Endovascular Repair of Concomitant Celiac and Splenic Artery Aneurysms Using a Combination of Coil Embolization and Aortic Cuff Stent Graft

Abstract

Visceral artery aneurysms comprise a small portion of all peripheral vascular aneurysms. Of these, the splenic artery is most commonly affected, while celiac artery involvement is rare. Repair is recommended for symptomatic aneurysms or those exceeding two centimeters in diameter. Most reported repairs for celiac artery aneurysms involve surgical excision with or without bypass grafting, but endovascular treatments are becoming more common. We present a case of a 75 year-old male with proximal celiac and distal splenic artery aneurysms treated with combined percutaneous coil embolization and aortic cuff stent graft placement. The splenic aneurysm sac and proximal splenic artery were coil embolized. Attempts to place a covered stent across the celiac artery aneurysm were unsuccessful from both femoral and brachial approaches. We then coil embolized the celiac artery distal to the aneurysm but proximal to the gastroduodenal branch. Coils were also placed into the celiac artery aneurysm sac and left gastric artery. There was insufficient neck length to place coils into the proximal celiac artery. Consequently, an aortic cuff stent graft was deployed across celiac artery origin to obliterate the inflow. There was no liver dysfunction afterwards due to retrograde flow through a patent gastroduodenal artery.