Giant Splenic Artery Aneurysm Research Articles

Morphological rationale for surgical treatment of patients with true splenic artery aneurysm

Aim. To study the morphological features of the wall structure of the splenic artery aneurysm in order to identify the safest and most effective method of surgical treatment.Materials and methods. From 2020 to 2023, 43 patients underwent surgery for true splenic artery aneurysm. Interventions involved laparoscopic clipping of aneurysm branches, laparoscopic resection of aneurysm, laparoscopic splenectomy, and resection of giant splenic artery aneurysm. A clinical and morphological study of 16 slides of splenic artery aneurysm was performed. The aneurysm wall and the adjacent wall of the splenic artery without macroscopic signs of lumen dilatation for 1 cm from the aneurysmal dilatation were examined.Results. Microscopic study revealed fragments of loose, edematous wall of large elastic arteries with atherosclerosis, atheromatosis and calcification. Atherosclerotic plaques were observed in the intima; calcium deposits were detected in 81.25% of slides, and defects in elastic fibers – in all slides. The elastic membrane was thinned or had a discontinuous structure. Morphological changes in the wall of the splenic artery persisted up to 1.0 ± 0.2 cm proximal and distal to the aneurysm.Conclusion. Taking into account the revealed features of the morphological structure of the aneurysm, the formation of an end-to-end vascular anastomosis of the splenic artery, clipping or suturing of the aneurysm neck pose a significant risk of aneurysm recurrence. Laparoscopic clipping of splenic artery aneurysm branches at a distance of >1.5 cm from the edges of the aneurysm becomes the operation of choice for patients in this category.

The Definition, Diagnosis, and Management of Giant Splenic Artery Aneurysms and Pseudoaneurysms: A Systematic Review

Background/Objectives: Giant splenic artery aneurysms (SAAs) and pseudoaneurysms (SAPs) represent rare conditions, characterized by a diameter greater than or equal to 5 cm. The risk of rupture is increased compared to common SAAs and SAPs, necessitating urgent treatments to prevent it. Methods: This systematic review was conducted through a comprehensive search involving the PubMed, Google Scholar, and Scopus databases. A total of 82 patients and 65 articles were included in the analysis. For each patient, we investigated age, sex, symptoms, comorbidities, the presence of a true or a false aneurysm, the dimensional criteria used to define dilations as giant aneurysms or pseudoaneurysms, the dimension of the two greatest diameters, imaging studies, surgical treatment, post-operative length of stay (LOS), and post-operative follow-up. Results: The results revealed a similar incidence in both genders (43 males vs. 39 females) with a median age of 55.79 years. The most frequently described symptom was pain (59.76%). Thirteen cases were false aneurysms and 69 were true aneurysms. The mean greatest diameter was 9.90 cm. The CT scan was the most utilized imaging study (80.49%). Open, endovascular, and hybrid surgery were performed in 47, 26, and 9 patients, respectively, with complication rates of 14.89%, 23.08%, and 22.22% occurring for each treatment. The post-operative LOS was 12.29 days, 2.36 days, and 5 days, respectively. The median follow-up was 17.28 months overall. No recanalization was observed after endovascular procedures during the follow-up period. Conclusions: The dimensional criterion to define SAAs and SAPs as giant was most frequently that at least one diameter was ≥ 5 cm. The CT scan was the most frequently utilized radiological study to diagnose giant SAAs and SAPs. Finally, endovascular procedures, open surgeries, and hybrid treatments presented similar post-operative complication rates. The post-operative LOS was lower for the endovascular group, and the follow-up period did not show aneurysm recanalization in any patients.

Ruptured giant splenic artery aneurysm with an exceptional concurrent gastric and transverse colonic fistula: A rare case report.

