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Tonpe S, Warbhe H, Banode P, Waghulkar S, Dugad S, Suryadevara M, Reddy Guggella S. Splenic Artery Pseudoaneurysm Management With Cyanoacrylate Glue: A Case Report. Cureus 2024; 16:e65926. [PMID: 39221370 PMCID: PMC11365004 DOI: 10.7759/cureus.65926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024] Open
Abstract
We present the case of a 40-year-old female who presented with abdominal pain, hematochezia, and melena for the past week and was diagnosed with a pseudoaneurysm emanating from the mid-splenic artery. The patient was managed with endovascular cyanoacrylate glue embolization, resulting in the complete resolution of an impending catastrophic hemorrhagic shock.
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Affiliation(s)
- Sudhanshu Tonpe
- Department of Interventional Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Himandri Warbhe
- Department of Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pankaj Banode
- Department of Interventional Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shubham Waghulkar
- Department of Interventional Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shubham Dugad
- Department of Interventional Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manasa Suryadevara
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Wang S, Huang W, Liu J, Liu Q, Wang Z, Wang Q, Shan Q, Li W, Ding X, Wu Z, Wang Z. Selection of endovascular treatment strategies and analysis of the efficacy of different locations and types of splenic artery aneurysms. CVIR Endovasc 2024; 7:16. [PMID: 38294662 PMCID: PMC10831027 DOI: 10.1186/s42155-024-00427-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/18/2024] [Indexed: 02/01/2024] Open
Abstract
PURPOSE To analyze the selection of endovascular treatment strategies and the efficacy of various locations and types of splenic artery aneurysms (SAAs). METHODS Sixty-three cases of patients diagnosed with SAA from January 2016 to October 2021 were collected, and their clinical data and follow-up results were analyzed. RESULTS Among the 63 patients, 55 had true SAAs, and 8 had false SAAs. The average diameter of the true SAAs was 2.0 ± 0.8 cm. There were 10 cases of intra-aneurysm embolization, 24 cases of intra-aneurysm and aneurysm-bearing artery embolization, 10 cases of bare stent-assisted coil embolization, and 11 cases of stent grafts. The false SAAs had an average diameter of 2.3 ± 1.1 cm. Aneurysm-bearing artery embolization was applied in 5 cases, and stent grafts were applied in 3 cases. The incidence of complications after embolization of the aneurysm-bearing artery was higher (P < 0.01). Postembolization syndrome occurred in 10 patients; 7 patients developed splenic infarction to varying degrees, 1 patient had mildly elevated blood amylase, and 1 patient developed splenic necrosis with abscess formation, all of which improved after active treatment. The average length of hospital stay was 5.5 ± 3.2 days. The average follow-up time was 17.2 ± 16.1 months, and the aneurysm cavity of all patients was completely thrombotic. CONCLUSION Endovascular treatments of SAAs are safe and effective. For various locations and types of SAAs, adequate selection of treatment is necessary. Stent grafts are recommended for their safety, economy, practicality, and preservation of the physiological functions of the human body.
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Affiliation(s)
- Shenjie Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Wei Huang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Jingjing Liu
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Qin Liu
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Ziyin Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Qingbing Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Qungang Shan
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Wenchang Li
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Xiaoyi Ding
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China
| | - Zhiyuan Wu
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China.
| | - Zhongmin Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 197#, Rui Jin Er Road, Shanghai, 200025, China.
- College of Health Science and Technology, Shanghai JiaoTong University School of Medicine, Shanghai, China.
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Iftekhar W, Shaikh FA, Jamil N, Shaikh H. Managing Splenic Artery Pseudoaneurysms-An Experience from a Developing Country. A Retrospective Review. Ann Vasc Dis 2023; 16:195-199. [PMID: 37779655 PMCID: PMC10539133 DOI: 10.3400/avd.oa.22-00114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/30/2023] [Indexed: 10/03/2023] Open
Abstract
Objectives: Splenic artery pseudoaneurysm is a rare but potentially fatal condition. Early diagnosis and intervention are the key steps in the management of this condition. We have reviewed our institution's 4-year data regarding the presentation and management of this condition. Methods: We conducted a prospective review of the records of 10 patients who presented to our institute from January 2018 to December 2021 with a splenic artery pseudoaneurysm. We found one patient with a true aneurysm, whom we excluded from the study. Results: This study included seven male and two female patients with a mean age of 47.7 years. Six patients presented to the emergency department with bleeding secondary to rupture aneurysm, which is the most common reason for admission. Pancreatitis was found to be the most common cause for splenic artery pseudoaneurysm (five patients). Computed tomography angiogram remained the modality of choice for diagnosing splenic artery pseudoaneurysm. All patients were successfully managed with endovascular intervention. Conclusion: Splenic artery pseudoaneurysm is usually a rare complication of pancreatitis, which is associated with high morbidity and mortality. Timely diagnosis and intervention are the keys to successful management. Endovascular embolization should be the first-line therapy in splenic artery pseudoaneurysm.
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Affiliation(s)
- Wafa Iftekhar
- Department of Surgery, Agha Khan University Hospital, Karachi, Pakistan
| | - Fareed Ahmed Shaikh
- Department of Vascular Surgery, Agha Khan University Hospital, Karachi, Pakistan
| | - Nida Jamil
- Department of Surgery, Mayo University Hospital, County Mayo, Ireland
| | - Hafsa Shaikh
- Department of Surgery, Agha Khan University Hospital, Karachi, Pakistan
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Muacevic A, Adler JR, Nagendra V, Suryadevara M, Shetty N. Giant Abdominal Pseudoaneurysm Secondary to Recurrent Pancreatitis: Imaging and Endovascular Intervention. Cureus 2022; 14:e32872. [PMID: 36699761 PMCID: PMC9870600 DOI: 10.7759/cureus.32872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/23/2022] [Indexed: 12/24/2022] Open
Abstract
Chronic or necrotizing pancreatitis is characterized by repeated inflammation of the pancreas, leading to multiple complications, a few of which are vascular, such as splanchnic venous thrombosis and arterial pseudoaneurysms. Even though the frequency of pseudoaneurysm formation in patients with pancreatitis is as high as 10%, there is not much importance given to its management in the radiologic literature. The splenic artery is the most common visceral artery affected by pseudoaneurysms, followed by the gastroduodenal and pancreaticoduodenal arteries. Usually, pseudoaneurysms occur due to the erosion of a peripancreatic or pancreatic artery into a pseudocyst, but this can also occur without the development of a pseudocyst. Pseudoaneurysms may be asymptomatic (usually the ones less than 5 cm), but some of them may pose a threat due to spontaneous rupture and subsequent fistulization into other organs. Therefore, early diagnosis and management are of prime importance. Here, in this article, we present a case of pseudoaneurysm of the gastroduodenal artery with characteristic imaging features and preferred, recent techniques of management.
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Lee SH, Yang S, Park I, Im YC, Kim GY. Ruptured splenic artery aneurysms in pregnancy and usefulness of endovascular treatment in selective patients: A case report and review of literature. World J Clin Cases 2022; 10:9057-9063. [PMID: 36157677 PMCID: PMC9477030 DOI: 10.12998/wjcc.v10.i25.9057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/25/2022] [Accepted: 07/18/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The 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 SUMMARY We 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.
CONCLUSION Endovascular treatment might be a valuable alternative to surgery/lead to safer surgery for selected pregnant patients with ruptured SAAs.
