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Salimi J, Nikraftar P, Rashidi F, Azimi M, Shokri A. Emergent method for management of splenic artery aneurysms rupture: A case report. Int J Surg Case Rep 2024; 116:109406. [PMID: 38432167 PMCID: PMC10943993 DOI: 10.1016/j.ijscr.2024.109406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Although endovascular therapy is becoming more used for the treatment of splenic artery aneurysms (SAAs) instead of open surgery, there is limited information available on the emergent hybrid approach, selectively. We present our experience of hybrid therapy using an emergent endovascular balloon for inflow control and open resection. CASE PRESENTATION A 34-year-old woman was brought to the emergency room after it was reported that she had a pseudoaneurysm in her splenic artery at a different medical facility. The patient was hemodynamically stable. Then we underwent a combination of endovascular and open procedures, using balloon proximal control and open aneurysm resection. She was discharged from hospital on the fifth postoperative day after the operation. CLINICAL DISCUSSION There is no agreement on how to treat SAA patients. Endovascular procedures such as endovascular intervention are also being used, minimizing the risks of surgery and shortening the patient's hospital stay, but complications remain. We propose to try SAA's emergency hybrid strategy operation with a good prognosis and fewer complications. CONCLUSION It seems that, compared to open surgery alone when endovascular procedures were impossible, elective hybrid procedures are more secure and efficient in stable patients and could make the operation easier without more dissection for proximal control of splenic artery.
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Affiliation(s)
- Javad Salimi
- Department of Vascular Surgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran.
| | - Parham Nikraftar
- Department of Vascular Surgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Fatemeh Rashidi
- Department of Vascular Surgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Azimi
- School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amir Shokri
- Department of General Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Wang S, Huang W, Liu J, Liu Q, Wang Z, Wang Q, Shan Q, Li W, Ding X, Wu Z, Wang Z. Selection of endovascular treatment strategies and analysis of the efficacy of different locations and types of splenic artery aneurysms. CVIR Endovasc 2024; 7:16. [PMID: 38294662 PMCID: PMC10831027 DOI: 10.1186/s42155-024-00427-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/18/2024] [Indexed: 02/01/2024] Open
Abstract
PURPOSE To analyze the selection of endovascular treatment strategies and the efficacy of various locations and types of splenic artery aneurysms (SAAs). METHODS Sixty-three cases of patients diagnosed with SAA from January 2016 to October 2021 were collected, and their clinical data and follow-up results were analyzed. RESULTS Among the 63 patients, 55 had true SAAs, and 8 had false SAAs. The average diameter of the true SAAs was 2.0 ± 0.8 cm. There were 10 cases of intra-aneurysm embolization, 24 cases of intra-aneurysm and aneurysm-bearing artery embolization, 10 cases of bare stent-assisted coil embolization, and 11 cases of stent grafts. The false SAAs had an average diameter of 2.3 ± 1.1 cm. Aneurysm-bearing artery embolization was applied in 5 cases, and stent grafts were applied in 3 cases. The incidence of complications after embolization of the aneurysm-bearing artery was higher (P < 0.01). Postembolization syndrome occurred in 10 patients; 7 patients developed splenic infarction to varying degrees, 1 patient had mildly elevated blood amylase, and 1 patient developed splenic necrosis with abscess formation, all of which improved after active treatment. The average length of hospital stay was 5.5 ± 3.2 days. The average follow-up time was 17.2 ± 16.1 months, and the aneurysm cavity of all patients was completely thrombotic. CONCLUSION Endovascular treatments of SAAs are safe and effective. For various locations and types of SAAs, adequate selection of treatment is necessary. Stent grafts are recommended for their safety, economy, practicality, and preservation of the physiological functions of the human body.
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Affiliation(s)
- Shenjie Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Wei Huang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Jingjing Liu
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Qin Liu
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Ziyin Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Qingbing Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Qungang Shan
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Wenchang Li
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Xiaoyi Ding
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Zhiyuan Wu
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China.
| | - Zhongmin Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China.
- College of Health Science and Technology, Shanghai JiaoTong University School of Medicine, Shanghai, China.
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Rinaldi LF, Brioschi C, Marone EM. Endovascular and Open Surgical Treatment of Ruptured Splenic Artery Aneurysms: A Case Report and a Systematic Literature Review. J Clin Med 2023; 12:6085. [PMID: 37763025 PMCID: PMC10531855 DOI: 10.3390/jcm12186085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Ruptured splenic artery aneurysms (r-SAA), although rare, are burdened by high morbidity and mortality, even despite emergent surgical repair. It is suggested that endovascular treatment can achieve reduction in peri-operative death and complication rates, as in other vascular diseases, but evidence of such benefits is still lacking in this particular setting. We report a case of an r-SAA treated by trans-arterial embolization and then converted to open surgery for persistent bleeding, and we provide a systematic review of current results of open and endovascular repair of r-SAAs. MATERIALS AND METHODS A 50-year-old male presenting in shock for a giant r-SAA underwent emergent coil embolization and recovered hemodynamic stability. On the following day, he underwent laparotomy for evacuation of the huge intraperitoneal hematoma, but residual bleeding was noted from the splenic artery, which was ligated after coil removal, and a splenectomy was performed. A systematic literature review of the reported mortality and complications of r-SAA undergoing open (OSR) or endovascular (EVT) treatment was performed using the main search databases. All primary examples of research published since 1990 were included regardless of sample size. The main outcome measures were mortality and reinterventions. Secondary outcomes were post-operative complications. RESULTS We selected 129 studies reporting on 350 patients-185 treated with OSR and 165 with EVT. Hemodynamically unstable patients and ruptures during pregnancy were more frequently treated with open repair. Overall, there were 37 deaths (mortality: 10.6%)-24 in the OSR group and 13 in the EVTr group (mortality: 12.9% and 7.8% respectively, p-value: 0.84). There were 37 reinterventions after failed or complicated endovascular repair -6 treated with endovascular re-embolization and 31 with laparotomy and splenectomy (22.4%); there were 3 (1.6%) reinterventions after open repair. Overall complication rates were 7.3% in the EVT group (n: 12) and 4.2% in the OSR group (n: 7), and did not require reintervention. No significant differences in overall complications or in any specific complication rate were observed between the two groups. CONCLUSIONS Current results of r-SAA treatment show equipoise terms of morbidity and mortality between open and endovascular repair; however, in case of hemodynamic instability and rupture during pregnancy, open surgery might still be safer. Moreover, endovascular repair is still burdened by a significantly higher rate of reinterventions, mostly with conversions to open surgery.
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Affiliation(s)
- Luigi Federico Rinaldi
- Vascular Surgery, Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, 16132 Genoa, Italy
- Vascular Surgery, Ospedale Policlinico di Monza, 20900 Monza, Italy; (C.B.); (E.M.M.)
| | - Chiara Brioschi
- Vascular Surgery, Ospedale Policlinico di Monza, 20900 Monza, Italy; (C.B.); (E.M.M.)
| | - Enrico Maria Marone
- Vascular Surgery, Ospedale Policlinico di Monza, 20900 Monza, Italy; (C.B.); (E.M.M.)
- Vascular Surgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
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Khoury MK, Carney MH, Tsai S, Modrall JG, Eagleton MJ, Ramanan B. Women of Childbearing Age Have Higher Mortality Rates Following Inpatient Interventions for Splenic Artery Aneurysms. Ann Vasc Surg 2023; 94:172-177. [PMID: 37023919 DOI: 10.1016/j.avsg.2023.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/28/2023] [Accepted: 03/24/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Splenic artery aneurysms (SAAs) are the most common type of splanchnic aneurysms. Current guidelines recommend repair of SAAs in women of childbearing age because maternal mortality is high. The purpose of this study was to evaluate treatment modalities and outcomes following inpatient SAA repair in women. METHODS The National Inpatient Sample database from 2012 to 2018 was queried. Patients with SAAs were identified using International Classification of Diseases (ICD) 9 and 10 codes. Childbearing age was defined as 14-49 years. The primary outcome was in-hospital mortality. RESULTS A total of 561 patients were admitted with a diagnosis of SAA between the years of 2012 and 2018. There were 267 (47.6%) female patients and of these 103 (38.6%) were of childbearing age. The overall in-hospital mortality rate was 2.7% (n = 15). There were no differences in rates of elective admissions or type of repair (open versus endovascular) between women of childbearing age and the remainder of the cohort. However, women of childbearing age were significantly more likely to undergo a splenectomy compared to the remainder of the cohort (32.0% vs. 21.4%, P = 0.028). Women of childbearing age had higher rates of in-hospital mortality compared to the remainder of the cohort (5.8% vs. 2.0%, P = 0.040). Subset analysis of the women of childbearing age revealed that those undergoing a splenectomy versus no splenectomy (14.8% vs. 2.6%, P = 0.039) and those treated in the nonelective versus elective setting (10.5% vs. 0%, P = 0.032) had higher rates of in-hospital mortality. There was 1 patient with an ICD code associated with pregnancy and they survived. CONCLUSIONS Women of childbearing age had higher in-hospital mortality following inpatient interventions for SAAs with all of the deaths occurring in the nonelective setting. These data support the pursuit of aggressive elective treatment of SAAs in women of childbearing age.
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Affiliation(s)
- Mitri K Khoury
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
| | | | - Shirling Tsai
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX; Surgical Service, Dallas Veterans Affairs Medical Center, Dallas, TX
| | - J Gregory Modrall
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX; Surgical Service, Dallas Veterans Affairs Medical Center, Dallas, TX
| | - Matthew J Eagleton
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Bala Ramanan
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX; Surgical Service, Dallas Veterans Affairs Medical Center, Dallas, TX.
