Incidental splenic artery aneurysms: systematic literature review and single-centre study.

The spleen is a vital intra-abdominal organ that provides a role in hematopoietic and immunologic functions. It is highly vascular and is the most commonly injured organ in the setting of blunt trauma, potentially leading to life-threatening hemoperitoneum. Splenic artery embolization (SAE) serves as an alternative to operative management of patients with splenic trauma and has quickly become popular given the infectious risks associated with splenectomy. Since its inception, indications for SAE have evolved beyond the management of traumatic injury. The authors discuss splenic artery anatomy and the importance of maintaining critical collateral pathways when SAE is performed to preserve splenic and distal pancreatic arterial flow and minimize complication risks. An in-depth and evidence-based review of SAE in the setting of trauma is provided, including a comparison between proximal and distal embolization techniques. Nontraumatic indications for splenic embolization to induce splenic involution are covered, including for the treatment of hypersplenism, thrombocytopenia, portal hypertension, and complications of liver transplant such as the small-for-size syndrome and splenic artery steal syndrome. The use of SAE for the treatment of splenic aneurysms and upper gastrointestinal bleeding is also discussed. Periprocedural and intraprocedural technical considerations are covered, such as the routes of vascular access, type of embolic used, role of vaccination, preprocedural imaging, antibiotic therapy, and postprocedural management and complications. ©RSNA, 2026 Supplemental material is available for this article. See the invited commentary by Montgomery and Elliott in this issue.

Invited Commentary: Splenic Artery Embolization: Practical Overview of a Commonly Encountered Procedure.

To evaluate fetal pancreatic size, echogenicity, and splenic artery (SA) Doppler parameters during the mid-second trimester and determine their association with gestational diabetes mellitus (GDM). This prospective case-control study included 150 singleton pregnancies between 24 and 28 weeks, comprising 60 women with GDM and 90 healthy controls. GDM diagnosis was based on the International Association of Diabetes and Pregnancy Study Groups criteria using a one-step 75-g oral glucose tolerance test. Ultrasonography was performed to measure fetal pancreatic circumference, classify echogenicity, and obtain SA Doppler indices. Pancreatic circumference was significantly larger in the GDM group than in controls (7.65 ± 0.97 cm versus 6.88 ± 0.98 cm), remaining significant after adjusting for abdominal circumference (AC) (P < 0.001), body mass index (BMI; P = 0.001), and AC + BMI (P = 0.008). Increased echogenicity was more frequent in GDM pregnancies (85% versus 31.2%; P < 0.001). Although SA Doppler indices showed no group differences, pancreatic circumference correlated positively with SA peak systolic velocity (r = 0.232, P = 0.005) and SA time-averaged maximum velocity (r = 0.239, P = 0.003). Receiver operating characteristics analysis demonstrated modest discriminatory performance for pancreatic circumference (area under the curve [AUC] 0.708), comparable to maternal hemoglobin A1c (AUC 0.704) and higher than the homeostatic model assessment of insulin resistance (AUC 0.653). Fetal pancreatic circumference and echogenicity are significantly altered in GDM as early as the mid-second trimester, whereas SA Doppler parameters remain unchanged. These findings suggest that fetal pancreatic assessment may reflect concurrent metabolic changes in GDM.

Severe delayed post-pancreatectomy hemorrhage (SDPPH) is a fatal complication classified into pseudoaneurysm rupture and non-pseudoaneurysm hemorrhage. This study analyzed their clinical characteristics and outcomes. A retrospective multicenter cohort study was conducted on consecutive patients who underwent pancreatic resection between January 2014 and December 2023. All SDPPH cases included in the study were confirmed by digital subtraction angiography. Pseudoaneurysm rupture accounted for 47.3% (44/93) of SDPPH. Overall mortality was 29.0% (27/93), without significant difference between the pseudoaneurysm and non-pseudoaneurysm groups (p > 0.05). The hemorrhage sites differed significantly between groups, with the common hepatic artery and its branches (excluding gastroduodenal artery) being most frequent in the pseudoaneurysm group (15/44, 34.1%), versus other sites (including anastomosis, splenic artery, portal vein, superior mesenteric vein, and left gastric artery) in the non-pseudoaneurysm group (22/49, 44.9%). Intensive care unit stay was shorter in the pseudoaneurysm group (1.8 ± 3.9 days) than in the non-pseudoaneurysm group (5.3 ± 10.6 days; p = 0.040). The clinical hemostasis success was significantly higher in the pseudoaneurysm group (81.8%, 36/44) than in the non-pseudoaneurysm group (32.7%, 16/49; p < 0.001). Pseudoaneurysm rupture was associated with a better SDPPH prognosis than non-pseudoaneurysm hemorrhage. Heightened vigilance is warranted for rebleeding in non-pseudoaneurysm cases.

