Endovascular Management of Complex Splenic Aneurysm with the “Amplatzer” Embolic Platform: Application of Cone-beam Computed Tomography

Abstract

Splenic artery aneurysms have the highest prevalence of all visceral arterial aneurysms (0.04%e10%). Treatment indications comprise symptomatic aneurysms, aneurysms 2.5 cm, and the presence of portal hypertension [1]. Within the last few decades, different endovascular treatment options were established by using coils, vascular plugs, or stent grafts for aneurysms occlusion or exclusion from blood flow [2e5]. The success of any endovascular aneurysm treatment relies on the secure exclusion of the aneurysmal sac from arterial perfusion. Feeding afferent and draining efferent arteries (so termed front-door and back-door access) are mostly visualized through either pre-interventional computed tomography angiography (CTA) or single-plane digital subtraction angiography (DSA). Modern angiography suites offer cone-beam computed tomography (CT) functionality, which provides a 3-dimensional reconstruction of the relevant anatomy through a single injection rotational acquisition, essentially creating a volumetric data set that can be reviewed on the fly [6,7]. This technique has been shown to allow intraoperative assessment of, eg, stent-graft positioning or transcatheter arterial embolization [8,9]. We hereby demonstrated the usability of cone-beam CT for vascular assessment in splenic artery aneurysm embolization and demonstrated its potential benefits when compared with standard DSA.