1
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Kamada H, Oguro S, Fukushi T, Tannai H, Ota H, Takase K. Prophylactic splenic artery embolization using n-butyl-2-cyanoacrylate and coils prior to endoscopic necrosectomy in a patient with necrotizing pancreatitis: A case report. Radiol Case Rep 2024; 19:3483-3487. [PMID: 38872742 PMCID: PMC11169069 DOI: 10.1016/j.radcr.2024.05.027] [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] [Received: 03/18/2024] [Revised: 05/01/2024] [Accepted: 05/06/2024] [Indexed: 06/15/2024] Open
Abstract
We present a case of prophylactic endovascular embolization in a 51-year-old man with necrotizing pancreatitis (NP) before undergoing endoscopic necrosectomy (EN). Contrast-enhanced CT imaging revealed the presence of a walled-off necrosis (WON) surrounding the pancreas, with the splenic artery coursing through the cavity. The splenic artery was embolized using n-butyl-2-cyanoacrylate (NBCA) and coils to mitigate the risk of massive bleeding in EN. A newly developed polytetrafluoroethylene (PTFE)-coated microcatheter was used to inject NBCA, enabling embolization of a long segment of the splenic artery without adhering to the vessel wall. Coils were placed distal and proximal to the embolized segment to optimize control. Over 5 sessions of EN, no massive bleeding was encountered. This report demonstrates the benefits of utilizing PTFE-coated microcatheters for enhanced safety and maneuverability during embolization with NBCA. Furthermore, it highlights the importance of prophylactic embolization during EN for managing NP.
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Affiliation(s)
- Hiroki Kamada
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Sota Oguro
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Tatsuro Fukushi
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Hiromitsu Tannai
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
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2
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Meyer NS, Ullrich L. Giant splenic artery pseudoaneurysm with arteriovenous fistula: diagnostic challenges and interdisciplinary treatment considerations. BMJ Case Rep 2024; 17:e259035. [PMID: 38991575 DOI: 10.1136/bcr-2023-259035] [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] [Indexed: 07/13/2024] Open
Abstract
We present a compelling case of an elderly male with a complex medical history who presented with sepsis secondary to a urinary tract infection. During admission, changes in his abdominal exam prompted imaging studies, which revealed a grade IV splenic laceration with a giant splenic artery pseudoaneurysm containing a suspected arteriovenous fistula component. Multidisciplinary discussion was had regarding patient management which resulted in the decision to perform an emergent splenectomy. Learning points from this case underscore the crucial role of interdisciplinary collaboration in the treatment of this pathology. Additionally, we discuss the decision-making process to support surgical intervention in the absence of clear guidelines in this exceedingly rare condition.
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Affiliation(s)
- Nathaniel Scott Meyer
- Medical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Lauryn Ullrich
- St Luke's University Health Network, Bethlehem, Pennsylvania, USA
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3
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Choy CH, Lee YS, Cheung PL, Ho CH, Siu JCW. Splenic Arterial Embolization for Trauma and Beyond: A Case Series. Vasc Specialist Int 2024; 40:18. [PMID: 38845443 PMCID: PMC11157332 DOI: 10.5758/vsi.240030] [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: 03/12/2024] [Revised: 05/11/2024] [Accepted: 05/16/2024] [Indexed: 06/09/2024] Open
Abstract
Splenic artery embolization plays an important role in the management of various medical and surgical conditions that are non-traumatic in etiology, in addition to its well-established and widely discussed role in managing splenic trauma. In nontraumatic emergencies of catastrophic bleeding originating from the spleen or splenic artery, splenic artery embolization can be effective in achieving hemostasis as a definitive management, temporary stabilizing measure, or preoperative optimization technique. In addition to emergency clinical conditions, splenic artery embolization can be performed electively as an alternative to splenectomy for managing patients with hypersplenism. Herein, we report 6 cases of splenic artery embolization performed at our center to highlight its various indications. This article aims to demonstrate the role of splenic artery embolization in different clinical scenarios and the considerations behind the techniques employed through illustrative cases.
