[Aneurysms of the splanchnic arteries]

Jornal Vascular Brasileiro

Digestive Diseases and Sciences, 2004

Annals of Vascular Surgery, 2021

Objective: Splanchnic artery aneurysms (SAAs) are uncommon, and standards for surveillance and intervention are lacking. The goal of this study was to review our 20-year experience with managing SAAs. Methods: The Research Patient Data Registry at the Massachusetts General Hospital was queried, and all patients with SAAs identified by axial imaging from 1994 to 2014 were included. Aneurysms were stratified into two cohorts: those that underwent early intervention (<6 months after lesion discovery) and those that received surveillance. Primary study end points included aneurysm growth or rupture during surveillance and patient 30-day morbidity or mortality after aneurysm repair. Results: There were 264 SAAs identified in 250 patients. In 166 patients, 176 SAAs (66.6%) were placed into the surveillance cohort; 38 SAAs (21.6%) did not have subsequent axial imaging and were considered lost to follow-up. Mean aneurysm size in the surveillance cohort at first imaging study was 16.28 mm (8-41 mm), and mean surveillance time was 36.1 months (2-155 months); 126 SAAs (91.3%) remained stable in size over time, and 8 SAAs (5.8%) required intervention for aneurysm growth after a mean of 24 months. There were no ruptures in the surveillance cohort. There were 88 SAAs (33.3%) repaired early. Mean size of SAAs that were repaired early was 31.1 mm (10-140 mm). For intact SAAs, 30-day morbidity and mortality rates after repair were 13% and 3%, respectively. In the early repair cohort, 13 SAAs (14.7%) were ruptured at presentation. The 30-day morbidity and mortality rates after rupture were 54% and 8%, respectively. Five ruptured SAAs (38%) were anatomically located in the pancreaticoduodenal arcade. On univariate analysis, pancreaticoduodenal aneurysms were strongly associated with rupture (P [ .0002). Conclusions: Small SAAs (#25 mm) are not prone to significant expansion and do not require frequent surveillance imaging. Imaging every 3 years for small SAAs is adequate. Aneurysms of the pancreaticoduodenal arcade and gastroduodenal aneurysms are more likely to rupture and therefore warrant a more aggressive interventional approach.

CardioVascular and Interventional Radiology, 2003

Purpose: To assess the endovascular treatment of splenic artery aneurysms and false aneurysms. Methods: Twelve patients (mean age 59 years, range 47-75 years) with splenic artery aneurysm (n ϭ 10) or false aneurysm (n ϭ 2) were treated. The lesion was asymptomatic in 11 patients; hemobilia was observed in one patient. The lesion was juxta-ostial in one case, located on the intermediate segment of the splenic artery in four, near the splenic hilus in six, and affected the whole length of the artery in one patient. In 10 cases, the maximum lesion diameter was greater than 2 cm; in one case 30% growth of an aneurysm 18 mm in diameter had occurred in 6 months; in the last case, two distal aneurysms were associated (17 and 18 mm in diameter). In one case, stent-grafting was attempted; one detachable balloon occlusion was performed; the 10 other patients were treated with coils. Results: Endovascular treatment was possible in 11 patients (92%) (one failure: stenting attempt). In four cases among 11, the initial treatment was not successful (residual perfusion of aneurysm); surgical treatment was carried out in one case, and a second embolization in two. Thus in nine cases (75%) endovascular treatment was successful: complete and persistent exclusion of the aneurysm but with spleen perfusion persisting at the end of follow-up on CT scans (mean 13 months). An early and transient elevation of pancreatic enzymes was observed in four cases. Conclusion: Ultrasound and CT have made the diagnosis of splenic artery aneurysm or false aneurysm more frequent. Endovascular treatment, the morbidity of which is low, is effective and spares the spleen.

Srpski arhiv za celokupno lekarstvo

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

Annals of Vascular Surgery, 2007

Aneurysms of the splenic artery are the most common splanchnic aneurysms. Aneurysms of a splenic artery with an anomalous origin from the superior mesenteric artery are however rare, with eight previously reported cases. Their indications for treatment are superposable to those of aneurysms affecting an orthotopic artery. Methods of treatment of this condition include endovascular, minimally invasive techniques and surgical resection. We report one more case of aneurysm of an aberrant splenic artery, treated with surgical resection, and preservation of the spleen.

American Journal of Surgery, 2001

We sought to determine the results of surgical treatment of patients with tetralogy of Fallot and pulmonary atresia with or without major aortopulmonary collateral arteries, to clarify variables affecting early and late mortality, and to expose late, nonfatal events affecting surgical patients.

