1
|
Jabłońska B, Mrowiec S. Endovascular Treatment of Hepatic Artery Pseudoaneurysm after Pancreaticoduodenectomy: A Literature Review. Life (Basel) 2024; 14:920. [PMID: 39202663 PMCID: PMC11355561 DOI: 10.3390/life14080920] [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: 05/02/2024] [Revised: 07/13/2024] [Accepted: 07/22/2024] [Indexed: 09/03/2024] Open
Abstract
Pancreaticoduodenectomy (PD) is a complex surgical procedure performed in patients with periampullary tumors located within the pancreatic head, the papilla of Vater, the distal common bile duct, and the duodenum. In advanced tumors, the operative technique involves the need for dissection and divestment of the arteries located within the pancreaticoduodenal field, including the common hepatic artery (CHA) and the proper hepatic artery (PHA) and its branches. The second most important cause of post-PD visceral aneurysms is irritation of the peri-pancreatic arterial wall by pancreatic juice in a postoperative pancreatic fistula (POPF). Hepatic artery pseudoaneurysm (HAP) is a very dangerous condition because it is usually asymptomatic, but it is a rare and potentially lethal pathology because of the high risk of its rupture. Therefore, HAP requires treatment. Currently, selective celiac angiography is the gold-standard diagnostic and therapeutic management for postoperative bleeding and pseudoaneurysm in patients following PD. Open surgery and less invasive endovascular treatment are performed in patients with HAP. Endovascular treatment involves transarterial embolization (TAE) and stent graft implantation. The choice of treatment method depends on the general and local conditions, such as the patient's hemodynamic stability and arterial anatomy. In patients in whom preservation of the flow within the hepatic artery (to prevent hepatic ischemia complications such as liver infarction, abscess, or failure) is needed, stent graft implantation is the treatment of choice. This article focuses on a review of two common methods for endovascular HAP treatment. In addition, risk factors and diagnostic tools have been described.
Collapse
Affiliation(s)
- Beata Jabłońska
- Department of Digestive Tract Surgery, Medical University of Silesia, 40-752 Katowice, Poland;
| | | |
Collapse
|
2
|
Jhajharia A, Singh S, Chaudhary M, Ameta M, Ashdhir P, Nijhawan S. Efficacy and Rationale of Endoscopic Ultrasound-Guided Thrombin Injection in Visceral Artery Pseudoaneurysm Not Amenable to Angioembolization. Pancreas 2024; 53:e330-e337. [PMID: 38345925 DOI: 10.1097/mpa.0000000000002303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
BACKGROUND Pseudoaneurysm usually occurs after vascular injuries or erosions such as in trauma or inflammation like pancreatitis and is associated with high morbidity and mortality. AIM The aim of study is to assess efficacy and safety of EUS-guided thrombin injection in pseudoaneurysm. MATERIALS AND METHODS Prospective data collection was done at SMS Hospital, Jaipur, from January 2015 to March 2023. All patients with pseudoaneurysm were consecutively enrolled. RESULTS Twenty patients (M/F, 18:2) with median age of 41 years (25-58 years), were studied. Underlying etiology of pseudoaneurysm was chronic pancreatitis in 75% of the patients, blunt trauma abdomen in 15% of the patients, recurrent acute pancreatitis in 5%, and idiopathic in 5% of the patients. At the time of admission, mean hemoglobin was 6.7 g/dL (3.4-8.2), with median blood transfusion requirement was 2 units (0-6 units). Hemoglobin values after 4-6 weeks showed a significant improvement ( t = 9.21, P < 0.05).Mean dose of human thrombin required for complete obliteration of pseudoaneurysm was 520 ± 188.6 IU per patient (300-800 IU). Amount of thrombin (IU) dose needed to achieve complete obliteration correlated well significantly with the dimension of pseudoaneurysm, P value less than 0.05 ( R = 0.80). Median follow-up duration in this study was 44 months (3-84 months), which was the longest follow-up period by far. CONCLUSIONS Endoscopic ultrasound-guided thrombin injection in visceral artery pseudoaneurysm is a safe and effective alternative for patients not amenable for digital subtraction angiography-guided angioembolization.