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Affiliation(s)
- Chun Hin Choy
- Department of Radiology and Nuclear Medicine, Tuen Mun Hospital, Hong Kong, China
| | - Yat Sing Lee
- Department of Radiology, Pok Oi Hospital, Hong Kong, China
| | - Pui Lam Cheung
- Department of Radiology and Nuclear Medicine, Tuen Mun Hospital, Hong Kong, China
| | - Cheuk Him Ho
- Department of Radiology and Nuclear Medicine, Tuen Mun Hospital, Hong Kong, China
| | - Jimmy Chi Wai Siu
- Department of Radiology and Nuclear Medicine, Tuen Mun Hospital, Hong Kong, China
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4
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Mirande MH, Souza DLS, Thibodeaux L, Sutphin C. Spontaneous rupture of a mycotic splenic artery pseudoaneurysm secondary to histoplasmosis: a case report. Surg Case Rep 2024; 10:136. [PMID: 38829447 PMCID: PMC11147961 DOI: 10.1186/s40792-024-01920-y] [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: 02/22/2024] [Accepted: 05/03/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND A splenic artery pseudoaneurysm is a rare pathology that occurs mainly secondary to pancreatitis, abdominal trauma, peptic ulcers, pancreatic and gastric cancers, and infections. It is best diagnosed using computed tomography angiography and typically treated using endovascular embolization and, in some cases, open or laparoscopic surgery. In this report, we present a case of a ruptured mycotic splenic artery pseudoaneurysm containing Histoplasma capsulatum, which to our knowledge is the first case to report a mycotic splenic artery pseudoaneurysm of this nature. CASE PRESENTATION We report a case of a 42-year-old white male with past medical history of Hepatitis C and IV drug abuse who presented to the Emergency Department with a 24-h history of severe diffuse abdominal pain. He was tachycardic and peritonitic on exam. Work-up demonstrated leukocytosis and lactic acidosis. Computed tomography of the abdomen and pelvis with intravenous contrast showed hemoperitoneum and active extravasation of contrast from the splenic artery into the splenic hilum, associated with a surrounding hematoma measuring 5.3 × 5.0 cm, concerning for ruptured splenic artery pseudoaneurysm. The patient was taken emergently for exploratory laparotomy, where a large intraperitoneal hematoma was evacuated. A ruptured splenic artery pseudoaneurysm was identified, isolated, and controlled, followed by completion splenectomy. Final pathology demonstrated a 3.0 × 1.3 × 0.3 cm pseudoaneurysm wall and a 14 × 9.5 × 5.5 cm spleen containing multiple necrotizing granulomata positive for the presence of Histoplasmosis species. The patient recovered appropriately and was discharged on post-operative day five. CONCLUSIONS This case demonstrates a successful approach to a ruptured mycotic splenic artery pseudoaneurysm resulting in a positive outcome. It is a unique case as it highlights, to our knowledge, the first report of splenic artery aneurysm secondary to Histoplasma capsulatum infection. This report helps further the understanding of the pathophysiology as well as the natural history of mycotic splenic pseudoaneurysms.
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Affiliation(s)
- Mitchell H Mirande
- Department of Surgery, TriHealth, Good Samaritan Hospital, Cincinnati, OH, USA.
| | - Dante L S Souza
- Department of Surgery, TriHealth, Good Samaritan Hospital, Cincinnati, OH, USA
| | - Louis Thibodeaux
- Department of Surgery, TriHealth, Bethesda North Hospital, Cincinnati, OH, USA
| | - Cody Sutphin
- Department of Surgery, TriHealth, Good Samaritan Hospital, Cincinnati, OH, USA
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5
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Boukobza M, Raffoul R, Rebibo L, Khalil A, Laissy JP. Splenic Artery Infectious Aneurysms in Infective Endocarditis - An Observational Study and Comprehensive Literature Review. Ann Vasc Surg 2024; 99:389-399. [PMID: 37918659 DOI: 10.1016/j.avsg.2023.09.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND To determine the prevalence, the clinical and radiological features, associated factors, treatment, and outcome of splenic artery aneurysms (SAAs) in infective endocarditis (IE). METHODS We retrospectively reviewed 474 consecutive patients admitted to our institution with definite IE (2005-2020). RESULTS Six patients had SAAs (1.3%; 3 women; mean age: 50 years). In all cases, the diagnosis was obtained by abdominal computed tomography angiography (CTA). SAAs-IE were solitary and saccular with a mean diameter of 30 mm (range: 10-90 mm). SAAs-IE were intrasplenic (n = 4) or hilar (n = 2). Streptococcus spp. were the predominant organisms (n = 4). In all cases, a left-sided native valve was involved (aortic, n = 3; mitral, n = 2; mitral-aortic, n = 1). SAAs were silent in half patients and were revealed by abdominal pain (n = 2) and by the resurgence of fever after cardiac surgery (n = 1). All patients underwent emergent valve replacement. One patient died within 24 hr from multiorgan failure. For the others, uneventful coil embolization was performed in 4 patients after valve replacement (3 diagnosed early and 1 at 8 weeks). In the remaining patient, SAA-IE diagnosed at abdominal CTA at day 16, with complete resolution under appropriate antibiotherapy alone. CONCLUSIONS SAAs-IE are a rare occurrence that may be clinically silent. SAAs-IE can be intrasplenic or hilar in location. Endovascular treatment in this context was safe. According to current guidelines, radiologic screening by abdominal CTA allowed the detection of silent SAAs which could be managed by endovascular treatment to prevent rupture. The delayed formation of these SAAs could justify a CTA control at the end of antibiotherapy.
