Splanchnic Artery Aneurysms Research Articles

Management of True Gastroduodenal Artery Aneurysm: A Case Report and Literature Review

Abstract Gastroduodenal artery (GDA) aneurysms are rare forms of splanchnic artery aneurysms with varied etiopathogenesis. Mostly found incidentally, early identification with advanced imaging tools and timely intervention of these aneurysms are essential due to the associated high risk of rupture, morbidity, and mortality with GDA aneurysms. We report a case of successfully treated GDA aneurysm using endovascular coil embolization.

A commentary on 'Salvage surgeries for splanchnic artery aneurysms after failed endovascular therapy: case series'.

A commentary on 'Salvage surgeries for splanchnic artery aneurysms after failed endovascular therapy: case series'.

Superior Mesenteric Artery (Ileocolic Branch) Pseudoaneurysm with Contained Rupture Managed with Emergency Covered Stenting: A Case Report and Review of the Literature

Abstract Splanchnic artery aneurysms are rare, and aneurysms of the superior mesenteric artery (SMA) and its branches are rarer. A pseudoaneurysm can occur in SMA and its branches due to various factors such as infections or inflammation, postsurgical, and posttrauma. Although rare, they can have lethal consequences. Hence, they have to be identified and managed promptly. Here, we present a rare case of pseudoaneurysm of the ileocolic artery (branch of SMA) with contained rupture in a patient postappendicectomy, which was managed endovascularly with a covered stent.

Salvage surgeries for splanchnic artery aneurysms after failed endovascular therapy: case series.

Splanchnic arterial aneurysms are a rare but potentially lethal disease with a mortality rate of more than 10% after rupture. Endovascular therapy is the first-line treatment for splanchnic aneurysms. However, appropriate management for splanchnic aneurysms after failed endovascular therapy remained inconclusive. A retrospective review was performed for consecutive patients (from 2019 to 2022) who underwent salvage surgeries for splanchnic artery aneurysms following failed endovascular therapy. The authors defined failed endovascular therapy as the technical infeasibility to apply endovascular therapy, the incomplete exclusion of the aneurysm, or the incomplete resolution of preoperative aneurysm-associated complications. Salvage operations included aneurysmectomy with vascular reconstruction and partial aneurysmectomy with directly closing of bleeders from the intraluminal space of the aneurysms. Seventy-three patients received endovascular therapies for splanchnic aneurysms, and 13 failed endovascular trials. The authors performed salvage surgeries for five patients and enrolled them in this study, including four false aneurysms of the celiac or superior mesenteric arteries and a true aneurysm of the common hepatic artery. The causes of failed endovascular therapy included coil migration, insufficient space for safely deploying the covered stent, a persistent mass effect from the postembolized aneurysm, or infeasibility for catheter cannulation. The mean hospital stay was nine days (mean±SD, 8.8±1.6 days), with no one suffering 90-day surgical morbidity and mortality, and all patients getting symptoms improvement. During the follow-up period (mean±SD, 24±10 months), one patient suffered a small residual asymptomatic celiac artery aneurysm (8mm in diameter) and was treated conservatively due to underlying liver cirrhosis. Surgical management is a feasible, effective, and safe alternative for splanchnic aneurysms after failed endovascular therapy.

