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Fatal rupture of giant splenic artery pseudoaneurysm. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Hamid HKS, Suliman AEA, Piffaretti G, Spiliopoulos S, Tetreau R, Tozzi M, Pulli R. A systematic review on clinical features and management of true giant splenic artery aneurysms. J Vasc Surg 2020; 71:1036-1045.e1. [PMID: 31727456 DOI: 10.1016/j.jvs.2019.09.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/16/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND True giant splenic artery aneurysms (GSAAs) >5 cm are rare and present unique therapeutic challenges. The aim of this study was to evaluate the anatomic and clinical characteristics of these lesions and the current surgical and endovascular techniques available for their treatment. METHODS A systematic review of the literature from 2004 to 2018 and the personal experience of the authors with management of GSAAs are presented. A total of 92 GSAA cases were reviewed. Analyses were performed on anatomic and clinical features and management modalities and outcomes of GSAA, including reintervention, morbidity, and mortality. RESULTS GSAA presented at a mean age of 56.1 ± 17.3 years, with no sex predilection; 73% were symptomatic at presentation. Abdominal pain was the presenting symptom in >50% of cases; 34% percent were ruptured, with an overall mortality rate of 12.5%. This group often presented with gastrointestinal bleeding or hemodynamic collapse. The aneurysms were almost evenly distributed across the splenic artery and were not uncommonly associated with arteriovenous fistula formation (8.7%). There were 88 patients who had surgical (53.4%), endovascular (44.3%), or combination (2.3%) therapy. The most commonly performed procedure was aneurysmectomy and splenectomy with or without additional resection. Overall, surgical treatment had a lower morbidity (P = .041) than endovascular therapy and comparable reintervention and mortality rates. CONCLUSIONS GSAAs are uncommon vascular lesions, with distinct clinical features and aneurysm characteristics. Considering their high risk of rupture, timely diagnosis and management are essential to attain a satisfactory outcome. Surgery remains the standard treatment of these lesions. Endovascular intervention is a viable alternative in high-risk patients, particularly those with lesions <10 cm or with anomalous origin.
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Affiliation(s)
- Hytham K S Hamid
- Vascular Surgery Division, Department of Surgery, Soba University Hospital, Khartoum, Sudan.
| | - Abd Elaziz A Suliman
- Vascular Surgery Division, Department of Surgery, Soba University Hospital, Khartoum, Sudan
| | - Gabriele Piffaretti
- Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Stavros Spiliopoulos
- Department of Diagnostic and Interventional Radiology, Patras University Hospital, Rion, Greece
| | - Raphael Tetreau
- Centre d'Imagerie Médicale, Institut du Cancer, Montpellier, France
| | - Matteo Tozzi
- Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Raffaelle Pulli
- Vascular and Endovascular Surgery Unit, University of Bari, Bari, Italy
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Niu H, Junfeng S, Jianli A, Zibo Z, Yanchao D. Dual-interventional therapy for multiple splenic artery aneurysms in a patient with portal hypertension: A case report. Medicine (Baltimore) 2019; 98:e15205. [PMID: 31083153 PMCID: PMC6531276 DOI: 10.1097/md.0000000000015205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
RATIONALE Portal hypertension (PHT) is either a significant risk factor of development of splenic artery aneurysm (SAA), or predisposing factor of rupture. PATIENT CONCERNS A 57-year-old patient was admitted to our hospital because of multiple SAAs with PHT, suffered from episodes of haematemesis. DIAGNOSIS Emergency ultrasound of the abdomen showed remarkable cirrhosis and splenomegaly. Two days later, CT angiography reveal two SAA located in the splenic artery, as well as splenomegaly and features of PHT. INTERVENTIONS Transjugular intrahepatic portosystemic shunt (TIPS) was performed to decrease portal venous pressure and control esophagogastric variceal hemorrhage. Coil embolization of the main splenic artery was performed to complete thrombosis of the two SAAs and relieve critical hypersplenism. OUTCOMES After 3 months, follow-up enhanced CT confirmed complete thrombosis of the main splenic artery and the two aneurysm sac, and partial splenic infarction (approximately 50%). LESSENS TIPS can control easophagogastric variceal hemorrhage and decrease portal venous pressure, coil embolization of the main splenic artery can promote permanent thrombosis of aneurysm sac and relieve hypersplenism.
