Treatment Of Splenic Artery Aneurysm Research Articles

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.

Long-term Outcome Comparison of 2 Techniques for Embolization of Splenic Artery Aneurysms.

The aim of the study is to analyze our single-center experience in endovascular treatment of splenic artery aneurysms (SAAs) with transcatheter coil embolization, comparing long-term outcomes of packing and sandwich techniques. Between January 2010 and December 2021, 28 patients with certain diagnosis of non-ruptured asymptomatic SAA were treated with 2 different embolization techniques (packing, n=10, and sandwich, n=18). Early outcomes assessed were technical success, overall mortality, mean hospital stay, post-embolization syndrome rate, and freedom from splenectomy rate. Estimated 5-year outcomes in terms of freedom from sac reperfusion, and freedom from reintervention were evaluated and compared between the 2 different embolization techniques. The mean SAA diameter was 2.8±0.8 cm. Overall technical success rate was 100%. Intraoperative and 30-day mortality rates were 0 in both groups. One patient in the sandwich group required a postoperative splenectomy. The mean follow-up period was 58.3±44.5 months. Estimated overall 5-year survival was 86.7%. Five-year freedom from sac reperfusion was 100% in the sandwich group, and 85.7% in the packing group, with no difference between the 2 groups (p=0.131), whereas freedom from reintervention was 100% in the sandwich group, and 75% in the packing group with a statistically significant difference (p=0.049; log-rank=3.750). Embolization of SAAs seemed to be safe and effective with 100% of technical success rate and good perioperative results. Both sandwich and packing techniques yielded promising results also in the long-term period. Transcatheter coil embolization of splenic artery aneurysms seems to be a safe and effective procedure with a 100% technical success and satisfactory perioperative outcomes. Sandwich and packing techniques offer good results in the long-term period. Freedom from reintervention seems to be optimal and comparable between the 2 techniques.

Women of Childbearing Age Have Higher Mortality Rates Following Inpatient Interventions for Splenic Artery Aneurysms

Splenic artery aneurysms (SAAs) are the most common type of splanchnic aneurysms. Current guidelines recommend repair of SAAs in women of childbearing age because maternal mortality is high. The purpose of this study was to evaluate treatment modalities and outcomes following inpatient SAA repair in women. The National Inpatient Sample database from 2012 to 2018 was queried. Patients with SAAs were identified using International Classification of Diseases (ICD) 9 and 10 codes. Childbearing age was defined as 14-49years. The primary outcome was in-hospital mortality. A total of 561 patients were admitted with a diagnosis of SAA between the years of 2012 and 2018. There were 267 (47.6%) female patients and of these 103 (38.6%) were of childbearing age. The overall in-hospital mortality rate was 2.7% (n=15). There were no differences in rates of elective admissions or type of repair (open versus endovascular) between women of childbearing age and the remainder of the cohort. However, women of childbearing age were significantly more likely to undergo a splenectomy compared to the remainder of the cohort (32.0% vs. 21.4%, P=0.028). Women of childbearing age had higher rates of in-hospital mortality compared to the remainder of the cohort (5.8% vs. 2.0%, P=0.040). Subset analysis of the women of childbearing age revealed that those undergoing a splenectomy versus no splenectomy (14.8% vs. 2.6%, P=0.039) and those treated in the nonelective versus elective setting (10.5% vs. 0%, P=0.032) had higher rates of in-hospital mortality. There was 1 patient with an ICD code associated with pregnancy and they survived. Women of childbearing age had higher in-hospital mortality following inpatient interventions for SAAs with all of the deaths occurring in the nonelective setting. These data support the pursuit of aggressive elective treatment of SAAs in women of childbearing age.

Случай успешного лечения пациента с аневризмой селезеночной артерии, мальформацией селезеночной вены и спленомегалией

The clinical picture, diagnosis and selected option of surgical treatment of splenic artery aneurysm with splenic vein malformation and splenomegaly in a 30-year-old patient are discussed.