Gastro-Duodenal Artery Aneurysm Rupture – Case Report

Background The definition of an aneurysm is a dilation of an artery more than 1.5 to 2 times its normal diameter. Visceral (or splanchnic) artery aneurysms include those concerning the celiac truncus, superior mesenteric artery, inferior mesenteric artery, and their branches. This classification does not include aortic and renal artery aneurysms. It is a rare, but clinically significant pathology because of the high mortality risk. Despite this rarity, cases have been accumulated and this pathology is better understood. Novel techniques for the management of aneurysms have been developed with the advent of interventional radiology. However, our case concerns the emergent surgical repair of a ruptured aneurysm, rather than the elective repair. Case presentation The 61-year-old female patient complains of diffuse, intermittent abdominal pain lasting for almost one week. On the last day the patient suffers from excruciating abdominal pain and is brought to the emergency department. Objective evaluation shows pallor, diaphoresis, low blood pressure, tachycardia and abdominal guarding in all quadrants. An abdominal ultrasound spots the presence of free fluid in all recesses. A diagnostic peritoneal needle aspiration shows pure blood. AB0 and Rhesus blood type is identified and the patient is prepared for the operating theatre. Following a laparotomy, peritoneal lavage, a rupture of gastro-duodenal aneurysm is identified and the artery is ligated in its origin. The patient tolerated the procedure well and was discharged in good health. Discussion Rare case reports in literature have reported Gastro-duodenal artery aneurysms. Because of this rarity in incidence there is no clear protocol on how to diagnose and manage it. Possible risk factors and associated conditions include: chronic pancreatitis, liver cirrhosis, vascular abnormalities as fibromuscular dysplasia and polyarteritis nodosa. Other events and diseases such as trauma, septic emboli, hypertension and atherosclerosis are also mentioned. The main symptoms of visceral artery aneurysms, with or without rupture are abdominal pain, hypotension, gastric emptying delay and other non-specific manifestations such as vomiting, diarrhoea, jaundice, upper gastro-intestinal tract haemorrhage (which occurs in about 50% of the cases with gastro-duodenal artery aneurysms) and retro and intra-peritoneal bleeding. Conclusion The rupture of gastro-duodenal artery is a serious fatal presentation of a rare condition. It requires high alertness and decisive action, as warning signs and symptoms may be dull or absent. Quick diagnosis before rupture can change the course of this disease and prevent lethal complications. As this disorder is so uncommon, there are no specific screening or follow-up recommendations. Treatment and diagnostic options should be decided on a case basis. Keywords: General Surgery, Visceral Artery Aneurysm, VAA, Splanchnic Aneurysm, Aneurysm Rupture. DOI: 10.7176/JEP/14-8-02 Publication date: March 31 st 2023

S2569 Bleeding From Peg Tube Insertion Site due to a Gastroepiploic Artery Pseudoaneurysm

Introduction: Percutaneous endoscopic gastrostomy (PEG) is generally regarded as a safe procedure with rare complications. Gastroepiploic artery aneurysms (GEAAs) are extremely rare with only 22 cases reported in the literature and constituting 3-4% of all splanchnic artery aneurysms. GEAAs carry a mortality rate of 70% due to a 90% rate of rupture and can lead to complications like hemorrhagic shock. Therefore, early detection and management is necessary for survival. Case Description/Methods: A 55-year-old male with PEG tube placed for ALS-associated dysphagia presented with bleeding around the PEG tube site 10 days after placement. He was admitted twice for the complaint. On his first admission, EGD was normal and it was suspected that he had bleeding subcutaneously around the PEG site that self-resolved. He was discharged but promptly returned the next day with profuse bleeding around PEG tube. Emergent repeat EGD was again negative. This time, the diagnosis was confirmed with CTA of the abdomen that demonstrated a branch of the gastroepiploic artery that had an 8mm pseudoaneurysm. Interventional radiology successfully performed US-guided thrombin injection with successful thrombosis of the pseudoaneurysm. The patient’s PEG site bleeding stopped, and patient successfully discharged. Discussion: Gastric bleeding following PEG tube placement is rare and usually occurs secondary to injury of the small gastric vessels. Due to the rotated configuration of stomach, caution should be exercised when penetrating during the PEG insertion. The gastroepiploic artery (GEA) runs along the greater curvature and may be injured during PEG tube placement although this is rare. The bleeding in our patient was due to a pseudoaneurysm of the GEA as evident from CT scan. GEA peudoaneurysms are a very rare complication that occur due to iatrogenic injury to the artery. GEA pseudoaneurysms can present as abdominal pain, bleeding, and even shock due to intraperitoneal hemorrhage. Due to the risk of fatal bleeding by GEA pseudoaneurysms, early detection and management is needed. Our patient was treated with percutaneous thrombin injection leading to resolution of bleeding. Other treatment options include trans arterial embolization and more invasive including surgical repair. Systemic embolization is the main complication of thrombin injection and can be prevented by placing the needle tip away from the neck of the pseudoaneurysm. (Figure).Figure 1.: A (axial) and B (sagittal): Arrows represent a small 8 mm pseudoaneurysm off of the gastroepiploic artery at the level of the gastrostomy tube insertion site.