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Santos FS, Sousa KMDS, de Castro TAC, Coelho F, de Oliveira RG, de Araujo WJB, Dos Santos LCP, de Souza RCA. Endovascular treatment of pseudoaneurysms secondary to chronic pancreatitis: reports of two cases. J Vasc Bras 2018; 17:71-75. [PMID: 29930685 PMCID: PMC5990257 DOI: 10.1590/1677-5449.012517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pseudoaneurysm secondary to chronic pancreatitis is a rare complication, but one with a high mortality rate. It is etiologically associated with chronic pancreatitis, and most diagnoses are made after rupture, which manifests with clinical signs of acute hemorrhage. Computed tomography plays an important role in diagnosis, but digital subtraction angiography remains the gold-standard method for diagnostic confirmation and for treatment planning. This article describes two cases of pseudoaneurysm in patients with chronic alcoholic pancreatitis; one involving the splenic artery and the other the gastroduodenal artery, complicated by thoracic and abdominal bleeding respectively. Both were successfully treated, using minimally invasive endovascular methods to implant coils and stent-grafts.
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Affiliation(s)
- Fabiana Seifert Santos
- Pontifícia Universidade Católica do Paraná - PUCPR, Curso de Medicina, Londrina, PR, Brasil
| | | | | | - Felipe Coelho
- Universidade de Brasília - UnB, Programa de Pós-graduação em Ciências Médicas, Brasília, DF, Brasil.,Pontifícia Universidade Católica do Paraná - PUCPR, Londrina, PR, Brasil
| | | | - Walter Jr Boim de Araujo
- Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Serviço de Angiorradiologia e Cirurgia Endovascular, Curitiba, PR, Brasil
| | | | - Raquel Canzi Almada de Souza
- Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Serviço de Endoscopia Digestiva, Departamento de Medicina Interna, Curitiba, PR, Brasil
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Yagmur Y, Akbulut S, Gumus S, Demircan F. Giant Splenic Artery Pseudoaneurysm: A Case Report and Literature Review. Int Surg 2015; 100:1244-8. [PMID: 26595501 DOI: 10.9738/intsurg-d-15-00043.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Splenic artery aneurysms (SAAs) are the third most frequent intra-abdominal aneurysm, following abdominal aorta and iliac artery aneurysms. SAAs are classified according to their involvement of arterial wall layers: true aneurysms involve all 3 layers (intima, media, and adventitia), and pseudoaneurysms involve only one or two. Herein we present a new case of giant pseudo SAA. A 65-year-old female patient with a pancreatic mass and iron deficiency was referred to our clinic for further investigation. Abdominal ultrasonography, contrast-enhanced CT and magnetic resonance imaging showed a lesion resembling a subcapsular hemangioma in the spleen, and aneurysmatic dilation of the splenic artery with a diameter of >5 cm. The large size of the aneurysm and the clinical findings were indications for surgical treatment. The patient underwent en bloc resection of the spleen, distal pancreas, and aneurysmatic segment of the splenic artery. The patient remains complication-free 2 months after the operation. Spontaneous rupture is the most important life-threatening complications of giant SAAs. Therefore, all symptomatic patients with SAA should be treated, as well as asymptomatic patients with lesions ≥2 cm, who are pregnant or fertile, have portal hypertension, or are candidates for liver transplantation. Despite advances in endovascular techniques, conventional abdominal surgery remains the gold standard for treatment.