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Affiliation(s)
- Sang Hun Lee
- Department of Obstetrics and Gynecology, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
| | - Songsoo Yang
- Department of Surgery, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
| | - Inkyu Park
- Department of Surgery, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
| | - Yeong Cheol Im
- Department of Surgery, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
| | - Gyu Yeol Kim
- Department of Surgery, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
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Carriero S, Lanza C, Biondetti P, Renzulli M, Bonelli C, Piacentino F, Fontana F, Venturini M, Carrafiello G, Ierardi AM. Imaging-Guided Percutaneous Puncture and Embolization of Visceral Pseudoaneurysms: Feasibility and Outcomes. J Clin Med 2022; 11:jcm11112952. [PMID: 35683341 PMCID: PMC9181803 DOI: 10.3390/jcm11112952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 02/01/2023] Open
Abstract
Visceral artery pseudoaneurysms (VAPAs) are the most frequently diagnosed pseudoaneurysms (PSAs). PSAs can be asymptomatic or symptomatic. The aim of our study was to evaluate the safety and effectiveness of percutaneous embolization of VAPAs performed on patients with an unfeasible trans-arterial approach. Fifteen patients with fifteen visceral PSAs, with a median dimension of 21 mm (IQR 20–24 mm), were retrospectively analyzed. No patients were suitable for trans-arterial catheterization and therefore a percutaneous approach was chosen. During percutaneous treatments, two embolic agents were used, either N-butyl cyanoacrylate (NBCA) (Glubran II, GEM Milan, Italy) mixed with Lipiodol (Lipiodol, Guerbet, France) or thrombin. The outcomes of this study were technical success, primary clinical success, and secondary clinical success. In our population the 15 PSA were located as follows: 2 in the left gastric artery, 1 in the right gastric artery, 3 in the right hepatic artery, 2 in a jejunal artery, 1 in left colic artery branch, 1 in a right colic artery branch, 1 in the gastroepiploic artery, 1 in the dorsal pancreatic artery, 1 in an ileocolic artery branch, 1 in an iliac artery branch, and 1 in a sigmoid artery branch. 80% of PSAs (12/15) were treated with a NBCA:lipiodol mixture and 20% of PSAs (3/15) were treated with thrombin. Technical, primary, and secondary clinical successes were obtained in 100% of the cases. No harmful or life-threatening complications were observed. Minor complications were registered in 26.6% (4/15) of the patients. Percutaneous embolization of visceral PSA is a safe and effective treatment and should be considered as an option when the endovascular approach is unsuccessful or unfeasible.
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Affiliation(s)
- Serena Carriero
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy;
| | - Carolina Lanza
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy;
- Correspondence:
| | - Pierpaolo Biondetti
- Interventional Radiology Unit, Department of Radiology, Foundation IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; (P.B.); (G.C.); (A.M.I.)
- Department of Health Science, Università degli Studi di Milano, 20122 Milan, Italy
| | - Matteo Renzulli
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant’Orsola Hospital, University of Bologna, 40138 Bologna, Italy;
| | - Cristian Bonelli
- Healthcare Professional Department, Foundation IRCSS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy; (F.P.); (F.F.); (M.V.)
- Department of Radiology, Insubria University, 21100 Varese, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy; (F.P.); (F.F.); (M.V.)
- Department of Radiology, Insubria University, 21100 Varese, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy; (F.P.); (F.F.); (M.V.)
- Department of Radiology, Insubria University, 21100 Varese, Italy
| | - Gianpaolo Carrafiello
- Interventional Radiology Unit, Department of Radiology, Foundation IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; (P.B.); (G.C.); (A.M.I.)
- Department of Health Science, Università degli Studi di Milano, 20122 Milan, Italy
| | - Anna Maria Ierardi
- Interventional Radiology Unit, Department of Radiology, Foundation IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; (P.B.); (G.C.); (A.M.I.)
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7
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Hojo Y, Kamimura H, Owaki T, Kimura R, Iwasawa T, Watanabe Y, Takatsuna M, Ikarashi S, Takamura M, Setsu T, Arao Y, Horii Y, Sato T, Terai S. Liver cirrhosis with ruptured splenic artery aneurysm leading to hepatitis C treatment: A case report. KANZO 2021; 62:749-755. [DOI: 10.2957/kanzo.62.749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
- Yuki Hojo
- Department of Gastroenterology and Hepatology, Graduate School of Medical and Dental Science, Niigata University
| | - Hiroteru Kamimura
- Department of Gastroenterology and Hepatology, Graduate School of Medical and Dental Science, Niigata University
| | - Takashi Owaki
- Department of Gastroenterology and Hepatology, Graduate School of Medical and Dental Science, Niigata University
| | - Rika Kimura
- Department of Gastroenterology and Hepatology, Graduate School of Medical and Dental Science, Niigata University
| | - Takahiro Iwasawa
- Department of Gastroenterology and Hepatology, Graduate School of Medical and Dental Science, Niigata University
| | - Yusuke Watanabe
- Department of Gastroenterology and Hepatology, Graduate School of Medical and Dental Science, Niigata University
| | - Masafumi Takatsuna
- Department of Gastroenterology and Hepatology, Graduate School of Medical and Dental Science, Niigata University
| | - Satoshi Ikarashi
- Department of Gastroenterology and Hepatology, Graduate School of Medical and Dental Science, Niigata University
| | - Masaaki Takamura
- Department of Gastroenterology and Hepatology, Graduate School of Medical and Dental Science, Niigata University
| | - Toru Setsu
- Department of Gastroenterology and Hepatology, Graduate School of Medical and Dental Science, Niigata University
- Niigata University Hospital Center for Liver Diseases
| | - Yoshihisa Arao
- Department of Gastroenterology and Hepatology, Graduate School of Medical and Dental Science, Niigata University
- Niigata University Hospital Center for Liver Diseases
| | - Yosuke Horii
- Department of Radiology, Graduate School of Medical and Dental Science, Niigata University
| | - Tatsuhiko Sato
- Department of Radiology, Graduate School of Medical and Dental Science, Niigata University
| | - Shuji Terai
- Department of Gastroenterology and Hepatology, Graduate School of Medical and Dental Science, Niigata University
- Niigata University Hospital Center for Liver Diseases
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8
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Nevelskiy VV, Goltsov VR. [Treatment strategy for complicated pancreatic pseudocysts]. Khirurgiia (Mosk) 2021:29-35. [PMID: 34608777 DOI: 10.17116/hirurgia202110129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyze an effectiveness of various surgical approaches for complicated pancreatic pseudocysts. MATERIAL AND METHODS The results of surgical treatment were analyzed in 188 patients with complicated pancreatic pseudocysts. The study included patients with one of complications of pseudocyst (infection, bleeding, compression of adjacent organs, perforation). Depending on surgical treatment, patients were divided into 2 groups: the 1st group (76 patients) - laparotomy followed by certain open surgery, the 2nd group (112 patients) - various minimally invasive treatments without further open operations. RESULTS Effectiveness of surgical treatment was analyzed considering incidence of complications (postoperative wound suppuration, pneumonia, sepsis, multiple organ failure) and mortality. In the 1st group, postoperative wound suppuration - 22 (29%) patients, pneumonia - 17 (22.4%), sepsis - 14 (18.4%) patients, multiple organ failure - 14 (18.4%), 15 (19.8%) patients died. In the 2nd group, these values significantly differed: postoperative wound suppuration - 9 (8%), pneumonia - 5 (4.3%), sepsis - 1 (0.9%), multiple organ failure - 4 (3.5%), 1 (0.9%) patient died. CONCLUSION Minimally invasive measures are the most optimal for any complication of pancreatic pseudocyst. Laparotomy is indicated if minimally invasive intervention is impossible for certain reason. It is advisable to concentrate these patients in specialized centers.
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Affiliation(s)
- V V Nevelskiy
- Saint Petersburg «RZD-Medicine» Clinical Hospital, St. Petersburg, Russia
| | - V R Goltsov
- Saint Petersburg «RZD-Medicine» Clinical Hospital, St. Petersburg, Russia.,Dzhanelidze Research Institute for Emergency Care, St. Petersburg, Russia
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Successful endovascular embolization of a giant splenic artery pseudoaneurysm secondary to a huge pancreatic pseudocyst with concomitant spleen invasion. Pol J Radiol 2021; 86:e489-e495. [PMID: 34567295 PMCID: PMC8449560 DOI: 10.5114/pjr.2021.108876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/06/2020] [Indexed: 12/11/2022] Open
Abstract
Pseudoaneurysms of the pancreatic and peripancreatic arteries is a well-known complication of chronic or necrotizing pancreatitis due to proteolytic enzymatic digestion of the arterial wall. A major part of peripancreatic pseudoaneurysms involve the splenic artery, but any peripancreatic artery may be involved and bleed. They are potentially life threatening for patients, due to spontaneous intraperitoneal rupture, rupture and fistulization into the surrounding organs, or fistulization into the pancreatic duct. Small ones are usually asymptomatic and are often diagnosed incidentally, while giant (> 5 cm) aneurysms and pseudoaneurysms are symptomatic and may be detected as a pulsatile mass in the upper-left quadrant or epigastrium. Imaging plays a key role in the identification of splenic artery aneurysms and pseudoaneurysms, while angiography still represents the gold standard for the diagnosis, although nowadays it plays a prominent role in treatment. Treatment of splenic artery pseudoaneurysms is mandatory because of the high probability of rupture, with a mortality rate of up to 90%. The gold standard treatment is represented by surgery, with a mortality rate between 16% and 50%. In recent years the endovascular approach has proven to be an effective alternative treatment for splenic artery pseudoaneurysms, and it is currently the method of choice. In this article, we present the case of a ant pseudoaneurysm of the splenic artery due to huge pseudocysts in a young alcoholic patient with recurrent and chronic pancreatitis, complicated by fistulization and invasion of spleen parenchyma and arteriovenous fistula.