Ruptured splenic artery aneurysms in pregnancy and usefulness of endovascular treatment in selective patients: A case report and review of literature

BACKGROUNDThe rupture of a splenic artery aneurysm (SAA) in pregnancy is an uncommon condition. However, it is associated with high mortality rates in pregnant women and fetuses even after surgical treatment. Though the endovascular treatment of SAAs is currently preferred as it can improve the outcomes even in emergent cases, the endovascular treatment of a ruptured SAA during pregnancy has not been reported until date.CASE SUMMARYWe report a case of a 33-year-old woman with the sudden onset of epigastric pain due to a ruptured SAA at the mid-portion of the splenic artery at 18 wk of pregnancy. After emergent initial resuscitation, the patient was diagnosed with a ruptured SAA through digital angiography. Immediately upon diagnosis, she underwent emergent endovascular embolization of the splenic artery for the rupture on the spot. Next, surgery was performed to remove the hematoma under stable conditions. Although the fetus was found to be dead during resuscitation, the woman recovered without complications and was discharged 15 d postoperatively.CONCLUSIONEndovascular treatment might be a valuable alternative to surgery/lead to safer surgery for selected pregnant patients with ruptured SAAs.

Abstract No. 84 Impact of portal hypertension on outcomes of splenic arterial aneurysm embolization: a multi-institutional analysis

There are various management methods available for treatment of splenic artery aneurysm (SAA). However, there is still a lack of consensus regarding treatment of SAA in patients with portal hypertension (PHTN). We aim to evaluate outcomes of SAA embolization and to compare post-embolization complication rates in patients with and without PHTN.

Single-Center Experience With Endovascular Treatment for Splenic Artery Aneurysms in Long-Term Follow-Up: A Retrospective Study.

ObjectivesTo reveal a single-center experience with endovascular treatment for splenic artery aneurysm (SAA) and analyze the safety and efficacy of the operation in the long-term follow-up.Materials and MethodsA total of 49 patients with SAAs (21 men, 28 women; mean age, 52.4 ± 11.5 years) were enrolled in this study from July 2010 to December 2020. Baseline and characteristics of SAAs were collected. Parent artery coil embolization or combined with sac coil embolization of SAAs, graft-stent implantation, or bare-stent-assisted coil embolization were performed for the treatment of SAAs. Adverse events and follow-up data were recorded.ResultsThe average diameter of SAAs was 3.3 ± 2.5 cm (range, 1.0–13.6 cm). An individual-tailed modality was conducted for three patients. A 100% technical success rate was achieved. No re-intervention procedure was performed in all patients. No major treatment-related adverse events were observed, and no expansion or rupture of SAAs occurred in the average follow-up period of 57.9 ± 27.3 months (19–125 months).ConclusionEndovascular treatment of SAA, including the individual-tailed therapy for three cases, is safe, effective, and minimally invasive with high technical success rates and satisfactory outcomes during the long-term follow-up period.

Selecting the most appropriate surgical treatment of true splenic artery aneurysm

To analyze the results of diagnosis and treatment of true splenic artery aneurysms. We analyzed the results of diagnosis and treatment of 27 patients with true splenic artery aneurysm. All ones underwent surgical treatment at the Botkin Municipal Clinical Hospital between 2017 and 2021. Splenic artery aneurysm >1 cm was an indication for surgical treatment. Surgical option depended on aneurysm location. Laparoscopic splenectomy and aneurysmectomy were performed in 4 cases (14.8%), 5 (18.5%) patients underwent endovascular intervention, laparoscopic clipping was performed in 18 (66.7%) cases. Methods of surgical treatment, general and specific postoperative complications according to the Clavien-Dindo and ISGPS classifications were analyzed. Laparoscopic clipping was accompanied by fewer general and specific postoperative complications. Specific complications after laparoscopic splenectomy occurred in 2 patients (BL according to the ISGPS 2016 classification). There was one case of acute pancreatitis after endovascular interventions. In long-term postoperative period, aneurysm recanalization after endovascular intervention was observed in 1 case. Surgical treatment of splenic artery aneurysms requires a differentiated approach based on topographic and anatomical assessment of aneurysm relative to the arterial vessel.

Management of huge splenic artery aneurysm with new hybrid procedure including endovascular and open surgical approach: Case series.