Collapse
Affiliation(s)
- Ashok Jhajharia
- From the Department of Gastroenterology, SMS Medical College and Hospital
| | - Shashank Singh
- From the Department of Gastroenterology, SMS Medical College and Hospital
| | - Monika Chaudhary
- Department of Radiology, Santokba Durlabhji Memorial Hospital, Jaipur, India
| | - Mayank Ameta
- From the Department of Gastroenterology, SMS Medical College and Hospital
| | - Prachis Ashdhir
- From the Department of Gastroenterology, SMS Medical College and Hospital
| | - Sandeep Nijhawan
- From the Department of Gastroenterology, SMS Medical College and Hospital
| |
Collapse
|
3
|
Kang J, Kim S, Yang SS, Kim YW, Do YS, Park KB, Park YJ. Clinical Characteristics and Management of Peripancreatic Arterial Aneurysms: A 20-year Experience. Angiology 2023:33197231225281. [PMID: 38147027 DOI: 10.1177/00033197231225281] [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: 12/27/2023]
Abstract
Pancreaticoduodenal and gastroduodenal artery aneurysms (PDAAs and GDAAs) are rare visceral aneurysms. Considering the rupture risk regardless of size, treatment should be provided promptly. We reviewed the characteristics and management of peripancreatic aneurysms in a retrospective, single-center review of consecutive patients with PDAAs and GDAAs between 2000 and 2022. Demographics, clinical characteristics, radiologic features, treatment, and outcomes were recorded. Nineteen PDAAs and seven GDAAs were identified in 24 patients. The median sizes of the PDAAs and GDAAs were 21 mm (range: 8-50 mm) and 14 mm (range: 11-32 mm), respectively. There were 4 ruptured cases (15.4%). Ten aneurysms (38.5%) had concomitant visceral aneurysms, and 16 (61.6%) were associated with celiac pathology. Aneurysms were managed using endovascular in 12 (46.2%), surgical in 4 (15.4%), and combined methods in 3 (11.5%) cases; 7 patients (26.9%) were lost to follow-up or refused treatments. During a median 13.8-month follow-up (range: 1-147.6), two complications (7.7%) occurred including pancreatitis and coil migration into the superior mesenteric artery after embolization within 30 days. After 30 days, aorto-common hepatic artery bypass graft stenosis was identified in one PDAA. Depending on the characteristics of peripancreatic aneurysms, endovascular, surgical, and hybrid approaches might all be practical treatment options.
Collapse
Affiliation(s)
- Jihee Kang
- Division of Vascular Surgery, Department of Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Sejun Kim
- Division of Vascular Surgery, Department of Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin-Seok Yang
- Division of Vascular Surgery, Department of Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Department of Surgery, Incheon Sejong Hospital, Incheon, Korea
| | - Young-Soo Do
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang-Bo Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Minici R, Guerriero P, Fontana F, Venturini M, Guzzardi G, Piacentino F, Coppola A, Spinetta M, Siciliano A, Serra R, Costa D, Ielapi N, Santoro R, Brunese L, Laganà D. Endovascular Treatment of Visceral Artery Pseudoaneurysms with Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs). MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1606. [PMID: 37763725 PMCID: PMC10537405 DOI: 10.3390/medicina59091606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Treatment of visceral artery pseudoaneurysms (VAPs) is always indicated regardless of their diameters, as their risk of rupture is significantly higher than that of visceral artery aneurysms. The invasiveness of surgery and its associated complications have led to a shift in favor of radiological interventions as the initial treatment of choice. However, there are still some unanswered questions on endovascular treatment of VAPs regarding the optimal endovascular technique and the efficacy and safety outcomes. The purpose of this multicenter study was to retrospectively evaluate the effectiveness and safety of endovascular treatment of visceral pseudoaneurysms using Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs). Materials and Methods: Consecutive patients who underwent endovascular embolization with EVOH-based NALEAs for visceral artery pseudoaneurysms between January 2018 and June 2023 were retrospectively evaluated. Results: 38 embolizations were performed. Technical success was achieved in all patients. The clinical success rate was high (92.1% overall), with no significant differences between ruptured and unruptured VAPs (p = 0.679). Seven patients (18.4%) experienced procedure-related complications, related to one case of non-target embolization, four splenic abscesses due to end-organ infarction, and two femoral pseudoaneurysms. The rates of procedure-related complications, end-organ infarction, and vascular access-site complications did not significantly differ between ruptured and unruptured VAPs (p > 0.05). Conclusions: Both ruptured and unruptured visceral pseudoaneurysms can be effectively and safely treated with NALEA-based endovascular embolization. We suggest considering the use of NALEAs, particularly in specific clinical cases that highlight their advantages, including patients with coagulopathy, fragile vessels, and embolization targets that are located at a considerable distance from the microcatheter tip and are otherwise difficult to reach.
Collapse
Affiliation(s)
- Roberto Minici
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (A.S.); (D.L.)
| | - Pasquale Guerriero
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy;
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (F.F.); (M.V.); (F.P.); (A.C.)
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (F.F.); (M.V.); (F.P.); (A.C.)
| | - Giuseppe Guzzardi
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy; (G.G.); (M.S.)
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (F.F.); (M.V.); (F.P.); (A.C.)