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10
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Yurtsever C, Ak M. Splenic Arteriovenous Fistula with Pseudoaneurysm. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0041-1726656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Cagri Yurtsever
- Department of Radiology, Sultan Abdulhamid Han Teaching Hospital, Istanbul, Turkey
| | - Murat Ak
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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11
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CONTI L, CATTANEO G, BANCHINI F, BODINI FC, PALMIERI G, CAPELLI P. Laparoscopic distal pancreasectomy and resection of retro-pancreatic splenic artery aneurysm: preserving the spleen. Chirurgia (Bucur) 2021; 33. [DOI: 10.23736/s0394-9508.19.05052-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2025]
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12
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Lee W, Qi-Huang S, Ahmed Z, Shah SS. Hemosuccus Pancreaticus in Chronic Pancreatitis: An Uncommon Cause of Gastrointestinal Bleeding. J Clin Imaging Sci 2020; 10:72. [PMID: 33274116 PMCID: PMC7708967 DOI: 10.25259/jcis_169_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/16/2020] [Indexed: 11/04/2022] Open
Abstract
We present a case of a 69-year-old female who arrived in hemorrhagic shock with symptoms of upper gastrointestinal bleeding. Imaging on admission was diagnostic of a large splenic artery pseudoaneurysm, which was presumed to have bled into the pancreatic duct given clinical symptoms of upper gastrointestinal bleeding. The pseudoaneurysm was successfully treated with coil embolization resulting in resolution of clinical symptoms.
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Affiliation(s)
- William Lee
- Department of Radiology, Nassau University Medical Center, East Meadow, New York, United States
| | - Sunny Qi-Huang
- Department of Radiology, Nassau University Medical Center, East Meadow, New York, United States
| | - Zaid Ahmed
- Department of Medicine, Idaho College of Osteopathic Medicine, Idaho, United States
| | - Salman S Shah
- Department of Radiology, Nassau University Medical Center, East Meadow, New York, United States
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13
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Shreve L, Jarmakani M, Javan H, Babin I, Nelson K, Katrivesis J, Lekawa M, Kuncir E, Fernando D, Abi-Jaoudeh N. Endovascular management of traumatic pseudoaneurysms. CVIR Endovasc 2020; 3:88. [PMID: 33245433 PMCID: PMC7695774 DOI: 10.1186/s42155-020-00182-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/17/2020] [Indexed: 01/17/2023] Open
Abstract
Background Pseudoaneurysms (PAs) caused by traumatic injury to the arterial vasculature have a high risk of rupture, leading to life-threatening hemorrhage and mortality, requiring urgent treatment. The purpose of this study was to determine the technical and clinical outcomes of endovascular treatment of visceral and extremity traumatic pseudoaneurysms. Methods Clinical data were retrospectively collected from all patients presenting for endovascular treatment of PAs between September 2012 and September 2018 at a single academic level one trauma center. Technical success was defined as successful treatment of the PA with no residual filling on post-embolization angiogram. Clinical success was defined as technical successful treatment with no rebleeding throughout the follow-up period and no reintervention for the PA. Results Thirty-five patients (10F/25M), average age (± stdev) 41.7 ± 20.1 years, presented with PAs secondary to blunt (n = 31) or penetrating (n = 4) trauma. Time from trauma to intervention ranged from 2 h - 75 days (median: 4.4 h, IQR: 3.5–17.1 h) with 27 (77%) of PAs identified and treated within 24 h of trauma. Average hospitalization was 13.78 ± 13.4 days. Ten patients underwent surgery prior to intervention. PA number per patient ranged from 1 to 5 (multiple diffuse). PAs were located on the splenic (n = 12, 34.3%), pelvic (n = 11, 31.4%), hepatic (n = 9, 25.7%), upper extremity/axilla (n = 2, 5.7%), and renal arteries (n = 1, 2.9%). Technical success was 85.7%. Clinical success was 71.4%, for technical failure (n = 5), repeat embolization (n = 1) or post-IR surgical intervention (n = 4). There was no PA rebleeding or reintervention for any patient after discharge over the reported follow-up periods. Three patients died during the trauma hospitalization for reasons unrelated to the PAs. Conclusions Endovascular treatment of traumatic visceral and extremity PAs is efficacious with minimal complication rates and low reintervention requirements.
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Affiliation(s)
- Lauren Shreve
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rm 115 Rte 140, Orange, CA, 92868, USA
| | - Maha Jarmakani
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rm 115 Rte 140, Orange, CA, 92868, USA
| | - Hanna Javan
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rm 115 Rte 140, Orange, CA, 92868, USA
| | - Ivan Babin
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rm 115 Rte 140, Orange, CA, 92868, USA
| | - Kari Nelson
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rm 115 Rte 140, Orange, CA, 92868, USA
| | - James Katrivesis
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rm 115 Rte 140, Orange, CA, 92868, USA
| | - Michael Lekawa
- Department of Trauma Surgery, University of California, Irvine, Irvine, California, USA
| | - Eric Kuncir
- Department of Trauma Surgery, University of California, Irvine, Irvine, California, USA
| | - Dayantha Fernando
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rm 115 Rte 140, Orange, CA, 92868, USA
| | - Nadine Abi-Jaoudeh
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rm 115 Rte 140, Orange, CA, 92868, USA.
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Veterano C, Monteiro E, Rego D, Soares P, Almeida P, Almeida R. Laparoscopic Resection of a Splenic Artery Aneurysm with Vascular Reconstruction During Pregnancy. Ann Vasc Surg 2020; 72:666.e7-666.e11. [PMID: 33227481 DOI: 10.1016/j.avsg.2020.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/30/2020] [Accepted: 10/06/2020] [Indexed: 11/17/2022]
Abstract
Splenic artery aneurysms (SAA) are more frequent in women and have a high rupture risk during pregnancy, with catastrophic outcomes. It is advisable to treat these aneurysms in pregnant and fertile women, whatever their diameter, given their increased risk for rupture. There are several therapeutic approaches: endovascular surgery using coil embolization or stent graft coverage; laparoscopic or open surgical resection with arterial reconstruction and ligation followed by splenectomy when necessary. This paper aims to report the successful treatment of SAA in second-trimester pregnant women using a laparoscopic approach with aneurysm resection and arterial reconstruction. This is a unique report of a minimally invasive approach with arterial reconstruction in a pregnant woman, thus reducing the risk of spleen infarction and potentially avoiding splenectomy.
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Affiliation(s)
- Carlos Veterano
- Angiology and Vascular Surgery Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - Eunice Monteiro
- General Surgery Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Duarte Rego
- Angiology and Vascular Surgery Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Paulo Soares
- General Surgery Department, Centro Hospitalar Universitário do Porto, Porto, Portugal; Liver and Pancreatic Transplant Program, Transplantation Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Paulo Almeida
- Angiology and Vascular Surgery Department, Centro Hospitalar Universitário do Porto, Porto, Portugal; Kidney Transplant Program, Transplantation Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Rui Almeida
- Angiology and Vascular Surgery Department, Centro Hospitalar Universitário do Porto, Porto, Portugal; Kidney Transplant Program, Transplantation Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
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15
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Affiliation(s)
- G. Bunschoten
- Department of Vascular Surgery, St. Trudo Ziekenhuis, St. Truiden, Belgium
| | - F. Van Elst
- Department of Vascular Surgery, St. Trudo Ziekenhuis, St. Truiden, Belgium
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16
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Yalkin O, Uzunoglu MY, Altintoprak F, Muhtaroglu A. Coexisting giant splenic artery aneurysm and non-functioning pancreatic neuroendocrine tumor. Pak J Med Sci 2020; 36:843-845. [PMID: 32494285 PMCID: PMC7260904 DOI: 10.12669/pjms.36.4.1869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/24/2020] [Accepted: 02/28/2020] [Indexed: 11/29/2022] Open
Abstract
The splenic artery aneurysm (SAA) is rare clinical entity which is the third most common intra-abdominal aneurysm. Pancreatic neuroendocrine tumors (pNETs) are rare malignancies which comprise less than 2% of all pancreatic tumors. Non-functioning pancreatic neuroendocrine tumors set forth up to 90% of all PNETs. Sixty-seven-year-old female presented to our polyclinic with increasing pain in the left upper quadrant in the previous three months. A computed tomographic angiography revealed 13x13x12 cm sized regular bounded aneurysmatic expansion of medium part of splenic artery. In addition there was a 8x7 mm sized hypoecoic lesion in the distal pancreatic tissue. Distal pancreatectomy, splenic aneurysm resection and splenectomy was performed. Pathological results revealed that there was a 12 cm sized giant true splenic aneurysm and 0.7 cm sized neuroendocrine tumor in the pancreatic tissue. This manuscript is presentation of surgical approach to a case with coexistence of these two rare conditions.
