, follow-up results, and complications were analyzed retrospectively. Results: Thirty-six patients (22 female; mean age 59.2 years, range 36–80) with 37 aneurysms were treated in the following arteries: splenic (n = 18), hepatic (n = 8), renal (n = 7), superior mesenteric (n = 1), gastroduodenal (n = 1), external iliac (n = 1), and inferior genicular (n = 1). All procedures were technically successful. Immediate angiographic occlusion was achieved in 4 aneurysms (11%), while 33 (89%) showed reduced perfusion. At 3-month follow-up, 17 aneurysms (46%) were completely occluded and 14 (38%) showed reduced perfusion; six were not yet followed up. After 12 months, 27 aneurysms (73%) were occluded, including 17 already occluded at 3 months; one showed a small neck remnant. Two thromboembolic complications (5%) occurred, both related to inadequate platelet inhibition—one due to clopidogrel resistance and one after temporary interruption of antiplatelet therapy. Both patients recovered fully. Antiplatelet regimens varied between centers. Conclusion: Flow diversion for visceral and peripheral aneurysms is safe and effective, with high occlusion rates and low complication rates. All adverse events were associated with insufficient platelet inhibition, emphasizing the importance of platelet function testing and individualized antiplatelet therapy.