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (F.F.); (M.V.); (F.P.); (A.C.)
| | - Marco Spinetta
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy; (G.G.); (M.S.)
| | - Agostino Siciliano
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (A.S.); (D.L.)
| | - Raffaele Serra
- Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy;
| | - Davide Costa
- Department of Law, Economics and Sociology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Nicola Ielapi
- Department of Public Health and Infectious Disease, Sapienza University of Rome, 00185 Rome, Italy;
| | - Rita Santoro
- Haemophilia and Thrombosis Center, Dulbecco University Hospital, 88100 Catanzaro, Italy;
| | | | - Luca Brunese
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy;
| | - Domenico Laganà
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (A.S.); (D.L.)
| |
Collapse
|
6
|
Wang MD, Tian W, Zhou CG, Liu S. Safety and Efficacy of the Double Microcatheter Technique for Splenic Artery Aneurysms: A Single-center Retrospective Study. Vasc Endovascular Surg 2023:15385744231154087. [PMID: 36705019 DOI: 10.1177/15385744231154087] [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: 01/28/2023]
Abstract
PURPOSE We aimed to assess the safety and efficacy of the double microcatheter technique in the treatment of saccular splenic artery aneurysms. METHODS From November 2013 to October 2020, 56 patients with saccular splenic artery aneurysms underwent endovascular treatment with the double microcatheter technique at our institution. Technical success was defined as embolization of the aneurysmal cavity with no obstruction of the parent artery. Clinical success was defined as no deaths due to splenic artery aneurysms, and no reintervention, recrudescence or organ dysfunction at 1, 6, and 12 months. RESULTS The technical success rate was 100%. No major complications related to angiography or embolization were observed. Minor complications included fever, pain, and nausea, and 13 patients developed minor complications. At 1 month, the rate of clinical success was 96.4%. At 6 and 12 months, the clinical success rate was 92.9%. There were no aneurysmal recurrences or necessities of reintervention. CONCLUSIONS Coil embolization with the double microcatheter technique is a safe and effective modality for treating saccular splenic artery aneurysms and offers a reasonable choice for patients who want to retain their original hemodynamics.
Collapse
Affiliation(s)
- Mei-De Wang
- Department of Interventional Radiology, Jiangsu Province Hospital and Nanjing 74734Medical University First Affiliated Hospital, Nanjing, China
| | - Wei Tian
- Department of Interventional Radiology, Jiangsu Province Hospital and Nanjing 74734Medical University First Affiliated Hospital, Nanjing, China
| | - Chun-Gao Zhou
- Department of Interventional Radiology, Jiangsu Province Hospital and Nanjing 74734Medical University First Affiliated Hospital, Nanjing, China
| | - Sheng Liu
- Department of Interventional Radiology, Jiangsu Province Hospital and Nanjing 74734Medical University First Affiliated Hospital, Nanjing, China
| |
Collapse
|
7
|
Lamparski K, Procyk G, Bartnik K, Korzeniowski K, Maciąg R, Matsibora V, Sajdek M, Dryjańska A, Wnuk E, Rosiak G, Maj E, Januszewicz M, Gąsecka A, Ostrowski T, Kaszczewski P, Gałązka Z, Wojtaszek M. Can Color Doppler Ultrasound Be Effectively Used as the Follow-Up Modality in Patients Undergoing Splenic Artery Aneurysm Embolization? A Correlational Study between Doppler Ultrasound, Magnetic Resonance Angiography and Digital Subtraction Angiography. J Clin Med 2023; 12:jcm12030792. [PMID: 36769441 PMCID: PMC9917602 DOI: 10.3390/jcm12030792] [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: 11/22/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Splenic artery aneurysm (SAAs) rupture is associated with a high mortality rate. Regular surveillance with imaging before and after intervention is crucial to guide best evidence treatment. The following study aimed to determine the efficacy of color Doppler ultrasound imaging (DUS) compared to digital subtraction angiography (DSA) and magnetic resonance angiography (MRA) as a follow-up modality after selective coil embolization of true SAAs. We analyzed data from 20 patients, 15 females (48.1 ± 16.1 years) undergoing selective SAA coil embolization using detachable fibered embolization coils. Imaging using DUS, MRA, and DSA was performed 3 months after the initial embolization or the consequent re-embolization procedure. Primary clinical success, defined as Class I aneurysm occlusion, on 3-month follow-up was seen in 16 (80.0%) patients. DUS had a sensitivity of 94.4% and a specificity of 42.9% when compared to DSA and 92.3% and 30%, respectively, when compared to MRA in identifying Class I aneurysm occlusion. The positive predictive value (PPV) of DUS in identifying the need for re-embolization was 75.0%, while the NPV of DUS in these terms was 90.5%. DUS showed a high sensitivity in detecting aneurysm occlusion and clinical success, simultaneously exhibiting poor specificity. Still, with caution, this follow-up modality could be used for monitoring select low-risk patients after selective embolization of SAAs. DUS could provide a higher cost-to-benefit ratio, enabling more systematic post-procedural follow-up, as it is far more commonly used compared to MRA and non-invasive compared to DSA.
