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Zhang J, Ratner M, Harish KB, Speranza G, Hartwell CA, Rao A, Garg K, Maldonado T, Sadek M, Jacobowitz G, Rockman C. The natural history and long-term follow-up of splenic artery aneurysms. J Vasc Surg 2024; 79:801-807.e3. [PMID: 38081394 DOI: 10.1016/j.jvs.2023.11.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE Although splenic artery aneurysms (SAAs) are the most common visceral aneurysm, there is a paucity of literature on the behavior of these entities. The objective of this study was to review the natural history of patients with SAA. METHODS This single-institution, retrospective analysis studied patients with SAA diagnosed by computed tomography imaging between 2015 and 2019, identified by our institutional radiology database. Imaging, demographic, and clinical data were obtained via the electronic medical record. The growth rate was calculated for patients with radiologic follow-up. RESULTS The cohort consisted of 853 patients with 890 SAAs, of whom 692 were female (81.2%). There were 37 women (5.3%) of childbearing age (15-50 years). The mean age at diagnosis was 70.9 years (range: 28-100 years). Frequently observed medical comorbidities included hypertension (70.2%), hypercholesterolemia (54.7%), and prior smoking (32.2%). Imaging indications included abdominal pain (37.3%), unrelated follow-up (28.0%), and follow-up of a previously noted visceral artery aneurysm (8.6%). The mean diameter at diagnosis was 13.3 ± 6.3 mm. Anatomic locations included the splenic hilum (36.0%), distal splenic artery (30.3%), midsplenic artery (23.9%), and proximal splenic artery (9.7%). Radiographically, the majority were saccular aneurysms (72.4%) with calcifications (88.5%). One patient (38-year-old woman) was initially diagnosed at the time of rupture of a 25 mm aneurysm; this patient underwent immediate endovascular intervention with no complications. The mean clinical follow-up among 812 patients was 4.1 ± 4.0 years, and the mean radiological follow-up among 514 patients was 3.8 ± 6.8 years. Of the latter, 122 patients (23.7%) experienced growth. Aneurysm growth rates for initial sizes <10 mm (n = 123), 10 to 19 mm (n = 353), 20 to 29 mm (n = 34), and >30 mm (n = 4) were 0.166 mm/y, 0.172 mm/y, 0.383 mm/y, and 0.246 mm/y, respectively. Of the entire cohort, 27 patients (3.2%) eventually underwent intervention (81.5% endovascular), with the most common indications including size/growth criteria (70.4%) and symptom development (18.5%). On multivariate analysis, only prior tobacco use was significantly associated with aneurysm growth (P = .028). CONCLUSIONS The majority of SAAs in this cohort remained stable in size, with few patients requiring intervention over a mean follow-up of 4 years. Current guidelines recommending treatment of asymptomatic aneurysms >30 mm appear appropriate given their slow progression. Despite societal recommendations for intervention for all SAAs among women of childbearing age, only a minority underwent vascular surgical consultation and intervention in this series, indicating that these recommendations are likely not well known in the general medical community.
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Affiliation(s)
- Jason Zhang
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Molly Ratner
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Keerthi B Harish
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Giancarlo Speranza
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - C Austen Hartwell
- Department of Radiology, New York University Langone Medical Center, New York, NY
| | - Abhishek Rao
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Karan Garg
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Thomas Maldonado
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Mikel Sadek
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Glenn Jacobowitz
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Caron Rockman
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY.
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M Azmi N, Safri LS, Abdul Rahman N, Dualim DM, Chandrakanthan S. A Rare Incidence of Splenic Artery Aneurysm and Hypersplenism. Cureus 2024; 16:e54280. [PMID: 38371434 PMCID: PMC10870191 DOI: 10.7759/cureus.54280] [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] [Accepted: 02/16/2024] [Indexed: 02/20/2024] Open
Abstract
A 31-year-old woman with Child's B liver cirrhosis with portal hypertension and splenomegaly presented with a one-month history of abdominal pain. A physical examination confirmed splenomegaly. A blood investigation revealed a low white blood cell (WBC) and platelet count. Computed tomography (CT) revealed a splenic artery aneurysm at the distal splenic artery measuring 3.4 x 3.4 x 4.3 cm (AP x W x CC) with thrombus and splenic infarction. A successful angiographic embolisation was performed without immediate complications. The abdominal pain symptoms resolved, leading to the patient's discharge from the ward on the third day post-embolisation. Follow-up at the surgical outpatient clinic indicated the patient remained asymptomatic, and repeated blood counts showed improvement in both WBC and platelet counts. Furthermore, follow-up CT scans demonstrated a reduction in spleen size, indicating positive outcomes and a favourable response to the intervention.