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Affiliation(s)
- Monique Boukobza
- Department of Radiology, Bichat-Claude Bernard University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Richard Raffoul
- Department of Cardiac Surgery, Bichat-Claude Bernard University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lionel Rebibo
- Department of Digestive, Esogastric and Bariatric Surgery, Bichat-Claude Bernard University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Antoine Khalil
- Department of Radiology, Bichat-Claude Bernard University Hospital, Paris, France; Assistance Publique-Hôpitaux de Paris, Paris, France; Paris University, France
| | - Jean-Pierre Laissy
- Department of Radiology, Bichat-Claude Bernard University Hospital, Paris, France; Assistance Publique-Hôpitaux de Paris, Paris, France; Paris University, France; INSERM U1148, Paris, France
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6
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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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7
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Khatri S, Parikh R, Smith M, Friedman J. Endovascular management of colic artery pseudoaneurysm: A case report of successful intervention in a 59-year-old male with abdominal hematoma. Radiol Case Rep 2024; 19:449-454. [PMID: 38046917 PMCID: PMC10692486 DOI: 10.1016/j.radcr.2023.10.045] [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] [Received: 08/15/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
Visceral artery pseudoaneurysms, including inferior mesenteric artery pseudoaneurysms, are rare, occurring at an estimated incidence of 0.01%-0.2%. The literature reports only around 60 cases of inferior mesenteric pseudoaneurysm to date. The management of this condition lacks a consensus; nevertheless, coil embolization remains the preferred approach for stable patients. Here, we present a unique clinical scenario involving a 59-year-old male who underwent exploratory laparotomy for a retroperitoneal hematoma. Subsequently, he was diagnosed with an inferior mesenteric pseudoaneurysm, specifically affecting the left colic artery, and successfully managed using coil embolization.
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Affiliation(s)
| | | | - Matthew Smith
- Department of Radiology, Jamaica Hospital Medical Center, Queens, NY 11418, USA
| | - Joseph Friedman
- Department of Radiology, Jamaica Hospital Medical Center, Queens, NY 11418, USA
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8
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Bohler F, Romano G, Eikens P, Bohler D. Spontaneous Resolution of Recurrent Pancreatitis After Splenic Artery Pseudoaneurysm Stent Placement. Cureus 2023; 15:e50873. [PMID: 38249217 PMCID: PMC10799237 DOI: 10.7759/cureus.50873] [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: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Acute pancreatitis (AP) is a relatively common condition most often secondary to excess alcohol consumption, choledocholithiasis, medications, or hypertriglyceridemia. In rare cases, AP can result in a secondary splenic artery pseudoaneurysm (SAP). SAPs are a rare yet serious medical complication and are often under-diagnosed as they are usually asymptomatic. However, rupture and subsequent hemorrhage of SAPs pose life-threatening risks. This case involves a 72-year-old male presenting with portal vein thrombosis and recurrent episodes of AP with persistently elevated levels of lipase of no apparent etiology over a 6-month period. As patient history and pertinent test results ruled out all common causes of recurrent AP, the etiology of his AP remained unknown. After an SAP rupture and emergency treatment with an endovascular stent, the patient's recurrent AP spontaneously resolved, and lipase returned to normal levels. This case represents a yet-to-be-reported etiology of AP in which the proximal nature of the SAP with its associated inflammatory response to the pancreas resulted in intermittent AP. The lack of any other reasonable explanation for the etiology of the patient's recurrent AP along with the absence of any additional episodes after the treatment of his SAP supports this diagnosis. The findings of this case could prove useful to clinicians with patients suffering from recurrent episodes of AP with no known etiology and suggest that a potential undiagnosed SAP should be investigated further.
