Common Visceral Artery Aneurysm Research Articles

X-ray Endovascular Embolization for Splenic Artery Aneurysm Complicated by Intestinal Bleeding

Introduction. Splenic artery aneurysms refer to the most common visceral artery aneurysms. However, they are diagnosed quite rarely, since about 80% of them appear asymptomatic. Clinically, splenic artery aneurysms manifest themselves through their complications, including hemorrhage into pancreatic cysts or intra­abdominal bleeding due to their rupture, leading to lethality up to 8.5%. Other complications of splenic artery aneurysms appear extremely rare. The gold standard for the diagnosis of splenic artery aneurysms refers to digital subtraction angiography that enables their exact localization to be determined and aneurysm embolization to be performed. Materials and methods. In the period from 2015 to 2023, we observed 51 patients who underwent endovascular interventions on the splenic artery for hypersplenism (n = 32) and aneurysms (n = 19). In most cases, the aneurysms were asymptomatic. The paper presents a rare clinical case of splenic artery aneurysm complicated by recurrent intestinal bleeding. Results and discussion. Examination (EGD, CS) did not detect the source of recurrent intestinal bleeding. Contrast CT revealed a splenic artery aneurysm. Celiac angiography detected a large aneurysm (52×41 mm) of the splenic artery, closely adjacent to the lower horizontal branch of the duodenum. Endovascular embolization of the splenic artery was performed proximal to the aneurysm, resulting in complete occlusion of blood flow through the splenic artery and aneurysm. No repeated episodes of intestinal bleeding were observed after the intervention, thereby indicating the effectiveness of hemostasis. No signs of splenic ischemization were detected by clinical and examination data due to the preservation of blood flow through short splenic vessels. Conclusion. Endovascular embolization of the splenic artery is found to be an effective treatment for its complicated aneurysms.

Surgical treatment of multiple splenic artery aneurysms with portal vein occlusion

Splenic artery aneurysm (SAA) is the most common visceral artery aneurysm.1 It is usually asymptomatic but could be life-threatening once ruptured.2 In this article, we report a case with multiple SAAs, the largest exceeding 5 cm treated via open repair.

P-P56 Successful endovascular embolisation of a recurrent gastroduodenal artery aneurysm in a patient presenting with acute on chronic pancreatitis

Abstract Background Pseudoaneurysms are recognised to be a serious complication of chronic pancreatitis. Visceral artery aneurysms (VAA) can be difficult to determine and most commonly occur in the splenic or hepatic artery. Gastroduodenal artery pseudoaneurysms (GDA) have been reported to be the most common VAA following pancreatic surgery. We aim to outline the successful management of a patient with a recurrent 5.5cm GDA pseudoaneurysm following previous embolisation 2 years prior. Methods The 59yr old patient had a history of alcohol related necrotic pancreatitis with pseudocyst formation requiring percutaneous drainage in 2019. This was complicated by pseudoaneurysm formation requiring embolisation of the inferior pancreatico-duodenal artery and GDA. In April 2021 they were readmitted with recurrent abdominal pain thought to be secondary to chronic pancreatitis and one episode of haematemesis. Results Endoscopy revealed inflammation of D1 with signs of recent mucosal bleeding with a recent abdominal ultrasound showing a 4.7x4.6cm apparent pseudocyst. A CT pancreas was performed to assess the pseudocyst however an incidental pseudoaneurysm at the pancreatic head with a sac measuring 5.5cm in diameter and contrast material measuring 3cm in diameter was present. Peripancreatic and retroperitoneal inflammation indicative of acute on chronic pancreatitis. The patient underwent embolisation of the recurrent GDA pseudoaneurysm successfully with no more filling of the previously seen pseudoaneurysm and was safely discharged. Conclusions Recurrent GDA pseudoaneurysms are a very rare complication of recurrent pancreatitis, however should be considered in patients presenting severe epigastric pain with a history of previous pseudoaneurysms.