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Affiliation(s)
- Omer Yalkin
- Omer Yalkin Department of Surgical Oncology, Bursa City Hospital, Bursa, Turkey
| | - Mustafa Yener Uzunoglu
- Mustafa Yener Uzunoğlu Department of General Surgery, Sakarya Teaching and Research Hospital, Sakarya, Turkey
| | - Fatih Altintoprak
- Fatih Altıntoprak, Department of General Surgery, Sakarya University, Faculty of Medicine, Sakarya, Turkey
| | - Ali Muhtaroglu
- Ali Muhtaroglu, Department of General Surgery, Sakarya University, Faculty of Medicine, Sakarya, Turkey
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17
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Hamid HKS, Suliman AEA, Spiliopoulos S, Zabicki B, Tetreau R, Piffaretti G, Tozzi M. Giant Splenic Artery Pseudoaneurysms: Two Case Reports and Cumulative Review of the Literature. Ann Vasc Surg 2020; 64:382-388. [PMID: 31676381 DOI: 10.1016/j.avsg.2019.10.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Giant splenic artery pseudoaneurysms (GSAPs) > 5 cm are a rare clinical entity. The aim of this study was to present our experience with 2 such patients successfully treated by coil embolization and surgery and review the pertinent literature. METHODS A 58-year-old woman and 57-year-old man with a history of chronic pancreatitis were diagnosed with GSAP based on computed tomography (CT) angiography. The first patient had a 6-cm pseudoaneurysm, which was successfully treated with transcatheter coil embolization using a sandwich exclusion method. The second patient had two 7-cm lesions, which were successfully treated with distal pancreatectomy and splenectomy. RESULTS Postembolization CT angiography at 12 months showed remaining calcified pseudocyst without evidence of pseudoaneurysm in the first patient. Both patients remained well and symptom-free at 12 months. CONCLUSIONS Combined with the experience of the previous literature, we believe that management of GSAP should be tailored for each individual case depending on the location and number of pseudoaneurysms, the underlying etiology, and the patient's hemodynamic status. Embolization should be considered as the first-line treatment for clinically stable patients with GSAP, whereas GSAPs with a pseudocyst are best treated with surgery.
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Affiliation(s)
- Hytham K S Hamid
- Department of Surgery, Soba University Hospital, Khartoum, Sudan.
| | | | - Stavros Spiliopoulos
- Department of Diagnostic and Interventional Radiology, Patras University Hospital, Rion, Greece
| | - Bartosz Zabicki
- Department of Diagnostic and Interventional Radiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Raphael Tetreau
- Centre d'Imagerie Médicale, Institut du Cancer, Montpellier, France
| | - Gabriele Piffaretti
- Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Matteo Tozzi
- Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
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18
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Vittoria De Martini I, Pfammatter T, Puippe G, Clavien PA, Alkadhi H. Frequency and causes of delayed diagnosis of visceral artery pseudoaneurysms with CT: Lessons learned. Eur J Radiol Open 2020; 7:100221. [PMID: 32099872 PMCID: PMC7026741 DOI: 10.1016/j.ejro.2020.100221] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 11/27/2022] Open
Abstract
Objective Visceral artery pseudoaneurysms (VAPA) are associated with a high morbidity and mortality, but sometimes are missed in initial computed tomography (CT) examinations. The aims of this study were to determine the frequency and causes of misdiagnoses of VAPA with CT. Materials and Methods We retrospectively identified 77 patients with VAPA in our database who underwent contrast-enhanced CT. The frequency of delayed diagnosis was determined and the reasons were noted. We identified the etiology of VAPA, measured size, and noted the affected vessels. Results Forty-five of the 77 patients (58 %) had a delayed diagnosis of VAPA. There was no difference in the rate of missed VAPA in symptomatic compared to asymptomatic patients (p = 0.255). The majority of VAPA were associated with previous surgery or interventions (n = 48/62 %). The major affected vessel was the hepatic (n = 31) followed by the splenic artery (n = 17). The main reasons for misdiagnosis were a missed arterial phase in CT (n = 16/36 %), artifacts masking the aneurysm (n = 9/20 %), overlooked pseudoaneurysm (n = 19/42 %), and misinterpretation by attending radiologists (n = 1/2 %). Missed VAPA were smaller (median 8 mm) than those VAPA that were initially diagnosed (median 13 mm, p < 0.01), but occurred with a similar frequency in larger and smaller visceral arteries (p = 0.601). Conclusions Our study showed that 58 % of VAPA were diagnosed with delay, with the following four reasons for misdiagnosis: Lack of an arterial contrast phase in CT, no techniques for artifact reduction, and lack of awareness of the radiologists. Avoiding delayed diagnosis will most probably improve outcome of patients with VAPA.
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Affiliation(s)
- Ilaria Vittoria De Martini
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Thomas Pfammatter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Gilbert Puippe
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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19
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Wang W, Chang H, Liu B, Wang W, Yu Z, Chen C, Li Y, Wang Z, Wang Y. Long-term outcomes of elective transcatheter dense coil embolization for splenic artery aneurysms: a two-center experience. J Int Med Res 2019; 48:300060519873256. [PMID: 31510827 PMCID: PMC7262844 DOI: 10.1177/0300060519873256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objective This study was performed to analyze the long-term follow-up safety and efficacy of transcatheter dense coil embolization for splenic artery aneurysms. Methods Thirty-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. Results The 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. Conclusions Percutaneous elective transcatheter dense coil embolization is safe and effective to prevent aneurysm rupture and overcome aneurysm recanalization during long-term follow-up.
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Affiliation(s)
- Wujie Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Haiyang Chang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Bin Liu
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Wei Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Zhe Yu
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Chao Chen
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Zhenting Wang
- Medical Imaging Institute of Shandong Province, Jinan City, Shandong Province, China
| | - Yongzheng Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
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20
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Borzelli A, Amodio F, Paladini A, de Magistris G, Giurazza F, Silvestre M, Corvino F, Corvino A, Frauenfelder G, Pane F, Coppola M, Zobel DB, Paladini L, Amodeo E, Cavaglià E, Niola R. Successful endovascular treatment of a recurrent giant celiac artery aneurysm. Radiol Case Rep 2019; 14:723-728. [PMID: 30988864 PMCID: PMC6447743 DOI: 10.1016/j.radcr.2019.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 03/19/2019] [Accepted: 03/24/2019] [Indexed: 12/05/2022] Open
Abstract
Visceral artery aneurysms are very rare and aneurysms of the celiac trunk are the rarest ones: they are in most cases asymptomatic and their detection is frequently incidental. In this article we report the case of a man affected by severe abdominal pain with a huge aneurysm of the celiac trunk, first successfully treated with coil embolization, but, after 10 months, another endovascular embolization was required for deployment of the metallic coils previously released, ahead into the fund of the sac with recanalization of the aneurysm. A second endovascular treatment was performed with other coils and Amplatzer-Plug. The high risk of rupture makes treatment of such aneurysms mandatory and surgery is still considered the gold standard therapy of VAA, but, due to its high morbidity and mortality risks, in the last years, it has been widely replaced by endovascular embolization. An effective endovascular embolization requires not only the complete filling of the aneurysmal sac, but also the complete vascular exclusion of its in-flow and out-flow tracts, to reduce the risk of its anterograde or retrograde reperfusion.