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Affiliation(s)
- Nabil M Azmi
- Department of Surgery, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, MYS
| | - Lenny Suryani Safri
- Department of Surgery, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, MYS
| | | | - Diana Melissa Dualim
- Department of Surgery, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, MYS
| | - Soma Chandrakanthan
- Department of Surgery, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, MYS
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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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Phan D, Furtado R, Laurence JM, Pleass H. Splenic Artery Aneurysm Management in the Cirrhotic Patient Listed for Liver Transplantation: A Systematic Review. Transplant Proc 2022; 54:706-714. [PMID: 35272877 DOI: 10.1016/j.transproceed.2022.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/17/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Splenic artery aneurysms (SAA), although rare in the general population, occur more commonly in liver transplant candidates owing to cirrhosis-induced portal hypertension. In this population, particularly in the perioperative period, SAAs are at heightened risks of rupture with potentially fatal consequences. There is no consensus regarding optimal management of asymptomatic SAA diagnosed before liver transplantation. MATERIALS AND METHODS We performed a systematic review of the literature to investigate the management options and outcomes of asymptomatic SAAs in liver transplant candidates. The EMBASE and MEDLINE electronic databases were used to identify articles. RESULTS Eleven articles met the criteria for analysis and included 159 patients with SAAs, among whom 121 had asymptomatic aneurysms diagnosed pre transplant and subsequently underwent liver transplantation. The majority of SAAs were located distally or intrahilar (80%) and more than half of the patients had multiple SAAs. In 121 patients diagnosed pre transplant, 37 patients had treatment instigated (28 treated surgically and 8 treated radiologically). Post-transplant rupture was noted in 2 patients treated surgically (2/28) with no fatality. No rupture was observed in the radiologically treated group, although 1 patient died of splenic abscess and sepsis after embolization. In 86 untreated patients, 4 cases of post-transplant rupture were recorded (2/4 resulted in fatality). CONCLUSION Asymptomatic SAAs are at risks of rupture post transplant and treatment should be considered, regardless of aneurysm size. Both surgical and radiological treatments offer adequate control, and choice of treatment is dependent on location and number of SAA present.
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Affiliation(s)
- Du Phan
- Department of Surgery, Westmead Hospital, Sydney, Australia
| | - Ruelan Furtado
- Department of transplantation, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jerome M Laurence
- Department of Surgery, Westmead Hospital, Sydney, Australia; Department of transplantation, Royal Prince Alfred Hospital, Sydney, Australia; University of Sydney, Specialty of Surgery, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney, Australia
| | - Henry Pleass
- Department of Surgery, Westmead Hospital, Sydney, Australia; Department of transplantation, Royal Prince Alfred Hospital, Sydney, Australia; University of Sydney, Specialty of Surgery, Sydney, Australia.
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Northup PG, Garcia-Pagan JC, Garcia-Tsao G, Intagliata NM, Superina RA, Roberts LN, Lisman T, Valla DC. Vascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients With Liver Disease: 2020 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2021; 73:366-413. [PMID: 33219529 DOI: 10.1002/hep.31646] [Citation(s) in RCA: 267] [Impact Index Per Article: 89.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Patrick G Northup
- Division of Gastroenterology and Hepatology, Center for the Study of Hemostasis in Liver Disease, University of Virginia, Charlottesville, VA
| | - Juan Carlos Garcia-Pagan
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.,Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE-Liver), Barcelona, Spain
| | - Guadalupe Garcia-Tsao
- Department of Internal Medicine, Section of Digestive Diseases, Yale University, New Haven, CT.,Veterans Administration Healthcare System, West Haven, CT
| | - Nicolas M Intagliata
- Division of Gastroenterology and Hepatology, Center for the Study of Hemostasis in Liver Disease, University of Virginia, Charlottesville, VA
| | - Riccardo A Superina
- Department of Transplant Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Lara N Roberts
- Department of Haematological Medicine, King's Thrombosis Centre, King's College Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Ton Lisman
- Section of Hepatobiliary Surgery and Liver Transplantation, Surgical Research Laboratory, Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Dominique C Valla
- Hepatology Service, Hospital Beaujon, Clichy, France.,Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE-Liver), Barcelona, Spain
