Rupture Predictors and Clinical Outcomes in Jejunal Artery Aneurysms: A Literature Case Series Review

Abstract

Introduction

Jejunal artery aneurysms (JAAs) account for 1% of all visceral artery aneurysms (VAAs). Fewer than 100 cases have been reported in the English literature, rupture rates approach 60%, compared with 10%-20% for other VAAs. Their rupture risk and management remain poorly defined.

Methods

We reviewed the English literature from 1944 to June 2025 and identified 44 cases of JAAs with analyzable data. Primary objective was to explore predictors of rupture; secondary objective was management. Given the rarity and heterogeneity of reports, statistical analyses were exploratory. To the best of our knowledge, this is the largest series of JAAs with analyzable data reported to date.

Results

Overall rupture rate was 59%, most (64.7%) measured ≤10 mm and occurred in younger individuals (mean age 41.9 versus 57.3 ys, P = 0.0199). Mortality rate was 9.1% (n = 4), including two with connective tissue disease; 26.9% of ruptured cases had no medical history. Rupture was associated with gastrointestinal hemorrhage (P = 0.0019) but not with pain (P = 0.310). Surgical management most common was: aneurysm excision (47.7%) or bowel resection (27.3%). Embolization was performed in 7 cases, with no mortality.

Conclusions

Most of ruptures occurred in small aneurysms (<10 mm) challenging the conventional 2 cm intervention threshold applied to other VAAs. These findings suggest that arterial wall pathology and unstable flow may contribute to rupture, independently of size. Management should be individualized incorporating patient-specific risk factors and underlying vascular vulnerability. This is consistent with the recent international Society for Vascular Surgery Clinical Practical Guidelines recommendations. Further studies are required to define risk stratification.