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Lamparski K, Procyk G, Bartnik K, Korzeniowski K, Maciąg R, Matsibora V, Sajdek M, Dryjańska A, Wnuk E, Rosiak G, Maj E, Januszewicz M, Gąsecka A, Ostrowski T, Kaszczewski P, Gałązka Z, Wojtaszek M. Can Color Doppler Ultrasound Be Effectively Used as the Follow-Up Modality in Patients Undergoing Splenic Artery Aneurysm Embolization? A Correlational Study between Doppler Ultrasound, Magnetic Resonance Angiography and Digital Subtraction Angiography. J Clin Med 2023; 12:jcm12030792. [PMID: 36769441 PMCID: PMC9917602 DOI: 10.3390/jcm12030792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Splenic artery aneurysm (SAAs) rupture is associated with a high mortality rate. Regular surveillance with imaging before and after intervention is crucial to guide best evidence treatment. The following study aimed to determine the efficacy of color Doppler ultrasound imaging (DUS) compared to digital subtraction angiography (DSA) and magnetic resonance angiography (MRA) as a follow-up modality after selective coil embolization of true SAAs. We analyzed data from 20 patients, 15 females (48.1 ± 16.1 years) undergoing selective SAA coil embolization using detachable fibered embolization coils. Imaging using DUS, MRA, and DSA was performed 3 months after the initial embolization or the consequent re-embolization procedure. Primary clinical success, defined as Class I aneurysm occlusion, on 3-month follow-up was seen in 16 (80.0%) patients. DUS had a sensitivity of 94.4% and a specificity of 42.9% when compared to DSA and 92.3% and 30%, respectively, when compared to MRA in identifying Class I aneurysm occlusion. The positive predictive value (PPV) of DUS in identifying the need for re-embolization was 75.0%, while the NPV of DUS in these terms was 90.5%. DUS showed a high sensitivity in detecting aneurysm occlusion and clinical success, simultaneously exhibiting poor specificity. Still, with caution, this follow-up modality could be used for monitoring select low-risk patients after selective embolization of SAAs. DUS could provide a higher cost-to-benefit ratio, enabling more systematic post-procedural follow-up, as it is far more commonly used compared to MRA and non-invasive compared to DSA.
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Affiliation(s)
- Krzysztof Lamparski
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
- Correspondence: ; Tel.: +48-606-607-512
| | - Grzegorz Procyk
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Krzysztof Bartnik
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Krzysztof Korzeniowski
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Rafał Maciąg
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Vadym Matsibora
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Michał Sajdek
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Alicja Dryjańska
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Emilia Wnuk
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Grzegorz Rosiak
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Edyta Maj
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Magdalena Januszewicz
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Tomasz Ostrowski
- Department of General, Endocrine and Vascular Surgery, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Piotr Kaszczewski
- Department of General, Endocrine and Vascular Surgery, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Zbigniew Gałązka
- Department of General, Endocrine and Vascular Surgery, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Mikołaj Wojtaszek
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
- Everlight Radiology, 350 Euston Rd, London NW1 3AX, UK
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Riaz A, Entezari P, Malik A, Badar W, Scheller S, Gabr A, Thornburg B, Seedial S, Boike J, Resnick S, Sato K, Ladner D, Moore C, Ganger D, Donaldson J, Kulik L, Lewandowski RJ, Funaki BS, Ahmed O, Caicedo JC, Salem R. Impact of Portal Hypertension on Adverse Events after Splenic Arterial Aneurysm Embolization. J Vasc Interv Radiol 2022; 33:1519-1526.e1. [PMID: 35985557 DOI: 10.1016/j.jvir.2022.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate the outcomes of splenic artery aneurysm (SAA) embolization and compare adverse event (AE) rates after embolization in patients with and without portal hypertension (PHTN). MATERIALS AND METHODS A retrospective review of all patients who underwent embolization of SAAs at 2 institutions was performed (34 patients from institution 1 and 7 patients from institution 2). Baseline demographic characteristics, preprocedural imaging, procedural techniques, and postprocedural outcomes were evaluated. Thirty-day postprocedural severe and life-threatening AEs were evaluated using the Society of Interventional Radiology guidelines. Thirty-day mortality and readmission rates were also evaluated. t test, χ2 test, and/or Fisher exact test were used for the statistical analysis. RESULTS There was no statistically significant difference between patients with and without PHTN in the location, number, and size of SAA(s). All procedures were technically successful. There were 13 (32%) patients with and 28 (68%) patients without PHTN. The 30-day mortality rate (31% vs 0%; P = .007), readmission rates (61% vs 7%; P < .001), and severe/life-threatening AE rates (69% vs 0%; P < .001) were significantly higher in patients with PHTN than in those without PHTN. CONCLUSIONS There was a significantly higher mortality and severe/life-threatening AE rate in patients with PHTN than in those without PHTN. SAAs in patients with PHTN need to be managed very cautiously, given the risk of severe/life-threatening AEs after embolization.
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Affiliation(s)
- Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois.
| | - Pouya Entezari
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Asad Malik
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Wali Badar
- Department of Radiology, Section of Interventional Radiology, University of Chicago, Chicago, Illinois
| | - Stephen Scheller
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Ahmed Gabr
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Bartley Thornburg
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Stephen Seedial
- Department of Radiology, St Joseph Mercy Oakland Hospital, Pontiac, Michigan
| | - Justin Boike
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, Illinois
| | - Scott Resnick
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Kent Sato
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Daniela Ladner
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, Illinois
| | - Christopher Moore
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, Illinois
| | - Daniel Ganger
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, Illinois
| | - James Donaldson
- Department of Radiology, Section of Interventional Radiology, Lurie Children's Hospital, Chicago, Illinois
| | - Laura Kulik
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, Illinois
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Brian S Funaki
- Department of Radiology, Section of Interventional Radiology, University of Chicago, Chicago, Illinois
| | - Osman Ahmed
- Department of Radiology, Section of Interventional Radiology, University of Chicago, Chicago, Illinois
| | - Juan Carlos Caicedo
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, Illinois
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
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Xu Y, Wu Z. A case of a pregnant woman with a special splenic artery aneurysm. Malawi Med J 2022; 34:220-222. [PMID: 36406093 PMCID: PMC9641609 DOI: 10.4314/mmj.v34i3.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Visceral artery aneurysm, especially splenic artery aneurysm, is rare and is usually associated with pregnancy. When such aneurysms rupture, they can be fatal, and they often require emergency surgery. This case report includes a review of the literature and describes a effective multidisciplinary approach to managing this type of aneurysm. We describe the treatment of a ruptured splenic artery aneurysm and the careful coordination of obstetric, vascular surgery, and intensive care teams. The uniqueness of this case arose from the metal embolization coil that was found to have fallen off from a recently embolized ruptured splenic artery aneurysm. The management of this ruptured splenic artery aneurysm and iatrogenic foreign body insult required a combination of multiple specialties to provide life-saving treatment. Such cases should be managed by multidisciplinary teams if institutional resources allow for it.
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Affiliation(s)
- Yujia Xu
- Department of vascular surgery, West China Hospital, Sichuan University, Sichuan Province, China
| | - Zhoupeng Wu
- Department of vascular surgery, West China Hospital, Sichuan University, Sichuan Province, China
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8
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DeLallo JF, Carsten CG. A Rare Presentation of Multiple Visceral Artery Aneurysms. Am Surg 2022; 88:1349-1350. [DOI: 10.1177/0003134820945256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Yuan F, He L, Yao Z, Long Y, Xu S. Spontaneous rupturing of splenic artery aneurysm: Another reason for fatal syncope and shock (Case report and literature review). Open Med (Wars) 2022; 17:601-605. [PMID: 35434375 PMCID: PMC8951212 DOI: 10.1515/med-2022-0445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 02/03/2022] [Accepted: 02/12/2022] [Indexed: 11/30/2022] Open
Abstract
Splenic artery aneurysm (SAA) is a rare condition; however, it is one of the most common intra-abdominal aneurysm. In the emergency department (ED), due to an uncommon cause of shock and syncope in SAA, it poses great diagnostic challenge for emergency physicians. Here we reported a case of spontaneous rupturing of SAA. A 47-year-old man presented to the ED for syncope and shock. As he had unstable hemodynamic, we gave him fluid resuscitation and point-of-care ultrasound (POCUS), free intraperitoneal fluid was identified on ultrasound, then hemorrhagic ascites was identified by a diagnostic abdominal paracentesis. The rare but life-threatening diagnosis of spontaneous rupturing of SAA was confirmed by contrast-enhanced Computed Tomography and surgery. Spontaneous SAA rupturing is a rare fatal condition which needs immediate diagnosis and management to achieve a favorable outcome. Though there are no risk factors, emergency physicians should consider SAA in the differential diagnosis of sudden collapse. Also, as an emergency physician, it is very important to be a master of first aid skills such as POCUS and treat patients according to the process.
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Affiliation(s)
- Feng Yuan
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China , Hengyang , Hunan , China
| | - Liudang He
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China , Hengyang , Hunan , China
| | - Zhengbin Yao
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China , Hengyang , Hunan , China
| | - Yong Long
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China , Hengyang , Hunan , China
| | - Shugen Xu
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China , Hengyang , Hunan , China
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10
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Anand A, Khurana S, Ateriya N, Sunil Kumar Sharma GA. Sudden death due to non-traumatic rupture of splenic artery aneurysm. Med Leg J 2021; 90:76-78. [PMID: 34259054 DOI: 10.1177/00258172211018339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Splenic artery aneurysm is a rare form of vascular pathology that carries a high risk of mortality once it gets ruptured. It has a prevalence of 1% and occurs due to thinning and dilatation of the arterial wall. CASE We describe a case of a 35-year-old policeman who died suddenly. At medico-legal autopsy, intraperitoneal clotted blood about 1000 g and liquid blood about 3000 ml were seen. On further exploration, ruptured splenic artery aneurysm about 2.0 cm in diameter became visible near the hilum. CONCLUSION Rare cases typically present as sudden and unexpected death with intraperitoneal bleed and may be confused with blunt trauma abdomen. Therefore, splenic artery aneurysm is an appropriate differential diagnosis for sudden deaths and intraperitoneal bleeding, respectively.