IntroductionSplenic artery aneurysms (SAAs) account for more than half of all visceral artery aneurysms. Small SAAs are usually asymptomatic, but giant aneurysms are more likely to cause symptoms and result in life-threatening complications; these aneurysms treatment can be challenging. Splenic artery aneurysms treatment includes laparotomy, laparoscopy, or endovascular techniques.Case presentationThis case series reports the details of successful management of three patients with huge splenic artery aneurysms who underwent hybrid surgery, endovascular inflow control with a balloon, and open aneurysm resection.DiscussionAlthough endovascular treatment options are increasingly favored, only selected aneurysms are suitable for these procedures, as marked tortuosity of the artery or SAA in the proximal splenic artery may not be suitable for endovascular management.ConclusionOpen surgery escorted by endovascular techniques can be considered an ideal treatment of SAA in the proximal region of the splenic artery.

Abstract No. 46 Endovascular treatment of splenic artery aneurysms: a single-center experience

Endovascular treatment of splenic artery aneurysms (SAA) is purported in the literature to have decreased morbidity and comparable mortality to open surgical repair. Here, we report a single-center experience with endovascular management of 118 SAA, the largest reported in the literature to date.

Surgical and endovascular treatment of splenic artery aneurysm

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Оценить опыт хирургического и эндоваскулярного лечения больных с аневризмой селезеночной артерии (АСА). <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Представлены виды и результаты открытого хирургического и рентгенэндоваскулярного лечения 12 пациентов с АСА. <h3>РЕЗУЛЬТАТЫ</h3> Летальности после проведенного лечения не было. У 1 пациента отмечено повреждение поджелудочной железы с последующим дренированием брюшной полости. Расположение аневризмы в проксимальном или среднем отделе селезеночной артерии позволяет сохранить селезенку независимо от вида реконструкции, включая лигирование селезеночной артерии, за счет хорошего коллатерального кровообращения. <h3>ВЫВОД</h3> При отсутствии противопоказаний следует воспользоваться эндоваскулярными методами лечения, а именно стентированием АСА или ее эмболизацией. Открытая операция более травматична, но обладает более широкими хирургическими возможностями.

3D printing in the preoperative planning and endovascular treatment of splenic artery aneurysm. Own clinical experience and literature review.

Splenic artery aneurysms (SAAs) are the most common visceral aneurysms. Endovascular treatment of SAAs is increasingly used. Appropriate preoperative imaging of aneurysms is crucial to treatment planning. The case of a patient with accidentally detected SAA on angio-CT examination was the basis for implementation of 3D printing to prepare an artery model. The 3D model made it easier to qualify for endovascular treatment of the SAA and helped to visualize its morphology. An excellent treatment effect was achieved. 3D printing provides an opportunity for better visualization of SAA anatomy, which has a direct impact on the choice of minimally invasive treatment method.

Spleen-preserving surgical treatment of splenic artery aneurysm secondary to chronic pancreatitis and primary biliary cholangitis

Introduction. Splenic artery aneurysm (SAA) represents the third cause of abdominal aneurysms, just after abdominal aorta and iliac arteries aneurysms, with overall prevalence of 1%. Pancreatitis has been linked with pseudoaneurysm formation of SA due to destruction of arterial wall by pancreatic enzymes, however true SAA associated with pancreatitis has not been described yet. We are presenting the first case of true SAA in a patient with chronic pancreatitis and primary biliary cholangitis successfully treated by surgical excision, direct arterial reconstruction and spleen preservation. Case outline. A 74-year-old male patient was admitted for multidetector computed tomography angiography due to suspected SAA and renal artery aneurysm (RAA). He was previously treated for chronic pancreatitis and primary biliary cholangitis. Upon admission, computed tomography arteriography showed SAA 32 mm in diameter and RAA 12 mm with SAA being in direct contact with superior margin of the pancreas. Surgical treatment of SAA was indicated while RAA was treated conservatively. Intraoperatively, SAA adherent to the superior margin of pancreas was noted, followed by complete exclusion of the aneurysm and end-to-end splenic artery anastomosis. Histopathology showed atherosclerotic degeneration of arterial wall with all three layers presenting as true aneurysm. Two years after the surgery, control computed tomography angiography showed regular postoperative findings without further progression of RAA. Conclusion. This is the first case to describe a true SAA aneurysm originated on the field of previous episodes of chronic pancreatitis and primary biliary cholangitis. Surgical treatment including aneurysm resection and direct arterial reconstruction with spleen preservation showed satisfactory results.

