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Shu K, Shao J, Lai Z, Han X, Li K, Xie Y, Kong D, Xu L, Chen J, Feng Y, Wang Y, Liu X, Liu B. Treatment strategy for splenic artery aneurysms and novel classification based on imaging. J Vasc Surg 2024; 80:838-846.e1. [PMID: 38768832 DOI: 10.1016/j.jvs.2024.05.030] [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: 03/22/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE The incidence of splenic artery aneurysms (SAAs) has increased with advances in imaging techniques, necessitating a comprehensive classification to guide treatment strategies. This study aims to propose a novel classification system for SAAs based on aneurysm characteristics and to review treatment outcomes at our center. METHODS This retrospective study included 113 patients with SAAs admitted to Peking Union Medical College Hospital from January 2019 to December 2023, assessed using computed tomography angiography or digital subtraction angiography. A new classification system was devised based on the aneurysm location, morphology, integrity, and parent artery anatomy. Treatment strategies were determined based on these characteristics, with interventions ranging from endovascular therapy to laparoscopic and open surgery. Patients were followed up after the intervention to assess mortality, complications, reinterventions, and aneurysm-related outcomes. RESULTS The study cohort of 113 patients with 127 SAAs had a predominance of female patients (63.7%) and a mean age of 52.7 years. The SAAs were classified into five types, with type I being the most common. The intervention techniques varied across types, with sac embolization, covered stent implantation, and artery embolization being the most frequently used. The overall technical success rate was 94.7%, with perioperative complication and reintervention rates of 25.0% and 0.9%, respectively, and no deaths within 30 days after the intervention. The median follow-up duration was 21 months, with overall complications rate of 3.5% and no aneurysm-related complications or deaths. CONCLUSIONS The proposed classification system effectively guides the selection of treatment strategies for SAAs, incorporating key anatomical and morphological features. This system facilitated high technical success and low complication rates, underscoring the importance of tailored techniques in managing SAAs.
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Affiliation(s)
- Keqiang Shu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhichao Lai
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xianlin Han
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kang Li
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yiyun Xie
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Deqiang Kong
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Leyin Xu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Junye Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Yuyao Feng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuru Wang
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaolong Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Borghese O, Pisani A, Luparelli A, Sica S, Minelli F, Donati T, Tshomba Y. Endovascular Stent-Graft Repair of True and False Aneurysms of the Splenic Artery. J Clin Med 2024; 13:2802. [PMID: 38792344 PMCID: PMC11122477 DOI: 10.3390/jcm13102802] [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: 03/29/2024] [Revised: 04/29/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVE In treatment of aneurysms (SAAs) and pseudoaneurysms (SAPs) of the splenic artery, endovascular coil embolization is the approach most commonly used as it is minimally invasive and safe. However, it carries a significant rate of primary failure (up to 30%) and might be complicated by splenic infarction. The use of stent grafts might represent a valuable alternative when specific anatomical criteria are respected. We report a comprehensive review on technical and clinical outcomes achieved in this setting. Methods: We performed a comprehensive review of the literature through the MedLine and Cochrane databases (from January 2000 to December 2023) on reported cases of stenting for SAAs and SAPs. Outcomes of interest were clinical and technical success and related complications. The durability of the procedure in the long-term was also investigated. Results: Eighteen papers were included in the analysis, totalling 41 patients (n = 20 male 48.8%, mean age 55.5, range 32-82 years; n = 31, 75.6% SAAs). Mean aneurysm diameter in non-ruptured cases was 35 mm (range 20-67 mm), and most lesions were detected at the proximal third of the splenic artery. Stent grafting was performed in an emergent setting in n = 10 (24.3%) cases, achieving immediate clinical and technical success rate in 90.2% (n = 37) of patients regardless of the type of stent-graft used. There were no procedure-related deaths, but one patient died in-hospital from septic shock and n = 2 (4.9%) patients experienced splenic infarction. At the last available follow-up, the complete exclusion of the aneurysm was confirmed in 87.8% of cases (n = 36/41), while no cases of aneurysm growing nor endoleak were reported. None of the patients required re-intervention during follow-up. Conclusions: When specific anatomical criteria are respected, endovascular repair of SAAs and SAAPs using stent grafts appears to be safe and effective, and seems to display a potential advantage in respect to simple coil embolization, preserving the patient from the risk of end-organ ischemia.
