Percutaneous Endovascular Management of a Splenic Artery Aneurysm

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.

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Endovascular Management of a Ruptured Splenic Artery Aneurysm

Vascular and Endovascular Surgery ◽

10.1177/1538574406290209 ◽

2007 ◽

Vol 41 (1) ◽

pp. 68-72 ◽

Cited By ~ 7

Author(s):

David Varnagy ◽

Morgan Sendzischew ◽

Jeffrey A. Hertz ◽

Harry Sendzischew

Keyword(s):

Splenic Artery ◽

Artery Aneurysm ◽

Splenic Artery Aneurysm ◽

Endovascular Management

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Rebleeding of a Splenic Artery Aneurysm after Coil Embolisation

Case Reports in Surgery ◽

10.1155/2016/1858461 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Kyra D. Kingma ◽

Antonius N. van der Linden ◽

Rudi M. H. Roumen

Keyword(s):

Splenic Artery ◽

Artery Aneurysm ◽

Splenic Artery Aneurysm ◽

Endovascular Management ◽

Careful Monitoring ◽

Coil Embolisation ◽

Partial Pancreatectomy ◽

Case Presentation ◽

Difficult Diagnosis

Background. Splenic artery aneurysm (SAA) is an uncommon and difficult diagnosis. SAA is more common in females. Only 20% of SAA is symptomatic and may present as a rupture. A ruptured SAA is associated with a 25% mortality rate. Case Presentation. We present a case of a male patient with a bleeding SAA that rapidly increased in size. Distal coiling was technically impossible and despite proximal coil embolisation the SAA continued to bleed. A laparotomy including splenectomy and partial pancreatectomy was performed with an uneventful patient recovery. Discussion. Endovascular management is currently considered the optimal treatment of SAA. However, careful monitoring and follow-up is needed after embolisation as rapid recanalization of the SAA may possibly occur, especially when distal coiling of the aneurysm is unsuccessful. Conclusion. Endovascular treatment of an SAA is not necessarily effective. Surgeons must be prepared to perform open procedures to further reduce mortality rates.

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Endovascular Management of a Splenic Artery Aneurysm

Surgical Laparoscopy Endoscopy & Percutaneous Techniques ◽

10.1097/sle.0b013e31814a5772 ◽

2007 ◽

Vol 17 (5) ◽

pp. 459-461 ◽

Cited By ~ 14

Author(s):

Jason Roland ◽

Fred Brody ◽

Anthony Venbrux

Keyword(s):

Splenic Artery ◽

Artery Aneurysm ◽

Splenic Artery Aneurysm ◽

Endovascular Management

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Embolization of a Giant Splenic Artery Aneurysm with Only Proximal Coil Embolization: A Case Report

International Journal of Angiology ◽

10.1055/s-0032-1306194 ◽

2003 ◽

Vol 12 (03) ◽

pp. 209-210

Author(s):

Michael Herskowitz ◽

Yair Safriel ◽

Virgilio Gillego

Keyword(s):

Case Report ◽

Coil Embolization ◽

Splenic Artery ◽

Artery Aneurysm ◽

Splenic Artery Aneurysm

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Incidental Splenic Artery Aneurysm

Journal of the Royal Society of Medicine ◽

10.1177/014107680209500911 ◽

2002 ◽

Vol 95 (9) ◽

pp. 460-461 ◽

Cited By ~ 7

Author(s):

R Kenningham ◽

M J Hershman ◽

R G Mcwilliams ◽

F Campbell

Keyword(s):

Splenic Artery ◽

Artery Aneurysm ◽

Splenic Artery Aneurysm

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Splenic artery aneurysm in Sjögren’s syndrome

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2019.1082 ◽

2019 ◽

Vol 89 (2) ◽

Author(s):

Cuneyt Tetikkurt ◽

Zeynep Ferhan Ozseker ◽

Fatma Gülsüm Karakaş

Keyword(s):

Sjögren’S Syndrome ◽

Splenic Artery ◽

Sjögren's Syndrome ◽

Pulmonary Function Tests ◽

Artery Aneurysm ◽

Sjogren’S Syndrome ◽

Sjogren's Syndrome ◽

Splenic Artery Aneurysm ◽

Arterial Blood ◽

Sjögren‘S Syndrome

A 40-year-old female presented with cough, exertional dyspnea, abdominal pain with distention, fatigue, dry eyes and dry mouth. Past history revealed asthma. Physical examination was normal except for tachypnea. We found leukocytosis, azygos fissure on chest X-ray along with normal pulmonary function tests and arterial blood gases. Thorax computed tomography (CT) revealed bronchiectasis and ground glass opacities in both lungs. Abdominal CT demonstrated thrombosed proximal splenic artery aneurysm. Further diagnostic procedures were done and according to the positive Schirmer test and compatible histopathologic findings of the salivary gland, diagnosis of primary Sjögren’s syndrome was established. Splenic artery aneurysm is rare occurring in less than 1% of the population that usually appears as an incidental finding. This is the first case in literature that introduces Sjögren’s syndrome as a risk factor for splenic artery aneurysm. The silent presentation of the splenic artery aneurysm should previse the clinicians that such an occurrence may cause a significant diagnostic dilemma.

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