Robotic Treatment of Complex Splenic Artery Aneurysms with Deep Hilar Location: Technical Insights and Midterm Results

Splenic artery aneurysms are rare, but their occurrence is burdened by considerable mortality and morbidity rates. Although the indications to treatment are quite clear-cut, there is still debate on the first-choice technique of treatment (endovascular, open, or laparoscopic surgery). Recently, robotic surgery has been proposed as an alternative option in patients at high surgical risk. The present case series aims to assess the value of robotic treatment of splenic artery aneurysms in patients unfit for surgery. All cases of splenic artery aneurysms treated by robotic surgery at our center between 2014 and 2018 were retrospectively reviewed. Primary endpoints were clinical and technical success and disease-free survival. Robotic surgery was used to treat four patients affected by splenic artery aneurysms, with the guidance of 3D printed patient-specific models. All patients, after aneurysm excision, received reconstruction of the splenic artery by direct anastomosis. All cases were treated successfully without mortality. Reintervention-free survival at 24-month mean follow-up is 100%, and no systemic complication of clinical relevance was reported. The mean time of organ ischemia was 45min. Robotic surgery is a safe and effective option in treating visceral aneurysms, providing the possibility to reconstruct the splenic artery after aneurysm excision.

A simple and inexpensive option in nonsurgical splenic artery aneurysm treatment by coronary bare metal stents

Visceral artery aneurysms can be life-threatening conditions with a high incidence of rupture. The endovascular technique with coil embolization is successful procedure for aneurysm treatment. Herein, we presented a case with a new and inexpensive treatment of splenic artery aneurysm by a coronary bare metal stent.

Laparoscopic Treatment of Splenic Artery Aneurysm - Video Presentation and Review of the Literature

Introduction - Splenic artery aneurysm (SAA) is the most common splanchnic arterial aneurysm, accounting for approximately 60% of all visceral aneurysms, and is the third most common abdominal aneurysm, after aortic and iliac artery aneurysms. Symptomatic aneurysm, aneurysm of any diameter in a pregnant woman or a woman of childbearing age, and aneurysm > 2 cm are strong indications for surgery because of a significantly increased risk for splenic artery rupture. Female patients are 4 times more likely to have SAAs than male patients.

Long-term outcomes of elective transcatheter dense coil embolization for splenic artery aneurysms: a two-center experience.

ObjectiveThis study was performed to analyze the long-term follow-up safety and efficacy of transcatheter dense coil embolization for splenic artery aneurysms.MethodsThirty-two patients (18 women, 14 men; age range, 23–56 years; mean age, 43.1 ± 13.6 years) who underwent dense coil embolization for treatment of splenic artery aneurysms from August 2010 to January 2018 were retrospectively reviewed. The size and location of the splenic artery aneurysms, the technical and clinical outcomes of the procedure, and the complications related to the procedure were reviewed.ResultsThe technical success rate of embolization was 100% (mean aneurysm size, 29.4 ± 6.9 mm; range, 20–43 mm). Two (6.3%) patients underwent a successful repeat intervention procedure for recurrent aneurysm perfusion during follow-up (mean, 36 months; range, 6–72 months). No aneurysm ruptured during follow-up. Splenic infarction was observed in 8 of 32 (25%) patients. No patients developed major adverse events related to the procedure, such as splenic abscess or pancreatitis.ConclusionsPercutaneous elective transcatheter dense coil embolization is safe and effective to prevent aneurysm rupture and overcome aneurysm recanalization during long-term follow-up.

