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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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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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Lozano Sánchez FS, García-Alonso J, Torres JA, Velasco L, Salvador R, Peña R, González-Porras JR. Decision-making and therapeutic options in intact splenic artery aneurysms: single-center experience and literature review. INT ANGIOL 2020; 39:241-251. [PMID: 32057214 DOI: 10.23736/s0392-9590.20.04304-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Splenic artery aneurysms are rare, potentially serious, and usually asymptomatic. Several methods are currently available to treat them, each with their own advantages and drawbacks. Therefore, its therapeutic paradigm has changed. METHODS We review our database of splenic aneurysms (2009-2019) and undertake an exhaustive literature review. Demographic, clinical, diagnostic, therapeutic, early and follow-up outcome data were examined. Our experience comprised: 15 patients with 19 splenic aneurysms. 11 women (average age, 59.4 years) and 4 men (average age, 61.7 years). All asymptomatic. RESULTS At diagnosis, aneurysms had a mean cross-sectional diameter of 3.4 cm (3.2 and 3.9 for women and men, respectively), the largest measuring 8.5 cm. Two independent aneurysms were detected in four patients. Diagnoses were always incidental to a CT scan. Treatments consisted of open surgery (2 patients), endovascular surgery (10 patients: 7 embolizations, 3 covered stent) and observation/follow-up (3 patients). The cases of open surgery (with splenectomy) were carried out without postoperative morbidity. One embolization failed (requiring subsequent open surgery) and two suffered localized splenic infarction, but without further complications. In patients treated with a covered stent, the aneurysm was always excluded, without complications. There was no 30-day or follow-up (average 26.2 months) mortality. Splenic aneurysms are diagnosed more frequently and earlier (in the asymptomatic phase), albeit incidentally, than in the past. CONCLUSIONS The correct indication (identifying patients at risk) and individualization of treatment, in which endovascular techniques are the first-line option, have significantly improved morbidity and mortality outcomes in our hospital.
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Affiliation(s)
- Francisco S Lozano Sánchez
- Unit of Angiology and Vascular Surgery, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain -
| | - Jesus García-Alonso
- Unit of Interventional Radiology, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain
| | - José A Torres
- Unit of Angiology and Vascular Surgery, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain
| | - Luis Velasco
- Unit of Interventional Radiology, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain
| | - Roberto Salvador
- Unit of Angiology and Vascular Surgery, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain
| | - Ruben Peña
- Unit of Angiology and Vascular Surgery, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain
| | - José R González-Porras
- Unit of Thromobosis and Hemostasis, Department of Hematology, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain
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Toyoda Y, Igami T, Ochiai Y, Ebata T, Yokoyama Y, Sugawara G, Mizuno T, Yamaguchi J, Nagino M. Single-Incision Laparoscopic Splenectomy for an Unruptured Aneurysm of the Splenic Artery. Med Princ Pract 2018; 27:95-98. [PMID: 29186719 PMCID: PMC5968289 DOI: 10.1159/000485836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 11/29/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We describe our experience of single-incision laparoscopic splenectomy (SILS) for an unruptured aneurysm of the splenic artery. CLINICAL PRESENTATION AND INTERVENTION A 73-year-old woman was diagnosed as having a splenic aneurysm which grew from 14 to 22 mm in diameter within 2 years. Due to a contrast agent allergy, transcatheter arterial embolization could not be performed; therefore, SILS was performed with a 4-cm Z-shaped incision. The operative time and intraoperative blood loss were 132 min and 27 mL, respectively. The patient was discharged 4 days after surgery. CONCLUSION In selected cases, SILS is a suitable and safe procedure for an unruptured aneurysm of the splenic artery.
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Affiliation(s)
| | - Tsuyoshi Igami
- *Tsuyoshi Igami, Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550 (Japan), E-Mail
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Toyoda Y, Kyokane T, Kawai T, Watanabe K, Koide F, Ochiai Y, Asai Y, Igami T, Kuze S. Laparoscopic surgery for the treatment of a ruptured aneurysm of the right gastric artery: a case report. Asian J Endosc Surg 2017; 10:70-74. [PMID: 27596384 DOI: 10.1111/ases.12323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/20/2016] [Accepted: 07/24/2016] [Indexed: 12/23/2022]
Abstract
Laparoscopic surgery for the treatment of a ruptured visceral artery aneurysm is recognized as a challenging procedure. Here, we describe our experience with laparoscopic surgery to treat a ruptured aneurysm of the right gastric artery. A 72-year-old woman was diagnosed with intra-abdominal hemorrhage caused by a ruptured aneurysm of the right gastric artery. Transcatheter arterial embolization failed because the right gastric artery could not be cannulated. Therefore, we performed laparoscopic surgery. Using laparoscopy, we detected that the bleeding from the aneurysm had ceased; thus, the planned procedure was successful. The operative time and intraoperative blood loss were 100 min and 5 mL, respectively. The patient was discharged 7 days after surgery. Laparoscopic surgery after the failure of transcatheter arterial embolization is a suitable and safe procedure for ruptured visceral artery aneurysms, provided the circulatory dynamics are stable as a result of the temporary cessation of bleeding from the ruptured aneurysm.
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Affiliation(s)
- Yoshitaka Toyoda
- Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan
| | - Takanori Kyokane
- Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan
| | - Toru Kawai
- Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan
| | | | - Fumihiko Koide
- Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan
| | - Yosuke Ochiai
- Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan
| | - Yuichi Asai
- Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan
| | - Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shingo Kuze
- Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan
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Wang CX, Guo SL, Han LN, Jie Y, Hu HD, Cheng JR, Yu M, Xiao YY, Yin T, Chu FT, Liang FQ. Computed Tomography Angiography in Diagnosis and Treatment of Splenic Artery Aneurysm. Chin Med J (Engl) 2017; 129:367-9. [PMID: 26831243 PMCID: PMC4799585 DOI: 10.4103/0366-6999.174506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | | | - Li-Na Han
- Department of Cardiovascular Internal Medicine, Nanlou Branch of Chinese PLA General Hospital, Beijing 100853, China
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Guang LJ, Wang JF, Wei BJ, Gao K, Huang Q, Zhai RY. Endovascular Treatment of Splenic Artery Aneurysm With a Stent-Graft: A Case Report. Medicine (Baltimore) 2015; 94:e2073. [PMID: 26717355 PMCID: PMC5291596 DOI: 10.1097/md.0000000000002073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Splenic artery aneurysm, one of the most common visceral aneurysms, accounts for 60% of all visceral aneurysm cases. Open surgery is the traditional treatment for splenic artery aneurysm but has the disadvantages of serious surgical injuries, a high risk of complications, and a high mortality rate.We report a case who was presented with splenic artery aneurysm. A 54-year-old woman complained of upper left abdominal pain for 6 months. An enhanced computed tomography scan of the upper abdomen indicated the presence of splenic artery aneurysm. The splenic artery aneurysm was located under digital subtraction angiography and a 6/60 mm stent graft was delivered and released to cover the aneurysm. An enhanced computed tomography scan showed that the splenic artery aneurysm remained well separated, the stent graft shape was normal, and the blood flow was unobstructed after 1 year.This case indicates a satisfactory efficacy proving the minimal invasiveness of stent graft exclusion treatment for splenic artery aneurysm.
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Affiliation(s)
- Li-Jun Guang
- From the Department of Interventional Radiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot (LG); and Department of Interventional Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (JW, BW, KG, QH, RZ)
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