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.

911 Delayed Presentation of a Re-Bleed from A Traumatic Splenic Artery Rupture Following Endovascular Management in A Patient with Median Arcuate Ligament Syndrome

Abstract Endovascular management of splenic blunt trauma is widely accepted as a safe and effective alternative to open surgery in carefully selected patients. Following a radiologically successful intervention, patients are normally discharged with no follow up after 48-72 hours of haemodynamic stability and satisfactory serial haemoglobin levels. We present a case of a fit and well 24-year-old male patient who presented with abdominal pain, syncope and haemodynamic instability 14 days post successful splenic artery coil-embolization for splenic artery aneurysm rupture secondary to blunt trauma. After initial resuscitation, computed tomography angiography was performed and demonstrated active bleeding from the splenic artery aneurysm which was deemed likely to be a consequence of retrograde filling. The patient underwent successful emergency re-embolization using a combination of embolization coils and Onyx via a trans-splenic approach to eliminate retrograde flow. On further review of the imaging, it was incidentally noted there was evidence suggesting a diagnosis of median arcuate ligament syndrome, which may have predisposed the patient to splanchnic artery aneurysm formation. This case report highlights a potential limitation of endovascular management compared to open surgery and summarises the literature surrounding splenic artery anatomical variations and the implications of median arcuate ligament syndrome. A re-bleed following embolization is a hostile prospect with potentially catastrophic outcomes for patients if not recognised quickly. The authors propose that interval re-imaging should be considered following endovascular management of blunt splenic trauma.

Celiac Artery Aneurysms, a Case of Endovascular Management and a Systematic Review of Current Approaches

Celiac artery aneurysms (CAAs) compose an uncommon location for splanchnic artery aneurysms. Risk factors for acquiring a CAA include prior trauma, abdominal surgery, pancreatitis, or prior endovascular procedures. Strict guidelines for repair of CAA have yet to be delineated; however, many have advocated for prophylactic repair when dilation exceeds 2 cm. We present the case of a 6.8-cm CAA in a patient who presented with severe epigastric abdominal pain and a review of the literature.

Lesson by SARS-CoV-2 disease (COVID-19): whole-body CT angiography detection of "relevant" and "other/incidental" systemic vascular findings.

ObjectivesIncreasing evidence suggests that SARS-CoV-2 infection may lead to severe and multi-site vascular involvement. Our study aimed at assessing the frequency of vascular and extravascular events’ distribution in a retrospective cohort of 42 COVID-19 patients.MethodsPatients were evaluated by whole-body CT angiography between March 16 and April 30, 2020. Twenty-three out of the 42 patients evaluated were admitted to the intensive care unit (ICU). Vascular and extravascular findings were categorized into “relevant” or “other/incidental,” first referring to the need for immediate patient care and management. Student T-test, Mann-Whitney U test, or Fisher exact test was used to compare study groups, where appropriate.ResultsRelevant vascular events were recorded in 71.4% of cases (n = 30). Pulmonary embolism was the most frequent in both ICU and non-ICU cases (56.5% vs. 10.5%, p = 0.002). Ischemic infarctions at several sites such as the gut, spleen, liver, brain, and kidney were detected (n = 20), with multi-site involvement in some cases. Systemic venous thrombosis occurred in 30.9% of cases compared to 7.1% of systemic arterial events, the first being significantly higher in ICU patients (p = 0.002). Among incidental findings, small-sized splanchnic arterial aneurysms were reported in 21.4% of the study population, with no significant differences in ICU and non-ICU patients.ConclusionsVascular involvement is not negligible in COVID-19 and should be carefully investigated as it may significantly affect disease behavior and prognosis.Key Points • Relevant vascular events were recorded in 71.4% of the study population, with pulmonary embolism being the most frequent event in ICU and non-ICU cases. • Apart from the lung, other organs such as the gut, spleen, liver, brain, and kidneys were involved with episodes of ischemic infarction. Systemic venous and arterial thrombosis occurred in 30.9% and 7.1% of cases, respectively, with venous events being significantly higher in ICU patients (p = 0.002). • Among incidental findings, small-sized splanchnic arterial aneurysms were reported in 21.4% of the whole population.