E xcellent success rates have been achieved with differ-ent endovascular techniques in the treatment of splanchnic aneu-rysms. This pictorial essay describes the endovascular management of dif-ferent splanchnic aneurysms. METHOD This was a retrospective study that included all aneurysms involving the splanchnic arteries that were referred to our department for endovascular treatment over a period of more than 10 years (from June 2002 to December 2012). RESULTS 63 patients were included in this study. Males were more common than females (4.7:1) and more than half of the patients were in the 30 to 60 year age group. The most common symp-toms were abdominal pain, melena, and hematemesis (Figure 1A). Pancreatitis (29%), surgery (22%), infection (14%), and trauma (12%) were the most com-mon causes (Figure 1B). The most com-mon locations were the hepatic artery (39%) and the splenic artery (31%; Fig-ure 1C). The most common endovascu-lar techniques used were proximal coil embolization (51...

Diagnostic and interventional radiology (Ankara, Turkey)

T he splenic artery is the third most common location of intraabdominal aneurysms, following the abdominal aorta and iliac arteries. Visceral arterial aneurysms are rare pathologies, the splenic artery constitutes 60%, hepatic artery 25%, and superior mesenteric artery 5%. Generally they are incidentally diagnosed on autopsies or abdominal radiographic examinations. Rupture is the most critical complication that occurs in 3%-10% of cases (1).

Einstein (Sao Paulo, Brazil), 2017

Giant splenic artery aneurysm is a rare condition that represents an eminent life threatening for the patient, requiring, therefore, urgent surgical correction. A 61-year-old woman, former smoker, hypertensive, hypercholesterolemic and multipara sought our service because of a large tumor in the mesogastrium, which was an abdominal ultrasound finding. Despite the size of the tumor, the patient was asymptomatic. The angiotomography and the magnetic resonance image of the abdomen were suggestive of giant splenic artery aneurysm with more than 10cm in diameter that was confirmed by an angiography. She underwent surgery, open splenectomy, and partial aneurysmectomy. The approach of the celiac artery, which was ligated, was only possible with medialvisceral rotation because there was no possibility to view it through the anterior access. The histopathological test of aneurysmatic wall revealed atheroma plaques in the intima. The patient progressed without complications and she was discha...

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2009

patients with SAA underwent laparoscopic surgery. Among these patients, 4 had splenectomy alone and 2 had splenectomy with distal pancreatectomy. The mean size of the aneurysm was 3.1 cm (range: 2 to 4 cm).

Journal of Vascular Surgery, 2009

Objectives: The purpose of this study was to report a series of 16 consecutive patients who underwent laparoscopic treatment of splenic artery aneurysms. Methods: Over a period of 8 years, patients were selected for the laparoscopic option by a team of specialists that included the vascular surgeon, the interventional radiologist, and the laparoscopic surgeon. The mean size of the aneurysm was 32 mm and most was located at the splenic hilum. They were twice as common in females as in males. Ultrasonography with color Doppler function was used to define intraoperative strategy. Results: The laparoscopic treatment entailed excision of the aneurysm or its exclusion, usually reserved for distally located lesions. In one patient, laparoscopic resection and robotic anastomosis of the splenic artery was performed to re-establish flow to the spleen. In two patients, the intraoperative decision was added to combine a laparoscopic splenectomy due to insufficient residual arterial flow to the spleen. There was no conversion, or need for re-operation or related mortality. Analysis of intraoperative arterial flow data avoided unnecessary splenectomy following noncritical reduction of flow to the spleen. Conclusions: The use of intraoperative color Doppler ultrasonography is essential in deciding the appropriate procedure and whether the spleen should be removed or saved. Early control of the splenic artery proximal to the aneurysm can limit the risk of conversion due to intraoperative bleeding. Distally located aneurysms are more difficult to manage and entail a higher risk of associated splenectomy. The laparoscopic option offers some advantages over the endovascular treatment in selected patients. A multidisciplinary approach is the key to a successful treatment of this uncommon disease. ( J Vasc Surg 2009;50:275-9.)