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Affiliation(s)
- Ottavia Borghese
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Rome, Italy; (A.L.); (S.S.); (F.M.); (T.D.)
| | - Angelo Pisani
- Post Doctoral School Angio-Cardio-Thoracic Pathophysiology and Imaging, Sapienza University, 00185 Rome, Italy;
| | - Antonio Luparelli
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Rome, Italy; (A.L.); (S.S.); (F.M.); (T.D.)
- Unit of Vascular Surgery, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Gemelli IRCCS-Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Rome, Italy
| | - Simona Sica
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Rome, Italy; (A.L.); (S.S.); (F.M.); (T.D.)
- Unit of Vascular Surgery, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Gemelli IRCCS-Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Rome, Italy
| | - Fabrizio Minelli
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Rome, Italy; (A.L.); (S.S.); (F.M.); (T.D.)
- Unit of Vascular Surgery, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Gemelli IRCCS-Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Rome, Italy
| | - Tommaso Donati
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Rome, Italy; (A.L.); (S.S.); (F.M.); (T.D.)
| | - Yamume Tshomba
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Rome, Italy; (A.L.); (S.S.); (F.M.); (T.D.)
- Unit of Vascular Surgery, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Gemelli IRCCS-Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Rome, Italy
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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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Pratesi C, Esposito D, Martini R, Novali C, Zaninelli A, Annese AL, Baggi P, Bellosta R, Bianchini Massoni C, Bonardelli S, Carriero S, Cervelli R, Chisci E, Cioni R, Corvino F, DE Cobelli F, Fanelli F, Fargion AT, Femia M, Freyrie A, Gaggiano A, Gallitto E, Gennai S, Giampalma E, Giurazza F, Grego F, Guazzarotti G, Ierardi AM, Kahlberg AL, Mascia D, Mezzetto L, Michelagnoli S, Nardelli F, Niola R, Lenti M, Perrone O, Piacentino F, Piffaretti G, Pulli R, Puntel G, Puppini G, Rossato D, Rossi M, Silingardi R, Sirignano P, Squizzato F, Tipaldi MA, Venturini M, Veraldi GF, Vizzuso A, Allievi S, Attisani L, Fino G, Ghirardini F, Manzo P, Migliari M, Steidler S, Miele V, Taurino M, Orso M, Cariati M. Guidelines on the diagnosis, treatment and management of visceral and renal arteries aneurysms: a joint assessment by the Italian Societies of Vascular and Endovascular Surgery (SICVE) and Medical and Interventional Radiology (SIRM). THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:49-63. [PMID: 38037721 DOI: 10.23736/s0021-9509.23.12809-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
The objective of these Guidelines is to provide recommendations for the classification, indication, treatment and management of patients suffering from aneurysmal pathology of the visceral and renal arteries. The methodology applied was the GRADE-SIGN version, and followed the instructions of the AGREE quality of reporting checklist. Clinical questions, structured according to the PICO (Population, Intervention, Comparator, Outcome) model, were formulated, and systematic literature reviews were carried out according to them. Selected articles were evaluated through specific methodological checklists. Considered Judgments were compiled for each clinical question in which the characteristics of the body of available evidence were evaluated in order to establish recommendations. Overall, 79 clinical practice recommendations were proposed. Indications for treatment and therapeutic options were discussed for each arterial district, as well as follow-up and medical management, in both candidate patients for conservative therapy and patients who underwent treatment. The recommendations provided by these guidelines simplify and improve decision-making processes and diagnostic-therapeutic pathways of patients with visceral and renal arteries aneurysms. Their widespread use is recommended.