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Affiliation(s)
- Forrest Bohler
- Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Auburn Hills, USA
| | - Giuliano Romano
- Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Auburn Hills, USA
| | - Paul Eikens
- Department of Surgery, Inland Imaging Associates, Missoula, USA
| | - David Bohler
- Department of Surgery, Bitterroot Health, Hamilton, USA
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9
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Farrell A, Biswal R. Ultrasound-guided percutaneous coil and thrombin embolization of a left gastric artery pseudoaneurysm. Radiol Case Rep 2023; 18:4281-4286. [PMID: 37771379 PMCID: PMC10522854 DOI: 10.1016/j.radcr.2023.09.013] [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: 07/27/2023] [Revised: 08/24/2023] [Accepted: 09/05/2023] [Indexed: 09/30/2023] Open
Abstract
Pseudoaneurysms are a commonly encountered pathology, though pseudoaneurysms of the visceral arteries are a less frequent, but potentially deadly entity. Transarterial embolization is the typical treatment of visceral pseudoaneurysms, but success is dependent on anatomy that is conducive to selecting the supplying vessel. Abdominal ultrasound is a viable method to effectively treat visceral pseudoaneurysms when transarterial embolization is not possible. It is also an excellent example of the growing utilization of ultrasound guidance in various interventional radiologic procedures. The usefulness of ultrasound is demonstrated in this case report, where a left gastric artery pseudoaneurysm was embolized through ultrasound guidance.
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Affiliation(s)
- Aidan Farrell
- Hackensack Meridian School of Medicine, 123 Metro Blvd, Nutley, NJ 07110, USA
| | - Rajiv Biswal
- Jersey Shore University Medical Center, 1945 NJ-33, Neptune, NJ 07753, USA
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10
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Porcaro P, Turchino D, Quarantelli M, Guercio LD, Accarino G, Serra R, Venetucci P, Bracale UM. Endovascular treatment of a wide-necked renal artery aneurysm with a flow diverter stent. Radiol Case Rep 2023; 18:2854-2859. [PMID: 37388268 PMCID: PMC10300470 DOI: 10.1016/j.radcr.2023.05.030] [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: 03/28/2023] [Revised: 05/03/2023] [Accepted: 05/08/2023] [Indexed: 07/01/2023] Open
Abstract
Renal artery aneurysm (RAA) is a rare, often asymptomatic disease (0.1% incidence in general population) and can be incidentally diagnosed during an abdominal imaging workup. The traditional, gold standard of treatment is open surgery, carrying with it, however, a high risk of nephrectomy, mortality, and collateral morbidity. The endovascular approach is currently the most valid alternative to treating RAAs reducing, as it does, the risks associated with the surgical approach/open surgery. Herein we report on our experience with a case of wide-necked RAA treated with the Pipeline Vantage (Medtronic) flow diverter stent. Wide-neck aneurysms are defined as having neck diameters greater than 4 mm. Our choice of endovascular treatment was preferred over the surgical option notwithstanding the large size of the neck and the involvement of the branching vessels.