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Affiliation(s)
- Aditya Anand
- Department of Forensic Medicine, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, India
| | - Sahil Khurana
- Department of Forensic Medicine, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, India
| | - Navneet Ateriya
- Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences, Gorakhpur, India
| | - G A Sunil Kumar Sharma
- Department of Forensic Medicine, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, India
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11
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Atanasijevic I, Babic S, Tanaskovic S, Gajin P, Ilijevski N. Giant splenic artery aneurysm treated surgically with spleen and pancreas preservation. Ann Saudi Med 2021; 41:253-256. [PMID: 34420395 PMCID: PMC8380274 DOI: 10.5144/0256-4947.2021.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aneurysms of the splenic artery represent a rare clinical entity, even though they account for 60-70% of all visceral artery aneurysms. Splenic artery aneurysms larger than 5 cm are extremely rare, and they are considered to be giant. Possible causes of splenic artery aneurysm development include: trauma, hormonal and local hemodynamic changes in pregnancy, portal hypertension, arterial degeneration, infection and postsplenectomy occurrence. Surgical treatment of giant splenic artery aneurysms includes procedures that frequently require pancreatectomy and splenectomy. We present a case of a 10.2 cm giant splenic artery aneurysm, firmly adhered to the pancreas, which was treated surgically, with spleen and pancreas preservation. SIMILAR CASES PUBLISHED: Although many cases on treatment of giant splenic artery aneurysm have been published, the majority have described additional visceral resections associated with aneurysmectomy, which is in contrast with our report. Furthermore, aneurysms reaching 10 cm in size were extremely rare.
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Affiliation(s)
- Igor Atanasijevic
- From the Department of Vascular Surgery, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Srdjan Babic
- From the Department of Vascular Surgery, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Slobodan Tanaskovic
- From the Department of Vascular Surgery, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Predrag Gajin
- From the Department of Vascular Surgery, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Nenad Ilijevski
- From the Department of Vascular Surgery, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
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CONTI L, CATTANEO G, BANCHINI F, BODINI FC, PALMIERI G, CAPELLI P. Laparoscopic distal pancreasectomy and resection of retro-pancreatic splenic artery aneurysm: preserving the spleen. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.19.05052-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Tijani Y, Zahdi O, Hormat-Allah M, Zaid Y, Raux M, Gouëffic Y. [Embolization of splenic artery aneurysms: Treatment of choice. About a case and review of the literature]. Ann Cardiol Angeiol (Paris) 2020; 71:108-111. [PMID: 33267947 DOI: 10.1016/j.ancard.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
Splenic artery aneurysms constitute 60% of digestive artery aneurysms. They are often discovered incidentally and by imaging. Currently, endovascular treatment is considered the first-line treatment, as it is less invasive with less morbidity and mortality than surgery. An aggressive approach in their management is certainly justified because the overall mortality of ruptured splenic aneurysms is 25%. False splenic aneurysms have a greater potential for rupture than true aneurysms because they grow faster. Endovascular treatment is generally indicated for aneurysms larger than 2cm or with an increase in size of more than 0.5cm/year. Embolization is rarely associated with an infarction of the spleen due to the good supply of short gastric vessels. Embolization is performed using different materials including coils, which can be used alone or with other embolic agents. Post-embolization syndrome can be seen with persistent pain, fever and other systemic symptoms. Endovascular treatment compared to open surgery is associated with better quality of life and appears to be the most cost-effective strategy. Endovascular treatment and especially coil embolization are starting to be the standard treatment. Surgical and laparoscopic treatment are reserved for ruptured aneurysms which are burdened with significant mortality, especially in pregnant women. We report the case of a 66-year-old female patient in whom a splenic artery aneurysm was discovered incidentally during an ultrasound for an ovarian cyst.
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Affiliation(s)
- Y Tijani
- Département de chirurgie vasculaire et endovasculaire, Hôpital Universitaire International Cheikh Khalifa Ben Zaid, Faculté de Médecine, Université Mohammed VI des sciences de santé (UM6SS), Casablanca, Maroc.
| | - O Zahdi
- Service de chirurgie vasculaire, Centre hospitalo-universitaire Ibn Sina, Université Mohammed V, Rabat, Maroc
| | - M Hormat-Allah
- Service de chirurgie vasculaire, Centre hospitalo-universitaire Ibn Sina, Université Mohammed V, Rabat, Maroc
| | - Y Zaid
- Faculty of Sciences, Mohammed V University, Rabat, Maroc; Research Center of Abulcasis University of Health Sciences, Rabat, Maroc
| | - M Raux
- Department of vascular and endovascular surgery, hôpital Paris St Joseph, Paris, France
| | - Y Gouëffic
- Department of vascular and endovascular surgery, hôpital Paris St Joseph, Paris, France
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14
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Veterano C, Monteiro E, Rego D, Soares P, Almeida P, Almeida R. Laparoscopic Resection of a Splenic Artery Aneurysm with Vascular Reconstruction During Pregnancy. Ann Vasc Surg 2020; 72:666.e7-666.e11. [PMID: 33227481 DOI: 10.1016/j.avsg.2020.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/30/2020] [Accepted: 10/06/2020] [Indexed: 11/17/2022]
Abstract
Splenic artery aneurysms (SAA) are more frequent in women and have a high rupture risk during pregnancy, with catastrophic outcomes. It is advisable to treat these aneurysms in pregnant and fertile women, whatever their diameter, given their increased risk for rupture. There are several therapeutic approaches: endovascular surgery using coil embolization or stent graft coverage; laparoscopic or open surgical resection with arterial reconstruction and ligation followed by splenectomy when necessary. This paper aims to report the successful treatment of SAA in second-trimester pregnant women using a laparoscopic approach with aneurysm resection and arterial reconstruction. This is a unique report of a minimally invasive approach with arterial reconstruction in a pregnant woman, thus reducing the risk of spleen infarction and potentially avoiding splenectomy.
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Affiliation(s)
- Carlos Veterano
- Angiology and Vascular Surgery Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - Eunice Monteiro
- General Surgery Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Duarte Rego
- Angiology and Vascular Surgery Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Paulo Soares
- General Surgery Department, Centro Hospitalar Universitário do Porto, Porto, Portugal; Liver and Pancreatic Transplant Program, Transplantation Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Paulo Almeida
- Angiology and Vascular Surgery Department, Centro Hospitalar Universitário do Porto, Porto, Portugal; Kidney Transplant Program, Transplantation Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Rui Almeida
- Angiology and Vascular Surgery Department, Centro Hospitalar Universitário do Porto, Porto, Portugal; Kidney Transplant Program, Transplantation Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
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15
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Tijani Y, Belmir H, Zahdi O, Khalki L, El Khloufi S, Sefiani Y, Elmesnaoui A, Lekehal B. Giant anevrisms of the splenic artery about six cases. JOURNAL DE MÉDECINE VASCULAIRE 2020; 45:248-253. [PMID: 32862981 DOI: 10.1016/j.jdmv.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 07/04/2020] [Indexed: 11/25/2022]
Abstract
Splenic artery aneurysms are rare. Giant aneurysms more than 2,5cm are extremely rare. The splenic artery is the third site after the aorta and iliac arteries, and the first location for aneurysmal lesion of the visceral arteries. The etiology of splenic artery aneurysms is not yet well established, however, fibromuscular dysplasia, non-cirrhotic portal hypertension and pregnancy seem to contribute to the emergence and evolution of arterial lesions. The majority of splenic artery aneurysms are asymptomatic. However, epigastric or left hypochondrial pain may occur. Doppler ultrasound, computed tomography angiography or magnetic resonance imaging are usually performed in the diagnostic workup. Treatment procedure, surgical or endovascular, depends on the aneurysmal site (proximal or distal) and the type of elective or urgent intervention. The present study reports six cases of splenic artery aneurysm, with a diameter greater than 50mm, treated successfully with surgery.
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Affiliation(s)
- Y Tijani
- Department of vascular and endovascular surgery, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco.
| | - H Belmir
- Department of vascular and endovascular surgery, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - O Zahdi
- Department of vascular and endovascular surgery, Mohammed V University of Rabat, Rabat, Morocco
| | - L Khalki
- Department of vascular and endovascular surgery, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - S El Khloufi
- Department of vascular and endovascular surgery, Mohammed V University of Rabat, Rabat, Morocco
| | - Y Sefiani
- Department of vascular and endovascular surgery, Mohammed V University of Rabat, Rabat, Morocco
| | - A Elmesnaoui
- Department of vascular and endovascular surgery, Mohammed V University of Rabat, Rabat, Morocco
| | - B Lekehal
- Department of vascular and endovascular surgery, Mohammed V University of Rabat, Rabat, Morocco
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16
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Chaer RA, Abularrage CJ, Coleman DM, Eslami MH, Kashyap VS, Rockman C, Murad MH. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg 2020; 72:3S-39S. [DOI: 10.1016/j.jvs.2020.01.039] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/18/2022]
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17
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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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Sellier J, Karam C, Beauchet A, Dallongeville A, Binsse S, Blivet S, Bourgault-Villada I, Charron P, Chinet T, Eyries M, Fagnou C, Lesniak J, Lesur G, Lucas J, Nicod-Tran A, Ozanne A, Palmyre A, Soubrier F, El Hajjam M, Lacombe P. Higher prevalence of splenic artery aneurysms in hereditary hemorrhagic telangiectasia: Vascular implications and risk factors. PLoS One 2020; 15:e0226681. [PMID: 31971937 PMCID: PMC6977744 DOI: 10.1371/journal.pone.0226681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 12/02/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Splenic artery aneurysm (SAA) is a rare but potentially fatal condition. Rupture results in 25% mortality up to 75% in pregnant women with 95% fetal mortality. Brief reports suggest an increased risk of developing SAA in patients with HHT. METHODS We analyzed enhanced multidetector CT data in 186 HHT patients matched (gender and ± 5 year old) with 186 controls. We screened for SAA and recorded diameter of splenic and hepatic arteries and hepatic, pancreatic and splenic parenchymal involvements. We determined by univariate and multivariate analysis, the relationship with age, sex, genetic status, cardiovascular risk factors (CVRF) and visceral involvement. RESULTS SAA concerned 24.7% of HHT patients and 5.4% of controls, p<0.001. Factors associated with increased risk of SAA in HHT were female gender (p = 0.04, OR = 2.12, IC 95% = 1.03-4.50), age (p = 0.0003, OR = 1.04, 95% CI = 1.02-1.06) and pancreatic parenchymal involvement (p = 0.04, OR = 2.13, 95% CI = 1.01-4.49), but not type of mutation, hepatic or splenic parenchymal involvements, splenic size or splenic artery diameter or CVRF. CONCLUSIONS We found a 4.57 higher rate of SAA in HHT patients without evidence of splenic high output related disease or increased CVRF. These results suggest the presence of a vascular intrinsic involvement. It should lead to screening all HHT patients for SAA. The vasculopathy hypothesis could require a change in management as screening of all systemic arteries and even the aorta and to further research in the field.