Management of Splenic Artery Aneurysms during Pregnancy

Splenic artery aneurysms are considered rare; however, they are the most common visceral artery aneurysm in reality. The incidence of splenic artery aneurysm (SAA) increases in pregnancy and may result in significant maternal and fetal mortality if that would develop. This review summarizes etiologic, clinical, and diagnostic features and management of splenic artery aneurysms during pregnancy in the light of recent literature.

Transcatheter arterial embolization of a splenic artery aneurysm with N-butyl cyanoacrylate/lipiodol/ethanol mixture with coil-assisted sandwich technique.

Splenic artery aneurysm (SAA) is the most common visceral artery aneurysm, with a reported prevalence of 0.8% on arteriography and 0.04–0.10% at autopsy (1). Abbas et al . (2) reported that asymptomatic SAAs of >2 cm in size have an increased risk of rupture. SAAs are both more frequent and larger in adults with chronic liver disease and portal hypertension (3), and SAA rupture is associated with a higher mortality rate in patients with portal hypertension than in other patients (3). Percutaneous transcatheter embolization of SAAs with coils is widely accepted as the first line of treatment because it is safe, has a low mortality rate, and provides adequate short- and long-term results (4).

İntrabdominal Kanama İle Ortaya Çıkan Bir Splenik Arter Anevrizması Olgusu

Visceral artery aneurysms are rare pathologies. Splenic Artery Aneurysms SAA are the most common visceral artery aneurysms accounting for 60% to71% of them, with an incidence of 0.7% in the normal population, even though rates as high as 10% have been found on necropsy studies. This aneurysm has a risk of rupture resulting in death. It can be overlooked missed on the imaging modalities when it is thrombosed. Here, we present a case of splenic artery aneurysm, which could be diagnosed with repetitive computed tomography CT examinations because it was partially thrombosed and overlooked in the 1st CT. The aneurysm was treated with blind embolization in correlation with CT

A Rare Cause of Massive Upper Gastrointestinal Bleeding

Question: A 58-year-old woman was admitted with multiple episodes of melena. The patient had a history of surgery for colon cancer 7 years ago and underwent radiofrequency ablation for metastatic liver cancer 4 year ago. She was treated in another hospital for massive hematemesis and a transient loss of consciousness and was relieved after blood transfusion and proton pump inhibitor administration 5 days ago. Physical examination showed an anemic appearance. Laboratory tests revealed a low level of hemoglobin (73 g/L). An emergency gastroscopy in our department revealed a bleeding gastric ulcer, blood-like fluid effusion in stomach lumen (Figure A). What is the most likely cause of upper gastrointestinal (GI) bleeding in this patient? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Abdominal enhanced computed tomography (CT) scanning revealed multiple metastatic tumors in the liver (Figure B, black arrows) and the body and tail of pancreas (Figure B, white arrow). Importantly, invasion of stomach wall by the neighboring pancreatic tumors led to the formation of a gastric fistula, through which the contrast media was leaking into stomach lumen. CT angiography and vascular reconstruction further confirmed tumor erosion of the splenic artery and the formation of splenic artery pseudoaneurysm (SAPA) as well as tumor–gastric fistula (Figure C, D). Digital subtraction angiography also demonstrated extravasation of contrast media from SAPA through the fistula (Figure E). The patient was treated by splenic artery embolization. Postoperative angiography revealed complete blockade of the SAPA (Figure F). An enhanced CT examination on the following day showed no sign of active bleeding. The patient recovered uneventfully and was discharged without any symptoms over a 6-month follow-up period. Splenic artery aneurysms are the most common visceral artery aneurysms and are broadly classified as true aneurysms and pseudoaneurysms.1Illuminati G. LaMuraglia G. Nigri G. Surgical repair of an aberrant splenic artery aneurysm: report of a case.Ann Vasc Surg. 2007; 21: 216-218Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar Causes of SAPA include pancreatitis (52%), abdominal trauma (29%), iatrogenic and postoperative causes (3%), and peptic ulcer (2%).2Wang J. Wang B. Chen D.F. An unusual cause of recurrent massive upper gastrointestinal bleeding.Gastroenterology. 2012; 143: 542Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar Metastatic pancreatic tumor is rare, accounting for only 2% of all pancreatic tumors.3Lee C.W. Wu R.C. Hsu J.T. et al.Isolated pancreatic metastasis from rectal cancer: a case report and review of literature.World J Surg Oncol. 2010; 8: 26Crossref Scopus (15) Google Scholar To the best of our knowledge, SAPA caused by metastatic pancreatic tumor has not yet been reported. In the present case, the complicated patient history and endoscopic findings make the diagnosis difficult. In this scenario, enhanced CT examination and vascular reconstruction are beneficial for the diagnosis of SAPA. Superselective splenic artery embolization represents an effective approach to treat these patients with high surgical risk.