Collapse
Affiliation(s)
- Krzysztof Lamparski
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
- Correspondence: ; Tel.: +48-606-607-512
| | - Grzegorz Procyk
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Krzysztof Bartnik
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Krzysztof Korzeniowski
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Rafał Maciąg
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Vadym Matsibora
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Michał Sajdek
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Alicja Dryjańska
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Emilia Wnuk
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Grzegorz Rosiak
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Edyta Maj
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Magdalena Januszewicz
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Tomasz Ostrowski
- Department of General, Endocrine and Vascular Surgery, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Piotr Kaszczewski
- Department of General, Endocrine and Vascular Surgery, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Zbigniew Gałązka
- Department of General, Endocrine and Vascular Surgery, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Mikołaj Wojtaszek
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
- Everlight Radiology, 350 Euston Rd, London NW1 3AX, UK
| |
Collapse
|
8
|
Covantsev S, Alieva F, Mulaeva K, Mazuruc N, Belic O. Morphological Evaluation of the Splenic Artery, Its Anatomical Variations and Irrigation Territory. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010195. [PMID: 36676143 PMCID: PMC9861032 DOI: 10.3390/life13010195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Precise knowledge of the topographic features of the splenic artery and its branches in the hilum region is of practical interest due to the various interventions on the vessels of the spleen. MATERIALS AND METHODS The anatomy of the spleen was studied by means of macroscopic dissection on 330 organ complexes, which were carefully documented and analyzed statistically. RESULTS The analysis of the splenic artery trajectory led to identification of four types: straight (43.03%), sinusoidal (27.58%), serpentine (20.91%) and alternating (8.48%). To assess the relation between the trajectory of the splenic artery and its branches we performed a chi square test. Sinuous or serpentine trajectory was associated with the presence of long splenic artery branches (dorsal pancreatic artery or the great pancreatic artery), X2 (2, N = 330) = 12.85, p = 0.001. The artery was located suprapancreatic in 70.30% of cases, anteropancreatic in 4.55%, the vessel had an intrapancreatic course in 14.85% and in 10.00% of cases the artery was located retropancreatic. The presence of inferior polar arteries was associated with a longer pancreas (Spearman's correlation; r = 0.37; p = 0.037). In a multiple regression analysis, inferior polar arteries predicted the length of the pancreas although only a small number of cases could be explained by this model (R2 = 0.127, Adjusted R2 = 0.098; Betta = 0.357; t(330) = 2.091; p = 0.045). There were 30 (9.09%) cases of accessory spleens. CONCLUSIONS The arterial supply of the spleen is highly variable in its trajectory, terminal branches, and relation to other organs. The splenic artery tends to be sinuous or serpentine in zones when a large artery branches off (e.g., the dorsal pancreatic or greater pancreatic artery). Multiple short branches tend to stabilize the trajectory of the splenic artery. Inferior polar arteries and accessory spleens contribute to the length of the pancreas, most likely due to increased vascular supply to the tail of the gland.
Collapse
Affiliation(s)
- Serghei Covantsev
- Department of Research and Clinical Development, Botkin Hospital, 125284 Moscow, Russia
- Correspondence:
| | - Fariza Alieva
- Department of Surgery, Russian Medical Academy of Continuous Professional Education, 125993 Moscow, Russia
| | - Karina Mulaeva
- Department of Surgery, Russian Medical Academy of Continuous Professional Education, 125993 Moscow, Russia
| | - Natalia Mazuruc
- Department of Human Anatomy, State University of Medicine and Pharmacy “N. Testemitanu”, 2004 Chisinau, Moldova
| | - Olga Belic
- Department of Human Anatomy, State University of Medicine and Pharmacy “N. Testemitanu”, 2004 Chisinau, Moldova
| |
Collapse
|
9
|
Yoshikawa C, Yamato I, Nakata Y, Nakagawa T, Inoue T, Nakatani M, Nezu D, Doi S, Kuroda Y, Fujii K, Kishida S, Kamikubo M, Ko S. Giant splenic artery aneurysm rupture into the stomach that was successfully managed with emergency distal pancreatectomy. Surg Case Rep 2022; 8:148. [PMID: 35915344 PMCID: PMC9343537 DOI: 10.1186/s40792-022-01498-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 07/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background Splenic artery aneurysms usually rupture into the free peritoneal space and rarely into the gastrointestinal tract. We report the case of a patient with a giant splenic artery aneurysm that ruptured in to the stomach with hemorrhagic shock and was successfully treated with emergency surgery. Case presentation A 59-year-old man presented to the emergency department with chest pain and syncope. Contrast-enhanced computed tomography showed splenic artery aneurysm with active contrast extravasation. He developed upper gastrointestinal (UGI) bleeding and hypovolemic shock. We diagnosed a splenic artery aneurysm ruptured in to the stomach, performed emergency distal splenopancreatectomy including the aneurysm and partial gastric resection, and could prevent patient death. Conclusions This report shows that splenic artery aneurysm can cause UGI bleeding. Thus, clinicians should be alert about this condition when managing patients with UGI bleeding and/or splenic artery aneurysm.