Complex Aortic Aneurysm Associated with Multiple Splanchnic Arterial Aneurysms and A Giant Coronary Artery Aneurysm

A 50-year-old male diabetic, hypertensive and chronic smoker presented with complex aortic, splanchnic aneurysms with impending rupture of iliac artery aneurysm, underwent coiling of celiac artery, internal iliac artery, and fenestrated/chimney endovascular aortic repair. One month later, the patient landed in an emergency due to bleeding complications of common hepatic artery and gastroduodenal artery aneurysms, which were managed successfully using endovascular techniques. The mayhem of progressive nature of the disease in the patient continued as he had left lower limb ischemia due to occlusion of the iliac artery and iliac limb of the aortic graft device as he continued to smoke. All of the above sequences of events occurred over a period of 5 years. He also developed a giant aneurysm of left anterior descending of 6.8 cm diameter, which had to be repaired by open surgical technique. The patient has been followed up for 6 years since his first presentation, and he was managed successfully from all the catastrophe of events using endovascular techniques. Giant coronary artery aneurysm with previous aneurysms at multiple sites is quite unusual and rare. Currently, there is no consensus regarding the clinical characteristics, diagnostic method, and the treatment of these cases.

Natural History of Splanchnic Artery Aneurysms

Splanchnic artery aneurysms (SAAs) represent a rare and potential life-threatening disease with a documented incidence of 0.1-2.0%. The risk of rupture and the diameter to recommend surgery are still controversial. The purpose of this study was to review surveillance computed tomography scans (CTs) at a high-volume institution in order to better define the natural history of the SAA. Between January 2000 and February 2019, all SAAs patients in follow-up at a single center institution were selected for analysis. CTs from patients managed nonoperatively and CTs before surgery from patients submitted to surgery were studied. The first CTs were used to determine aneurysm size, morphology, and anatomic characteristics, and the last CTs performed during nonoperative follow-up were used to compare the diameter with the previous CTs. Primary endpoint included growth rate for all SAAs location, and secondary endpoint included the clinical or anatomical characteristic associated with a faster growth rate. In total, 116 consecutive patients were identified with SAAs and 74 patients with 87 SAAs who had at least 2 CTs during follow-up were analyzed. From those 74 patients, 12 were submitted to surgery and only their preoperative CTs were analyzed. The SAAs' locations were: splenic (55.4%), hepatic (12.2%), superior mesenteric artery (17.6%), celiac trunk (27.0%), gastric and gastroepiploic arteries (1.4%), pancreaticoduodenal and gastroduodenal arteries (4.1%). The median follow-up for all patients was 46.7months (±35.3), and the median of growth for all aneurysms was 0.63mm/year (±2.19). Only the splenic aneurysms presented growth with statistic significance of 1.08mm per/year (±1.99) (P<0.001). Only portal hypertension showed statistically significance to splenic aneurysm growth (P=0.002). Multivariate analysis for variables associated with splenic aneurysm growth ≥1mm/year showed that portal hypertension was the only variable with statistical significance (P<0.01, IC 95% 2.0-186.9, β=19.5). Although longer-term follow-up and larger sample size are needed to better understand the natural history of SAAs, the majority of SAAs tends to remain stable in size through follow-up. Portal hypertension was the only risk factor found for true splenic aneurysm growth, and so those patients must have a closer follow-up.

A Case Of Splenic Artery Aneurysm, Treated By Aneurysmectomy And Splenic Artery End-To-End Anastomosis

Splenic artery aneurysms (SAA)’s account about 60% of all splanchnic artery aneurysms and are the third common intrabdominal aneurysm after abdominal aorta and iliac artery aneurysms...