Splenic artery aneurysm (SAA) is a focal dilation of the splenic artery with varying etiologies including atherosclerosis, arteritis, or trauma. Giant SAAs with a diameter of 10 cm is rare and can lead to severe complications like rupture and fistulas. Therefore, an accurate and timely diagnosis and treatment are important. A 50-year-old male presented with acute epigastric pain and hemorrhagic shock. Considering his symptoms and examination, ultrasound, multi-slice computed tomography and digital subtraction angiography results, a ruptured giant splenic artery aneurysm complicated with an exceptional gastric and transverse colonic fistula was suspected. Ruptured giant splenic artery aneurysm. Left anterolateral thoracotomy to control the severe aortic bleeding just above the diaphragm, aneurysmectomy, splenectomy, and closing the gastric and transverse colon perforations. Multi-slice computed tomography demonstrated the presence of splenic artery aneurysm in the distal third measuring (10 × 12 cm) in diameter with a true lumen measuring (7 × 3.5 cm) and a large hematoma extending to the greater and lesser gastric curvature. Intraoperatively, a large pulsating mass was detected occupying the epigastrium and the left hypochondrium with severe adhesions with the stomach and transverse colon. Giant SAA with a diameter of 10 cm is rare and is associated with severe complications. Therefore, successful treatment of splenic artery aneurysms involves prompt diagnosis, immediate surgical intervention to control bleeding, and tailored approaches like thoracotomy to control the thoracic aorta for better hemodynamic stabilization, aiming to eliminate the aneurysm and reduce complications effectively.

Giant splenic artery aneurysm rupture into the stomach that was successfully managed with emergency distal pancreatectomy

BackgroundSplenic artery aneurysms usually rupture into the free peritoneal space and rarely into the gastrointestinal tract. We report the case of a patient with a giant splenic artery aneurysm that ruptured in to the stomach with hemorrhagic shock and was successfully treated with emergency surgery.Case presentationA 59-year-old man presented to the emergency department with chest pain and syncope. Contrast-enhanced computed tomography showed splenic artery aneurysm with active contrast extravasation. He developed upper gastrointestinal (UGI) bleeding and hypovolemic shock. We diagnosed a splenic artery aneurysm ruptured in to the stomach, performed emergency distal splenopancreatectomy including the aneurysm and partial gastric resection, and could prevent patient death.ConclusionsThis report shows that splenic artery aneurysm can cause UGI bleeding. Thus, clinicians should be alert about this condition when managing patients with UGI bleeding and/or splenic artery aneurysm.

Giant aneurysm of the splenic artery

Splenic artery aneurysms (SAA) are one of the common visceral aneurysms. However giant SAA have barely been reported. We discuss a case of SAA, who had prior history of caroli disease at the stage of secondary biliary cirrhosis for which he was a candidate for liver transplantation. The patient underwent open surgical repair. The proximal and distal spenic artery were ligated from within the aneurysm and surgery was completed with splenectomy. The post operative period was uneventful.
 Bang Med J Khulna 2021; 54 : 26-27

Endovascular treatment of a giant splenic artery aneurysm.

Endovascular treatment of a giant splenic artery aneurysm.

Splenic artery aneurysms and extrahepatic portal hypertension during pregnancy

Clinical case demonstrates successful treatment of a pregnant woman, who had multiple giant splenic artery aneurysms with a high risk of spontaneous rupture. Pregnancy proceeded along with hereditary thrombophilia, thrombosis and cavernous transformation of the vena cava, extrahepatic portal hypertension, esophageal and gastric varices II–III. The surgical and obstetric tactics, surgical intervention, appropriate salvage and multidisciplinary pregnancy follow-up ensured a successful Cesarean delivery at 38 weeks, saving the life of the child and mother.

Multimodal Imaging of an Atherosclerotic Splenic Artery Aneurysm Enables Endovascular Treatment of a Potentially Lethal Entity

Splenic artery aneurysms (SAAs) are the third most frequent site of intraabdominal aneurysm and the most frequent splanchnic artery aneurysm. Surgery may be morbid and may include splenectomy and distal pancreatectomy. True aneurysm needs differentiation from a pseudoaneurysm caused by pancreatic enzymatic destruction. A giant SAA was diagnosed in an elderly atherosclerotic male with chronic calcific pancreatitis. Layered thrombus on multimodal imaging ruled out enzyme action and excluded possibility of a pseudoaneurysm. The distal splenic artery beyond the aneurysm was collateralized by left gastric artery. The aneurysm was closed with multiple coils and a vascular plug. Imaging after 6 months confirmed complete closure. Endovascular closure of SAA needs strategies to avoid an endoleak from the distal splenic artery. Pseudoaneurysm of splenic artery should be excluded, as they do not respond to the same strategies applied for true atherosclerotic aneurysms.