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Affiliation(s)
- Jacques Sellier
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Carma Karam
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
- * E-mail:
| | - Alain Beauchet
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Axel Dallongeville
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Stephen Binsse
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Sandra Blivet
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Isabelle Bourgault-Villada
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Philippe Charron
- Pitié-Salpêtrière Hospital, Department of Genetics, AP-HP, Paris, France
| | - Thierry Chinet
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Mélanie Eyries
- Pitié-Salpêtrière Hospital, Department of Genetics, AP-HP, Paris, France
| | - Carole Fagnou
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Jérome Lesniak
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Gilles Lesur
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Jérome Lucas
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Agnès Nicod-Tran
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Augustin Ozanne
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Aurélien Palmyre
- Pitié-Salpêtrière Hospital, Department of Genetics, AP-HP, Paris, France
| | - Florent Soubrier
- Pitié-Salpêtrière Hospital, Department of Genetics, AP-HP, Paris, France
| | - Mostafa El Hajjam
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Pascal Lacombe
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
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A rare case of non-traumatic intrasplenic pseudoaneurysms in a patient with acute T-cell lymphoblastic leukemia. J Ultrasound 2019; 24:85-90. [PMID: 31372947 DOI: 10.1007/s40477-019-00401-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/18/2019] [Indexed: 02/07/2023] Open
Abstract
Pseudoaneurysm (PSA) or false aneurysm is a vascular lesion resulting from a focal and incomplete rupture of the arterial wall (intimate and/or elastic lamina), that allows blood to escape into the arterial wall; this small contained break causes a contained collection of blood and the creation of a "new" less resistant vessel wall, consisting of adventitia and perivascular tissues. Intrasplenic pseudoaneurysms are rare and more frequently recognize traumatic origin, sometimes are also unexpected lesions due to non-recent trauma. In contrast, non-traumatic intrasplenic pseudoaneurysms are rare complications usually due to splenic infarction, infiltration by malignant systemic disorders, infectious process, chronic pancreatitis, and arteritis. Both traumatic and non-traumatic PSA are potentially life threatening, known to cause spontaneous rupture of the spleen with massive hemoperitoneum. Contrast-enhanced CT is the gold standard technique to detect splenic PSA; however, it is important to know how to recognize it also with other imaging methods such as with ultrasound (US) and contrast-enhanced ultrasound (CEUS). US and CEUS can be often the first-line diagnostic techniques and allow to detect these lesions; they are also very useful in the follow-up. Our case report can be a reminder of the utility of the US and CEUS in detecting splenic pseudoaneurysms, which are potentially a life-threatening complication; we also recall the semiotics of these lesions with baseline ultrasound (US), color Doppler US and contrast-enhanced ultrasound (CEUS). Then, we highlight the role of contrast-enhanced CT in confirming the diagnosis and we report about the diagnostic and therapeutic value of angiography. We have to think about the possibility of a pseudoaneurysm even in the absence of a recent trauma, associated with other conditions such as a lymphoproliferative disease.
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20
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Endovascular and Surgical Management of Intact Splenic Artery Aneurysm. Ann Vasc Surg 2019; 57:75-82. [DOI: 10.1016/j.avsg.2018.08.088] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 06/04/2018] [Accepted: 08/08/2018] [Indexed: 12/19/2022]
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21
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Tani R, Hori T, Yamamoto H, Harada H, Yamamoto M, Yamada M, Yazawa T, Tani M, Kamada Y, Aoyama R, Sasaki Y, Zaima M. Severely Calcified True Aneurysm: A Thought-Provoking Case of Solitary Origin and Postoperative Management. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:620-627. [PMID: 31031402 PMCID: PMC6501733 DOI: 10.12659/ajcr.915010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patient: Male, 70 Final Diagnosis: Splenic artery aneurysm Symptoms: Asymptomatic Medication: — Clinical Procedure: Surgery and Endoscopy Specialty: Surgery
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Affiliation(s)
- Ryotaro Tani
- Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
| | - Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
| | - Hidekazu Yamamoto
- Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
| | - Hideki Harada
- Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
| | | | - Masahiro Yamada
- Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
| | - Takefumi Yazawa
- Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
| | - Masaki Tani
- Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
| | - Yasuyuki Kamada
- Department of Surgery, Shiga General Hospital, Moriyama, Japan
| | - Ryuhei Aoyama
- Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
| | - Yudai Sasaki
- Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
| | - Masazumi Zaima
- Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
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Hosn MA, Xu J, Sharafuddin M, Corson JD. Visceral Artery Aneurysms: Decision Making and Treatment Options in the New Era of Minimally Invasive and Endovascular Surgery. Int J Angiol 2019; 28:11-16. [PMID: 30880885 PMCID: PMC6417896 DOI: 10.1055/s-0038-1676958] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The abdominal viscera blood supply is derived from anterior branches of the abdominal aorta. Visceral artery aneurysms (VAAs) include aneurysms of the following arteries and their branches: the celiac artery, the hepatic artery, the splenic artery, the superior mesenteric artery, the inferior mesenteric artery, the pancreaticoduodenal artery, and the gastroduodenal artery. Overall VAAs comprise < 2% of all types of arterial aneurysms. Asymptomatic VAAs are now being encountered more frequently due to the widespread use of advanced diagnostic abdominal imaging. The incidental finding of a VAA frequently leaves clinicians with a dilemma as to the best course of management. The focus of this review is on current treatment options and management guidelines for both symptomatic and asymptomatic VAAs.
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Affiliation(s)
- Maen Aboul Hosn
- Department of Surgery, Division of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | - Jun Xu
- Department of Surgery, Division of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | - Mel Sharafuddin
- Department of Surgery, Division of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | - John D. Corson
- Department of Surgery, the University of New Mexico, Albuquerque, New Mexico
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Branchi V, Meyer C, Verrel F, Kania A, Bölke E, Semaan A, Koscielny A, Kalff JC, Matthaei H. Visceral artery aneurysms: evolving interdisciplinary management and future role of the abdominal surgeon. Eur J Med Res 2019; 24:17. [PMID: 30819253 PMCID: PMC6396446 DOI: 10.1186/s40001-019-0374-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/14/2019] [Indexed: 01/17/2023] Open
Abstract
Background Visceral artery aneurysms (VAA) are rare vascular lesions. Clinically silent VAA are increasingly detected by cross-sectional imaging but some lesions are at risk for rupture with severe bleeding. The aim of the present study was to evaluate the trends in the interdisciplinary management at a tertiary center. Methods Patients who underwent treatment for VAA at University Hospital of Bonn between 2005 and 2018 were enrolled in this retrospective study. Demographic, clinical, VAA-specific data as well as information on therapy, early and long-term outcome were collected and statistically analyzed. Results Forty-two consecutive patients, 19 females and 23 males with a median age of 59 years (range 30–91 years), were diagnosed with 56 VAA. The majority were true aneurysms (N = 32; 57%), whereas 43% (N = 24) were pseudoaneurysms. The most common localization was the splenic artery (N = 18; 32%) and the average diameter was 3 cm (range 1–5 cm). Twenty-five patients (59.5%) had VAA-related symptoms such as chronic abdominal pain and hemorrhage at primary diagnosis, while the diagnosis was incidental in 17 patients (40.5%). Eleven patients (26%) underwent open surgery whereas 29 patients (69%) received an endovascular treatment. Patients with pseudoaneurysms were significantly older (P = 0.003), suffered more often from associated symptoms (P < 0.001) and required more emergency interventions (P < 0.0001) compared to those with true VAA. In the last years, the number and proportion of true VAA increased significantly (P < 0.001) while a significantly larger proportion could be managed interventionally (P = 0.017). Conclusions VAA are increasingly detected on imaging with lesions presenting very heterogeneously. Due to the risk of lethal rupture and in the absence of reliable prognostic markers, all the patients with VAA should be offered definite treatment. Localization, anatomy and the end-organ perfusion after intervention or operation are the most important aspects to consider when planning a treatment for VAA. For this reason, a multidisciplinary evaluation of every individual patient is necessary for an optimized outcome.