Extensive Embolization of Splanchnic Artery Aneurysms due toSegmental Arterial Mediolysis.

Segmental arterial mediolysis (SAM) is a rare non-atherosclerotic, non-inflammatory, non-infectious arteriopathy in middle-aged patients that tends to affect medium-sized splanchnic arteries typically leading to dissecting aneurysms which in case of rupture have a high mortality. Treatment options include watchful waiting and endovascular or surgical intervention. There are no official treatment guidelines and to the best of our knowledge, there has not been any report of extensive exclusion of multiple splanchnic vessel regions in affected patients to date. We retrospectively examined the outcome of extensive splanchnic embolization in four patients suffering from SAM between 2011 and 2016 with follow-up periods of up to 7 years. One patient presented with abdominal pain due to rupture of aneurysms of the pancreaticoduodenal arcade, one with abdominal pain due to dissection, and two were clinically asymptomatic but displayed rapidly progressing disease over the course of 12 months. All patients were treated with complete exclusion of the diseased vessel segments by coiling all branches to and from the diseased segment. In three cases the main hepatic artery was excluded completely. In one case, the complete vascular bed of the celiac axis was excluded by coiling the distal vessel branches and placing a stent graft over the orifice of the celiac trunk. During a follow-up period of a minimum of 2 and a maximum of 7 years after intervention, there were no immediate or long-term complications except for a temporary arterio-portal fistula. Interestingly, no new diseased areas of SAM were detected afterwards. Extensive endovascular exclusion of the entire diseased arterial segment with coils seems to be a safe and effective treatment option in patients with SAM presenting with ruptured or rapidly growing aneurysms. Provided that patients have normal liver function and proper portal venous flow, risk of hepatobiliary complications seems to be low even after extensive embolization. · An asymptomatic SAM can be followed up.. · In case of disease progression or suspicion of aneurysm rupture, an endovascular approach is indicated where the whole pathological vessel bed should be excluded with coils.. · It seems that exclusion of even extensive vessel areas is tolerated.. · Najafi A, Sheikh GT, Binkert C. Extensive Embolization of Splanchnic Artery Aneurysms due to Segmental Arterial Mediolysis. Fortschr Röntgenstr 2019; 191: 1010 - 1014.

Endovascular Therapy of Splanchnic Artery Aneurysms: For Each and Every Aneurysm?

True visceral artery aneurysms (VAA) and visceral artery pseudoaneurysms (VAPA) are located in the celiac trunk, the superior mesenteric artery and inferior mesenteric artery. In addition to surgical treatment, endovascular embolisation therapy of visceral aneurysms and pseudoaneurysms is an alternative interventional method that has developed precipitously over the last two decades and is considered a first-choice method in many centres. The procedure is characterised by a high technical success rate with a low complication rate. This article presents the basic principles of endovascular treatment and discusses the indications and limitations of the procedure.

Clinical impact of collateral circulation in patients with median arcuate ligament syndrome.

We aimed to analyze computed tomography (CT) findings and medical records of patients diagnosed with median arcuate ligament syndrome (MALS) and evaluate possible risk factors associated with vascular complications that develop in patients with MALS. This retrospective study was approved by the institutional review board, and the requirement to obtain informed consent was waived. A total of 37 consecutive patients were diagnosed with MALS using both axial and sagittal CT reconstruction imaging at a single institution over a 7-year period. Dynamic contrast-enhanced CT data, medical records, and angiography results were reviewed. Thirty-two (86.5%) patients were asymptomatic and incidentally diagnosed with MALS using CT. Seventeen (45.9%) patients exhibited significant arterial collateral circulations and nine (24.3%) were found to have splanchnic artery aneurysms, including one (2.7%) with acute bleeding secondary to aneurysm rupture. Peripancreatic vascular network including pancreaticoduodenal arcades and dorsal pancreatic artery was the most common site for development of both collateral circulations (16/22, 72.7%) and aneurysms (9/16, 56.3%). Splanchnic artery aneurysms were significantly more common in patients with collateral circulations (8/17, 47.1%) compared with those without collateral circulations (1/20, 5%) (P < 0.01). At least one peripancreatic vascular aneurysm was found in five of nine patients with splanchnic artery aneurysms (55.6%). Splanchnic artery aneurysms are not uncommon in asymptomatic patients with collateral circulations caused by significant celiac trunk stenosis or obstruction due to median arcuate ligament. Therefore, careful imaging evaluation is necessary in patients with peripancreatic collateral circulations associated with MALS and regular follow-up is recommended for possibility of aneurysm development and rupture. Prophylactic endovascular treatment should be specifically performed in patients with pancreaticoduodenal arcade aneurysms to prevent life-threatening aneurysm rupture regardless of size.

