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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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Sebai A, Elaifia R, Atri S, Hammami Y, Haddad A, Kacem JM. Surgical management of a proximal splenic artery aneurysm: A case report. Int J Surg Case Rep 2024; 117:109499. [PMID: 38492317 PMCID: PMC10958614 DOI: 10.1016/j.ijscr.2024.109499] [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: 01/31/2024] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 03/18/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Splenic artery aneurysms (SAA's) pose a rare yet clinically significant challenge, characterized by the weakening and ballooning of the splenic artery, potentially leading to severe complications such as rupture and hemorrhage. CASE PRESENTATION A 52-year-old female presenting with biliary colic. Diagnostic imaging revealed a saccular lesion closely associated with gallstones. A multidisciplinary approach guided the decision for surgery due to the size and location of the aneurysm. A bi sub costal laparotomy was performed, after the resection of the aneurysm, an arterial anastomosis with pds 5/0 suture was performed. CLINICAL DISCUSSION SAA's treatment modalities are tailored based on aneurysm localization and size. Imaging modalities such as Doppler ultrasound and CT angiography play a crucial role in accurate diagnosis, providing essential information for treatment planning. Treatment options include endovascular embolization, and surgical intervention. Traditionally open surgical techniques, including ligation of the splenic artery, aneurysmectomy, and splenectomy. Surgical treatment, especially for proximal aneurysms, is highlighted, with the presented alternative approach of resection with end-to-end anastomosis, showcasing an alternative surgical technique aimed at reducing the risk of spleen infarction. CONCLUSION SAA's are a rarity that emphasizes the need for early detection and intervention. We are urged to maintain a high index of suspicion, particularly in high-risk individuals. We report an alternative surgical technique that we hope will contributes to the expanding repertoire of approaches, calling for further research to optimize SAA management strategies in the quest for improved patient outcomes.
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Affiliation(s)
- A Sebai
- Department of Surgery A La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - R Elaifia
- Department of Surgery A La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - S Atri
- Department of Surgery A La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Y Hammami
- Department of Surgery A La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - A Haddad
- Department of Surgery A La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - J M Kacem
- Department of Surgery A La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
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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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Vemireddy LP, Majlesi D, Prasad S, Tahir N, Parkash O, Jeelani HM, Shayuk M. Early Thrombosis of Splenic Artery Stent Graft. Cureus 2021; 13:e16285. [PMID: 34381645 PMCID: PMC8349697 DOI: 10.7759/cureus.16285] [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] [Accepted: 07/08/2021] [Indexed: 11/30/2022] Open
Abstract
Splenic artery aneurysms (SAAs) are among the most common visceral aneurysms behind aortic and iliac arteries. Certain factors like aneurysm size (especially giant SAAs), hypertension (HTN), symptomatology, pregnancy, portal hypertension (pHTN), and liver transplantation increase the risk of rupture. Most often found incidentally, but when symptomatic, can present with nonspecific symptoms like nausea, vomiting, anorexia, and epigastric/left upper quadrant pain. Diagnosis can be accomplished with different modalities of CT or MRI and digital subtraction angiography (DSA) being the gold standard for diagnosis. Treatment is usually preferred for aneurysms >2 cm, symptomatic cases, and pregnant women. Various surgical/interventional procedures can be performed and selected based on the patient’s sex, age, location of the aneurysm, size of the aneurysm, and presenting complaints/complications. Endovascular techniques with or without stent-graft placement are being used more, given the minimally invasive nature of these procedures. No clear guidelines exist on initiation of dual antiplatelet therapy (DAPT), but based on guidelines from visceral arterial stenting (especially iliac arteries and renal arteries), multiple case reports/series on SAAs, we highly recommend the usage of DAPT pre- and post-stent-graft placement to improve patency.
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Affiliation(s)
| | | | - Sonika Prasad
- Internal Medicine, Chicago Medical School, McHenry, USA
| | - Nayha Tahir
- Internal Medicine, Northwestern Medicine McHenry Hospital, McHenry, USA
| | - Om Parkash
- Internal Medicine, Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, USA
| | | | - Maryna Shayuk
- Internal Medicine, Chicago Medical School Internal Medicine Residency Program at Northwestern Medicine McHenry Hospital, McHenry, USA
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Fatal rupture of giant splenic artery pseudoaneurysm. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Nasser HA, Kansoun AH, Sleiman YA, Mendes VM, Van Vyve E, Kachi A, Berjawi T, Hamdan WS, El Nakadi I. Different laparoscopic treatment modalities for splenic artery aneurysms: about 3 cases with review of the literature. Acta Chir Belg 2018; 118:212-218. [PMID: 29631508 DOI: 10.1080/00015458.2018.1459363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The first laparoscopic treatment of splenic artery aneurysm (SAA) was performed in 1993. Since then, many papers have been published mentioning different laparoscopic treatment modalities, including splenectomy, aneurysmectomy, ligation or even occlusion. PATIENTS AND METHODS An updated literature review of the English medical literature using the following MeSH, 'Lapaorscopic splenic artery aneurysm', 'laparoscopic aneurysectomy', 'Laparoscopic Splenic artery Aneurysm Ligation' and 'Laparoscopic Splenic artery aneurysm excision' was done. Also three cases performed at our institutions are discussed, in terms of techniques, morbidity, mortality and postoperative outcomes. RESULTS About eight case series and 16 case reports were retrieved from the literature. Different techniques were described by the authors, including splenectomy, aneurysmectomy, splenic aneurysm ligation or even occlusion. Few morbidity cases were reported and none of the authors has mentioned a single mortality case. In our three cases, the postoperative course was uneventful, with good long-term results. CONCLUSIONS Despite the variations in the adopted operative techniques, the laparoscopic approach seems to be harmless. However, no treatment algorithm or consensus has been published.
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Affiliation(s)
- Haydar A. Nasser
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
- Department of General and Digestive Surgery, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Alaa H. Kansoun
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
| | - Youssef A. Sleiman
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
| | - Vanessa Marron Mendes
- Department of General and Digestive Surgery, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Etienne Van Vyve
- Department of General and Digestive Surgery, Clinique Saint-Jean, Brussels, Belgium
| | - Antoine Kachi
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
| | - Tarek Berjawi
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
| | - Wajdi S. Hamdan
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
| | - Issam El Nakadi
- Department of General and Digestive Surgery, Université Libre de Bruxelles (ULB), Brussels, Belgium
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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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Abstract
BACKGROUND Pseudoaneurysm of the aortic arch is uncommonly associated with cancer, and is extremely rare in pulmonary cancer. Here, we report an unusual and successfully treated case of aortic arch pseudoaneurysm in a male patient with lung squamous cell carcinoma. METHODS A 64-year-old male patient was admitted to the Emergency Department, presenting with massive hemoptysis (>500 mL blood during the 12 hours prior to treatment). The diagnosis of aortic arch pseudoaneurysm was confirmed after inspection of computed tomographic angiography and three-dimensional reconstruction. We processed the immediate endovascular stent-grafting for this patient. RESULTS This patient recovered with no filling or enlargement of the pseudoaneurysm, no episodes of hemoptysis, and no neurological complications during the 4-week follow-up period. CONCLUSION Herein, we compare our case with other cancer-related pseudoaneurysms in the medical literature and summarize the clinical features and treatment of this unusual case.
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Affiliation(s)
- Yuan-Qiang Lu
- Department of Emergency Medicine, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
- Correspondence: Yuan-Qiang Lu, Department of Emergency Medicine, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, People's Republic of China (e-mail: or )
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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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