Ruptured hepatic artery aneurysm precipitated by gangrenous perforated appendicitis: a case report

Hepatic artery aneurysms are among the most common visceral artery aneurysms although still relatively rare. Repair of aneurysms >2 cm in diameter is important due to the high rate of rupture and associated mortality. Here, we present a case of a sudden rupture of a hepatic artery aneurysm after presentation with a perforated gangrenous appendicitis. There is increasing evidence that expansion and rupture of abdominal aortic aneurysm is related to degradation of elastin and collagen by matrix metalloproteinases (MMPs). Elastin degradation leads to expansion, while collagen degradation leads to rupture. The activity of MMPs has been shown to be upregulated by both sepsis and peritonitis. Here, we suggest that the inflammation from sepsis and peritonitis led to the activation and/or upregulation of MMPs, which precipitated aneurysm rupture via collagenase activity.

Postpartum rupture of a splenic artery aneurysm: A case report and review of the literature

Splenic artery aneurysm is the most common visceral artery aneurysm ( Lang et al, 2002 ). There is a strong association with the formation of splenic artery aneurysms in pregnancy and multiparity. They remain largely asymptomatic unless they rupture—a potentially catastrophic event. This article presents an unfortunate case of a fatal ruptured splenic artery aneurysm in the postpartum period, where the initial diagnosis was thought to be a pulmonary embolus. The various anatomical and physiological changes that occur during pregnancy can make the diagnosis, evaluation and treatment of a pregnant or postpartum woman difficult. Considering other less prevalent pathologies and relying less on protocol-driven care where no definite diagnosis has been made is vital in ensuring timely management. A ruptured splenic artery aneurysm, although infrequent, is an important differential diagnosis to consider when faced with an acutely unwell pregnant or postpartum patient. Early recognition, prompt diagnosis and urgent surgical intervention are essential to avoid fatal outcome.

Spontaneous rupture of splenic artery aneurysm in pregnancy: is splenectomy always necessary?