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Affiliation(s)
- Vittorio Branchi
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Carsten Meyer
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Frauke Verrel
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Alexander Kania
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Edwin Bölke
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine, Henirich-Heine Universität, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Alexander Semaan
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Arne Koscielny
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Jörg C Kalff
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
| | - Hanno Matthaei
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany
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Bradley S, Quenzer F, Wittler M. Ruptured Visceral Artery Aneurysms: A Deadly Cause of Epigastric Pain. Clin Pract Cases Emerg Med 2019; 3:132-136. [PMID: 31061969 PMCID: PMC6497188 DOI: 10.5811/cpcem.2019.1.41057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/21/2018] [Accepted: 01/23/2019] [Indexed: 11/17/2022] Open
Abstract
Visceral artery aneurysms (VAA) are rare, life-threatening disease processes that often affect the celiac, superior mesenteric, or inferior mesenteric arteries and their respective branches. The splenic, hepatic, superior mesenteric, and tripod celiac arteries are most commonly affected and have high rupture and mortality rates. This case describes splenic and celiac artery aneurysms in a patient that led to hemorrhagic shock and multisystem organ failure despite timely diagnosis and ligation. A brief review of the literature further elucidates the key risk factors in identifying patients with VAAs and their treatment course.
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Affiliation(s)
- Sara Bradley
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, California
| | - Faith Quenzer
- Desert Regional Medical Center, Department of Emergency Medicine, Palm Springs, California
| | - Micah Wittler
- Desert Regional Medical Center, Department of Emergency Medicine, Palm Springs, California
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25
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Bacalbasa N, Balescu I, Tanase A, Pautov M, Brezean I, Vilcu M, Brasoveanu V. Spleno-pancreatectomy En Bloc with Parcelar Gastrectomy for Splenic Artery Aneurysm - A Case Report and Literature Review. In Vivo 2018; 32:915-919. [PMID: 29936480 DOI: 10.21873/invivo.11329] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 02/07/2023]
Abstract
Splenic artery aneurysms are common arterial lesions which might remain asymptomatic for a long period of time. In certain cases, these lesions might encounter a significant growth and might become symptomatic. Once diagnosed, a therapeutic strategy should be taken in consideration in order to avoid the apparition of life-threatening complications such as aneurysmal rupture. This is a case report of a 45-year-old patient diagnosed with a splenic artery aneurysm who was successfully submitted to an aneurysmal resection en bloc with distal spleno-pancreatectomy and parcelar gastrectomy.
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Affiliation(s)
- Nicolae Bacalbasa
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Alina Tanase
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Mihai Pautov
- "Dan Setlacec" Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Iulian Brezean
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"I. Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - Mihaela Vilcu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"I. Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - Vladislav Brasoveanu
- "Dan Setlacec" Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
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26
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Erben Y, Brownstein AJ, Rajaee S, Li Y, Rizzo JA, Mojibian H, Ziganshin BA, Elefteriades JA. Natural history and management of splanchnic artery aneurysms in a single tertiary referral center. J Vasc Surg 2018; 68:1079-1087. [DOI: 10.1016/j.jvs.2017.12.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/30/2017] [Indexed: 10/17/2022]
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27
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Therakathu J, Panwala HK, Bhargava S, Eapen A, Keshava SN, David D. Contrast-enhanced Computed Tomography Imaging of Splenic Artery Aneurysms and Pseudoaneurysms: A Single-center Experience. J Clin Imaging Sci 2018; 8:37. [PMID: 30197828 PMCID: PMC6118105 DOI: 10.4103/jcis.jcis_21_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 05/21/2018] [Indexed: 11/22/2022] Open
Abstract
AIM The aim of our study was to evaluate the computed tomography (CT) imaging features of splenic artery aneurysm and pseudoaneurysm and to identify the disease conditions related to the same. We also wanted to ascertain any relationship between these associated disease conditions and the imaging features of the aneurysms. MATERIALS AND METHODS This retrospective study included patients diagnosed to have splenic artery aneurysms on contrast-enhanced CT examination between January 2001 and January 2016. Data were obtained from the picture archiving and communication system. The size, number, location, morphology, the presence of thrombosis, calcification, and rupture of the aneurysms were evaluated. RESULTS A total of 45 patients were identified with a mean age of 45 years. Splenic artery aneurysms were idiopathic in 12 (26.6%) patients. In the remaining patients, the main associated disease conditions included pancreatitis 15 (33%), chronic liver disease with portal hypertension 8 (18%), and extrahepatic portal vein obstruction (EHPVO) 6 (13%). Statistically significant findings included the relationship between EHPVO and multiple aneurysms (P = 0.002), chronic liver disease and fusiform aneurysm (P = 0.008), and smaller size of idiopathic aneurysms (P < 0.001). CONCLUSION Based on this study, splenic artery aneurysms were associated with a variety of etiologies. The characteristics of the aneurysms such as size, location, and morphology vary with the associated disease conditions. These variations may have implications for the management.
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Affiliation(s)
- Jacob Therakathu
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Salil Bhargava
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anu Eapen
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Deepu David
- Department of Gastroenterology, Christian Medical College, Vellore, Tamil Nadu, India
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28
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Covered stenting and transcatheter embolization of splenic artery aneurysms in diabetic patients: A review of endovascular treatment of visceral artery aneurysms in the current era. Pharmacol Res 2018; 135:127-135. [PMID: 30055250 DOI: 10.1016/j.phrs.2018.07.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/20/2018] [Accepted: 07/24/2018] [Indexed: 12/20/2022]
Abstract
Diabetes mellitus is associated with both microvascular and macrovascular complications, which can result in visceral aneurysms as for example splenic artery aneurysms: in their management, an endovascular treatment, less invasive than surgery, is generally preferred. Endovascular treatment of splenic artery aneurysms can be based either on covered stenting (CS) or transcatheter embolization (TE). CS generally allows aneurysm exclusion with vessel preservation, while TE usually determines target artery occlusion with potential risk of distal ischemia. We performed a review of the existing literature on endovascular treatment of visceral artery aneurysms (VAAs) and psudoaneurysms (VAPAs) in the current era.
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29
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Ouchi T, Kato N, Nakajima K, Higashigawa T, Hashimoto T, Chino S, Sakuma H. Splenic Artery Aneurysm Treated With Endovascular Stent Grafting: A Case Report and Review of Literature. Vasc Endovascular Surg 2018; 52:663-668. [PMID: 29940816 DOI: 10.1177/1538574418785252] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION: Although endovascular therapy is becoming an alternative to open surgical repair of splenic artery aneurysms (SAAs), reports on the use of stent grafts for SAA repair are limited. We present our experience of endovascular therapy using a stent graft for the treatment of an SAA that had ruptured into the gastric lumen. We also reviewed 18 cases of stent graft repair for SAAs, including the present case. CASE REPORT: A 43-year-old man was admitted due to hematemesis. Endoscopic examination and contrast-enhanced computed tomography (CT) revealed a dissecting SAA that had ruptured into the stomach. Two 10 × 100 mm Viabahn (W.L. Gore, Flagstaff, Arizona) stent grafts were used to exclude the aneurysm. No complications occurred during the procedure. Although postoperative CT showed complete exclusion of the aneurysm, endoscopic examination showed a discharge of purulent matter from the aneurysm. Therefore, surgical debridement and omental implantation were added to avoid stent graft infection. Follow-up CT obtained 1 year later showed the residual aneurysm almost disappeared without any evidence of infection. LITERATURE REVIEW: A literature search in the PubMed database returned 17 cases with sufficient data. Review of these cases, together with the present case, revealed a 100% technical success rate, 11% splenic infarction rate, 94% graft patency rate, and 0% reintervention rate. CONCLUSION: Endovascular repair of SAAs using stent grafts appears to be safe and effective. In terms of preserving the blood flow and avoiding splenic infarction, it may be superior to coil embolization. Even in a case with aneurysm infection, stent graft repair may be an acceptable method to minimize invasion of concomitant surgical intervention.
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Affiliation(s)
- Takafumi Ouchi
- 1 Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | - Noriyuki Kato
- 1 Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | - Ken Nakajima
- 1 Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | | | | | - Shuji Chino
- 1 Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | - Hajime Sakuma
- 1 Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
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30
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Wernheden E, Brenøe AS, Shahidi S. Emergency endovascular coiling of a ruptured giant splenic artery aneurysm. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2018; 3:240-242. [PMID: 29349435 PMCID: PMC5765173 DOI: 10.1016/j.jvscit.2017.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/24/2017] [Indexed: 11/26/2022]
Abstract
Splenic artery aneurysms (SAAs) are the third most common abdominal aneurysm. Endovascular treatment of SAAs is preferred, and coiling is the most commonly used technique. Ruptured giant (>5 cm) SAAs are usually treated with open surgery including splenectomy. We present a rare case of a ruptured 15-cm giant SAA in an 84-year-old woman treated successfully with emergency endovascular coiling. To our knowledge, this is one of the few reports of emergency endovascular treatment for ruptured giant SAA.
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Affiliation(s)
- Erika Wernheden
- Department of Vascular Surgery, Slagelse Hospital, Slagelse, Denmark
| | - Anne-Sofie Brenøe
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Saeid Shahidi
- Department of Vascular Surgery, Slagelse Hospital, Slagelse, Denmark
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31
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Song C, Dong J, Yu G, Zhou J, Xiang F, Pei Y, Lu Q, Jing Z. Comparison of open surgery and endovascular procedures as a therapeutic choice for visceral artery aneurysms. Vascular 2017; 26:387-392. [PMID: 29228875 DOI: 10.1177/1708538117744102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objectives Visceral arterial aneurysms may be treated using open surgery or endovascular repair, but the best approach remains controversial. This was a retrospective study aiming to compare open surgery and endovascular treatment strategies for visceral arterial aneurysms. Methods The study included all 93 patients who were admitted with visceral artery aneurysms between January 2001 and January 2011 at the Department of Vascular Surgery, Changhai Hospital, Shanghai, China. All cases underwent either open or endovascular procedures. Overall survival and adverse events were compared between the groups. Success rate, blood loss, length of surgery, and length of hospital stay were also compared. The patients were followed up at three, six, and 12 months then every year until April 2014. Results Open surgery was performed on 34 patients and endovascular procedures on 59. There were no differences in characteristics of the patients between the open surgery and endovascular groups. The perioperative complication rate was 52.9 and 13.6% in the open surgery and endovascular groups, respectively. Mean follow-up was 36.8 months (range: 11 months to 10 years). The one- and five-year survival rates were 100 and 60.6%, respectively, in the open surgery group, compared to 100 and 84.5% in the endovascular group. Multivariate analysis for factors related to overall survival showed that there was a significant relationship with the treatment approach (HR = 0.479, 95%CI: 0.278-0.825; P = 0.008) and the presence of false aneurysm (HR = 2.929, 95%CI: 1.388-6.180, P = 0.005). Conclusions Endovascular repair could be considered as an effective method for visceral artery aneurysm. Endovascular repair showed lower perioperative complication rates and better long-term survival.
