Endovascular treatment of a patient with false aneurysm of splenic artery and sharp tortuosity of the arterial flow

A case of endovascular treatment of a patient with a large false aneurysm of the splenic artery resulting from arrosion of its wall into the cavity of a previously existing pancreatic pseudocyst is described. In addition to the rather rare occurrence of this pathology, a feature of this clinical case was the patient’s sharp tortuosity of the access vessels, including the iliac arteries, abdominal aorta, and the splenic artery. Thus, both the endovascular prosthetics of the affected splenic artery and its embolization according to the traditional method using standard angiographic catheters and Gianturco coils turned out to be technically impossible because of the inability to reach the lesion site, especially with access through the common femoral artery that typical for such interventions, which was used by us when performing diagnostic selective arteriography. The second stage was the embolization of the splenic artery by access through the left axillary artery by means of conducting of guiding catheter into the celiac trunk. Through the lumen of this catheter, we introduced a microcatheter, through which detachable microcoils (usually used in interventional neuroradiology) were introduced into the splenic artery proximal and distal to the aneurysm cavity. As a result, the affected area of the splenic artery with aneurysm was completely turned off from the bloodstream and thrombosed, that allowed to avoid extremely risky open surgical intervention and eliminated the risk of rupture of the aneurysm. Medication support included hypotensive therapy to reduce the risk of rupture of the aneurysm (before and after surgery), analgesics for the relief of post-embolization pain, and antibiotics for the prevention of infectious complications associated with pancreatitis and the possible development of spleen infarction. Monitoring the effectiveness of the intervention in the postoperative period was carried out using ultrasound dopplerography.

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Complex endovascular treatment of a celiac trunk artery aneurysm with splenic artery rescue

Radiology Case Reports ◽

10.1016/j.radcr.2021.08.008 ◽

2021 ◽

Vol 16 (11) ◽

pp. 3359-3362

Author(s):

Gianpaolo Santini ◽

Pasquale Quassone ◽

Francesco Arienzo ◽

Giuseppe Sarti

Keyword(s):

Endovascular Treatment ◽

Splenic Artery ◽

Artery Aneurysm ◽

Celiac Trunk

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Current evidence and prospects for medical treatment of abdominal aortic aneurysms

VASA ◽

10.1024/0301-1526.34.4.217 ◽

2005 ◽

Vol 34 (4) ◽

pp. 217-223 ◽

Cited By ~ 11

Author(s):

Diehm ◽

Schmidli ◽

Dai-Do ◽

Baumgartner

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Medical Treatment ◽

Endovascular Treatment ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Current Evidence ◽

Significant Morbidity ◽

Abdominal Aortic ◽

Risk Of Rupture

Abdominal aortic aneurysm (AAA) is a potentially fatal condition with risk of rupture increasing as maximum AAA diameter increases. It is agreed upon that open surgical or endovascular treatment is indicated if maximum AAA diameter exceeds 5 to 5.5cm. Continuing aneurysmal degeneration of aortoiliac arteries accounts for significant morbidity, especially in patients undergoing endovascular AAA repair. Purpose of this review is to give an overview of the current evidence of medical treatment of AAA and describe prospects of potential pharmacological approaches towards prevention of aneurysmal degeneration of small AAAs and to highlight possible adjunctive medical treatment approaches after open surgical or endovascular AAA therapy.

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Gender differences in abdominal aortic aneurysm therapy – a systematic review

VASA ◽

10.1024/0301-1526/a000703 ◽

2018 ◽

Vol 47 (4) ◽

pp. 267-272 ◽

Cited By ~ 9

Author(s):

Konstanze Stoberock ◽

Tilo Kölbel ◽

Gülsen Atlihan ◽

Eike Sebastian Debus ◽

Nikolaos Tsilimparis ◽

...

Keyword(s):

Gender Differences ◽

Abdominal Aortic Aneurysm ◽

Survival Rate ◽

Aortic Aneurysm ◽

Endovascular Treatment ◽

Aortic Aneurysms ◽

Lower Survival Rate ◽

Lower Survival ◽

Abdominal Aortic ◽

Risk Of Rupture

Abstract. This article analyses if and to what extent gender differences exist in abdominal aortic aneurysm (AAA) therapy. For this purpose Medline (PubMed) was searched from January 1999 to January 2018. Keywords were: “abdominal aortic aneurysm”, “gender”, “prevalence”, “EVAR”, and “open surgery of abdominal aortic aneurysm”. Regardless of open or endovascular treatment of abdominal aortic aneurysms, women have a higher rate of complications and longer hospitalizations compared to men. The majority of studies showed that women have a lower survival rate for surgical and endovascular treatment of abdominal aneurysms after both elective and emergency interventions. Women receive less surgical/interventional and protective medical treatment. Women seem to have a higher risk of rupture, a lower survival rate in AAA, and a higher rate of complications, regardless of endovascular or open treatment. The gender differences may be due to a higher age of women at diagnosis and therapy associated with higher comorbidity, but also because of genetic, hormonal, anatomical, biological, and socio-cultural differences. Strategies for treatment in female patients must be further defined to optimize outcome.

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

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2021.03.464 ◽

2021 ◽

Vol 32 (5) ◽

pp. S21

Author(s):

J. Lee ◽

R. Posham ◽

S. Choi ◽

D. Goldman ◽

A. Fischman ◽

...