Sir, We wish to call attention to the case of a 39-year-old woman, pluripara, in her 35 weeks’ gestation who presented acute abdominal pain with vomiting. The past clinical and obstetric history was unremarkable. The pain was dull and gradually increasing, mainly located to the epigastric and left upper quadrant. Blood pressure and heart rate were normal. Ultrasound examination was performed showing normal fetal heart rate and biometry and a considerable collection of free-fluid and blood clot in the pouch of Douglas. The patient developed severe hypotension, acute anemia and syncope. An emergency cesarean section was performed and a massive hemoperitoneum confirmed. The uterus was intact and there was no visible bleeding from any other pelvic organ. A live fetus (Apgar score 4–8) was delivered and was transferred to the Neonatal Intensive Care Center. The placenta did not show evidence of abruption. Exploration of the abdomen with a general surgeon in attendance showed a ruptured splenic artery aneurysm located in the distal segment of the vessel. The aneurysmal sac was conservatively treated by surgical ligature of the splenic artery. Bleeding was controlled with prompt recovery of the blood pressure. Careful inspection of the spleen was undertaken and no signs of ischemic areas were noted and it was decided to avoid splenectomy meantime. A postoperative total body computed tomography scan was done to confirm possible residual bleeding and/or ischemic areas in the spleen, but both were negative. The patient received three units of red blood cells and was discharged home with her baby 10 days after surgery. Splenic artery aneurysm is the most common visceral artery aneurysm (1–3). It occurs more frequently in younger females. Up to 95% of cases take place during pregnancy, particularly in third-trimester multiparous women, considered to be related to endocrine and mechanical causes (3). Most are asymptomatic until rupture. A recent review reports 32 cases showing a mean maternal and gestational age of 27.9 years and 34.5 weeks, respectively (3). In our case the distal part of the splenic artery was involved, which is rare (3). Splenic artery rupture in pregnancy is rare and can be catastrophic, with high maternal and fetal mortality (1–3). Splenectomy is usually performed in addition to resection and/or ligation of the aneurysm (2) but may sometimes be avoided because of multiple peripancreatic and perisplenic collateral vessels that enable perfusion even after splenic artery ligation. The development of such a vascular variant was demonstrated by magnetic resonance imaging six months after surgery. Obstetricians should consider possible rupture of a splenic artery aneurysm as a cause of acute abdominal hemoperitoneum in the third trimester of pregnancy.

Surgical Treatment of a Ruptured Giant Renal Artery Aneurysm - Case Report and Literature Review

Renal artery aneurysms are the second most common visceral artery aneurysms after splenic artery aneurysms, and before hepatic artery aneurysms. The study presented a case of a ruptured giant right renal artery aneurysm in a female patient. The presented case is worth mentioning, due to the giant size of the lesion. The diameter of the aneurysm exceeded 10 cm. Available literature data mentioned single reports of such large aneurysms located in the renal arteries. In spite of the fact that renal artery aneurysms are the second most common visceral artery aneurysms, their management is accompanied by some controversy. Literature data mentioned the dominance of endovascular techniques. However, surgical treatment remains to be the most effective and radical method.

A rare clinic presentation of abdominal pain: rupture of splenic artery aneurysm: a case report

BackgroundSplenic artery aneurysms (SAA) are uncommon but the most common visceral artery aneurysm. Splenic artery aneurysms are important to recognize because up to 25% may be complicated by rupture and the mortality rate after rupture is between 25% and 70%.Case reportWe present a patient who have abdominal pain. Previously healthy 22-year-old female admitted to emergency department with abdominal pain. Her physical examination reveals only left upper quadrant tenderness. Suddenly she developed hypovolemic shock. On emergent laparotomy massive blood collection within peritoneal cavity and retroperitoneal space at the left upper quadrant was detected. The source of bleeding was evident as rupture of splenic artery aneurysm. Splenectomy was performed following the ligation of splenic artery proximal to lesion. On the tenth day she was discharged from the hospital with complete recovery.ConclusionIt is important to remember rupture of splenic artery aneurysm in patients with abdominal pain and hypovolemic shock status.

Splenic artery aneurysm rupture

Splenic artery aneurysms are the most common visceral artery aneurysms and are known for their potential for rupture. Pregnancy and portal hypertension have been known as major risk factors. With improved methods of diagnosis and minimally invasive therapy, management and outcome of SAA may change significantly. SAA may rupture at any age. When rupture of the aneurysm occurs, the mortality rate remains low if immediate resuscitation is performed and an aggressive surgical approach is taken. Conservation of the spleen might have been preferred.