Embolization of a Giant Splenic Artery Aneurysm

Embolization of a Giant Splenic Artery Aneurysm

Fatal rupture of giant splenic artery pseudoaneurysm

Abstract Background Pseudoaneurysm of splenic artery is an uncommon complication of blunt trauma to the abdomen. Most of such pseudoaneurysms are ≤3 cm in size. Rarely, its size may increase to ≥5 cm, to form a giant pseudoaneurysm, which has potential to rupture with fatal outcome. We report here a child who developed post-traumatic giant pseudoaneurysm of splenic artery measuring 8 cm × 7 cm in size. Giant pseudoaneurysm of splenic artery has not been reported in children so far. Besides reporting this case because of the size of the aneurysm in a child, we also want to emphasize the importance of early management of such case due to its potential to rupture, which could turn out to be a fatal complication. Case presentation An eight-year-old boy presented to our hospital with complain of swelling over the abdomen after he sustained blunt trauma. Ultrasonography and CT demonstrated a giant splenic artery aneurysm. Patient was admitted for percutaneous coil embolization but before this procedure could be done, his pseudoaneurysm got ruptured spontaneously. This was followed by shock and cardiac arrest and he could not be revived despite our resuscitative efforts. Conclusion A giant pseudoaneurysm should be treated as soon as possible to prevent life threatening complication due to its rupture.

Giant Splenic Artery Aneurysm as a Rare Sequelae of Chronic Pancreatitis

Splenic Artery Aneurysms (SAAs) is the third commonest intra-abdominal aneurysms, following abdominal aorta and iliac artery aneurysms. The SAAs can be either true aneuryms or pseudoaneurysms. SAA measuring >5 cm are generally described as giant. Herein, a case of giant SAA is presented. A 52-year-old male patient with history of alcohol related chronic pancreatitis for the past five years presented with abdominal pain and upper abdominal fullness. Computed Tomography (CT) abdomen was suggestive of giant splenic aneursymal mass. Surgical treatment was planned due to the large size and symptomatic nature of the aneurysm. Splenic artery aneurysmectomy with distal pancreatectomy with splenectomy was performed. The most important and critical complication of giant SAA is spontaneous rupture which has high mortality. Open abdominal surgical excision is still the gold standard for management of giant splenic artery aneuryms, despite recent advances in endovascular treatment options.

Giant splenic artery aneurysm with extrahepatic portal vein obstruction – A rare entity: Case report with literature review

Giant splenic artery aneurysm with extrahepatic portal vein obstruction – A rare entity: Case report with literature review

Giant splenic artery aneurysm presenting with massive upper gastrointestinal bleeding: A case report and review of literature

BACKGROUNDSplenic artery aneurysm (SAA) and pseudoaneurysm are rare vessel’s lesions. Pseudoaneurysm is often symptomatic and secondary to pancreatitis or trauma. True SAA is the most common aneurysm of visceral vessels. In contrast to pseudoaneurysm, SAA is usually asymptomatic until the rupture, with high mortality rate. The clinical onset of SSA’s rupture is a massive life-threatening bleeding with hemodynamic instability, usually into the free peritoneal space and more rarely into the gastrointestinal tract.CASE SUMMARYWe describe the case of a 35-year-old male patient, with negative past medical history, who presented to the emergency department for massive upper gastrointestinal bleeding, severe anemia and hypotension. An esophagogastroduodenoscopy performed in emergency showed a gastric bulging in the greater curvature/posterior wall with a small erosion on its surface, with a visible vessel, but no active bleeding. Endoscopic injection therapy with cyanoacrylate glue was performed. Urgent contrast-enhanced computed tomography was carried out due to the clinical scenario and the unclear endoscopic aspect: The radiological examination showed a giant SAA which was adherent to posterior stomach wall, and some smaller aneurysms of the left gastric and ileocolic artery. Because of the high risk of a two-stage rupture of the giant SAA with dramatic outcome, the patient underwent immediate open surgery with aneurysmectomy, splenectomy and distal pancreatectomy with a good postoperative outcome.CONCLUSIONThe management of a ruptured giant SAA into the stomach can be successful with surgical approach.