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Affiliation(s)
- Chao Song
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Jian Dong
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Guanyu Yu
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Feng Xiang
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Yifei Pei
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
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32
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Katirci Y, Karamercan MA, Ramadan H, Baran NT, Aksoy O, Coskun F. Spontaneous Ruptured Splenic Artery Aneurysm: A Case Report. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791302000410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Splenic artery aneurysms are rare and occur predominantly in women. Most of them are asymptomatic until the aneurysms rupture. We report a previously healthy 46-year-old female who attended emergency department with abdominal pain for four hours. She had left upper quadrant tenderness and pulsatile mass. Laboratory tests showed her haematocrit 29.8%. Subsequent examinations with ultrasound and computed tomography (CT) showed a large aneurysm of the splenic artery and a heterogeneous hypodense shadows around the aneurysmal sac and perihepatic area. Just after CT scan she collapsed and was taken into emergency surgery. Splenectomy was performed following the ligation of splenic artery proximal to lesion. On the fifth day, she was discharged from the hospital with complete recovery. This case report highlights that rapid resuscitation, diagnostic imaging, surgical consultation, and subsequent laparotomy remain the priorities in patient management.
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Affiliation(s)
- Y Katirci
- Ankara Research and Training Hospital, Ministry of Health, Department of Emergency Medicine, Ankara Egitim Arastirma Hastanesi Acil Tip Klinigi, 06340 Ulucanlar - Ankara, Turkey
| | | | - H Ramadan
- Ankara Research and Training Hospital, Ministry of Health, Department of Emergency Medicine, Ankara Egitim Arastirma Hastanesi Acil Tip Klinigi, 06340 Ulucanlar - Ankara, Turkey
| | - NT Baran
- Ankara Research and Training Hospital, Ministry of Health, Department of Emergency Medicine, Ankara Egitim Arastirma Hastanesi Acil Tip Klinigi, 06340 Ulucanlar - Ankara, Turkey
| | - O Aksoy
- Ankara Research and Training Hospital, Ministry of Health, Department of Emergency Medicine, Ankara Egitim Arastirma Hastanesi Acil Tip Klinigi, 06340 Ulucanlar - Ankara, Turkey
| | - F Coskun
- Ankara Research and Training Hospital, Ministry of Health, Department of Emergency Medicine, Ankara Egitim Arastirma Hastanesi Acil Tip Klinigi, 06340 Ulucanlar - Ankara, Turkey
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33
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Dong SL, Chen X, Tu ZX, Ai X, Zhang ZW, Guan Y, Chen H, Yang J. Aneurysm of the Anomalous Splenic Artery Arising from Superior Mesenteric Artery Treated by Coil Embolization: A Report of Two Cases and Literature Review. Ann Vasc Surg 2017; 48:251.e5-251.e10. [PMID: 29221838 DOI: 10.1016/j.avsg.2017.09.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/26/2017] [Accepted: 09/27/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Aneurysm of splenic artery (SA) which arises from the superior mesenteric artery (SMA) is a very rare condition. The aim of this study was to present our experience with 2 such patients treated by coil embolization. METHODS A 33-year-old man and a 61-year-old woman were incidentally identified with aneurysms of the SA which arose from the SMA. Endovascular therapy of coil embolization was chosen to treat the aneurysm. RESULTS Follow-up computed tomography showed no change in the location of the coils and occlusion of majority of the aneurysm sac. The 2 patients have been doing well during a 26-month and 10-month follow-up period, respectively. CONCLUSIONS Combined with the experience of the previous literature, we think coil embolization can be cost-effective and minimally invasive in selected cases, depending on the morphology and site of the lesion.
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Affiliation(s)
- Shui-Lin Dong
- Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen-Xiao Tu
- Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Ai
- Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhi-Wei Zhang
- Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Guan
- Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Chen
- Department of Operation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Yang
- Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Multidetector Computed Tomography Findings of Splenic Artery Aneurysms Associated With Liver Involvement in Wilson's Disease. Transplant Proc 2017; 49:1806-1809. [PMID: 28923629 DOI: 10.1016/j.transproceed.2017.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 04/04/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE The purposed of this study was to examine the incidence and multidetector computed tomography (MDCT) findings of splenic artery aneurysms (SAAs) in patients with liver involvement related to Wilson's disease. METHODS Eighteen patients with clinically and/or pathologically proven Wilson's disease underwent triphasic MDCT. Arterial, portal, and equilibrium phase images were obtained. The analysis of the CT features included the presence and characteristics of the SAA, splenic artery (SA) diameter, the presence and size of the portosystemic collateral vessels, and spleen volume. RESULTS SAAs were detected in 11 patients (61.1%). Eight (72.7%) patients had multiple aneurysms. In 6 (54.5%) patients, the SAAs were located in the distal third of the SA and the intraparenchymal part of the SA. In 3 (27.3%) patients, the SAAs were located only in the distal third of the SA. In 1 (9.1%) patient, the aneurysms were located in the intermediate, distal third, and intraparenchymal part of the SA; in another (9.1%) patient, the aneurysms were located only in the intraparenchymal part of the SA. There were significant differences between the patients with SAA and those without SAA with respect to SA diameter, portosystemic collateral vessel diameter, and spleen volume (P = .007, P < .001, and P = .006, respectively). CONCLUSIONS The incidence of SAAs seems to be higher in patients with liver involvement related to Wilson's disease compared with patients with other causes of cirrhosis and portal hypertension. Large portosystemic collaterals, increased SA diameter, and spleen volume were significant factors for the presence of SAAs.
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35
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Creidi E, El Asmar A, Abou Zahr R, El Rassi Z. Giant splenic artery aneurysm in a pregnant patient: a case report and literature review. Clin Case Rep 2017; 5:1132-1135. [PMID: 28680611 PMCID: PMC5494404 DOI: 10.1002/ccr3.1000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 02/02/2017] [Accepted: 04/14/2017] [Indexed: 12/01/2022] Open
Abstract
Pregnancy and giant splenic artery aneurysms should be addressed in a way to achieve optimal results for the mother and the fetus. In our case, the need for immediate intervention, with minimal risk, made open aneurysmectomy and distal splenopancreatectomy, the ideal approach to undertake.
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Affiliation(s)
- Elie Creidi
- General Surgery Resident Saint Georges Hospital University Medical Center,Beirut Lebanon.,Faculty of MedicineUniversity of BalamandBeirutLebanon
| | - Antoine El Asmar
- General Surgery Resident Saint Georges Hospital University Medical Center,Beirut Lebanon.,Faculty of MedicineUniversity of BalamandBeirutLebanon
| | - Rawad Abou Zahr
- Faculty of MedicineUniversity of BalamandBeirutLebanon.,Urology Resident Saint Georges Hospital University Medical Center Beirut Lebanon
| | - Ziad El Rassi
- Faculty of MedicineUniversity of BalamandBeirutLebanon.,Department of Clinical Surgery General and Digestive Surgery - Oncologic Surgery Saint Georges Hospital University Medical Center Beirut Lebanon
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36
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Termos S, Taqi A, Hayati H, Alhasan AJMS, Alali M, Adi A. Segmental arterial mediolysis with 5 splenic artery aneurysms. A rare finding of a rare disease: Case report and literature review. Int J Surg Case Rep 2017; 33:158-162. [PMID: 28327420 PMCID: PMC5358818 DOI: 10.1016/j.ijscr.2017.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 02/12/2017] [Accepted: 02/13/2017] [Indexed: 11/28/2022] Open
Abstract
The article represents SAM in SAA which is a rare finding in a rare disease and due to the paucity of sample of cases there is no standardization in the management. SAM should be suspected when multiple aneurysms are found in the same anatomic site. Angiography is important to detect adjacent involvement. CT angiography of brain should be done to rule out distal vascular disease. Endovascular option is the first choice but sometimes it is not feasible, in this case was excluded due to anatomical and configuration reasons.
Introduction Splenic artery aneurysms (SAA) are uncommon findings. They are usually single and isolated; however they can be multiple; hence vasculopathy and segmental artery mediolysis may be considered. Presentation of case In our manuscript we present a case of a 54 year old multiparous lady who was discovered incidentally to have a diseased splenic artery containing five SSAs. The largest aneurysm was close to the takeoff of the vessel and the smallest was distal embedded in the splenic hilum. Endovascular option was technically not feasible. Therefore the patient underwent a complete splenic artery resection with splenectomy and the histopathologic examination was suggestive of segmental arterial mediolysis (SAM). Discussion and conclusion Multiple SAAs remains a rare finding of a rare disease. Complications can be crucial and high index of suspicion is important. Segmental arterial mediolysis can be considered in patients with several aneurysms on one anatomic site; Angiography is the gold standard diagnostic and therapeutic method. Complete splenic artery resection with splenectomy is the best treatment option for solitary vessel involvement.