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Affiliation(s)
- Carlo Pratesi
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Davide Esposito
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy -
| | - Romeo Martini
- Department of Angiology, San Martino Hospital, Belluno, Italy
| | - Claudio Novali
- Department of Vascular Surgery, GVM Maria Pia Hospital, Turin, Italy
| | | | - Antonio L Annese
- Department of Diagnostic and Interventional Radiology, Careggi University Hospital, Florence, Italy
| | - Paolo Baggi
- Department of Vascular Surgery, ASST Spedali Civili, Brescia, Italy
| | - Raffaello Bellosta
- Department of Vascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | | | | | - Serena Carriero
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosa Cervelli
- Department of Diagnostic and Interventional Radiology, A.O.U. Pisana, Pisa, Italy
| | - Emiliano Chisci
- Department of Vascular Surgery, S. Giovanni di Dio Hospital, Florence, Italy
| | - Roberto Cioni
- Department of Diagnostic and Interventional Radiology, A.O.U. Pisana, Pisa, Italy
| | - Fabio Corvino
- Department of Diagnostic and Interventional Radiology, AORN Cardarelli, Naples, Italy
| | - Francesco DE Cobelli
- Department of Diagnostic and Interventional Radiology, San Raffaele Hospital, Milan, Italy
| | - Fabrizio Fanelli
- Department of Diagnostic and Interventional Radiology, Careggi University Hospital, Florence, Italy
| | - Aaron T Fargion
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Marco Femia
- Department of Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Antonio Freyrie
- Department of Vascular Surgery, University Hospital of Parma, Parma, Italy
| | - Andrea Gaggiano
- Department of Vascular Surgery, Umberto I Mauriziano Hospital, Turin, Italy
| | - Enrico Gallitto
- Department of Vascular Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Stefano Gennai
- Department of Vascular Surgery, Baggiovara Hospital, Modena, Italy
| | - Emanuela Giampalma
- Department of Diagnostic and Interventional Radiology, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Francesco Giurazza
- Department of Diagnostic and Interventional Radiology, AORN Cardarelli, Naples, Italy
| | - Franco Grego
- Department of Vascular Surgery, University Hospital of Padua, Padua, Italy
| | - Giorgia Guazzarotti
- Department of Diagnostic and Interventional Radiology, San Raffaele Hospital, Milan, Italy
| | - Anna M Ierardi
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Daniele Mascia
- Department of Vascular Surgery, San Raffaele Hospital, Milan, Italy
| | - Luca Mezzetto
- Department of Vascular Surgery, University Hospital of Verona, Verona, Italy
| | | | - Floriana Nardelli
- Department of Diagnostic and Interventional Radiology, Città della Salute e della Scienza, Turin, Italy
| | - Raffaella Niola
- Department of Diagnostic and Interventional Radiology, AORN Cardarelli, Naples, Italy
| | - Massimo Lenti
- Department of Vascular Surgery, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Orsola Perrone
- Department of Diagnostic and Interventional Radiology, A.O.U. Pisana, Pisa, Italy
| | - Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Varese, Italy
| | | | - Raffaele Pulli
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Gino Puntel
- Department of Diagnostic and Interventional Radiology, University Hospital of Verona, Verona, Italy
| | - Giovanni Puppini
- Department of Diagnostic and Interventional Radiology, University Hospital of Verona, Verona, Italy
| | - Denis Rossato
- Department of Diagnostic and Interventional Radiology, Città della Salute e della Scienza, Turin, Italy
| | - Michele Rossi
- Department of Diagnostic and Interventional Radiology, Sant'Andrea University Hospital, Rome, Italy
| | | | | | | | - Marcello A Tipaldi
- Department of Diagnostic and Interventional Radiology, Sant'Andrea University Hospital, Rome, Italy
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Varese, Italy
| | - Gian F Veraldi
- Department of Vascular Surgery, University Hospital of Verona, Verona, Italy
| | - Antonio Vizzuso
- Department of Diagnostic and Interventional Radiology, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Sara Allievi
- Department of Vascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Luca Attisani
- Department of Vascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Gianluigi Fino
- Department of Vascular Surgery, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | - Paola Manzo
- Department of Vascular Surgery, Umberto I Mauriziano Hospital, Turin, Italy
| | - Mattia Migliari
- Department of Vascular Surgery, Baggiovara Hospital, Modena, Italy
| | - Stephanie Steidler
- Department of Diagnostic and Interventional Radiology, San Raffaele Hospital, Milan, Italy
| | - Vittorio Miele
- Department of Diagnostic and Interventional Radiology, Careggi University Hospital, Florence, Italy
| | - Maurizio Taurino
- Department of Vascular Surgery, Sant'Andrea University Hospital, Rome, Italy
| | - Massimiliano Orso
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