We present a case of concomitant splenic artery aneurysmal rupture with uterine rupture in a 32 year-old pregnant woman at 34 weeks of gestation with a history of one previous Cesarean section. The patient presented to the Emergency Department (ED) due to a sudden abdominal pain, which resolved spontaneously. In the ED, she displayed tachycardia, sweating, and lethargy, with no detectable fetal heart rate, raising suspicion of uterine rupture. Surgical exploration revealed significant intra-abdominal hemorrhage from a prior uterine incision, resulting in intrauterine fetal demise (IUFD) and placental abruption. The uterine rupture was promptly repaired, and the uterus remained stable. Subsequently, substantial bleeding and a massive hematoma were discovered. The patient received blood transfusions and underwent surgery to address the source of bleeding, identified as a ruptured splenic artery aneurysm, and successfully managed with packing and ligation. She recovered in the Intensive Care Unit (ICU). This case highlights the rare co-occurrence of uterine rupture and splenic artery aneurysm without apparent changes in vital signs or abdominal findings. In spite of the IUFD and massive hemorrhage, the patient ultimately maintained normal blood pressure.

Cost-effectiveness of Preventive Transarterial Embolization for Splenic Artery Aneurysm Below the Guideline-Recommended Size Threshold: A Japanese Claims-Based Study.

Emergency Deceased Donor Liver Transplantation Using a PTFE Graft for Complex Arterial Reconstruction: A Technical Note.

We report an incidental finding of a coeliac trunk (CeT) hexafurcation in a 62-year-old female during computed tomography angiography, where the trunk sequentially branches off the left and right inferior phrenic arteries (IPAs) and the left gastric artery (LGA) as collateral branches, before a terminal trifurcation into the common hepatic (CHA), splenic (SA), and dorsal pancreatic (DPA) arteries. While the CeT typically trifurcates, hexafurcation is exceedingly rare. This variation likely stems from the failure of standard regression of primitive splanchnic arteries. The aberrant branches (IPA and DPA) are involved in numerous surgical and interventional procedures. Therefore, this image emphasizes the necessity of high-resolution preoperative imaging and three-dimensional reconstruction to identify complex vascular morphologies.

BackgroundSplenic hilar aneurysms exceeding 2cm in diameter typically warrant surgical intervention given their elevated risk of fatal rupture. While complete splenectomy has historically been the conventional approach to mitigate operative complexity, this procedure carries significant postoperative concerns including compromised immune function and increased thrombotic risks associated with splenic absence.Case presentationIn two cases of splenic artery aneurysms (SAAs) deeply embedded within the pancreatic tail at the splenic hilar region, we performed laparoscopic resection of the splenic artery aneurysm and distal pancreas. Intraoperative indocyanine green (ICG) fluorescence imaging was employed to map perfusion patterns of the spleen, demonstrating sequential greening and subsequent fading of the splenic upper pole. This confirmed preserved arterial inflow and venous drainage, thus confirming maintained vascularization following splenic artery ligation. The patients achieved an uneventful recovery and were discharged without complications.ConclusionsWe described the first use of a technique that integrates distal pancreatectomy with ICG-guided partial splenic preservation for complex splenic hilar aneurysms. This strategy facilitates precise resection of the aneurysm and non-viable spleen, thereby maximizing functional preservation and establishing itself as a promising option for managing these challenging lesions.

Letter to the Editor: Graft inflow modulation by splenic artery ligation in live donor liver transplant recipients in different time frames-A parallax!

To elucidate morphological characteristics of the splenic artery (SA) arising from the superior mesenteric artery (SMA). Contrast-enhanced CT images of 13 patients with SA arising from SMA were retrospectively analyzed. Gross appearance of SA arising from SMA was observed on volume-rendering 3D images. Additionally, we measured the following lengths m each patient on the appropriate multiplanar reformation (MPR) images; (A) the distance from the origin of SMA to the origin of SA, (B) SA length from the origin of SA to the point which is at the shortest distance from the celiac artery (CA), (C) the shortest distance between CA and SA, (D) the distance from the origin of SA to the origin of the middle colic artery. In all 13 patients, SA arising from SMA showed similar course. It first runs cranially toward the point which is very close to CA, and then curves toward the left and afterwards runs along almost the same course as the conventional SA. The shortest distance between SA and CA (distance C) was 3.3 ± 1.4 [mm]. SA arising from SMA invariably shows characteristic morphology. This characteristic morphology suggests that longitudinal anastomosis between primitive CA and SMA may be the developmental basis of this variant vascular anatomy.