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Affiliation(s)
- Salah Termos
- Hepatobiliary and Transplant Unit, Department of Surgery, Amiri Hospital, Kuwait.
| | - Ali Taqi
- Hepatobiliary and Transplant Unit, Department of Surgery, Amiri Hospital, Kuwait
| | - Hussein Hayati
- Hepatobiliary and Transplant Unit, Department of Surgery, Amiri Hospital, Kuwait
| | - Ameera J M S Alhasan
- Hepatobiliary and Transplant Unit, Department of Surgery, Amiri Hospital, Kuwait
| | - Mohammad Alali
- Hepatobiliary and Transplant Unit, Department of Surgery, Amiri Hospital, Kuwait
| | - Ayman Adi
- Department of Pathology, Amiri Hospital, Kuwait
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37
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Visceral aneurysms: Old paradigms, new insights? Best Pract Res Clin Gastroenterol 2017; 31:97-104. [PMID: 28395793 DOI: 10.1016/j.bpg.2016.10.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 09/22/2016] [Accepted: 10/02/2016] [Indexed: 02/07/2023]
Abstract
True visceral artery aneurysms (VAAs) are a rare entity with an incidence of 0.01-2%. The risk of rupture varies amongst the different types of VAAs and is higher for pseudo aneurysms compared with true aneurysms. Size, growth, symptoms, underlying disease, pregnancy and liver transplantation have all been associated with increased risk of rupture. Mortality rates after rupture are around 25%. The splenic artery is most commonly affected and the etiology is predominantly atherosclerosis. Open repair can be done by simple ligation or reconstruction of the artery, while endovascular options include embolization or using a stent graft. Location, collateral circulation and medical condition of the patient should all be taken into account when an intervention is planned. We compared types of treatment and searched for risk factors for rupture but unfortunately, the level of evidence found in the literature is low. Therefore, deciding when and how to treat a patient with a VAA based on the current literature, remains challenging for clinicians.
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38
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LaBella GD, Muck P, Kasper G, Welling R, Schlueter F, Vaughan A. Operative Management of an Aberrant Splenic Artery Aneurysm: Utility of the Medial Visceral Rotation Approach. Vasc Endovascular Surg 2016; 40:331-3. [PMID: 16959727 DOI: 10.1177/1538574406292005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors report an unusual case of a splenic artery aneurysm arising off the superior mesenteric artery. This was an incidental finding on computed tomography scan found during evaluation for a different or a separate disease process.
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Affiliation(s)
- Gennaro D LaBella
- Department of Surgery, Good Samaritan Hospital, Cincinnati, OH 45220, USA
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39
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Robaldo A, Gramondo F, Beccaria F, Colotto P. Giant splenic artery aneurysm rupture. Clin Case Rep 2016; 4:620-2. [PMID: 27398212 PMCID: PMC4891494 DOI: 10.1002/ccr3.578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 04/17/2016] [Indexed: 12/14/2022] Open
Abstract
Little exists on treatment for SAAs rupture which may require a fast bleeding control because of the hemodynamic instability and a large perisplenic/peritoneal hematoma. This case shows the use of endovascular clamping and midline laparotomy to perform the splenectomy because of the severe hypotension and the dimension of the lesion.
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Affiliation(s)
- Alessandro Robaldo
- Vascular and Endovascular Unit Public Imperia Hospital 56, Sant'Agata Street Imperia 18100 (IM) Italy
| | - Fabrizio Gramondo
- Vascular and Endovascular Unit Public Imperia Hospital 56, Sant'Agata Street Imperia 18100 (IM) Italy
| | - Fabio Beccaria
- Department of Radiology Public Imperia Hospital 56, Sant'Agata Street Imperia 18100 (IM) Italy
| | - Patrizio Colotto
- Vascular and Endovascular Unit Public Imperia Hospital 56, Sant'Agata Street Imperia 18100 (IM) Italy
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Rebonato A, Maiettini D, Krokidis M, Graziosi L, Rossi M. Late Migration of a Covered Stent into the Stomach after Repair of a Splenic Artery Pseudoaneurysm. J Radiol Case Rep 2016; 10:26-32. [PMID: 27200159 DOI: 10.3941/jrcr.v10i2.2620] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We would like to report our experience of a rather rare complication that occurred in a 76-year old patient tree years after endovascular repair of a splenic artery pseudoaneurysm with a covered stent. Three years after stent insertion, the patient complained of mild abdominal pain and melena; it was revealed endoscopically that the covered stent has eroded the stomach wall and migrated into the stomach. The splenic artery is the most common location among the spectrum of potential presentation sites of visceral arteries aneurysms and pseudoaneurysms. Endovascular treatment with the use of coils or stents is the first option due to lower morbidity and mortality than open surgery. Endovascular repair may also lead to complications and patients need to be followed up in order to confirm aneurysm sealing, and exclude late complication. Minor stent graft migration may occur in the long term, however extra vascular migration is extremely rare.
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Affiliation(s)
- Alberto Rebonato
- Department of Surgical and Biomedical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Daniele Maiettini
- Department of Surgical and Biomedical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Miltiadis Krokidis
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Luigina Graziosi
- Department of Surgical and Biomedical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Michele Rossi
- Radiology Department, St. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
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Trauma associated splenic artery aneurysms: an analysis of the National Trauma Data Bank. Am J Surg 2016; 211:739-43. [DOI: 10.1016/j.amjsurg.2015.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 11/12/2015] [Accepted: 11/23/2015] [Indexed: 12/18/2022]
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Bizueto-Rosas H, Barajas-Colón JÁ, Delgadillo-de la O I, Malo-Martínez NP, Pérez-González HA, Hernández-Pérez NA. [Multiple aneurysms splenic; surgical exclusion with conservation of the spleen]. CIR CIR 2015; 84:58-64. [PMID: 26238591 DOI: 10.1016/j.circir.2015.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 11/10/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND Aneurysm of the splenic artery is diagnosed when the diameter of the splenic artery is greater than 1cm. It occupies third place among abdominal aneurysms. It is more frequent in women (4:1). It is associated with trauma, haemodynamics and local hormonal effects during pregnancy, portal hypertension (including the Caroli syndrome), arterial degeneration, atherosclerosis, and liver transplantation. It is difficult to diagnose, and it generally presents as ruptured, thus once the diagnosis is made, the surgical approach is indicated due to its high mortality. CLINICAL CASE Female of 66 years of age with a diagnosis of splenic artery aneurysm, with pulsing sensation at epigastric level of 8 months onset. On physical examination there is a palpable throbbing mass of 9 cm of diameter approximately, for which she was admitted. The computed tomography angiography with reconstruction showed three splenic aneurysms. Two were tied and the larger one was repaired by endo-aneurysmorrhaphy. DISCUSSION Visceral aneurysms are extremely rare. They are currently increasing and are the third leading cause of cardiovascular death, as morbidity/mortality is high. The surgical treatment must be done selectively according to their size. Selection of the surgical techniques depends on the anatomic location and the need for revascularisation, the aetiology and the experience of the surgeon. CONCLUSION A review has been presented on the advances in diagnostic, and management, concluding that the best is to preserve the spleen, and whatever the technique it must be performed by trained surgeons.
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Affiliation(s)
- Héctor Bizueto-Rosas
- Servicio de Angiología, Hospital de Especialidades, Centro Médico Nacional La Raza, La Raza, D.F., México.
| | - José Ángel Barajas-Colón
- Servicio de Angiología, Hospital de Especialidades, Centro Médico Nacional La Raza, La Raza, D.F., México
| | - Ivan Delgadillo-de la O
- Servicio de Angiología, Hospital de Tecamac, Instituto Mexicano del Seguro Social, La Raza, D.F., México
| | | | - Hugo Alonso Pérez-González
- Servicio de Angiología, Hospital de Especialidades, Centro Médico Nacional La Raza, La Raza, D.F., México
| | - Noemí Antonia Hernández-Pérez
- Servicio de Medicina Familiar y Laboral, Unidad de Medicina Familiar y Hospital General de Zona Número 29, Instituto Mexicano del Seguro Social, D.F., México
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Lachhab I, Benkabbou A, Souadka A, El Malki HO, Mohsine R, Ifrine L, Belkouchi A. [Splenic artery aneurysm ruptured in the stomach: surgery after failed attempt of embolization]. Pan Afr Med J 2015; 20:66. [PMID: 26090024 PMCID: PMC4450033 DOI: 10.11604/pamj.2015.20.66.3667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/05/2015] [Indexed: 11/12/2022] Open
Abstract
L'anévrisme de l'artère splénique (AAS) est une entité pathologique rare le plus souvent asymptomatique. Nous rapportons le cas d'un patient âgé de 60 ans, hypertendu qui s'est présenté aux urgences pour un épisode d'hématémèse sans retentissement hémodynamique. Un bilan complet comportant un Angioscanner abdominal a mis en évidence un anévrisme de l'artère splénique refoulant la paroi postérieure de l'estomac en avant. Le diagnostic d'anévrisme de l'artère splénique rompu dans l'estomac a été posé et un traitement endovasculaire à type d'embolisation par coils effectué. Au 5ème jour post embolisation, le patient nous a été référé pour une persistance de mélénas. Un traitement chirurgical a été décidé. La mise à plat de l'anévrisme a permis d’évacuer les coils et le thrombus. L'objectif de cette observation est de montrer que l'embolisation d'un AAS rompu dans l'estomac a été une cause de retard thérapeutique qui pourrait être fatal pour le patient. Le traitement de référence est la cure chirurgicale de l'AAS par voie conventionnelle sans rétablissement de la continuité artérielle splénique, sans splénectomie et avec suture de l'orifice digestif.