Natural history and management of splanchnic artery aneurysms in a single tertiary referral center

ObjectiveSplanchnic artery aneurysms (SAAs) are rare, and little is known about their natural history and management. We reviewed our single-center experience in managing this population of patients. MethodsA retrospective review of the Yale radiologic database from January 1999 to December 2016 was performed. Only patients with an SAA and a computed tomography scan of the abdomen were selected for review. Demographics of the patients, aneurysm characteristics, management, postoperative complications, and follow-up data were collected. Our primary outcomes included aneurysm growth rate and risk of rupture in those patients managed nonoperatively and morbidity and mortality of those SAA patients who underwent operative intervention. ResultsThere were 122 patients with 138 SAAs identified; 77 were male (62%), with a mean age of 66 years (range, 25-94 years). On computed tomography, 56 (45%) had previously diagnosed or concomitant aneurysms elsewhere. Of the patients managed nonoperatively, 101 patients (79%) had 108 SAAs; in the operative intervention group, 25 (21%) patients had 30 SAAs. The mean overall vessel diameter was 1.76 ± 0.83 cm. The diameter of observed and operatively repaired SAAs was 1.58 ± 0.56 cm and 2.41 ± 1.23 cm, respectively (P = .00001). Mean follow-up was 50 ± 42 months for nonoperative management without any adverse events related to SAA, including 10 patients with SAA >2.0 cm. The mean observed growth rate for SAA was 0.064 ± 0.18 cm/y. All symptomatic patients who presented with severe abdominal pain (n = 11 [44%]) underwent operative intervention. Five patients presented with a ruptured SAA (3.6%; range, 2.3-5.0 cm); all of them except one underwent operative intervention. Other indications for repair included large size in seven, rapid growth in two, other open abdominal surgical procedures in two, multiple aneurysms in one, and desire to pursue fertility treatment in one. Operative repair included 14 (56%) endovascular embolizations and 11 (44%) open abdominal operations. After endovascular embolization, two patients underwent abdominal operation for hemorrhage and splenectomy. Open repairs included bypasses in six, splenectomy in two, resection in two, and plication in one. Two patients had postoperative acute kidney injury that resolved and one died of multisystem organ failure. One bypass occluded without sequelae. On multivariable regression analysis, female sex (P = .02) was associated with faster growth rate, and a history of smoking (P = .04) was associated with slower growth rate. ConclusionsIt seems reasonable to observe asymptomatic patients with an SAA <2.0 cm because of the slow growth rate (0.064 ± 0.18 cm/y) and benign behavior. When intervention is needed, both open and endovascular options should be considered.