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Affiliation(s)
- A. Borzelli
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
| | - F. Amodio
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
| | - A. Paladini
- Department of Services Diagnosis and Therapies, Radiology Institute, Maggiore della Carità Hospital, University of Eastern Piedmont - UPO University, Corso G. Mazzini 18, 28100 Novara, Italy
| | - G. de Magistris
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
| | - F. Giurazza
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
| | - M. Silvestre
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
| | - F. Corvino
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
| | - A. Corvino
- Dipartimento di scienze biomediche avanzate, Università degli studi di Napoli “Federico II”, Via S.Pansini, 80131 Naples, Italy
| | - G. Frauenfelder
- Department of Radiology, Campus Bio-medico University, Via Alvaro del Portillo, 200, 00100 Rome, Italy
| | - F. Pane
- Dipartimento di scienze biomediche avanzate, Università degli studi di Napoli “Federico II”, Via S.Pansini, 80131 Naples, Italy
| | - M. Coppola
- Dipartimento di scienze biomediche avanzate, Università degli studi di Napoli “Federico II”, Via S.Pansini, 80131 Naples, Italy
| | - D. Beomonte Zobel
- Division of Interventional Radiology, IFO Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144 Rome, Italy
| | - L. Paladini
- Università Cattolica del Sacro Cuore, Rome- Fondazione Gemelli, Rome, Italy
| | - E.M. Amodeo
- Università Cattolica del Sacro Cuore, Rome- Fondazione Gemelli, Rome, Italy
| | - E. Cavaglià
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
| | - R. Niola
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
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21
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Aydın E, Gök M, Bozkaya H, Çınar C, Parıldar M. Splenik arter psödoanevrizmasında acil endovasküler tedavi. EGE TIP DERGISI 2019. [DOI: 10.19161/etd.418365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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22
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Ugwumadu L, Hayes K, Belli AM, Heenan S, Loftus I. Uterine artery pseudoaneurysm requiring embolization in pregnancy: a case report and review of the literature. CVIR Endovasc 2018; 1:31. [PMID: 30652162 PMCID: PMC6319527 DOI: 10.1186/s42155-018-0040-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/09/2018] [Indexed: 02/28/2023] Open
Abstract
Background Uterine Artery Pseudoaneurysm is a rare cause of pelvic pain and haemorrhage in pregnancy. It should be considered in the differential diagnosis of pregnant women presenting with abdominal pain and is readily diagnosed by colour Doppler ultrasound. If left untreated, they may bleed into the peritoneum causing severe pain and haemorrhagic shock and may progress to maternal and fetal death. Case presentation We describe a case of a woman presenting with severe right iliac fossa pain at 26 weeks gestation attributed to a right uterine artery pseudoaneurysm diagnosed on duplex ultrasound which was successfully treated by uterine artery embolization at 28 weeks gestation without complication to the fetus. Conclusion Uterine artery embolization appears to be a safe and effective method to treat pseudoaneurysm during pregnancy without compromising uteroplacental perfusion.
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Affiliation(s)
- Lilian Ugwumadu
- 1Department of Obstetrics & Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Kevin Hayes
- 1Department of Obstetrics & Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Anna-Maria Belli
- 2Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Susan Heenan
- 2Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Ian Loftus
- 3Department of Vascular Surgery, St George's University Hospitals NHS Foundation Trust, London, UK
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23
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Santos FS, Sousa KMDS, de Castro TAC, Coelho F, de Oliveira RG, de Araujo WJB, Dos Santos LCP, de Souza RCA. Endovascular treatment of pseudoaneurysms secondary to chronic pancreatitis: reports of two cases. J Vasc Bras 2018; 17:71-75. [PMID: 29930685 PMCID: PMC5990257 DOI: 10.1590/1677-5449.012517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pseudoaneurysm secondary to chronic pancreatitis is a rare complication, but one with a high mortality rate. It is etiologically associated with chronic pancreatitis, and most diagnoses are made after rupture, which manifests with clinical signs of acute hemorrhage. Computed tomography plays an important role in diagnosis, but digital subtraction angiography remains the gold-standard method for diagnostic confirmation and for treatment planning. This article describes two cases of pseudoaneurysm in patients with chronic alcoholic pancreatitis; one involving the splenic artery and the other the gastroduodenal artery, complicated by thoracic and abdominal bleeding respectively. Both were successfully treated, using minimally invasive endovascular methods to implant coils and stent-grafts.
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Affiliation(s)
- Fabiana Seifert Santos
- Pontifícia Universidade Católica do Paraná - PUCPR, Curso de Medicina, Londrina, PR, Brasil
| | | | | | - Felipe Coelho
- Universidade de Brasília - UnB, Programa de Pós-graduação em Ciências Médicas, Brasília, DF, Brasil.,Pontifícia Universidade Católica do Paraná - PUCPR, Londrina, PR, Brasil
| | | | - Walter Jr Boim de Araujo
- Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Serviço de Angiorradiologia e Cirurgia Endovascular, Curitiba, PR, Brasil
| | | | - Raquel Canzi Almada de Souza
- Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Serviço de Endoscopia Digestiva, Departamento de Medicina Interna, Curitiba, PR, Brasil
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24
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Massive Hematemesis from a Splenic Artery Pseudoaneurysm Presenting Two Years after Penetrating Trauma. Case Rep Radiol 2018; 2018:7473168. [PMID: 29862112 PMCID: PMC5971296 DOI: 10.1155/2018/7473168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/11/2018] [Indexed: 11/18/2022] Open
Abstract
Splenic artery pseudoaneurysms (PSA) are rare entities and far less common than true aneurysms of the splenic artery. The most common etiology is pancreatitis, recurrent either in the setting of chronic pancreatitis or as an episode of acute pancreatitis. Less common causes include trauma, peptic ulcer disease, or iatrogenic causes. Almost all of the trauma-related case reports have been due to blunt trauma. We believe this to be the first reported case of a splenic artery PSA presenting with massive hematemesis at a significant time frame after penetrating trauma. Successful transcatheter treatment was performed and alternative techniques are also discussed.
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25
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Arisar FAQ, Shah SHA, Haq TU. Partial Splenic Artery Embolization in Cirrhosis Is a Safe and Useful Procedure. OPEN JOURNAL OF GASTROENTEROLOGY 2018; 08:327-336. [DOI: https:/doi.org/10.4236/ojgas.2018.89035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Abstract
We present a unique vascular complication of α-1 antitrypsin deficiency (AATD) in a patient with an acute onset of epigastric pain and hemodynamic instability. Abdominal computed tomography angiography detected hemoperitoneum and hematoma within the gastrohepatic ligament with active extravasation. Abdominal angiography revealed left gastric aneurysms. An association between AATD and vascular aneurysms has been suggested to be secondary to unopposed proteolytic activity against arterial structural proteins. The aneurysm formation in aortic, superior mesenteric, inferior mesenteric, and splenic arteries has been reported. We report the first case with ruptured gastric artery aneurysm as a complication of AATD.
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27
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Kickuth R, Hoppe H, Saar B, Inderbitzin D, Triller J, Raessler S, Gschossmann J. Superselective transcatheter arterial embolization in patients with acute peripancreatic bleeding complications: review of 44 cases. Abdom Radiol (NY) 2016; 41:1782-92. [PMID: 27188888 DOI: 10.1007/s00261-016-0772-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate the efficacy of superselective transcatheter arterial embolization (TAE) in the treatment of acute peripancreatic bleeding complications. METHODS During a 9-year period, 44 patients with acute bleeding of the peripancreatic arteries underwent TAE in our institution. Thirty-eight patients were treated using microcatheters and 6 patients with a diagnostic catheter. Embolic agents included coils (n = 38), polyvinyl alcohol (PVA) particles (n = 2), isobutyl cyanoacrylate (n = 2), coils plus PVA particles (n = 1), and coils plus isobutyl cyanoacrylate (n = 1). Outcome measures included technical success, clinical success, and the rate of complications. RESULTS Identified bleeding sources included gastroduodenal artery (n = 14), splenic artery (n = 9), pancreaticoduodenal artery (n = 6), common hepatic artery (n = 5), superior mesenteric artery branches (n = 4), proper hepatic artery (n = 3), and dorsal/transverse pancreatic artery (n = 3). Technical success with effective control of active bleeding was achieved in 41/44 patients (93 %). Clinical success attributed to TAE alone was documented in 40/44 patients (91 %). The rate of major complications was 2 % including death in one patient. CONCLUSIONS Superselective TAE allows effective, minimally invasive control of acute peripancreatic bleeding complications with a low rate of therapeutically relevant complications.