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Rocha MA, Marques ESS, Leão LRDS, Magdalena TRF, Dórea AA, Yamauchi FI, Wolosker N, Tachibana A. Prevalence, growth rate and complications of splenic artery aneurysms in chronic liver disease patients. VASA 2020; 50:139-144. [PMID: 33115387 DOI: 10.1024/0301-1526/a000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Chronic liver disease (CLD) patients are at greater risk for developing splenic artery aneurysm (SAA). Treatment for aneurysms > 2.5 cm in this population is considered. However, the procedure might be challenging in CLD patients, and complications may interfere in liver transplantation. We, therefore, sought to estimate the prevalence, growth rate and complications of SAA in patients with CLD. As secondary objective, we sought to evaluate whether those features differ in pre and post transplantation follow-up and among aneurysms with diameters greater or less than 2.5 cm at diagnosis. Patients and methods: We searched for the terms "SAA" and "CLD" on CT or MRI reports from January 2009 to December 2016. Patients with single examination or less than 6 months follow-up were excluded. Results: Fifty nine out of 2050 CLD patients presented SAA (prevalence of 2.9%). Fifteen patients were excluded (due to exclusion criteria). Forty-four CLD patients (mean age 55.9 years) presented 76 SAA (follow-up median of 27.2 months). Aneurysms presented mean size of 1.5 ± 0.74 cm at diagnosis and growth rate of 0.12 ± 0.14 cm/y. Two (4.5%) patients presented mild complications (aneurysm thrombosis). No significant differences were observed in the growth rates of aneurysms < 2.5 cm and ≥ 2.5 cm or in the initial size and growth rates of aneurysms of patients submitted to and not submitted to liver transplantation. Conclusions: The estimated prevalence of SAA in patients with DLC in the Brazilian population is 2.9% (CI95% 2.2-3.6%). Although SAA in CLD patients are less likely to remain stable and grow faster than in general population, aneurysms are usually diagnosed at smaller size and complications are rare. These findings might support conservative management with close surveillance, especially in smaller aneurysms.
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How to provide vascular control of splenic artery aneurysms? A case series. Ann Med Surg (Lond) 2020; 58:95-98. [PMID: 32953107 PMCID: PMC7486577 DOI: 10.1016/j.amsu.2020.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022] Open
Abstract
Background Spleen artery aneurysm represents the most common visceral aneurysm and the third most common splanchnic aneurysm. Most patients have no symptoms and are diagnosed as a part of other diagnostic focuses and examinations. Greater prevalence and application of modern diagnostic and imaging procedures has resulted in greater detection of this disease. Results We present two patients with splenic artery aneurysms localized in the splenic hilum, who auspiciously underwent laparoscopic splenectomies with the use of hem-o-lock clips in the vascular hilum without complications. Both postoperative courses were uneventful. At six months follow up, both patients are asymptomatic. Conclusion These two cases showed that in addition to the numerous advantages of minimally invasive approaches for treating splenic arterial aneurysms, there is a possibility to improve laparoscopic technique in terms of safety and economic reasons by using hem - o - lock clips as a hemostatic technique for the vascular elements of the spleen hilum. Spleen artery aneurysm represents the most common visceral aneurysm. We present 2 patients with splenic artery aneurysms localized in the splenic hilum. Hem-o-lock clips can be safely used to secure the splenic hilium.
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Leung E, Maingard J, Yeh J, Lee MJ, Brooks DM, Asadi H, Burrows DA, Kok HK. Contemporary endovascular management of splenic vascular pathologies. Clin Radiol 2020; 75:960.e23-960.e34. [PMID: 32819705 DOI: 10.1016/j.crad.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
Abstract
The spleen is a commonly injured organ and the splenic vasculature is also susceptible to inflammation and trauma, often resulting in aneurysm formation. Splenic artery aneurysms carry a high risk of rupture and are associated with high mortality and morbidity. Due to the advances in endovascular techniques and devices, endovascular management of splenic vascular pathologies is now considered a first-line strategy. Endovascular embolisation and advance techniques including balloon- or stent-assisted coil embolisation enables minimally invasive management option while preserving splenic function.
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Affiliation(s)
- E Leung
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia.
| | - J Maingard
- Interventional Neuroradiology Service - Monash Imaging, Monash Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - J Yeh
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia
| | - M J Lee
- Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D M Brooks
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia; Interventional Neuroradiology Service - Radiology Department, Austin Hospital, Melbourne, Australia
| | - H Asadi
- Interventional Neuroradiology Service - Monash Imaging, Monash Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia; Interventional Neuroradiology Service - Radiology Department, Austin Hospital, Melbourne, Australia
| | - D A Burrows
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia
| | - H K Kok
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
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