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Affiliation(s)
- Imad Lachhab
- Service de Chirurgie Générale A, Hôpital Ibn Sina-CHU Rabat, Faculté de Médecine et de Pharmacie Mohamed V, Rabat, Maroc
| | - Amine Benkabbou
- Service de Chirurgie Générale A, Hôpital Ibn Sina-CHU Rabat, Faculté de Médecine et de Pharmacie Mohamed V, Rabat, Maroc
| | - Amine Souadka
- Service de Chirurgie Générale A, Hôpital Ibn Sina-CHU Rabat, Faculté de Médecine et de Pharmacie Mohamed V, Rabat, Maroc
| | - Haj Omar El Malki
- Service de Chirurgie Générale A, Hôpital Ibn Sina-CHU Rabat, Faculté de Médecine et de Pharmacie Mohamed V, Rabat, Maroc
| | - Raouf Mohsine
- Service de Chirurgie Générale A, Hôpital Ibn Sina-CHU Rabat, Faculté de Médecine et de Pharmacie Mohamed V, Rabat, Maroc
| | - Lahcen Ifrine
- Service de Chirurgie Générale A, Hôpital Ibn Sina-CHU Rabat, Faculté de Médecine et de Pharmacie Mohamed V, Rabat, Maroc
| | - Abdelkader Belkouchi
- Service de Chirurgie Générale A, Hôpital Ibn Sina-CHU Rabat, Faculté de Médecine et de Pharmacie Mohamed V, Rabat, Maroc
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Ilic N, Banzic I, Stekovic J, Koncar I, Davidovic L, Fatic N. Multiple visceral artery aneurysms. Ann Vasc Surg 2015; 29:1318.e7-1318.e10. [PMID: 26072724 DOI: 10.1016/j.avsg.2015.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 02/04/2015] [Accepted: 02/08/2015] [Indexed: 01/17/2023]
Abstract
A 63-year-old woman patient was presented with 3 visceral artery aneurysms, which were identified accidentally at nuclear magnetic resonance imaging carried out because of small mass in the left adrenal gland, which was suspected by ultrasound. Computed tomography (CT) examination was indicated and showed fusiform aneurysm on splenic artery, saccular aneurysm of right renal artery, and saccular aneurysm of left segmental renal artery. Also, she experienced hypertension, cardiomyopathy, thyroid gland strum with normal hormone levels, osteoporosis, and rheumatoid arthritis. The patient was treated by open conventional surgery followed by end-to-end anastomosis reconstructions firstly of the right renal and then splenic artery. In 5 days, the patient was released from hospital in good condition. Control CT examination in 9 months did not show enlargement of remaining aneurysm. Histopathology confirmed just typical aneurysm degeneration based on atherosclerosis.
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Affiliation(s)
- Nikola Ilic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Igor Banzic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Jovana Stekovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Igor Koncar
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Lazar Davidovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Nikola Fatic
- Department of Vascular Surgery, Clinical Center of Montenegro, University of Montenegro, Podgorica, Montenegro.
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Affiliation(s)
- Madhu M.P.
- Department Gastroenterology, SMS Medical College, Jaipur, Rajasthan, India
| | - Bir Singh
- Department Gastroenterology, SMS Medical College, Jaipur, Rajasthan, India
| | - Rupesh Pokharna
- Department Gastroenterology, SMS Medical College, Jaipur, Rajasthan, India,Address for correspondence: Rupesh Pokharna, Professor, Department Gastroenterology, SMS Medical College, Jaipur, Rajasthan, India. Tel.: +91 9829171612.
| | - Garima Sharma
- Department of Pathology, SMS Medical College, Jaipur, Rajasthan, India
| | - Gyan P. Rai
- Department Gastroenterology, SMS Medical College, Jaipur, Rajasthan, India
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Schatz RA, Schabel S, Rockey DC. Idiopathic Splenic Artery Pseudoaneurysm Rupture as an Uncommon Cause of Hemorrhagic Shock. J Investig Med High Impact Case Rep 2015; 3:2324709615577816. [PMID: 26425639 PMCID: PMC4528868 DOI: 10.1177/2324709615577816] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Splenic artery pseudoaneurysms are infrequently encountered but critical to recognize. Limited literature to date describes associations with pancreatitis, trauma, and rarely peptic ulcer disease. Hemorrhage and abdominal pain are the most common manifestations. There is typically overt gastrointestinal blood loss but bleeding can also extend into the peritoneum, retroperitoneum, adjacent organs, or even a pseudocyst. Most patients with ruptured splenic artery pseudoaneurysms present with hemodynamic instability. Here, we describe a patient recovering from acute illness in the intensive care unit but with otherwise no obvious risk factors or precipitants for visceral pseudoaneurysm. He presented with acute onset altered mental status, nausea, and worsening back and abdominal pain and was found to be in hypovolemic shock. The patient was urgently stabilized until more detailed imaging could be performed, which ultimately revealed the source of blood loss and explained his rapid decompensation. He was successfully treated with arterial coiling and embolization. Thus, we herein emphasize the importance of prompt recognition of hemorrhagic shock and of aggressive hemodynamic stabilization, as well as a focused diagnostic approach to this problem with specific treatment for splenic artery pseudoaneurysm. Finally, we recommend that multidisciplinary management should be the standard approach in all patients with splenic artery pseudoaneurysm.
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Affiliation(s)
- Richard A Schatz
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Stephen Schabel
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Don C Rockey
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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Hogendoorn W, Lavida A, Hunink MGM, Moll FL, Geroulakos G, Muhs BE, Sumpio BE. Open repair, endovascular repair, and conservative management of true splenic artery aneurysms. J Vasc Surg 2014; 60:1667-76.e1. [PMID: 25264364 DOI: 10.1016/j.jvs.2014.08.067] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 08/11/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE True splenic artery aneurysms (SAAs) are a rare but potentially fatal pathology. For many years, open repair (OPEN) and conservative management (CONS) were the treatments of choice, but throughout the last decade endovascular repair (EV) has become increasingly used. The purpose of the present study was to perform a systematic review and meta-analysis evaluating the outcomes of the three major treatment modalities (OPEN, EV, and CONS) for the management of SAAs. METHODS A systematic review of all studies describing the outcomes of SAAs treated with OPEN, EV, or CONS was performed using seven large medical databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to ensure a high-quality review. All articles were subject to critical appraisal for relevance, validity, and availability of data regarding characteristics and outcomes. All data were systematically pooled, and meta-analyses were performed on several outcomes, including early and late mortality, complications, and number of reinterventions. RESULTS Original data of 1321 patients with true SAAs were identified in 47 articles. OPEN contained 511 patients (38.7%) in 31 articles, followed by 425 patients (32.2%) in CONS in 16 articles and 385 patients (29.1%) in EV in 33 articles. The CONS group had fewer symptomatic patients (9.5% vs 28.7% in OPEN and 28.8% in EV; P < .001) and fewer ruptured aneurysms (0.2% vs 18.4% in OPEN and 8.8% in EV; P < .001), but no significant differences were found in existing comorbidities. CONS patients were usually older and had smaller-sized aneurysms than patients in the OPEN and EV groups. The only identified difference in baseline characteristics between OPEN and EV was the number of ruptured aneurysms (18.4% vs 8.8%; P < .001). OPEN had a higher 30-day mortality than EV (5.1% vs 0.6%; P < .001), whereas minor complications occurred in a larger number of the EV patients. EV required more reinterventions per year (3.2%) compared with OPEN (0.5%) and CONS (1.2%; P < .001). The late mortality rate was higher in patients treated with CONS (4.9% vs 2.1% in OPEN and 1.4% in EV; P = .04). CONCLUSIONS EV of SAA has better short-term results compared with OPEN, including significantly lower perioperative mortality. OPEN is associated with fewer late complications and fewer reinterventions during follow-up. Patients treated with CONS showed a higher late mortality rate. Ruptured SAAs are predictors of a significantly higher perioperative mortality compared with nonruptured SAAs in the OPEN and EV groups.
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Affiliation(s)
- Wouter Hogendoorn
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn; Section of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
| | - Anthi Lavida
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn; Department of Vascular Surgery, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - M G Myriam Hunink
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Health Policy & Management, Harvard School of Public Health, Boston, Mass
| | - Frans L Moll
- Section of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
| | - George Geroulakos
- Department of Vascular Surgery, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - Bart E Muhs
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn
| | - Bauer E Sumpio
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn.
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Abdulrahman A, Shabkah A, Hassanain M, Aljiffry M. Ruptured spontaneous splenic artery aneurysm: A case report and review of the literature. Int J Surg Case Rep 2014; 5:754-7. [PMID: 25240215 PMCID: PMC4189090 DOI: 10.1016/j.ijscr.2014.08.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/07/2014] [Accepted: 08/24/2014] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Splenic artery aneurysm is a rare condition, however, potentially fatal. The importance of splenic artery aneurysm lies in the risk for rupture and life threatening hemorrhage. PRESENTATION OF CASE This is a case of a ruptured splenic artery aneurysm in a 58-year-old lady. She presented with hypovolemic shock and intra-peritoneal bleeding. Diagnosis was confirmed by CT angiography and she was managed by operative ligation of the aneurysm with splenectomy and distal pancreatectomy. DISCUSSION The literature pointed the presence of some risk factors correlating to the development of splenic artery aneurysm. In this article we discuss a rare case of spontaneous (idiopathic) splenic artery aneurysm and review the literature of this challenging surgical condition. CONCLUSION Splenic artery aneurysm needs prompt diagnosis and management to achieve a favorable outcome, high index of suspicion is needed to make the diagnosis in the absence of known risk factors.
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Affiliation(s)
- Aisha Abdulrahman
- Department of Surgery, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Alaa Shabkah
- Department of Surgery, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mazen Hassanain
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Murad Aljiffry
- Department of Surgery, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
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Alabousi A, Patlas MN, Scaglione M, Romano L, Soto JA. Cross-Sectional Imaging of Nontraumatic Emergencies of the Spleen. Curr Probl Diagn Radiol 2014; 43:254-67. [DOI: 10.1067/j.cpradiol.2014.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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