Collapse
|
10
|
Alhyari A, Geisler L, Eilsberger F, Dietrich CF, Findeisen H, Trenker C, Görg C, Safai Zadeh E. „Hyposplenie“, eine weitgehend unerkannte Immunschwäche: Ist die Sonografie hilfreich? ZEITSCHRIFT FÜR GASTROENTEROLOGIE 2022. [PMID: 36413992 DOI: 10.1055/a-1901-9569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
ZusammenfassungDas Immundefizienzsyndrom der funktionellen Hyposplenie/Asplenie ist weitgehend unerkannt.
Die Goldstandardprozedur stellt die Technetium-99m-Szintigrafie von hitzedenaturierten
Erythrozyten (TSZ) sowie der Nachweis von pitted Erythrozyten oder Howell-Jolly-Körperchen
(HJB) dar. Erste Arbeiten weisen darauf hin, dass dieses Krankheitsbild mit einer kleinen Milz
assoziiert ist. Ziel der vorliegenden Übersicht ist es, den Stellenwert der B-Bild-Sonografie
und der kontrastunterstützten Sonografie bei der Immunschwäche der Hyposplenie
darzustellen.
Collapse
Affiliation(s)
- Amjad Alhyari
- Klinik für Gastroenterologie, Endokrinologie, Stoffwechsel und klinische Infektiologie, und Interdisziplinäres Ultraschallzentrum, Universitätsklinikum Gießen und Marburg - Standort Marburg, Marburg, Germany
| | - Lisa Geisler
- Interdisziplinäres Ultraschallzentrum, Universitätsklinikum Gießen und Marburg - Standort Marburg, Marburg, Germany
| | - Friederike Eilsberger
- Klinik für Nuklearmedizin, Universitätsklinikum Gießen und Marburg - Standort Marburg, Marburg, Germany
| | - Christoph F. Dietrich
- Allgemeine Innere Medizin (DAIM) Kliniken Beau Site, Salem und Permanence, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Hajo Findeisen
- Interdisziplinäres Ultraschallzentrum, Universitätsklinikum Gießen und Marburg - Standort Marburg, Marburg, Germany
| | - Corinna Trenker
- Hämatologie/Onkologie/Immunologie, Universitätsklinikum Gießen und Marburg - Standort Marburg, Marburg, Germany
| | - Christian Görg
- Klinik für Gastroenterologie, Endokrinologie, Stoffwechsel und klinische Infektiologie, und Interdisziplinäres Ultraschallzentrum, Universitätsklinikum Gießen und Marburg - Standort Marburg, Marburg, Germany
| | - Ehsan Safai Zadeh
- Klinik für Gastroenterologie, Endokrinologie, Stoffwechsel und klinische Infektiologie, und Interdisziplinäres Ultraschallzentrum, Universitätsklinikum Gießen und Marburg - Standort Marburg, Marburg, Germany
| |
Collapse
|
11
|
Okumura T, Kimura T, Nakajima D, Kondo S, Kako S, Takahashi Y, Yamaka K, Ichinohe F, Tsukahara Y, Nagaya T, Umemura T. Splenic artery pseudoaneurysm resulting from gastric ulcer presenting acute upper gastrointestinal bleeding. Radiol Case Rep 2022; 18:97-99. [PMID: 36324839 PMCID: PMC9619333 DOI: 10.1016/j.radcr.2022.09.105] [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: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
Splenic artery pseudoaneurysm (SAP) is a rare entity, which occurs when the arterial wall is composed only of the intima and media mainly caused by pancreatitis, or abdominal trauma. Regardless of size, SAP is a high mortality disease that carries a high risk of rupture, causing abdominal pain and severe pancreatic and gastrointestinal bleeding. Here, we describe a rare case of SAP rupture caused by a large gastric ulcer due to Helicobacter pylori infection and NSAIDs use. Understanding the characteristic enhanced CT images of SAP, the complications of splenic infarction, and the therapeutic efficacy of arterial embolization is essential for the clinician to properly diagnose and treat SAP.