| | - Maurizio Cariati
- Department of Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, Milan, Italy
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Fang G, Lu Y, Zou L, Wang Y, Fu W, Dong Z. Endovascular Strategies and Outcomes for Aberrant Splenic Artery Aneurysms. J Endovasc Ther 2024:15266028231224165. [PMID: 38197227 DOI: 10.1177/15266028231224165] [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: 01/11/2024]
Abstract
OBJECTIVES Aberrant splenic artery aneurysms (ASAAs) located at the splenomesenteric trunk (SMT) and the celiacomesenteric trunk have a close anatomical relationship with the superior mesenteric artery (SMA). The aim of this study was to review our institutional experience of endovascular treatment for ASAAs and evaluate the long-term outcomes. METHODS A retrospective review of patients with ASAAs who underwent endovascular treatment between December 2006 and December 2022 was performed. The demographics of the patients, aneurysm characteristics, treatment strategies, perioperative and long-term outcomes, and complications were analyzed. RESULTS A total of 29 patients with ASAAs were endovascularly treated at our institution. The SMT variant occurred in the majority of the patients. All ASAAs were characterized by eccentric growth and extremely short inflow arteries. Only 1 patient's inflow artery of the aneurysm exceeded 1 cm in length. Thirteen patients were treated by coil embolization alone. Four patients received bare stent-assisted coil embolization. A combination of coil embolization and covered stent placement across the orifice of the aberrant splenic artery was performed in the remaining 12 cases. Coil migration into the SMA occurred in 2 patients during the operation. Technical success was achieved in all patients. With a median duration of 63 (34-101) months of follow-up, no intestinal ischemia, aneurysm-related death, aneurysm rupture, or sac enlargement occurred. Three cases of aneurysm sac reperfusion were observed, and 1 patient underwent reintervention with secondary embolization. Asymptomatic occlusion of the covered stent was detected in 1 patient at 2 years. CONCLUSIONS Endovascular treatment is a safe, effective, and durable option for ASAAs. Inflow embolization might be difficult to achieve in ASAAs and poses a high risk of coil migration into the SMA. Long-term observation indicates that reasonable use of the covered stent could achieve reliable inflow artery exclusion in ASAAs without intestinal complications. CLINICAL IMPACT Aberrant splenic artery aneurysm (ASAA) is an extremely rare entity. This study reported a large sample size of ASAAs treated by endovascular techniques with long-term follow-up. The ASAA was characterized by an extremely short inflow artery and a close anatomical relationship with the superior mesenteric artery (SMA). Endovascular treatment is a safe, effective, and durable option for ASAAs. Inflow embolization might be difficult to achieve in ASAAs and pose a high risk of coil migration into the SMA. Long-term observation indicates that reasonable use of the covered stent could achieve reliable inflow artery exclusion in ASAAs without intestinal complications.
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Affiliation(s)
- Gang Fang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Vascular Surgery, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yige Lu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Vascular Surgery, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Lingwei Zou
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Vascular Surgery, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yuning Wang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Vascular Surgery, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Vascular Surgery, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhihui Dong
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Vascular Surgery, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
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Kuwada N, Akagi D, Watanabe Y, Kanaoka Y, Tanemoto K. Endovascular Stent Graft Placement and Coil Embolization for Splenic Artery Aneurysm with an Anatomical Variant. Int J Angiol 2023; 32:273-276. [PMID: 37927835 PMCID: PMC10624522 DOI: 10.1055/s-0042-1742588] [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: 10/19/2022] Open
Abstract
A 62-year-old woman with abdominal pain was diagnosed with a splenic artery aneurysm (SAA) and an anatomical variant in the splenic artery (SA) arising from the superior mesenteric artery (SMA) as its first branch. To treat the SAA, the draining artery and a small branch of the SAA were embolized, and then small-diameter stent grafts were deployed from SMA orifice, covering the aberrant origin of the SA and preserving the second branch of SMA. Intraoperative angiography confirmed successful exclusion of the SAA without endoleak or arterial dissection. The stent graft was patent and the aneurysm had shrunk 3.5 years after the operation.