2018

Splenic artery aneurysm is rare although it is the third most common location of intra-abdominal aneurysms, its diagnosis is challenging due to the nonspecific presentation, the ruptured aneurysm can be life-threatening and sometimes present with the double-rupture phenomenon, in which an aneurysm ruptures into the lesser sac primarily, and blood overflows into the peritoneal. We report a case of a 32-year-old female who presented with moderate left abdominal pain, tachycardia and hypotensive, CT revealed multiple splenic artery aneurysm and significant hemoperitoneum, the patient was operated successfully, splenectomy and proximal ligation of the splenic artery were performed. Early and immediate diagnosis and intervention of splenic artery aneurysm are substantial in preventing the predictable complications and to consider the double rupture phenomenon. Introduction: Splenic artery aneurysm (SAA) is a rare condition although it is the third most common location of intraabdominal aneurysms after the abdominal aorta and iliac arteries (1). The significance of splenic artery aneurysm lies in the potential risk for rupture and life-threatening hemorrhage which occurs in 10% of cases with a mortality rate of 10-25% in non-pregnant patient and up to 70% in pregnancy (2). With a ruptured SAA, delayed intraperitoneal bleeding occasionally occurs 6 to 96 hours later, with blood initially contained within the lesser sac. Approximately 80% of SAAs are asymptomatic and are detected incidentally, however, there might be some symptoms like epigastric or back pain (3). Risk factors for SAA include pregnancy, portal hypertension secondary to liver cirrhosis, collagen vascular diseases, and atherosclerosis (4-6). Early and accurate clinical suspicion and diagnosis is the most important step in the management of patients with SAA. Early and immediate intervention is substantial in preventing the predictable complications. Here is a case of a present who was admitted through the emergency department with multiple splenic artery aneurysms. Case report: A 32-years-old female patient was transferred from a peripheral hospital as a case of query perforated acute appendicitis. At presentation, the patient was complaining of mild epigastric and left upper quadrant pain, Associated with dizziness few hours prior to presentation. There was no history of any systemic infections, trauma, family history of an aneurysm or any connective tissue disorders. she did not have any previous surgeries. The patient was three months post-delivery. On examination, the patient had a pallor look, cold and clammy extremities, pulse rate of 135/min and BP of 80/40 mm Hg. The abdominal examination showed tenderness at left upper quadrant area. Initial laboratory results showed hemoglobin 8.2 g/dL, hematocrit 25.6%, PT 12.4 sec, INR 1.08, electrolytes, liver and renal functions were within normal limits. Ultrasonography of the abdomen showed a significant amount of free fluid in the abdomen and pelvis. After resuscitation and stabilization of the patient, an abdominal computed tomography (CT) scan revealed multiple aneurysmal dilatations of splenic artery with largest one measured about 12mm, associated with moderate to marked hemoperitoneum but no active extravasation. (figure 1 and 2).

Journal of Vascular Surgery, 2011

The management of patients with splenic artery aneurysms (SAAs) is variable since the natural history of these aneurysms is poorly delineated. The objective of this study was to review our experience with open repair, endovascular therapy, and observation of SAAs over a 14-year interval. Methods: Between January 1, 1996 and December 31, 2009, 128 patients with SAAs were evaluated. Sixty-two patients underwent surgical repair (n ‫؍‬ 13) or endovascular coil/glue ablation (n ‫؍‬ 49), while 66 patients underwent serial observation. The original medical records and computed tomography (CT) imaging were reviewed. Statistical analyses were performed using 2 or Fisher's exact test for categorical patient characteristics and t-test for continuous variables. Kaplan-Meier estimates for survival were calculated. Mortality was verified via the Social Security Death Index. Results: Patients (61 ؎ 11 years, 69% female) were investigated for abdominal symptoms (49%) or had the incidental finding of SAA (mean size, 2.4 ؎ 1.4 cm). Seven patients (5.5%) presented with rupture and were treated emergently with two perioperative mortalities (29%). Patients requiring surgical or endovascular treatment were more likely male (40% vs 21%, P ‫؍‬ .031), younger (58 vs 64 years; P ‫؍‬ .004), and current smokers (18% vs 5%; P ‫؍‬ .035). Increased aneurysm calcification was associated with decreased SAA size (P ‫؍‬ .013). The mean aneurysm size at initial diagnosis was 1.67 cm for patients undergoing observation and 3.13 cm for the treated group (P < .001). Endovascular repair was safe and durable with a mean 1.5-mm regression in SAA size over 2 years. The mean rate of growth for observed SAA was 0.2 mm/y. Ten-year survival was 89.4% (95% confidence interval: 82.0, 97.4) for all patients (observed group, 94.9%; treated group, 85.1%; P ‫؍‬ .18). No late aneurysm-related mortality was identified. Conclusions: Ruptured SAAs are lethal. Large SAAs can undergo endovascular ablation safely with durable SAA regression. Smaller SAAs (<2 cm) grow slowly and carry a negligible rupture risk.

JSLS, Journal of the Society of Laparoendoscopic Surgeons, 2013

Splenic artery aneurysm is more frequently diagnosed today with the advancement and liberal use of imaging modalities. A symptomatic aneurysm, an aneurysm of any diameter in a pregnant woman or a woman of childbearing age, and an aneurysm Ͼ2 cm are all strong indications for surgery because of a significantly increased risk for splenic artery rupture.