BACKGROUND Left-sided portal hypertension (LSPH) is a rare condition that occurs when the splenic vein pressure elevated, which can lead to gastric varices, without abnormalities of hepatic function or esophageal varices. The main causes of LSPH are splenic vein compression, stenosis, and thrombosis. However, no cases of LSPH resulting from vascular malformation have been reported. In this case report, we describe our experience of a patient with LSPH caused by a splenic vein malformation. CASE REPORT The patient was a 53-year-old man who reported having melena for 2 weeks. Gastroscopy performed at another hospital revealed gastric varices, and abdominal contrast-enhanced computed tomography (CT) showed gastric fundal varices and splenic vascular malformation. The patient denied any history of pancreatitis, abdominal trauma, or related surgeries. After further examination, comprehensive imaging, including contrast-enhanced CT and magnetic resonance imaging (MRI), revealed tortuous vascular cluster between the splenic artery and vein, marked dilatation of the left gastric vein, and numerous collateral vascular branches surrounding the perigastric area, with no signs of cirrhosis and gastro-renal shunt or splenic-renal shunt. Therefore, we suspected he had LSPH caused by splenic arteriovenous malformation. To improve the melena, after analyzing the advantages and disadvantages of the surgical approach, we abandoned the embolization approach and opted for splenectomy and Hassab's operation. After Hassab's operation, LSPH caused by arteriovenous malformation was diagnosed by pathology and immunohistochemistry. CONCLUSIONS We report our experience with a rare case of LSPH caused by arteriovenous malformation. We suggest the importance of early differentiation of vascular malformations and non-invasive vascular testing in patients suspected of having LSPH.

Splenomegaly commonly occurs in portal hypertension due to cirrhosis, potentially causing leukopenia, thrombocytopenia and portal hypertension. Partial splenic artery embolization (PSE) serves as a substitute for splenectomy, given the significant risks associated with surgery in cirrhotic patients. In addition to improving hematologic indices, PSE may indirectly benefit liver-related outcomes and reduce portal hypertension complications. The objective of this study was to assess the short-term (One-month) and long-term (24-month) impact on hematological parameters and liver function post-PSE, to compare the hematological parameters and liver function in patients with different volumes of spleen embolization (group A-< 50% and group B-> 50%) and to evaluate the changes in the status of esophageal varices and Child-Turcotte-Pugh (CTP) score after PSE. A review of medical records of 47 patients who underwent PSE between March 2011 and March 2023 was conducted from the hospital database. PSE was primarily indicated for hypersplenism-related complications in cirrhotic patients and to improve blood counts for safer anti-viral therapy in hepatitis C virus (HCV) infection. Information regarding patient demographics, underlying liver disease, indication for PSE and baseline laboratory values was noted at short-term (Onemonth) and long-term duration (24months). Short-term follow-up revealed an 80 ± 11.8% increase in total leukocyte count (TLC) and a 143 ± 39% rise in platelet count, while long-term follow-up showed a 56 ± 8.6% increase in TLC and an 83.7 ± 21% increase in platelet count. Albumin levels rose from 3.0 ± 0.6g/dL before PSE to 3.3 ± 0.58g/dL (10.4 ± 1.4% increase) in the long term. Cumulative variceal bleeding episodes decreased from 2.1 to 0.72, alongside an improved CTP score from baseline. PSE leads to sustained hematologic improvement and favorable changes in liver-related parameters. Embolization limited to < 50% achieves comparable long-term benefits with fewer complications, supporting its role as a safer therapeutic strategy in cirrhotic patients with hypersplenism.

Introduction: Liver transplantation is a definitive treatment for patients with end-stage liver disease and liver neoplasms. Vascular complications remain an important cause of morbidity and mortality in these patients. Splenic artery embolization is an alternative to improve the clinical and hemodynamic conditions of such patients. Methods: The research was conducted in October 2025 on the PubMed and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) platforms, based on the descriptors: “Splenic artery,” “Embolization, therapeutic,” and “Liver Transplantation”; 15 articles were selected based on eligibility criteria. Results: Seven case reports and eight cohort studies, or retrospective case series were found, reflecting the current level of evidence on the application of splenic artery embolization in patients undergoing liver transplantation. Analysis of the articles allowed the data to be synthesized into three central thematic categories: indications for the procedure, techniques used, and clinical outcomes, including complications. Conclusion: Splenic artery embolization is a minimally invasive, safe, and effective therapeutic strategy for the management of selected complications after liver transplantation, such as splenic artery steal syndrome, refractory ascites, hydrothorax, and hypersplenism

A giant splenic artery aneurysm: Endovascular constraints and surgical strategy in complex anatomy.