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Affiliation(s)
- Yusuf Yagmur
- 1 Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
| | - Sami Akbulut
- 2 Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Serdar Gumus
- 1 Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
| | - Firat Demircan
- 1 Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
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Abstract
To provide an overview of the medical literature on giant splenic artery aneurysm (SAA).The PubMed, Medline, Google Scholar, and Google databases were searched using keywords to identify articles related to SAA. Keywords used were splenic artery aneurysm, giant splenic artery aneuryms, huge splenic artery aneurysm, splenic artery aneurysm rupture, and visceral artery aneurysm. SAAs with a diameter ≥5 cm are considered as giant and included in this study. The language of the publication was not a limitation criterion, and publications dated before January 15, 2015 were considered.The literature review included 69 papers (62 fulltext, 6 abstract, 1 nonavailable) on giant SAA. A sum of 78 patients (50 males, 28 females) involved in the study with an age range of 27-87 years (mean ± SD: 55.8 ± 14.0 years). Age range for male was 30-87 (mean ± SD: 57.5 ± 12.0 years) and for female was 27-84 (mean ± SD: 52.7 ± 16.6 years). Most frequent predisposing factors were acute or chronic pancreatitis, atherosclerosis, hypertension, and cirrhosis. Aneurysm dimensions were obtained for 77 patients with a range of 50-300 mm (mean ± SD: 97.1 ± 46.0 mm). Aneurysm dimension range for females was 50-210 mm (mean ± SD: 97.5 ± 40.2 mm) and for males was 50-300 mm (mean ± SD: 96.9 ± 48.9 mm). Intraperitoneal/retroperitoneal rupture was present in 15, among which with a lesion dimension range of 50-180 mm (mean ± SD; 100 ± 49.3 mm) which was range of 50-300 mm (mean ± SD: 96.3 ± 45.2 mm) in cases without rupture. Mortality for rupture patients was 33.3%. Other frequent complications were gastrosplenic fistula (n = 3), colosplenic fistula (n = 1), pancreatic fistula (n = 1), splenic arteriovenous fistula (n = 3), and portosplenic fistula (n = 1). Eight of the patients died in early postoperative period while 67 survived. Survival status of the remaining 3 patients is unclear. Range of follow-up period for the surviving patients varies from 3 weeks to 42 months.Either rupture or fistulization into hollow organs risk increase in compliance with aneurysm diameter. Mortality is significantly high in rupture cases. Patients with an evident risk should undergo either surgical or interventional radiological treatment without delay.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
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Darki A, Goswami NJ, Mishkel GJ. Endovascular management of splenic artery aneurysms: case series using telescoping guide and cage/coil technique. Catheter Cardiovasc Interv 2014; 84:E65-70. [PMID: 24155131 DOI: 10.1002/ccd.25268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 10/17/2013] [Accepted: 10/17/2013] [Indexed: 11/07/2022]
Abstract
Splenic artery aneurysms are rare, but still the third most common abdominal aneurysm. Rupture is associated with significant morbidity and mortality. Traditionally, cardiologists have rarely been involved in the management of this entity. We present a series of four patients managed percutaneously by interventional cardiology using a combined telescoping guide and cage/coil technique.
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Affiliation(s)
- Amir Darki
- Division of Cardiology, Loyola University Medical Center, Maywood, Illinois
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Marmagkiolis K, Gobal F, Mego D, Cilingiroglu M, Rollefson W. Endovascular management of splenic arterial aneurysms. Int J Cardiol 2014; 174:146-9. [PMID: 24726351 DOI: 10.1016/j.ijcard.2014.03.158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 03/22/2014] [Indexed: 11/15/2022]
Affiliation(s)
| | - Freij Gobal
- Arkansas Heart Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - David Mego
- Arkansas Heart Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Mehmet Cilingiroglu
- Arkansas Heart Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - William Rollefson
- Arkansas Heart Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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Transcatheter embolization for giant splenic artery aneurisms: still an open question. Case Rep Radiol 2012; 2012:652469. [PMID: 22900219 PMCID: PMC3414005 DOI: 10.1155/2012/652469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 06/24/2012] [Indexed: 01/17/2023] Open
Abstract
Transcatheter embolization is the mainstay of the therapy of splenic artery aneurysms (SAAs) in
patients with portal hypertension. It is indicated when the SAA diameter reaches 20 mm. Although endovascular techniques are effective and safe for the treatment of medium-sized SAAs, little is known about their applicability to large-sized SAAs. Herein, we report a case of giant SAA, which was treated with transcatheter coil embolization. The case was not considered suitable for surgery because of the presence of severe portal hypertension. The procedure was complicated by bacterial infection of the coils within the aneurismatic sac, leading to the development of hepatic failure. A liver transplant was then successfully performed despite the presence of a nonresponsive infection.
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Endovascular embolization of a third jejunal artery aneurysm: Isolation technique using the amplatzer vascular plug 4. Catheter Cardiovasc Interv 2012; 81:1049-52. [DOI: 10.1002/ccd.24415] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Accepted: 03/09/2012] [Indexed: 11/07/2022]
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