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Affiliation(s)
- Noriaki Kuwada
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Daisuke Akagi
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yoshiko Watanabe
- First Department of Physiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yuji Kanaoka
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
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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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8
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Cao Y, Song S, Ouyang T, Zheng C. Single-Center Experience With Endovascular Treatment for Splenic Artery Aneurysms in Long-Term Follow-Up: A Retrospective Study. Front Cardiovasc Med 2022; 8:793053. [PMID: 35155605 PMCID: PMC8831690 DOI: 10.3389/fcvm.2021.793053] [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: 10/11/2021] [Accepted: 12/24/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives To reveal a single-center experience with endovascular treatment for splenic artery aneurysm (SAA) and analyze the safety and efficacy of the operation in the long-term follow-up. Materials and Methods A total of 49 patients with SAAs (21 men, 28 women; mean age, 52.4 ± 11.5 years) were enrolled in this study from July 2010 to December 2020. Baseline and characteristics of SAAs were collected. Parent artery coil embolization or combined with sac coil embolization of SAAs, graft-stent implantation, or bare-stent-assisted coil embolization were performed for the treatment of SAAs. Adverse events and follow-up data were recorded. Results The average diameter of SAAs was 3.3 ± 2.5 cm (range, 1.0–13.6 cm). An individual-tailed modality was conducted for three patients. A 100% technical success rate was achieved. No re-intervention procedure was performed in all patients. No major treatment-related adverse events were observed, and no expansion or rupture of SAAs occurred in the average follow-up period of 57.9 ± 27.3 months (19–125 months). Conclusion Endovascular treatment of SAA, including the individual-tailed therapy for three cases, is safe, effective, and minimally invasive with high technical success rates and satisfactory outcomes during the long-term follow-up period.
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Affiliation(s)
- Yanyan Cao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Songlin Song
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Tao Ouyang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- *Correspondence: Chuansheng Zheng
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9
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Saito K, Yamagata Y, Hakozaki Y, Nakata M, Oya M. Early gastric cancer with splenic artery aneurysm successfully treated with laparoscopic distal gastrectomy after endovascular coil embolization: A case report. Asian J Endosc Surg 2021; 14:590-593. [PMID: 33319465 DOI: 10.1111/ases.12905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/19/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022]
Abstract
Splenic artery aneurysm (SAA) is a relatively rare disease. Most patients with SAA have no symptoms, and detection is incidental detection. The incidence of rupture is not particularly high, but the mortality rate of ruptured SAAs is high. The main treatment for gastric cancer is gastrectomy with lymph node dissection, with dissection around the celiac artery suggested to be the most important. A 68-year-old woman with early gastric cancer in the lesser curvature of the lower gastric corpus was referred to our hospital. CT showed no remarkable findings except for a saccular SAA (diameter, 1.5 cm). We planned laparoscopic distal gastrectomy. However, because the SAA was close to the surgical field and its saccular shape created a rupture risk, we performed interventional radiology for SAA before surgery. One month later, laparoscopic distal gastrectomy with D1+ was performed successfully. The patient has remained disease-free in the 51 months since the operation.
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Affiliation(s)
- Kazuyuki Saito
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Yukinori Yamagata
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.,Department of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yuhei Hakozaki
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Manabu Nakata
- Department of Radiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Masatoshi Oya
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
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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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Wang W, Chang H, Liu B, Wang W, Yu Z, Chen C, Li Y, Wang Z, Wang Y. Long-term outcomes of elective transcatheter dense coil embolization for splenic artery aneurysms: a two-center experience. J Int Med Res 2019; 48:300060519873256. [PMID: 31510827 PMCID: PMC7262844 DOI: 10.1177/0300060519873256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objective This study was performed to analyze the long-term follow-up safety and efficacy of transcatheter dense coil embolization for splenic artery aneurysms. Methods Thirty-two patients (18 women, 14 men; age range, 23–56 years; mean age, 43.1 ± 13.6 years) who underwent dense coil embolization for treatment of splenic artery aneurysms from August 2010 to January 2018 were retrospectively reviewed. The size and location of the splenic artery aneurysms, the technical and clinical outcomes of the procedure, and the complications related to the procedure were reviewed. Results The technical success rate of embolization was 100% (mean aneurysm size, 29.4 ± 6.9 mm; range, 20–43 mm). Two (6.3%) patients underwent a successful repeat intervention procedure for recurrent aneurysm perfusion during follow-up (mean, 36 months; range, 6–72 months). No aneurysm ruptured during follow-up. Splenic infarction was observed in 8 of 32 (25%) patients. No patients developed major adverse events related to the procedure, such as splenic abscess or pancreatitis. Conclusions Percutaneous elective transcatheter dense coil embolization is safe and effective to prevent aneurysm rupture and overcome aneurysm recanalization during long-term follow-up.
