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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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Wang T, Wang J, Zhao J, Yuan D, Huang B. Endovascular Treatment of Aberrant Splenic Artery Aneurysm Presenting With Painless Progressive Jaundice: A Case Report and Literature Review. Vasc Endovascular Surg 2021; 55:756-760. [PMID: 33759651 DOI: 10.1177/15385744211005296] [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: 02/05/2023]
Abstract
Splenic artery (SA) originating from the superior mesenteric artery is a rare condition, and aneurysms in relation to this aberrant SA are even rarer. We reported the case of a 67-year-old female who presented with painless progressive jaundice for 2 months accompanied by thrombocytopenia and liver dysfunction. The computed tomographic angiography (CTA) showed an aberrant SAA located behind the pancreatic head along with the dilation of common bile duct. Stent-graft deployment in SMA and coil embolization of the aneurysm were performed. Her liver dysfunction and thrombocytopenia improved postoperatively. CTA at 2-year follow-up showed patency of stent-graft and SMA and the shrinkage of the excluded aneurysm sac. Considering the particular location of the aneurysm, painless progressive jaundice can be the initial symptom for the aberrant SAAs. This combined endovascular technique completely excluded the aneurysm and was beneficial for treating secondary liver dysfunction and thrombocytopenia.
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Affiliation(s)
- Tiehao Wang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jiarong Wang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Ding Yuan
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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Kakamad FH, Hammood ZD, Salih AM, Abdalla BY, Mohammed KS, Karim SO, Hamasalih HM, Salih RQ, Mohammed SH, Qadr OO, Sofi Mohammed HA, Hussein SI, Anwar SB, Abulkarim UY. Aneurysm of anomalous splenic artery arising from a splenomesenteric trunk: Review of the literature with a report of a new case. Int J Surg Case Rep 2021; 80:105618. [PMID: 33592420 PMCID: PMC7893412 DOI: 10.1016/j.ijscr.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Aneurysm of splenic artery arising from splenomesentric trunk is an extremely rare condition. The aim of this study is to report a new case with literature review. PRESENTATION OF CASE A 52-year-old housewife presented with mild central abdominal pain for two month duration. Abdomen was soft. Abdominal ultrasound examination showed a focal aneurysmal dilatation in the splenic artery (SA) near the portal vein. Abdominal computed tomographic angiography (CTA) revealed presence of the splenomesentric trunk with fusiform aneurysm (45 × 33 mm) of the proximal part of the SA. In supine position, through upper midline laparotomy incision, exploration of both superior mesenteric artery (SMA) and SA was performed, total excision of the aneurysm was done, the SMA was side-repaired and SA was ligated. The post-operative period was uneventful. DISCUSSION It is interesting to note that orthotopic SA aneurysms, most commonly present in the distal third of the artery, followed by the middle third, while in cases of splenomesentric trunk, all reported cases of anomalous SA aneurysms including the current one, showed the aneurysms to be located in the proximal portion or root of the SA. CONCLUSION Splenomesentric trunk is a rare anatomical anomaly, aneurysm of which is even rarer. It can be managed either by endovascular intervention or open surgery.
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Affiliation(s)
- Fahmi H Kakamad
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq; Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq.
| | - Zuhair D Hammood
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Abdulwahid M Salih
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq; Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
| | - Bzhwen Y Abdalla
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Shar Hospital, Sulaimani, Kurdistan, Iraq
| | - Karzan S Mohammed
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Shar Hospital, Sulaimani, Kurdistan, Iraq
| | - Sanaa O Karim
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; College of Nursing, University of Sulaimani, Sulaimani, Kurdistan, Iraq
| | - Hussein M Hamasalih
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; College of Nursing, University of Sulaimani, Sulaimani, Kurdistan, Iraq
| | - Rawezh Q Salih
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Shvan H Mohammed
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Othman O Qadr
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
| | | | | | - Sana B Anwar
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
| | - Usama Y Abulkarim
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
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Lee M, Trpkovski M, Hans SS. Aneurysm of the aberrant splenic artery arising from the superior mesenteric artery. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:324-325. [PMID: 33367188 PMCID: PMC7748987 DOI: 10.1016/j.jvscit.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/01/2020] [Indexed: 10/30/2022]
Affiliation(s)
- Mary Lee
- Department of Vascular Surgery, Henry Ford Health System, Clinton Township, Mich
| | - Michael Trpkovski
- Department of Interventional Radiology, Henry Ford Health System, Clinton Township, Mich
| | - Sachinder S Hans
- Department of Vascular Surgery, Henry Ford Health System, Clinton Township, Mich
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Effraemidou E, Souftas V, Kofina K, Karanikas M, Lyratzopoulos N. Spontaneous rupture of a splenic artery aneurysm treated with a spleen-preserving procedure: a case report. J Surg Case Rep 2020; 2020:rjz412. [PMID: 32064078 PMCID: PMC7015077 DOI: 10.1093/jscr/rjz412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/27/2019] [Accepted: 01/01/2020] [Indexed: 12/02/2022] Open
Abstract
Splenic artery aneurysm is a rare and life-threatening condition, in case of spontaneous rupture. A rare case of such a rupture, treated successfully with an endovascular procedure, is presented. A 21-year-old man presented to the emergency department after an episode of loss of consciousness. After initial conservative treatment, he developed hemodynamic instability 12 hours later, with concurrent diffuse abdominal pain. Abdominal CT revealed a ruptured splenic artery aneurysm, which was immediately treated with coil embolization. The patient had an uneventful recovery and was discharged on the 12th day after the procedure. Although open surgery is the choice of treatment in cases of ruptured splenic artery aneurysms, endovascular embolization can also be considered a safe procedure with low complication and mortality rates.
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Affiliation(s)
- Eleni Effraemidou
- 1st Department of Surgery, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Vasileios Souftas
- Department of Radiology, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Konstantinia Kofina
- 1st Department of Surgery, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Michael Karanikas
- 1st Department of Surgery, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Nikolaos Lyratzopoulos
- 1st Department of Surgery, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
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Sousa J, Costa D, Mansilha A. Visceral artery aneurysms: review on indications and current treatment strategies. INT ANGIOL 2019; 38:381-394. [DOI: 10.23736/s0392-9590.19.04194-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Aberrant splenic artery complicated by aneurysm during pregnancy. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2018; 4:119-121. [PMID: 29942897 PMCID: PMC6012991 DOI: 10.1016/j.jvscit.2018.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/16/2018] [Indexed: 12/02/2022]
Abstract
The aberrant splenic artery is an uncommon anomaly. It may become a challenging problem when it is associated with an aneurysm diagnosed during pregnancy. Our experience with a patient who underwent two interventions, each performed in the postpartum period without incident, highlights the need to employ techniques that ensure aneurysm closure and thus avoid recurrence and need for repetitive procedures.
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