Collapse
Affiliation(s)
- Taiki Okumura
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takefumi Kimura
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
- Consultation Center for Liver Diseases, Shinshu University Hospital, Matsumoto, Japan
- Corresponding author
| | - Daichi Nakajima
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shohei Kondo
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoko Kako
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiyuki Takahashi
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kosuke Yamaka
- Division of Nephrology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Fumihito Ichinohe
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshinori Tsukahara
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tadanobu Nagaya
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takeji Umemura
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
- Consultation Center for Liver Diseases, Shinshu University Hospital, Matsumoto, Japan
| |
Collapse
|
12
|
Shah P, Patel J, Patel R, Patel R, Gandhi F. Delayed traumatic superficial femoral artery pseudoaneurysm and arteriovenous fistula over the left lower limb. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.4103/ijves.ijves_3_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
13
|
Seetharaman J, Yadav RR, Srivastava A, Sarma MS, Kumar S, Poddar U, Yachha SK. Gastrointestinal bleeding due to pseudoaneurysms in children. Eur J Pediatr 2022; 181:235-243. [PMID: 34263405 DOI: 10.1007/s00431-021-04201-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/04/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022]
Abstract
Radiological embolization is the treatment of choice in adults with visceral artery pseudoaneurysm (PSA) and gastrointestinal bleeding, but pediatric data is scanty. We analyzed the etiology, clinical presentation, and outcome of radiological intervention in children with PSA of celiac (CA) or superior mesenteric artery (SMA) branches. Electronic records of children with PSA of CA or SMA branches were reviewed and data on clinical and laboratory profile, radiological intervention, and outcome was recorded. Eleven children with PSA (5 boys, 11 [7-17] years) were studied. Etiology was liver abscess (n 4), abdominal trauma (n 3), pancreatitis (n 3), and indeterminate in 1 case. Ten (91%) patients were symptomatic: abdominal pain (10, 91%), hematemesis/melena (9, 81%), and Quincke's triad (1, 9%). One child with pancreatic pseudocyst was diagnosed incidentally on imaging. Doppler ultrasound identified PSA only in 3 cases, while computed tomography angiography (CTA) picked all cases. Children with liver abscess, trauma, and unknown etiology had PSA from CA (right hepatic artery 7, left hepatic artery 1). Of the 3 pancreatitis cases, 2 had PSA from SMA (inferior pancreatico-duodenal artery and ileal branch) and 1 from CA (left gastric artery). Radiological embolization was done in 9 (81%) cases (coil 6, glue 2, both 1), without any complications or failure. One case resolved spontaneously and 1 died pre-intervention. Nine intervened cases were asymptomatic in follow-up [6 (1-24) months].Conclusion: Liver abscess, trauma, and pancreatitis are causes of PSA of CA and SMA branches in children. A majority present with gastrointestinal bleeding and are identified on CTA. Radiological embolization was safe with 100% success. What is Known: • Pseudoaneurysm of visceral artery is an uncommon cause of gastrointestinal bleeding. • Endoluminal intervention is an established and efficacious treatment modality in adults and preferred over surgery. What is New: • Liver abscess, abdominal trauma and pancreatitis are common causes of celiac artery and superior mesenteric artery branch pseudoaneurysm in children and computed tomography angiography has high sensitivity in identifying these pseudoaneurysms. • Minimally invasive radiological angio-embolization, in the hands of trained radiologists, is a safe and successful modality of treatment in children.
Collapse
Affiliation(s)
- Jayendra Seetharaman
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Raebareily Road, Lucknow, 226014, Uttar Pradesh, India
| | - Rajanikant R Yadav
- Department of Radiodiagnosis, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Raebareily Road, Lucknow, 226014, Uttar Pradesh, India.
| | - Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Raebareily Road, Lucknow, 226014, Uttar Pradesh, India
| | - Sheo Kumar
- Department of Radiodiagnosis, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Raebareily Road, Lucknow, 226014, Uttar Pradesh, India
| | - Surender Kumar Yachha
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Raebareily Road, Lucknow, 226014, Uttar Pradesh, India
| |
Collapse
|
14
|
Dinh Luan N, Duc NM, Hong Son N, Minh Hien T, Anh Huy L, Tan Tai N, Tran Kinh B, Minh Loi H. A rare case report of acute upper gastrointestinal hemorrhage due to splenic artery pseudoaneurysm. SAGE Open Med Case Rep 2021; 9:2050313X211061910. [PMID: 34900257 PMCID: PMC8664300 DOI: 10.1177/2050313x211061910] [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: 09/08/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022] Open
Abstract
Splenic artery aneurysm and splenic artery pseudoaneurysm are rare vascular pathologies. The splenic artery represents the third most common site for intra-abdominal aneurysms. In contrast with true splenic artery aneurysm, splenic artery pseudoaneurysm is typically symptomatic, presenting with a range of symptoms, from abdominal pain to hemodynamic instability due to rupture. However, gastrointestinal hemorrhage is an uncommon complication of splenic artery pseudoaneurysm. We report a case of acute upper gastrointestinal hemorrhage due to splenic artery pseudoaneurysm rupture. The patient was successfully treated by endovascular intervention.