Role of three-dimensional multidetector computed tomography for a huge superior mesenteric artery aneurysm management

Superior mesenteric artery (SMA) aneurysms are the third most common visceral artery aneurysms. Diagnosis of SMA aneurysm can be achieved by abdominal ultrasonogram, postcontrast computed tomography (CT), three-dimensional (3-D) multidetector (MD) CT, or selective angiography of the SMA. 3-D MD CT may play an important role for the evaluation of characteristic morphology of SMA aneurysm and for delineation of the correct relationship between SMA aneurysm and other adjacent branches of the abdominal aorta. We report a case of huge SMA aneurysm visualized by 3-D MD CT images in detecting anatomic details and its role for the best surgical approach in a patient with huge SMA aneurysm.

A Ruptured Mycotic Aneurysm of a Branch of the Superior Mesenteric Artery and Pulmonary Tuberculosis

Superior mesenteric artery aneurysms are the third most common visceral artery aneurysm and account for 5.5% of all visceral aneurysms. Aneurysms at these sites are more susceptible to rupture and death may occur due to delayed diagnosis.A case of a ruptured mycotic aneurysm of a branch of a superior mesenteric artery in association with pulmonary tuberculosis, treated successfully with resection, is presented.

A Ruptured Mycotic Aneurysm of a Branch of the Superior Mesenteric Artery and Pulmonary Tuberculosis

Superior mesenteric artery aneurysms are the third most common visceral artery aneurysm and account for 5.5% of all visceral aneurysms. Aneurysms at these sites are more susceptible to rupture and death may occur due to delayed diagnosis.A case of a ruptured mycotic aneurysm of a branch of a superior mesenteric artery in association with pulmonary tuberculosis, treated successfully with resection, is presented.

Splenomegaly, hypersplenism and coagulation abnormalities in liver disease

Splenomegaly is a frequent finding in patients with liver disease. It is usually asymptomatic but may cause hypersplenism. Thrombocytopenia is the most frequent manifestation of hypersplenism and may contribute to portal hypertension related bleeding. A number of therapies are available for treating thrombocytopenia due to hypersplenism including splenectomy, partial splenectomy, partial splenic embolization, TIPS etc. None is entirely satisfactory. Hypersplenism usually improves following liver transplantation. Therapy with cytokines such as thrombopoietin may offer hope for the future. Patients with liver disease also have abnormalities in coagulation. This is not surprising as all coagulation proteins (except for von willebrand factor vWF) and most inhibitors of coagulation are synthesized in the liver. Genetic or acquired abnormalities of coagulation may predispose to thrombosis of the hepatic or portal veins with significant clinical sequelae. An understanding of the mechanisms involved in coagulation and thrombosis is valuable in choosing from the increasing treatment options available. These include clotting factors, haemeostatic drugs and newer therapies such as recombinant factor VIIa. Splenic artery aneurysms are the most common visceral artery aneurysms in man. Rupture is frequently catastrophic. These aneurysms are being increasingly recognized in liver transplant patients and require treatment before or during transplant surgery.

Splenic Artery Aneurysm in the 1990s

Splenic artery aneurysms (SAA), although rare, are the most common visceral artery aneurysms and are known for their potential for rupture. Pregnancy and portal hypertension have been known as major risk factors. With improved methods of diagnosis and minimally invasive therapy, management and outcome of SAA may change significantly. The purpose of this study was to analyze our institutional experience with SAA during the past decade. Charts of all patients (six women, three men; mean age, 60.5 [range: 31 to 81] years) with diagnoses of SAA from 1988 to 1999 were reviewed. Associated conditions included essential hypertension (6), portal hypertension (3), diabetes (1), intracranial aneurysm (1), and polyarteritis nodosa (1). Six patients were asymptomatic, and three had ruptured SAA. Diagnosis was made by angiography (2), computed tomography (3), ultrasonography (3), and exploratory laparotomy (1). Six patients underwent surgery (five required splenectomy), one had embolization, and two had no intervention. Three postoperative deaths occurred-two (intracranial aneurysm, myocardial infarction) in the first month, one (sepsis) in the ninth month. An association of liver disease with SAA was confirmed; however, no association with pregnancy was noted. Surgical treatment followed traditional methods, and mortality correlated with presence of severe comorbidity.