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Affiliation(s)
- Wujie Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Haiyang Chang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Bin Liu
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Wei Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Zhe Yu
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Chao Chen
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Zhenting Wang
- Medical Imaging Institute of Shandong Province, Jinan City, Shandong Province, China
| | - Yongzheng Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
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12
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Lejay A, Kuntz S, Chakfé N. Born to be tortuous. J Vasc Surg 2019; 70:606. [PMID: 31345476 DOI: 10.1016/j.jvs.2019.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 02/15/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.
| | - Salome Kuntz
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Nabil Chakfé
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
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13
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Prette PR, Fagundes FB, Marchon LRC, Maciel RDRT, Martins IM, Riguetti-Pinto CR. Endovascular treatment of acute gastrointestinal bleeding from a large splenic artery pseudoaneurysm: case report and literature review. J Vasc Bras 2018; 17:234-242. [PMID: 30643510 PMCID: PMC6326128 DOI: 10.1590/1677-5449.005517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/19/2018] [Indexed: 11/22/2022] Open
Abstract
Pseudoaneurysm of the splenic artery is a rare entity, with little more than 150 cases described in the literature. Pancreatitis is the most common etiology, followed by trauma. In contrast with true aneurysms, pseudoaneurysms are frequently symptomatic, with a 47% risk of rupture and 90% mortality if left untreated. We describe the case of a 48-year-old female patient who suffered a gastrointestinal hemorrhage associated with acute-on-chronic pancreatitis. During workup, endoscopy revealed signs of recent bleeding and magnetic resonance angiography of the abdomen showed a large pseudoaneurysm of the splenic artery. The patient underwent endovascular treatment with microcoil embolization and no further bleeding episodes occurred. Endovascular treatment is now an effective option with low morbidity and mortality and success rates in the range of 79-100%, making it a viable technique for patients with active abdominal inflammation. We conducted a review of endovascular techniques and embolization agents used to treat this pathology.
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Affiliation(s)
- Paulo Roberto Prette
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
| | - Felipe Borges Fagundes
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
| | - Livia Ramos Carvalho Marchon
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
| | - Rodrigo de Rezende Teixeira Maciel
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
| | - Igor Miguel Martins
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
| | - Cristina Ribeiro Riguetti-Pinto
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
- Curso de Formação em Cirurgia Endovascular – Endocurso, Rio de Janeiro, RJ, Brasil.
- Vascularis Centro de Angiologia e Cirurgia Endovascular, Rio de Janeiro, RJ, Brasil.
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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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Tannoury J, Honein K, Abboud B. Splenic artery aneurysm presenting as a submucosal gastric lesion: A case report. World J Gastrointest Endosc 2016; 8:496-500. [PMID: 27499832 PMCID: PMC4959943 DOI: 10.4253/wjge.v8.i14.496] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/23/2016] [Accepted: 06/16/2016] [Indexed: 02/05/2023] Open
Abstract
We are reporting the rare case of splenic artery aneurysm of 4 cm of diameter presenting as a sub mucosal lesion on gastro-duodenal endoscopy. This aneurysm was treated by endovascular coil embolization and stent graft implantation. The procedure was uneventful. On day 1, the patient presented an acute severe epigastric pain and cardiovascular arrest. Abdominal computed tomography scan showed an active leak of the intravenous contrast dye in the peritoneum from the splenic aneurysm. We performed an emergent resection of the aneurysm, and peritoneal lavage. Postoperatively, hemorrhagic choc was refractory to large volumes replacement, and intravenous vaso-active drugs. On day 2, he presented massive hematochezia. We performed a total colectomy with splenectomy and cholecystectomy for ischemic colitis, with spleen and gallbladder infarction. Despite vaso-active drugs and aggressive treatment with Factor VIIa, the patient died after uncontrolled disseminated intravascular coagulation.
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