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Affiliation(s)
| | - Davide Turchino
- Department of Public Health, Unit of Vascular Surgery, University Federico II of Naples, Naples, Italy
| | - Mario Quarantelli
- Department of Radiology, University Federico II of Naples, Naples, Italy
| | - Luca del Guercio
- Department of Public Health, Unit of Vascular Surgery, University Federico II of Naples, Naples, Italy
| | - Giulio Accarino
- Department of Public Health, Unit of Vascular Surgery, University Federico II of Naples, Naples, Italy
| | - Raffaele Serra
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Pietro Venetucci
- Department of Radiology, University Federico II of Naples, Naples, Italy
| | - Umberto Marcello Bracale
- Department of Public Health, Unit of Vascular Surgery, University Federico II of Naples, Naples, Italy
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11
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Aoki R, Kobayashi Y, Nawata S, Kamide H, Sekikawa Z, Utsunomiya D. Gastrointestinal Bleeding Due to the Rupture of Splenic Artery Caused by Pancreatic Carcinoma: A Case Requiring Repeated Transcatheter Arterial Embolization in a Short Period of Time. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:88-91. [PMID: 37485488 PMCID: PMC10359172 DOI: 10.22575/interventionalradiology.2022-0034] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/22/2022] [Indexed: 07/25/2023]
Abstract
In this report, we present a case of gastrointestinal bleeding due to splenic artery rupture, which required repeated transcatheter arterial embolization (TAE) within a short period of time. A 75-year-old man with pancreatic carcinoma was transported to our hospital with active hematemesis and vital signs consistent with shock. Contrast-enhanced computed tomography images showed a pancreatic tumor that had caused a pseudoaneurysm of the splenic artery to rupture. The pseudoaneurysm was embolized using only an N-butyl-2-cyanoacrylate (NBCA) and lipiodol mixture. However, hematemesis with signs of shock recurred 13 h later, and angiography showed rebleeding from the origin of the splenic artery. The splenic artery was subsequently embolized using an NBCA and lipiodol mixture. Repeated TAE finally controlled the hemorrhage; however, asymptomatic splenic infarction and hepatic infarction occurred due to nontarget embolization.
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Affiliation(s)
- Ryo Aoki
- Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Japan
- Department of Radiology, Yokohama City University Medical Center, Japan
| | - Yusuke Kobayashi
- Department of Radiology, Yokohama City University Medical Center, Japan
| | - Shintaro Nawata
- Department of Radiology, St. Marianna University School of Medicinen, Japan
| | - Hiroyuki Kamide
- Department of Radiology, Yokohama City University Medical Center, Japan
| | - Zenjiro Sekikawa
- Department of Radiology, Yokohama City University Medical Center, Japan
| | - Daisuke Utsunomiya
- Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Japan
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Fukamatsu F, Sugiura K, Takekoshi D, Fukuzawa T, Oyama K, Tsukahara Y, Kurozumi M, Shimizu A, Fujinaga Y. A ruptured splenic artery aneurysm treated by transcatheter arterial embolization using n-butyl cyanoacrylate-Lipiodol-Iopamidol. Radiol Case Rep 2023; 18:2385-2390. [PMID: 37179814 PMCID: PMC10172629 DOI: 10.1016/j.radcr.2023.04.005] [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: 02/20/2023] [Revised: 03/25/2023] [Accepted: 04/03/2023] [Indexed: 05/15/2023] Open
Abstract
N-butyl cyanoacrylate, one of embolic materials, is usually used as a mixture with Lipiodol (N-butyl cyanoacrylate-Lipiodol mixture). N-butyl cyanoacrylate-Lipiodol-Iopamidol was developed by adding a nonionic iodine contrast agent (Iopamiron) to N-butyl cyanoacrylate-Lipiodol mixture. N-butyl cyanoacrylate-Lipiodol-Iopamidol has lower adhesiveness than N-butyl cyanoacrylate-Lipiodol mixture and the ability to form a single large droplet. We report the case of a 63-year-old man with a ruptured splenic artery aneurysm treated by transcatheter arterial embolization using N-butyl cyanoacrylate-Lipiodol-Iopamidol. He was referred to the emergency room because of sudden onset of upper abdominal pain. A diagnosis was established using contrast-enhanced computed tomography and angiography. Emergency transcatheter arterial embolization was performed, and the ruptured splenic artery aneurysm was successfully embolized using a combination of coil framing and N-butyl cyanoacrylate-Lipiodol-Iopamidol packing. This case demonstrates the usefulness of a combination of coil framing and N-butyl cyanoacrylate-Lipiodol-Iopamdol packing for the embolization of aneurysms.