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28
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LaBella GD, Muck P, Kasper G, Welling R, Schlueter F, Vaughan A. Operative Management of an Aberrant Splenic Artery Aneurysm: Utility of the Medial Visceral Rotation Approach. Vasc Endovascular Surg 2016; 40:331-3. [PMID: 16959727 DOI: 10.1177/1538574406292005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors report an unusual case of a splenic artery aneurysm arising off the superior mesenteric artery. This was an incidental finding on computed tomography scan found during evaluation for a different or a separate disease process.
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Affiliation(s)
- Gennaro D LaBella
- Department of Surgery, Good Samaritan Hospital, Cincinnati, OH 45220, USA
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29
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Abstract
Purpose: To retrospectively review our experience with visceral artery aneurysms (VAAs) treated with percutaneous coil embolization techniques. Methods: Patient records were retrospectively reviewed between 1988 and 1998 for VAA cases treated with catheter-based techniques. Nine patients (5 women; mean age 64 ± 11 years) with 12 (8 false and 4 true) VAAs were identified. The majority (67%) of these patients presented with symptoms of aneurysm rupture. The etiology of the aneurysm was iatrogenic in 4, pancreatitis in 4, and idiopathic in 4. Ten cases involved the hepatic artery; the other 2 aneurysmal arteries were the middle colic and the gastroduodenal. Selective and superselective catheter techniques were used to obtain access to the VAA. A variety of microcoils were delivered to entirely fill saccular aneurysms, whereas fusiform aneurysms were thrombosed by occluding the inflow and outflow vessels. Results: Aneurysm exclusion was achieved in 9 (75%) of the 12 cases. The 3 technical failures resulted from the inability to cannulate the aneurysm neck. Coil embolization of the neck of the aneurysm sac did not result in occlusion of the native vessel, with a single exception. No procedure-related complications or deaths were noted. All patients remained symptom free during a mean follow-up of 46.0 ± 29.6 months. Conclusions: Percutaneous transcatheter coil embolotherapy is an effective alternative to open surgery for the management of VAAs. This therapy may decrease the morbidity and mortality associated with an open surgical procedure in patients with ruptured aneurysms and pseudoaneurysms, selectively thrombosing the aneurysm while preserving flow in the native vessel.
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Affiliation(s)
- K Kasirajan
- Department of Vascular Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA
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Rebonato A, Maiettini D, Krokidis M, Graziosi L, Rossi M. Late Migration of a Covered Stent into the Stomach after Repair of a Splenic Artery Pseudoaneurysm. J Radiol Case Rep 2016; 10:26-32. [PMID: 27200159 DOI: 10.3941/jrcr.v10i2.2620] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We would like to report our experience of a rather rare complication that occurred in a 76-year old patient tree years after endovascular repair of a splenic artery pseudoaneurysm with a covered stent. Three years after stent insertion, the patient complained of mild abdominal pain and melena; it was revealed endoscopically that the covered stent has eroded the stomach wall and migrated into the stomach. The splenic artery is the most common location among the spectrum of potential presentation sites of visceral arteries aneurysms and pseudoaneurysms. Endovascular treatment with the use of coils or stents is the first option due to lower morbidity and mortality than open surgery. Endovascular repair may also lead to complications and patients need to be followed up in order to confirm aneurysm sealing, and exclude late complication. Minor stent graft migration may occur in the long term, however extra vascular migration is extremely rare.
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Affiliation(s)
- Alberto Rebonato
- Department of Surgical and Biomedical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Daniele Maiettini
- Department of Surgical and Biomedical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Miltiadis Krokidis
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Luigina Graziosi
- Department of Surgical and Biomedical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Michele Rossi
- Radiology Department, St. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
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31
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Trauma associated splenic artery aneurysms: an analysis of the National Trauma Data Bank. Am J Surg 2016; 211:739-43. [DOI: 10.1016/j.amjsurg.2015.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 11/12/2015] [Accepted: 11/23/2015] [Indexed: 12/18/2022]
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Lo WL, Mok KL. Ruptured splenic artery aneurysm detected by emergency ultrasound-a case report. Crit Ultrasound J 2015; 7:26. [PMID: 26069053 PMCID: PMC4463952 DOI: 10.1186/s13089-015-0026-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 05/28/2015] [Indexed: 02/06/2023] Open
Abstract
Splenic artery aneurysm is a rare but a potentially fatal condition. It is usually asymptomatic until it ruptures. Here, we present a case of ruptured splenic artery aneurysm in a 59-year-old gentleman presenting with epigastric pain and hypovolemic shock. The diagnosis was made by emergency ultrasound and CT scan, and he was managed by laparotomy and excision of the splenic artery aneurysm. Priorities in patient management lie in rapid resuscitation, diagnostic imaging, surgical consultation, and subsequent laparotomy. Pitfalls should be borne in mind to differentiate splenic artery aneurysm from abdominal aortic aneurysm when using the emergency ultrasound.
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Affiliation(s)
- W L Lo
- Accident and Emergency Department, Ruttonjee Hospital, Wanchai, Hong Kong,
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Bizueto-Rosas H, Barajas-Colón JÁ, Delgadillo-de la O I, Malo-Martínez NP, Pérez-González HA, Hernández-Pérez NA. [Multiple aneurysms splenic; surgical exclusion with conservation of the spleen]. CIR CIR 2015; 84:58-64. [PMID: 26238591 DOI: 10.1016/j.circir.2015.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 11/10/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND Aneurysm of the splenic artery is diagnosed when the diameter of the splenic artery is greater than 1cm. It occupies third place among abdominal aneurysms. It is more frequent in women (4:1). It is associated with trauma, haemodynamics and local hormonal effects during pregnancy, portal hypertension (including the Caroli syndrome), arterial degeneration, atherosclerosis, and liver transplantation. It is difficult to diagnose, and it generally presents as ruptured, thus once the diagnosis is made, the surgical approach is indicated due to its high mortality. CLINICAL CASE Female of 66 years of age with a diagnosis of splenic artery aneurysm, with pulsing sensation at epigastric level of 8 months onset. On physical examination there is a palpable throbbing mass of 9 cm of diameter approximately, for which she was admitted. The computed tomography angiography with reconstruction showed three splenic aneurysms. Two were tied and the larger one was repaired by endo-aneurysmorrhaphy. DISCUSSION Visceral aneurysms are extremely rare. They are currently increasing and are the third leading cause of cardiovascular death, as morbidity/mortality is high. The surgical treatment must be done selectively according to their size. Selection of the surgical techniques depends on the anatomic location and the need for revascularisation, the aetiology and the experience of the surgeon. CONCLUSION A review has been presented on the advances in diagnostic, and management, concluding that the best is to preserve the spleen, and whatever the technique it must be performed by trained surgeons.
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Affiliation(s)
- Héctor Bizueto-Rosas
- Servicio de Angiología, Hospital de Especialidades, Centro Médico Nacional La Raza, La Raza, D.F., México.
| | - José Ángel Barajas-Colón
- Servicio de Angiología, Hospital de Especialidades, Centro Médico Nacional La Raza, La Raza, D.F., México
| | - Ivan Delgadillo-de la O
- Servicio de Angiología, Hospital de Tecamac, Instituto Mexicano del Seguro Social, La Raza, D.F., México
| | | | - Hugo Alonso Pérez-González
- Servicio de Angiología, Hospital de Especialidades, Centro Médico Nacional La Raza, La Raza, D.F., México
| | - Noemí Antonia Hernández-Pérez
- Servicio de Medicina Familiar y Laboral, Unidad de Medicina Familiar y Hospital General de Zona Número 29, Instituto Mexicano del Seguro Social, D.F., México
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34
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Won Y, Lee SL, Kim Y, Ku YM. Clinical efficacy of transcatheter embolization of visceral artery pseudoaneurysms using N-butyl cyanoacrylate (NBCA). Diagn Interv Imaging 2015; 96:563-9. [PMID: 25686776 DOI: 10.1016/j.diii.2015.01.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE Transcatheter endovascular embolization within a reasonable time before rupture or deterioration of a patient's general condition is an important procedure for managing visceral pseudoaneurysms. N-butyl 2-cyanoacrylate (NBCA, enbucrilate) is an embolic material used in the blockade of visceral pseudoaneurysms. This study evaluated the clinical efficacy of transcatheter embolization of visceral artery pseudoaneurysms using NBCA. PATIENTS AND METHODS Between June 2004 and February 2014, 13 patients (9 males and 4 females; age range, 26-80years; mean, 57.9years) with 14 pseudoaneurysms were treated by transcatheter embolization using NBCA. NBCA was mixed with iodized oil at a 1:3 ratio to control its polymerization time and to render it radiopaque. Pseudoaneurysms were located on the gastroduodenal artery (n=1), pancreaticoduodenal artery (n=2), dorsal pancreatic artery (n=1), proximal jejunal artery (n=1), colic artery (n=1), splenic artery (n=3), renal artery (n=4; two in one patient), and hepatic artery (n=1). RESULTS All patients recovered immediately following the embolization procedure, and two patients showed minor complications that required only medical observation. CONCLUSIONS Transcatheter embolization using NBCA for the treatment of visceral pseudoaneurysms is a safe, effective, and low-cost treatment method with a high success rate.