Splenic Artery Embolization for Refractory Ascites Following Hepatectomy for Hepatocellular Carcinoma

Thinking beyond gastroenteritis: a rare case of splenic artery pseudoaneurysm in a 17-year-old without risk factors

Abstract Background Visceral pseudoaneurysms are a rare but potentially fatal complication of chronic pancreatitis, with up to 90% mortality rate if left untreated. Currently, percutaneous and endovascular angioembolization are used in elective and emergency settings employing coils, glue, stents, and thrombin injections. Previously, surgery was the only option when percutaneous attempts were unsuccessful. Endoscopic ultrasound-guided (EUS) allows direct examination of visceral pseudoaneurysms with potential for endoscopic therapy. Limited literature has reported EUS-guided thrombin injection, particularly in challenging cases with poor visualization or endovascular inaccessibility. Aims To describe a successful obliteration of a peri-pancreatic pseudoaneurysm using EUS-guided thrombin injection. Methods A detailed chart and literature review were performed. Results A 49-year-old male with a history of alcohol related pancreatitis presented with a 2-week history of melena and worsening of abdominal pain. On investigations, he had a hemoglobin drop (110 g/L-4 months prior, to 67 g/L) and elevated lipase (836 U/L). CT showed peripancreatic stranding with calcifications suggestive of acute-on-chronic pancreatitis, a small pseudocyst (3.0x2.9x4.2 cm) in the pancreatic tail, and a small adjacent well-circumscribed hyperattenuating focus (1.3x1.7x1.7 cm). The splenic vein appeared patent distally, with extensive SMV abdominal collaterals. Gastroscopy showed an oozing esophageal varix at the gastro-esophageal junction, requiring bandings to achieve hemostasis, and friable gastric mucosa with a fullness in the cardia that was felt to be gastroesophageal varix-type 1. CT angiography showed a small peripancreatic pseudoaneurysm from the small pancreatic arterial branch of the splenic artery (2.8x2.6x2.3 cm), significantly increased from the previous. Initial attempts at IR-guided intervention were unsuccessful due to a lack of access to the pseudoaneurysm. Given the proximity to the gastric body, EUS-guided thrombin injection was pursued; there was a 33x32 mm pseudoaneurysm adjacent to the pancreatic tail, showing a Yin-Yang sign on Doppler. With a 22-gauge Olympus EZ shot needle, the pseudoaneurysm was punctured. 350 IU of thrombin was injected into the pseudoaneurysm with excellent opacification and loss of Doppler flow. A small amount of thrombin was injected as the needle was withdrawn to minimize the risk of bleeding or extravasation into the tract. The patient remained stable with no complications. Subsequent imaging showed successful obliteration of the pseudoaneurysm. Conclusions EUS-guided thrombin injection is a novel modality in pancreatic pseudoaneurysm management, particularly in cases with limited visualization or challenging vascular access. Larger studies with long-term follow-ups are required to further evaluate this technique. Funding Agencies None

Background: Visceral artery aneurysms (VAAs) are rare vascular lesions associated with a substantial risk of rupture and high mortality. Splenic artery aneurysms (SAAs) are the most common and best studied, with relatively well-established risk factors and management strategies. In contrast, uncommon VAAs arising from the hepatic, celiac, superior mesenteric, gastroduodenal, pancreaticoduodenal, gastroepiploic, gastric, jejunal, ileal, colic, and inferior mesenteric arteries are exceedingly rare, and their natural history and rupture predictors remain poorly defined. Rupture has been reported at small diameters, challenging size-based thresholds derived largely from SAA data. Objectives: This systematic review and pooled analysis aims to determine rupture rates, predictors of rupture, and rupture-related mortality of uncommon true VAAs, and to compare these outcomes with those reported for SAAs, which will serve as reference lesions. Methods: The review will be conducted in accordance with PRISMA 2020 guidelines and is registered in PROSPERO (CRD420251155062). A comprehensive search of PubMed/MEDLINE, Embase, Web of Science, Scopus, and Google Scholar will be performed. For uncommon VAAs, eligible studies will include meta-analyses, systematic reviews, cohort studies, case series, and case reports. For SAAs, only meta-analyses, systematic reviews, and large cohort studies will be included. Pooled patient-level data will be extracted where available. Primary outcomes are rupture rate and rupture-related mortality; secondary outcomes include predictors of rupture according to aneurysm location, size, patient characteristics, and clinical presentation. Risk of bias will be assessed using JBI, ROBINS-I, and AMSTAR 2 tools. Expected Impact: This review aims to clarify rupture behaviour of uncommon VAAs, identify clinically relevant predictors, and provide a stronger evidence base to support risk stratification and harmonisation of clinical decision-making.