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Affiliation(s)
- Fumiaki Fukamatsu
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
- Corresponding author.
| | - Kazusa Sugiura
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Daiya Takekoshi
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Takuya Fukuzawa
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Kazuki Oyama
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Yoshinori Tsukahara
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Masahiro Kurozumi
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Akira Shimizu
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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Special Issue on "Advances in Image-Guided Diagnosis and Treatment of Abdominal Diseases". Diagnostics (Basel) 2023; 13:diagnostics13020169. [PMID: 36672979 PMCID: PMC9858105 DOI: 10.3390/diagnostics13020169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
This Special Issue is a collection of five scientific papers and five reviews concerning current topics in abdominal imaging with attention on the diagnosis and interventional management of specific diseases [...].
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14
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Orel YH, Orel HY, Khorkavyi YZ, Slabyy OM. Features of Surgical Treatment of Patients with Splenic Artery Aneurysms (Case Report and Literature Review). UKRAINIAN JOURNAL OF CARDIOVASCULAR SURGERY 2022. [DOI: 10.30702/ujcvs/22.30(04)/oo055-8893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Despite the insigniϐicant prevalence, aneurysms of the splenicartery take a dominant share among all visceral aneurysms with a predominance of morbidity in women of childbearing age. Taking into account the mostly asymptomatic course and the high risk of mortality due to its rupture, timely diagnosis and correct treatment strategy remain extremely important. Questions regarding the choice of surgical treatment tactics for patients with this pathology remain debatable.
The aim. Demonstration of a clinical case, improvement of diagnosis andsurgical treatment of patients with splenic artery aneurysms.
Clinical case. Female patient G., 32 years old, with complaints of periodic pain in the left hypochondrium, signs of portal hypertension against the background of cavernous transformationof the portal vein, history of recurrent bleeding from the esophageal veins, hypersplenism admitted with a pre-diagnosed aneurysm of the splenic artery of giant dimensions (diameter 8x5 cm). The patient was qualified for open surgery and aneurysm resection with splenectomy and spleen autotransplantation by N. Roth. The postoperative period was complicated by the occurrence of reactive pancreatitis on day 7, which was successfully treated conservatively. In the future, the course was unremarkable. The remote follow-up lasted two years, and no recurrence of the aneurysm was detected. The performed immunogram showed normal results.
Conclusion. The timely diagnosis makes it possible to establish the correct diagnosis, justify the treatment tactics and prevent fatal complications. Open surgical intervention in somecases remains the method of choice in the treatment of this pathology. Autotransplantation of the spleen has shown good long-term results and can be performed in patients of this category for the prevention of immunodeficiency states.
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Zhou Y, Zhou Y, Li W, Lin S. Idiopathic Spontaneous Intraperitoneal Hemorrhage Due to Vascular Malformations in the Muscularis of the Stomach: A Case Report. Front Med (Lausanne) 2022; 9:927899. [PMID: 36117972 PMCID: PMC9474647 DOI: 10.3389/fmed.2022.927899] [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: 04/25/2022] [Accepted: 06/20/2022] [Indexed: 11/30/2022] Open
Abstract
Idiopathic spontaneous intraperitoneal hemorrhage (ISIH) is a phenomenon caused by spontaneous rupture of intra-abdominal visceral vessels, and vascular malformations (VMs) leading to ISIH are rare in previously reported cases. VMs of the gastric wall, which are commonly located in the mucosa and submucosa, mostly lead to upper gastrointestinal bleeding rather than intraperitoneal hemorrhage. To our knowledge, this is the first report of ISIH caused by VMs in gastric muscularis. In the current case, a 22-year-old male patient presented with sudden abdominal pain for 4 h, accompanied by tachycardia and hypotension. CT revealed a hematoma in the omental bursa and fluids in abdominopelvic cavities. Then intraperitoneal hemorrhage was confirmed after abdominal paracentesis. Furthermore, ultrasonic gastroscopy indicated that vascular malformation in the muscularis of the stomach probably led to intraperitoneal hemorrhage. The patient recovered after conservative treatment based on fluid resuscitation and remained stable for 12 months of follow-up. This case suggests that VMs located in the gastrointestinal tract may lead to ISIH and ultrasonic gastroscopy is helpful in the diagnosis of VMs in the gastrointestinal tract.
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Affiliation(s)
- Yuhang Zhou
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Yuchen Zhou
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Weihua Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
- *Correspondence: Weihua Li,
| | - Shengtao Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
- Shengtao Lin,
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