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Affiliation(s)
- Y Won
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - S L Lee
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Y Kim
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Y M Ku
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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35
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36
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Rodríguez-Cordero M, González-Quintela A, Díaz-Peromingo JA. Splenic artery aneurysm presenting with abdominal discomfort and weight loss. Acta Clin Belg 2014; 69:386-8. [PMID: 25092196 DOI: 10.1179/0001551214z.00000000080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Splenic artery aneurysm (SAA) is uncommon, but it is the most frequent visceral artery aneurysm. It is more common in women, especially during pregnancy. SAA is usually asymptomatic, but abdominal pain and rupture may develop. At present, computerized tomography (CT) angiogram is the best diagnostic test but not the only. Surgical or endovascular treatment may be considered both in symptomatic or asymptomatic aneurysms greater then 2 cm in diameter. We present the case of an elderly woman with an SAA and review the literature.
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Kukliński A, Batycki K, Matuszewski W, Ostrach A, Kupis Z, Lęgowik T. Embolization of a large, symptomatic splenic artery pseudoaneurysm. Pol J Radiol 2014; 79:194-8. [PMID: 25009678 PMCID: PMC4089775 DOI: 10.12659/pjr.889974] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 01/31/2014] [Indexed: 01/30/2023] Open
Abstract
Background Splenic artery aneurysm is the third most common abdominal aneurysm. Most often it is due to pancreatitis. There were only 19 cases of aneurysms larger than 5 cm in diameter described in the literature. Management of splenic artery aneurysms depends on the size and symptoms. Invasive treatment modalities involve open procedures and interventional radiology methods (endovascular). Case Reports A 44-years-old male with chronic pancreatitis, in a gradually worsening general condition due to a large splenic artery aneurysm, was subjected to the procedure. Blood flow through the aneurysm was cut-off by implanting a covered stent between celiac trunk and common hepatic artery. Patient’s general condition rapidly improved, allowing discharge home in good state soon after the procedure. Conclusions Percutaneous embolization appears to be the best method of treatment of large splenic artery aneurysms. Complications of such treatment are significantly less dangerous than those associated with surgery.
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Affiliation(s)
- Adam Kukliński
- Department of Surgery, Radom Specialist Hospital, Radom, Poland
| | - Krzysztof Batycki
- Department of Diagnostic Imaging, Radom Specialist Hospital, Radom, Poland
| | | | - Andrzej Ostrach
- Department of Surgery, Radom Specialist Hospital, Radom, Poland
| | - Zbigniew Kupis
- Department of Surgery, Radom Specialist Hospital, Radom, Poland
| | - Tomasz Lęgowik
- Department of Diagnostic Imaging, Radom Specialist Hospital, Radom, Poland
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38
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Han YM, Lee JY, Choi IJ, Kim CG, Cho SJ, Lee JH, Kim HB, Choi JM. Endoscopic removal of a migrated coil after embolization of a splenic pseudoaneurysm: a case report. Clin Endosc 2014; 47:183-7. [PMID: 24765602 PMCID: PMC3994262 DOI: 10.5946/ce.2014.47.2.183] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/17/2013] [Accepted: 07/08/2013] [Indexed: 12/26/2022] Open
Abstract
Splenic artery pseudoaneurysms can be caused by pancreatitis, trauma, or operation. Traditionally, the condition has been managed through surgery; however, nowadays, transcatheter arterial embolization is performed safely and effectively. Nevertheless, several complications of pseudoaneurysm embolization have been reported, including coil migration. Herein, we report a case of migration of the coil into the jejunal lumen after transcatheter arterial embolization of a splenic artery pseudoaneurysm. The migrated coil was successfully removed by performing endoscopic intervention.
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Affiliation(s)
- Yoo Min Han
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Yeul Lee
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Il Ju Choi
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Chan Gyoo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Soo-Jeong Cho
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Jun Ho Lee
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Hyun Beom Kim
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Ji Min Choi
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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39
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Li ES, Mu JX, Ji SM, Li XM, Xu LB, Chai TC, Liu JX. Total splenic artery embolization for splenic artery aneurysms in patients with normal spleen. World J Gastroenterol 2014; 20:555-560. [PMID: 24574725 PMCID: PMC3923031 DOI: 10.3748/wjg.v20.i2.555] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 11/10/2013] [Accepted: 11/30/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate total embolization of the main splenic artery in patients with splenic artery aneurysms (SAAs) and normal spleen.
METHODS: Thirty-five consecutive patients with SAAs were referred for treatment with coil embolization. Patients were classified into two groups: coil embolization of the main splenic artery with complete occlusion of the artery and aneurysms (group A, n = 16), and coil embolization of the aneurysmal sac with patency of the splenic artery (group B, n = 19). Data on white blood cell (WBC) and platelet counts, liver function, and complications were collected on days 7 and 30, and subsequently at a 6-mo interval postoperatively. Abdominal computed tomography was routinely performed to calculate the splenic volume before and 1 mo after the procedure, and subsequently every 6 mo during follow-up.
RESULTS: Coil embolization of the SAAs was technically successful in all 35 patients, with no procedure-related complications. The post-embolization syndrome, including abdominal pain, fever and vomiting, occurred in six patients (37.5%) in group A and three patients in group B (15.8%). There were no significant differences in WBC and platelet counts between preoperatively and at each follow-up point after the procedures. There were also no significant differences in average WBC and platelet counts between the two groups at each follow-up point. There were significant differences in splenic volume in group A between preoperatively and at each follow-up point, and there were also significant differences in splenic volume between the two groups at each follow-up point.
CONCLUSION: Total embolization of the main splenic artery was a safe and feasible procedure for patients with SAAs and normal spleen.
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40
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Müller-Eschner M, Kortes N, Rehnitz C, Sumkauskaite M, Rengier F, Böckler D, Kauczor HU, Radeleff B. Endovascular Repair of a Complex Splenic Artery Aneurysm Using a Multilayer Stent. Cardiovasc Intervent Radiol 2013; 38:494-497. [PMID: 24232043 DOI: 10.1007/s00270-013-0788-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 10/05/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Matthias Müller-Eschner
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany,
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41
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Badea R, Andreica V, Caraiani C, Procopet B. Atherosclerotic splenic artery aneurysm in a decompensated cirrhotic patient. J Med Ultrason (2001) 2013; 40:487-490. [DOI: 10.1007/s10396-013-0434-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 01/18/2013] [Indexed: 10/27/2022]
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Abstract
Peripheral arterial aneurysms are uncommon; for some aneurysm types, data are limited to case reports and small case series. There is no Level A evidence in most cases to determine the choice between open or endovascular intervention. The evolution of endovascular technology has vastly improved the armamentarium available to the vascular surgeon and interventionalists in the management of these rare and unusual aneurysms. The choice of operative approach will ultimately be determined on an individual basis, dependent on the patient risk factors, and aneurysm anatomy. After consideration, some aneurysms (femoral, subclavian, carotid and ECAA) fare better with an open first approach; renal, splenic and some visceral artery aneurysms do better with an endovascular first approach. In our practice PAAs are treated with an endovascular first approach. For these rare conditions, both open and endovascular therapy will continue to work in harmony to enhance and extend the capabilities of modern surgical management.