Collapse
Affiliation(s)
- Nguyen Dinh Luan
- Department of Radiology, Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.,Department of Radiology, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Nguyen Hong Son
- Department of General Surgery, Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| | - Tran Minh Hien
- Department of Radiology, Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| | - Le Anh Huy
- Department of Radiology, Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Tan Tai
- Department of Radiology, Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| | - Bui Tran Kinh
- Department of Radiology, Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| | - Hoang Minh Loi
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue, Vietnam
| |
Collapse
|
15
|
Osman S, Sefa E, Muge Y, Can TB, Mehmet V, Salih P. Management of the Splenic Artery Aneurysm: with a Six Different Clinical Presentation and Treatment Modality. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03042-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
16
|
Kazantsev AN, Burkov NN, Bayandin MS, Guselnikova YI. [Delayed complication of iliofemoral bypass surgery: giant false aneurysm of distal anastomosis]. Khirurgiia (Mosk) 2021:73-77. [PMID: 33710831 DOI: 10.17116/hirurgia202103173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report the results of open surgical correction of a giant false aneurysm of the distal anastomosis in long-term period after iliofemoral bypass surgery. Preoperative diagnostic procedures made it possible to determine the most appropriate treatment strategy. Aneurysm resection was followed by distal anastomosis repair on the right with prosthesis 10 mm. Postoperative imaging is presented. The authors concluded the effectiveness of revascularization strategy.
Collapse
Affiliation(s)
- A N Kazantsev
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia.,Barbarash Kemerovo Regional Clinical Cardiology Dispensary, Kemerovo, Russia
| | - N N Burkov
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia.,Barbarash Kemerovo Regional Clinical Cardiology Dispensary, Kemerovo, Russia
| | - M S Bayandin
- Kemerovo State Medical University, Kemerovo, Russia
| | | |
Collapse
|
17
|
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
| |
Collapse
|
18
|
Khurram R, Al-Obudi Y, Glover TE, Shah R, Khalifa M, Davies N. Splenic artery pseudoaneurysm: Challenges of non-invasive and endovascular diagnosis and management. Radiol Case Rep 2021; 16:1395-1399. [PMID: 33912254 PMCID: PMC8063705 DOI: 10.1016/j.radcr.2021.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/09/2021] [Indexed: 01/03/2023] Open
Abstract
Splenic artery pseudoaneurysms (PAs) are uncommon and often occur as a complication of pancreatitis or trauma. Unlike true aneurysms, PAs are symptomatic in a majority of cases and patients can present with a constellation of non-specific symptoms. Diagnosis can be challenging due to variation in presenting features and mimicking pathologies. PAs are associated with a very high morbidity and mortality if left untreated. We present an unusual case of a 47-year-old gentleman diagnosed with a splenic artery pseudoaneurysm despite initial negative catheter angiography and discuss the challenges of splenic artery pseudoaneurysm diagnosis and management.
Collapse
|
19
|
Shimohira M, Nagai K, Ohta K, Sawada Y, Nakayama K, Shibamoto Y. Safety of Transcatheter Arterial Embolization for Visceral Artery Pseudoaneurysms: Incidence of Intraprocedural Rupture. Vasc Endovascular Surg 2021; 55:361-366. [PMID: 33541256 DOI: 10.1177/1538574421992938] [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: 11/16/2022]
Abstract
INTRODUCTION Transcatheter arterial embolization is the first-line treatment for visceral artery pseudoaneurysms (VAPAs); however, the intraprocedural rupture of pseudoaneurysms is an important complication. The present study was performed to evaluate the safety of embolization for VAPAs, including the incidence of intraprocedural rupture. METHODS Among 56 consecutive patients with 57 VAPAs who underwent treatment between April 2009 and October 2020, 46 patients with 47 VAPAs underwent embolization. Complications related to embolization including intraprocedural rupture, the technical success rate, and clinical outcomes were evaluated. Complications that required extended hospitalization, an advanced level of care, or resulted in permanent adverse sequelae or death were classified as major complications, while the remainder were considered to be minor. Technical success was defined as the completion of embolization. RESULTS The intraprocedural rupture of pseudoaneurysms occurred in 3 out of 47 VAPAs treated with embolization (6%) and resulted in minor complications. One liver abscess requiring drainage was regarded as a major complication (2%). Focal infarction after embolization was observed as a minor complication in 20 cases. Complications occurred in 24 out of 47 cases (51%), comprising one major complication (2%) and 23 minor complications (48%). The technical success rate was 100% (47/47). Fifty-three out of 56 patients (95%) were alive in a median follow-up period of 18 months (range: 2 days-137 months). CONCLUSIONS Embolization is safe and useful for the treatment of VAPAs; however, the intraprocedural rupture of pseudoaneurysms may occur, and, thus, care is needed during this procedure.