Keyword(s):

Endovascular Treatment ◽

Splenic Artery ◽

Single Center ◽

Single Center Experience

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Endovascular treatment of a ruptured post-traumatic false aneurysm of the aortic isthmus: A case report

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2021.106190 ◽

2021 ◽

pp. 106190

Author(s):

Oussama Anane ◽

Abdellah Rezziki ◽

Adnane Benzirar ◽

Omar El Mahi

Keyword(s):

Case Report ◽

Endovascular Treatment ◽

False Aneurysm ◽

Aortic Isthmus ◽

Post Traumatic

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Splenic artery pseudoaneurysm and resultant haematosuccus pancreaticus

BMJ Case Reports ◽

10.1136/bcr-2020-239485 ◽

2021 ◽

Vol 14 (3) ◽

pp. e239485

Author(s):

Shwetambari Sonanis ◽

Benjamin Layton ◽

Oliver Nicholson ◽

DA Subar

Keyword(s):

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Splenic Artery ◽

Clinical Symptoms ◽

Cross Sectional ◽

Artery Pseudoaneurysm ◽

Risk Of Rupture ◽

Cross Sectional Imaging ◽

Sectional Imaging ◽

Splenic Artery Pseudoaneurysm

Splenic artery pseudoaneurysm (SAP) is a rare and dangerous diagnosis with a high risk of rupture and death. It is the most common cause of main pancreatic duct haematoma—haematosuccus pancreaticus (HP). Neither SAP nor HP have specific clinical features that allow diagnosis without cross-sectional imaging. Upper gastrointestinal haemorrhage and a history of pancreatitis should raise clinical suspicion but ultimately endoscopy and CT are required. We report a case of a 51-year-old man without clinical symptoms in whom cross-sectional imaging was undertaken for incidental severe acute anaemia. This demonstrated stigmata of chronic pancreatitis and the main pancreatic duct was distended with dense material in keeping with haematoma. The diagnosis of a SAP bleeding into the main pancreatic duct was made radiologically. A subsequent oesophago-gastro-duodenoscopy confirmed the diagnosis. The imaging appearances, pathophysiology and management are discussed.

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Alterations of blood flow pattern after triple stent endovascular treatment of saccular abdominal aortic aneurysm: a porcine model.

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912016003004 ◽

2016 ◽

Vol 43 (3) ◽

pp. 154-159

Author(s):

JAHIR RICHARD DE OLIVEIRA ◽

MAURÍCIO DE AMORIM AQUINO ◽

SVETLANA BARROS ◽

GUILHERME BENJAMIN BRANDÃO PITTA ◽

ADAMASTOR HUMBERTO PEREIRA

Keyword(s):

Blood Flow ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Treatment ◽

Flow Pattern ◽

Blood Flow Pattern ◽

Large White ◽

Abdominal Aortic ◽

Before And After ◽

Infrarenal Abdominal Aorta

ABSTRACT Objective: to determine the blood flow pattern changes after endovascular treatment of saccular abdominal aortic aneurysm with triple stent. Methods: we conducted a hemodynamic study of seven Landrace and Large White pigs with saccular aneurysms of the infrarenal abdominal aorta artificially produced according to the technique described. The animals were subjected to triple stenting for endovascular aneurysm. We evaluated the pattern of blood flow by duplex scan before and after stent implantation. We used the non-paired Mann-Whitney test for statistical analysis. Results: there was a significant decrease in the average systolic velocity, from 127.4cm/s in the pre-stent period to 69.81cm/s in the post-stent phase. There was also change in the flow pattern from turbulent in the aneurysmal sac to laminate intra-stent. Conclusion: there were changes in the blood flow pattern of saccular abdominal aortic aneurysm after endovascular treatment with triple stent.

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The endovascular management of splenic artery aneurysms and pseudoaneurysms

Vascular ◽

10.1258/vasc.2011.oa0289 ◽

2011 ◽

Vol 19 (5) ◽

pp. 257-261 ◽

Cited By ~ 18

Author(s):

Jia Xin ◽

Liu Xiao-ping ◽

Guo Wei ◽

Xiong Jiang ◽

Zhang Hong-peng ◽

...

Keyword(s):

Endovascular Treatment ◽

Splenic Artery ◽

Endovascular Procedures ◽

Endovascular Management ◽

Total Procedure Time ◽

The Mean ◽

Postembolization Syndrome ◽

Mid Term Results ◽

Total Procedure

The purpose of this study was to evaluate outcomes of the endovascular treatment of splenic artery aneurysms (SAAs) and pseudoaneurysms (SAPAs). From April 2003 to December 2009, 12 patients (mean age 46.8 years, range 29–58) with SAAs ( n = 9) or SAPAs ( n = 3) underwent endovascular treatment. Four patients were asymptomatic and three had ruptured aneurysms. Lesions were in the proximal splenic artery ( n = 3), intermediate splenic artery ( n = 3) and distal splenic artery ( n = 6). Endovascular procedures included embolization by sac packing ( n = 5), sandwich occlusion of the splenic artery ( n = 4) or stent graft deployment ( n = 3). Computed tomography (CT) was done before the operation, 3 and 12 months after the operation, then yearly. Endovascular treatment was successful at the first attempt in all 12 (100%) patients, with complete angiographic exclusion of the aneurysm at the end of the operation. The mean amount of contrast medium used was 165 mL (range 100–230), and the mean total procedure time was 92 minutes (range 55–160). No major complications occurred. Postoperational CT scans showed splenic multisegmental infarcts in eight patients (66.7%, 8/12) and among them postembolization syndrome developed in six patients, manifesting as abdominal pain and fever. The mean follow-up was 32 months (range 9–51). No patient demonstrated gross evidence of aneurysm sac growth, and no significant decrease in aneurysm sac size postintervention was noted on follow-up. The endovascular management of SAAs and SAPAs is safe and effective and may induce less mortality than open surgery. Regardless of the etiology, endovascular treatment can provide excellent mid-term results.

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