September 5-9 | Copenhagen, Denmark
September 5-9 | Copenhagen, Denmark
September 5-9 | Copenhagen, Denmark
September 5-9 | Copenhagen, Denmark
September 5-9 | Copenhagen, Denmark
1. The ideal situation for using a covered stent in the treatment of visceral aneurysms
2. The long-term and very long-term outcomes of covered stents
3. How flow-diversion stents achieve endovascular aneurysm exclusion as well as covered stents, and in which clinical scenarios they should be preferred or excluded.
Prof. Michele Rossi
The endovascular treatment of visceral aneurysms has evolved over the past two decades. What was once a field dominated by coil embolization and parent vessel sacrifice has progressively moved toward strategies designed to preserve arterial patency while maintaining durable aneurysm exclusion. In this context, covered stents and flow diverters have emerged as two important, but fundamentally different, tools.
Visceral artery aneurysms are uncommon, many are incidental, some are silent for years, but rupture can be sudden and life-threatening. This is why contemporary management has moved away from rigid treatment paradigms and toward a more anatomy-driven approach, in which lesion morphology, vascular territory, branch anatomy, and the need to preserve organ perfusion all contribute to decision-making.
Covered stents represent a major advance because they introduced a simple principle: immediate exclusion of the aneurysm while preserving the flow through the parent vessel. In anatomically favourable settings, this remains one of the most effective endovascular solutions. When the target artery has sufficient calibre, limited tortuosity, and adequate proximal and distal landing zones, stent grafting can provide an elegant alternative to both surgery and deconstructive embolization.
However, many visceral aneurysms are not anatomically suited for covered stent repair. They often arise at bifurcations, in tortuous segments, across calibre transitions, or in close relation to important side branches. In these settings, the limitations of covered stents become evident: immediate exclusion may be technically feasible, yet biologically suboptimal if it compromises branch patency or downstream organ perfusion. This is particularly relevant in the hepatic, mesenteric, and renal circulations, where treatment decisions must be guided not only by technical feasibility but also by the physiological consequences of reconstruction.
Flow diversion offers a different perspective of this issue. Flow diverters aim to remodel haemodynamics, reduce inflow into the sac and promote progressive thrombosis while preserving patency of the main vessel and adjacent branches. Their potential value lies in the anatomical regons where preservation is complex.
At the same time, flow diversion should not be interpreted as a replacement for covered stents or a universal treatment for visceral aneurysm. Many situations require immediate and definitive exclusion, particularly unstable bleeding and many pseudoaneurysms.
The device landscape is also expanding rapidly. Earlier multilayer concepts opened the field, but more recent devices adapted from neurovascular intervention, and now dedicated abdominal devices, are bringing greater flexibility and broader applicability to visceral practice. Early multicenter experience is encouraging, but indications remain selective and the evidence base is still evolving. This makes the topic especially timely; the question is no longer whether these devices can be used, but how they should be integrated into a rational treatment algorithm.
This lecture will define the anatomical and technical conditions that make stent grafting an effective option for visceral aneurysm treatment, as well as the situations in which its limitations become evident. The talk will examine whether flow-diverting stents truly have a role in visceral artery aneurysms and in which vascular territories or aneurysm configurations that role becomes clinically relevant.
Finally, it will review the devices currently available for visceral use and discuss the evidence supporting their use, with a critical focus on what is promising, what is established, and what remains uncertain.
Michele Rossi is a Professor of Radiology at the Faculty of Medicine and Psychology University of Rome “Sapienza,” and Head of the Interventional Radiology Unit at S. Andrea University Hospital, Rome. He trained under the leadership of Prof. Plinio Rossi in Rome and gained additional experience at Massachusetts General Hospital, Boston. His clinical and research work focuses on peripheral and endovascular therapies, including embolization of benign and malignant diseases, ischemic stroke management, chronic subdural hematomas, and interventional pain treatments such as joint embolization. He has been a strong advocate for a clinically integrated role of interventional radiology and has contributed extensively to advancing patient-centered practice. Rossi has served on multiple CIRSE committees, including the Executive Board, and obtained his European Board of Interventional Radiology (EBIR) certification in 2011.