Laparoscopic Treatment of Splenic Artery Aneurysm

Visceral artery aneurysms are a rare but dangerous vascular pathology. The branches of the coeliac trunc are most frequently affected, especially the splenic artery. A visceral aneurysm is usually diagnosed only when a bleeding complication occurs due to rupture. It is therefore recommended to treat this pathology at an early stage after diagnosis. Endovascular elimination is the preferred procedure. However, if endovascular elimination is not suitable, the visceral aneurysm can be successfully treated by minimally invasive surgery. Splenic artery aneurysms are located at the splenic hilum, and are therefore considered to be at high risk of splenic ischemia and secondary complications following endovascular coiling. Laparoscopic treatment of splenic artery aneurysm. In the case of complex vascular pathologies unsuitable for an endovascular approach, laparoscopic treatment of splenic artery aneurysm is a safe and effective minimally invasive option and alternative.

03:27 PM Abstract No. 251 Post-embolization outcomes of splenic artery aneurysms in cirrhotic and non-cirrhotic patients

Splenic artery aneurysm is a rare entity. Embolization is the treatment of choice. We aim to evaluate the outcomes of embolization for the treatment of splenic artery aneurysms in cirrhotic and non-cirrhotic patients From 2008 to 2017, all patients who underwent embolization for splenic arterial aneurysms were included in this IRB-approved retrospective review. Treatment technique was studied. Outcomes included complications, 30-day leukocytosis, liver function tests, and platelet counts. Univariate logistic regression analyses were performed to compare laboratory values pre- and post-embolization. Substratification analyses based on presence and absence of cirrhosis were performed (serious adverse events among cirrhotic/non-cirrhotic patients were compared using Fischer’s test). 30 patients (7 males, mean age 52 [range:37-75]) were included. 20 (66%) splenic artery aneurysms were incidentally detected on imaging; 10 (33%) patients had concurrent cirrhosis. Post-embolization, patients had median length of hospitalization of 1 day (CI:0-2). Within 30 days, 12 (40%) patients had post-embolization leukocytosis (median of 22,000/μl). 26 (87%) of aneurysms were located distal to the origin of the dorsal pancreatic artery branches; no patients had post-embolization pancreatitis. 30-day post-embolization platelet count increase in cirrhotic vs. non-cirrhotic patients was 90×103/μl (CI: 55-124) and 225×103/μl (CI: 23-428) (p=0.015). Cirrhotic patients had higher incidence of hilar aneurysms (80%) than non-cirrhotic patients (60%) (p=0.4). Greather than 50% splenic infarction rate was higher in cirrhotics (50%) vs. non-cirrhotics (15%) (p=0.08). Rate of serious adverse events (sepsis due to spontaneous bacterial peritonitis/empyema or death) was higher in the cirrhotic (66%) vs non-cirrhotic (0%) patients (p=0.003). Splenic artery aneurysm embolization can be performed safely in non-cirrhotic patients. There is a significantly higher serious adverse event rate in cirrhotic vs. non-cirrhotic patients. We recommend caution in treating splenic artery aneurysms in cirrhotic patients.

Laparoscopic splenectomy in the treatment of splenic artery aneurysm - case report and literature review

Introduction. Splenic artery aneurysm is the most common visceral aneurysm with a prevalence of 0.2?10%. It is the third most frequent abdominal aneurysm as well. It can be true or false. It occurs more often in women than in men. We present our experience with a 34-year-old female patient who underwent laparoscopic splenectomy due to the splenic aneurysm located in the splenic hilum. Case outline. We present a case of a 34-year-old female patient diagnosed with an enlarged splenic artery during a routine abdominal ultrasound examination. Abdominal scan and computed tomography angiography showed saccular aneurysm of the splenic artery located in the hilum of the spleen, 24 ? 17 mm in size. Given the good general condition and age of the patient, we decided to perform laparoscopic splenectomy. The operation was performed without complications, which was also the case with the postoperative flow. The patient was discharged from the hospital on the third postoperative day. Conclusion. Laparoscopic splenectomy is a safe and effective modality for the treatment of splenic artery aneurysm, localized in the splenic hilum. Considering all the benefits of minimally invasive surgery, laparoscopic splenectomy should be the treatment of choice, over the classical open approach.