Strategy of endovascular treatment for renal artery aneurysms

Renal artery aneurysm (RAA) is a rare disease. The incident rate detected upon autopsy was 0.3–0.7%. The incidence is almost 1% for the population undergoing renal artery angiography. 1 Tham G. Ekelund L. Herrlin K. et al. Renal artery aneurysms. Natural history and prognosis. Ann Surg. 1983 Mar; 197: 348-352 Crossref PubMed Scopus (254) Google Scholar In recent years, with increasing use of ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) for renal artery, asymptomatic RAA has been widely recognised and treated. 2 González J. Esteban M. Andrés G. et al. Renal artery aneurysms. Curr Urol Rep. 2014 Jan; 15: 376https://doi.org/10.1007/s11934-013-0376-z Crossref PubMed Scopus (35) Google Scholar In the last century, RAA was most commonly treated with surgical resection. Now, with the development of interventional microcatheter-guidewire systems and new embolic materials, endovascular treatment has become the first-line therapy for RAA because of its minimal invasiveness and because it is associated with minor complications and low mortality. 3 Cochennec F. Riga C.V. Allaire E. et al. Contemporary management of splanchnic and renal artery aneurysms: results of endovascular compared with open surgery from two European vascular centers. Eur J Vasc Endovasc Surg. 2011 Sep; 42: 340-346https://doi.org/10.1016/j.ejvs.2011.04.033 Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar The aim of the present study was to describe the authors' experience with RAA, focusing on the outcomes of different therapeutic modalities for RAA and to provide a scientific approach to the treatment for RAA.

Spontaneous Rupture of Splenic Artery Aneurysm Reported cause of Post-Partumcollapse

Splenic artery aneurysm (SAA) is a rare condition, with a prevalence of 1% [1]. However, potentially fatal .The importance of splenic artery aneurysm lies in the risk for rupture and life threatening hemorrhage, which occurs in 10% of cases with a mortality rate of 10-25% in non-pregnant patient and up to 70% during pregnancy [2]. It accounts for about 60% of all splanchnic arterial aneurysms. It only follows aortic and iliac arteries aneurysms as the third most common intra-abdominal aneurysm [1]. We report a case of rupture SAA at Latifa Hospital, a government tertiary hospital, Dubai Health Authority, Dubai, UAE, where 5586 deliveries was registered in the year 2014. Hospital Authority obtained ethical Clearance for this case report.

PC084 Natural History and Management of Splanchnic Artery Aneurysms in a Single Tertiary Referral Center

Splanchnic artery aneurysms (SAA) are rare, and little is known about their natural history and management. We reviewed our single-center experience managing this patient population. A retrospective review of the Yale radiology database from January 1999 to December 2016 was performed. Only patients with a SAA and a computed tomography (CT) scan of the abdomen were selected for review. Patient demographics, aneurysm characteristics, management, post-operative complications and follow-up data were collected. A total of 125 patients (77 men [62%]) with 138 SAA were identified. The mean age was 66 years (range, 25-94 years). On CT, 56 (45%) had previously diagnosed/concomitant aneurysms elsewhere. There were 30 patients (22%) who underwent operative repair (OR). The rest were monitored with serial scans without operative intervention (NOR). All patients who presented with severe abdominal pain (n = 11 [44%]) underwent OR. Five patients presented with a ruptured SAA (3.6%; range, 2.3-5.0 cm), for which all underwent OR except one. Other indications for repair included large size in 7, rapid growth in 2, other open abdominal surgical procedures in 2, multiple aneurysms in 1, and desire to pursue fertility treatment in 1. The mean overall vessel diameter was 1.76 ± 0.83 cm. The diameter of OR and NOR was 2.41 ± 1.23 cm and 1.58 ± 0.56 cm, respectively (P = .00001). Operative repair included 14 (56%) endovascular embolizations and 11 (44%) open abdominal operations. Two patients after embolization underwent abdominal operation for hematoma and splenectomy. Open repairs included bypasses in 6, splenectomy in 2, resection in 2, and plication in 1. Two patients had postoperative acute kidney injury that resolved and one died of multisystem organ failure. One bypass occluded without sequelae. The overall complication rate was 20% (6 of 30). Mean follow-up was 50 ± 42 months for NOR, without any adverse events related to SAA, including 10 patients with SAA >2.0 cm. On multivariate regression analysis, a history of smoking (P = .04) and male gender (P = .02) were inversely related to growth rates. The mean growth rate for SAA was 0.064 ± 0.18 cm/y (Fig). It seems reasonable to follow asymptomatic patients with a SAA <2.0 cm because of their slow growth rate (0.064 ± 0.18 cm/y) and because in our series, the smallest ruptured SAA was 2.3 cm in diameter. However, when intervention is needed, open and endovascular options should both be considered. The complication rate is not insignificant; therefore, careful patient selection is necessary.