Wilson Disease With Giant Splenic Artery Aneurysms Caused by Fibromuscular Dysplasia During Living Donor Liver Transplantation: A Case Report

Liver cirrhosis can cause splenic artery aneurysms (SAA) that pose a threat to patients undergoing liver transplantation. However, liver transplantation with multiple visceral artery aneurysms including giant SAA caused by arterial fragility has never been reported. We describe a 36-year-old man with decompensated liver cirrhosis due to Wilson disease that was complicated by giant SAA and multiple aneurysms in the bilateral renal arteries caused by fibromuscular dysplasia (FMD). The maximal diameter of the triple snowball-shaped SAA was 11 cm. We planned a 2-stage strategy consisting of a splenectomy with distal pancreatectomy to treat the SAA and subsequent living donor liver transplantation (LDLT) to address the liver cirrhosis. This strategy was selected to prevent fatal postoperative infectious complications caused by the potential development of pancreatic fistula during simultaneous procedures and to histopathologically diagnose the arterial lesion before LDLT to promote safe hepatic artery reconstruction. However, a postoperative pancreatic fistula did not develop after a splenectomy with distal pancreatectomy, and the pathologic findings of the artery indicated FMD. The patient underwent ABO-identical LDLT with a right lobe graft donated by his brother. Other than postoperative rupture of the aneurysm in the left renal artery requiring emergency interventional radiology, the patient has remained free of any other arterial complications and continues to do well at 2 years after LDLT.

Multiple Giant Splenic Artery Aneurysms with Hypersplenism and Portal Hypertension: A Case Report.

Multiple giant splenic artery aneurysms (>10 cm in diameter) are rare. We report a patient presenting with these aneurysms who had also associated portal hypertension and massive splenomegaly. Almost all the aneurysms were sealed by endovascular means at the first stage. Later, for the residual aneurysms at splenic hilum and enlarged spleen, splenectomy was performed. She made an uneventful recovery.

Giant splenic artery aneurysm

Giant splenic artery aneurysm

Acute fissuration of a giant splenic artery aneurysm detected by point-of-care ultrasound: case report

BackgroundEpigastric pain is frequent in Emergency Medicine and remains a challenging situation. Besides benign etiologies such as gastritis or uncomplicated cholelithiasis, it could reveal myocardial infarction or vascular disease. Point-of-care ultrasound (POCUS) could be performed in such situation.Case presentationA healthy 66-year-old man with no previous medical history was admitted to the Emergency Department for a rapid onset epigastric pain. He reported taking non-steroidal anti-inflammatories for 1 week prior to admission. His pain had rapidly subsided and the physical examination was inconclusive. ECG and blood samples were normal. POCUS revealed a vascular mass located between the spleen and the left kidney measuring 80 * 74 mm associated with small amounts of free peritoneal fluid. Computed tomography diagnosed a fissurated giant aneurysm of the splenic artery. The aneurysm was managed emergently by endovascular exclusion by selective splenic artery embolization. The post-intervention course was uneventful and the patient was discharged home 3 days later. The patient has remained free from any complications of the embolization 6 months after the procedure.ConclusionSpontaneously regressive epigastric pain with a normal physical and biology/ECG should not necessarily reassure the physician, in particular if patients have cardiovascular risk factors. A POCUS should be considered for these patients.

Giant splenic artery aneurysm: A case report

Splenic artery aneurysm is rare. Only a few cases with giant splenic artery aneurysm has been reported in the literature. In this article, we aimed to present a case with giant splenic artery aneurysm. A 60-year-old female patient presented with a complaint of abdominal pain. On physical examination, there was stiffness on the left subcostal area. Laboratory examinations were normal. Magnetic resonance imaging revealed an appearance in compatible with splenic artery aneurysm with a diameter of 10 cm. Splenectomy was done. Blood replacement was not performed in the peroperative and postoperative period. She was discharged on the second postoperative day. No complication occurred in the patient. Symptomatic and splenic artery aneurysms over 2 cm should be treated.

A Case Report: Splenoaneurysmectomy by Using a Powered Vascular Staplerin A Giant Splenic Artery Aneurysm with Connective Tissue Disease

A Case Report: Splenoaneurysmectomy by Using a Powered Vascular Staplerin A Giant Splenic Artery Aneurysm with Connective Tissue Disease

A Rare Clinical Case: Giant Splenic Artery Aneurysm and Its Successful Endovascular Treatment

Objectives The true giant splenic artery aneurysms are extremely rare and can be fatal. Although surgical approach has been the standard of care in the past, endovascular methods gained more importance in recent years. Background We describe a case with true giant splenic artery aneurysm, treated with endovascular approach. Methods A 68-year-old female patient with abdominal pain admitted to our clinic had true splenic artery aneurysm (14 × 10 × 9 cm). We decided on endovascular treatment using vascular plug and the treatment was performed successfully. Conclusions Due to high mortality and morbidity in open surgery, endovascular treatment of giant splenic artery aneurysm is a better treatment option.