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Affiliation(s)
- Irwin V Mohan
- Westmead Hospital, University of Sydney Medical School, Sydney, NSW 2145, Australia.
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43
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Jesinger RA, Thoreson AA, Lamba R. Abdominal and Pelvic Aneurysms and Pseudoaneurysms: Imaging Review with Clinical, Radiologic, and Treatment Correlation. Radiographics 2013; 33:E71-96. [DOI: 10.1148/rg.333115036] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Taori K, Rathod J, Disawal A, Mundhada R, Rewatkar A, Bakare V, Wavare P, Puria RP. Endovascular Embolization of Pseudoaneurysms Complicating Pancreatitis Using Microcoils: Case Series. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojrad.2013.31005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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45
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Hamed Ibrahim W, M Bassurrah H. Endovascular management of splenic arteriovenous fistula with giant venous aneurysmal dilatation. Ann Vasc Dis 2012; 5:439-44. [PMID: 23641267 DOI: 10.3400/avd.cr.12.00009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 07/23/2012] [Indexed: 11/13/2022] Open
Abstract
Although splenic artery aneurysm is the commonest visceral and third most common intra abdominal aneurysm after aorta and iliac artery, aneurysm of splenic artery along with aneurysm of splenic vein and arteriovenous fistula is a rare entity. Most of them are <3 cm in diameter. Giant true splenic artery aneurysms are rare and very few lesions >10 cm have been reported. We report a case of 11 cm × 8 cm giant splenic vein aneurysm with splenic arteriovenous fistula as the 1st case of giant splenic venous aneurysm with arteriovenous fistula managed by endovascular treatment.
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Affiliation(s)
- Wael Hamed Ibrahim
- Medical Imaging Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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46
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Singh AK, Shankar S, Gervais DA, Hahn PF, Mueller PR. Image-guided percutaneous splenic interventions. Radiographics 2012; 32:523-34. [PMID: 22411947 DOI: 10.1148/rg.322115135] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In the spleen, image-guided interventional procedures such as biopsy and catheter drainage have not been widely performed because of the perceived increased risk of complications. The ability of image-guided biopsy to allow tissue diagnosis of a focal splenic mass without the need for splenectomy is the driving force behind use of this procedure in oncology patients. The literature on image-guided splenic biopsy suggests that the highest biopsy yield is achieved with core biopsy and the lowest complication rate is achieved with fine-needle aspiration. Image-guided catheter drainage is an effective alternative to splenectomy for management of infected splenic collections. In clinical practice, image-guided splenic biopsy, fluid aspiration, and catheter drainage have high success rates. Image-guided alcohol ablation is effective in treatment of splenic cysts. The literature on splenic radiofrequency ablation (RFA) is sparse; therefore, further studies are needed to determine the role of RFA in management of splenic neoplasms and hypersplenism. Image-guided percutaneous thrombin injection can be used to treat splenic artery pseudoaneurysms. Awareness of the correct interventional techniques and their limitations is important for safe performance of image-guided percutaneous splenic interventions.
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Affiliation(s)
- Ajay K Singh
- Department of Radiology, Division of Emergency Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114, USA.
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47
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Mishra PK, Saluja SS, Sharma AK, Pattnaik P. Management of splenic artery aneurysm associated with extrahepatic portal vein obstruction. Hepatobiliary Pancreat Dis Int 2012; 11:330-3. [PMID: 22672830 DOI: 10.1016/s1499-3872(12)60170-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Splenic artery aneurysms although rare are clinically significant in view of their propensity for spontaneous rupture and life-threatening bleeding. While portal hypertension is an important etiological factor, the majority of reported cases are secondary to cirrhosis of the liver. We report three cases of splenic artery aneurysms associated with extrahepatic portal vein obstruction and discuss their management. METHODS The records of three patients of splenic artery aneurysm associated with extrahepatic portal vein obstruction managed from 2003 to 2010 were reviewed retrospectively. The clinical presentation, surgical treatment and outcome were analyzed. RESULTS The aneurysm was >3 cm in all patients. The clinical symptoms were secondary to extrahepatic portal vein obstruction (hematemesis in two, portal biliopathy in two) while the aneurysm was asymptomatic. Doppler ultrasound demonstrated aneurysms in all patients. A proximal splenorenal shunt was performed in two patients with excision of the aneurysm in one patient and ligation of the aneurysm in another one. The third patient had the splenic vein replaced by collaterals and hence underwent splenectomy with aneurysmectomy. All patients had an uneventful post-operative course. CONCLUSIONS Splenic artery aneurysms are associated with extrahepatic portal vein obstruction. Surgery is the mainstay of treatment. Although technically difficult, it can be safely performed in an experienced center with minimal morbidity and good outcome.
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Patel A, Weintraub JL, Nowakowski FS, Kim E, Fischman AM, Ellozy SH, Faries PL, Vouyouka AG, Marin ML, Lookstein RA. Single-center experience with elective transcatheter coil embolization of splenic artery aneurysms: technique and midterm follow-up. J Vasc Interv Radiol 2012; 23:893-9. [PMID: 22579853 DOI: 10.1016/j.jvir.2012.03.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 03/13/2012] [Accepted: 03/29/2012] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To review a single-center experience with elective coil embolization of splenic artery aneurysm (SAA) and analyze efficacy of the technique at midterm follow-up. MATERIALS AND METHODS From 2002 through 2011, 50 patients (28 women, 22 men; age range, 24-89 y; mean age, 53.5 y ± 13.6) underwent transcatheter coil embolization for treatment of SAAs. Pseudoaneurysms and ruptured aneurysms were excluded. A total of 63 SAAs were treated (size, 13-97 mm; mean, 29 mm). Ninety-eight percent of aneurysms were treated with coils alone. Regular follow-up consisted of an office visit and imaging. Patient medical records were reviewed for aneurysm location, procedural approach, and technical and clinical outcomes. RESULTS Ninety-eight percent of procedures were technically successful at thrombosing the aneurysm at the time of procedure. Repeat intervention was performed in four of 47 patients (9%) because of continued aneurysm perfusion at follow-up. Mean time to repeat intervention was 125 days (range, 42-245 d). All repeat interventions were technically successful. Neither aneurysm growth nor aneurysm rupture was observed in any patient during the follow-up period (mean, 78 weeks; range, 9 d to 7.1 y). There were no major adverse events. Major splenic infarction occurred in three of 33 patients (9%) with no underlying liver disease and normal splenic volume and in seven of 14 patients (50%) with portal hypertension. CONCLUSIONS Percutaneous transcatheter coil embolization is a safe, effective, and minimally invasive treatment for SAAs as evidenced by high rates of technical success and freedom from aneurysm rupture.
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Affiliation(s)
- Amish Patel
- Division of Interventional Radiology, Mount Sinai Medical Center, 1 Gustave L. Levy Place, New York, NY 10029, USA
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Endovascular Exclusion of a Splenic Artery Aneurysm Using a Pipeline Embolization Device. J Vasc Interv Radiol 2012; 23:131-5. [DOI: 10.1016/j.jvir.2011.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 05/03/2011] [Accepted: 09/09/2011] [Indexed: 01/17/2023] Open
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50
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Saba L, Anzidei M, Lucatelli P, Mallarini G. The multidetector computed tomography angiography (MDCTA) in the diagnosis of splenic artery aneurysm and pseudoaneurysm. Acta Radiol 2011; 52:488-98. [PMID: 21498313 DOI: 10.1258/ar.2011.100283] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Splenic artery aneurysm is the most frequent visceral artery aneurysm and rupture of the aneurysm is associated with a high mortality rate. It is important to discriminate between a true aneurysm and a pseudoaneurysm that may be caused by pancreatitis, iatrogenic and postoperative causes, trauma and peptic ulcer disease. Multidetector-row CT angiography (MDCTA) allows detailed visualization of the vascular anatomy and may allow identification of aneurysms and pseudoaneurysms that affect the splenic artery. The objective of this article is to provide a review of the general characteristics of splenic artery aneurysms and pseudoaneurysms and to describe the findings of MDCTA.
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Affiliation(s)
- Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (AOU), Cagliari
| | - Michele Anzidei
- Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy
| | - Pierleone Lucatelli
- Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy
| | - Giorgio Mallarini
- Department of Radiology, Azienda Ospedaliero Universitaria (AOU), Cagliari
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