Collapse
Affiliation(s)
- Masashi Shimohira
- Department of Radiology, 12963Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Keiichi Nagai
- Department of Radiology, 12963Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kengo Ohta
- Department of Radiology, 12963Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yusuke Sawada
- Department of Radiology, 12963Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Keita Nakayama
- Department of Radiology, 12963Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, 12963Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| |
Collapse
|
20
|
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. [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: 11/08/2022]
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
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: 3] [Impact Index Per Article: 0.8] [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.
Collapse
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.
| |
Collapse
|
23
|
Shetty GS, K S Bhat P, Balaji G, Ravindra BS, Udgire SP. Endovascular Trapping of a Giant Splenic Artery Aneurysm by Liquid Embolic in a Case of EHPVO with Hypersplenism with a Complicated Post Procedure Course. Ann Vasc Surg 2020; 72:666.e1-666.e6. [PMID: 33227466 DOI: 10.1016/j.avsg.2020.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 10/22/2022]
Abstract
Case of extrahepatic portovenous obstruction (EHPVO) with giant splenic artery aneurysm and concomitant hypersplenism. The presence of bicytopenia and venous collaterals around the giant splenic aneurysm made splenectomy risky, and endovascular trapping of the giant aneurysm with partial splenic embolization was planned. Due to high flow, intraprocedural crossing of the giant aneurysm was not possible, and large coils were unstable. The aneurysm was successfully embolized with liquid embolic glue: lipiodol 50% mixture. Although the patient did not have septic complications despite large splenic infarct, the patient had secondary thrombocytosis leading to significant thrombotic complications akin to postsplenectomy syndrome. These were all successfully managed medically, and splenectomy was avoided.
Collapse
Affiliation(s)
- Gurucharan S Shetty
- Department of Imaging & Interventional Radiology, Fortis Hospital and Cancer Institute, Bangalore, Karnataka, India.
| | - Prasanna K S Bhat
- Department of Medical Gastroenterology, Fortis Hospital and Cancer Institute, Bangalore, Karnataka, India
| | - G Balaji
- Department of Medical Gastroenterology, Fortis Hospital and Cancer Institute, Bangalore, Karnataka, India
| | - B S Ravindra
- Department of Medical Gastroenterology, Fortis Hospital and Cancer Institute, Bangalore, Karnataka, India
| | - Sunil P Udgire
- Department of Hematology & Bone Marrow transplant, Fortis Hospital and Cancer Institute, Bangalore, Karnataka, India
| |
Collapse
|
24
|
Luo Z, Zhou Z. Splenic Arteriovenous Fistula Complicated by Severe Diarrhea: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e922067. [PMID: 32892206 PMCID: PMC7491958 DOI: 10.12659/ajcr.922067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 36-year-old Final Diagnosis: Splenic arteriovenous fistula Symptoms: Chronic diarrhea • hematemesis Medication:— Clinical Procedure: — Specialty: Gastroenterology and Hepatology
Collapse
Affiliation(s)
- Zunwei Luo
- Department of Emergency, The Fourth People's Hospital of Zunyi City, Zunyi, Guizhou, China (mainland)
| | - Ziyu Zhou
- Department of Gastroenterology, The General Hospital of the People's Liberation Army, Beijing, China (mainland)
| |
Collapse
|
25
|
A novel technique for treating visceral artery pseudoaneurysm: Selective arterial embolization with cut-inflateddeflated balloon. Anatol J Cardiol 2020; 24:56-59. [PMID: 32628140 PMCID: PMC7414821 DOI: 10.14744/anatoljcardiol.2020.59507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
|
26
|
Chaer RA, Abularrage CJ, Coleman DM, Eslami MH, Kashyap VS, Rockman C, Murad MH. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg 2020; 72:3S-39S. [DOI: 10.1016/j.jvs.2020.01.039] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/18/2022]
|
27
|
Marjara J, Al Juboori A, Aggarwal A, Davis RM, Bhat AP. Metalophagia: Splenic artery pseudoaneurysm after foreign body ingestion and retrieval. Radiol Case Rep 2020; 15:1149-1154. [PMID: 32528603 PMCID: PMC7280363 DOI: 10.1016/j.radcr.2020.04.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 02/08/2023] Open
Abstract
Persistent eating of non-nutritive, nonfood substances (Pica) is seen in children and adult patients with psychiatric problems. Ingestion of multiple metallic FBs with resultant bezoar formation is rare. While many FBs are passed without complication, mucosal injury, bleeding, obstruction or perforation can occur in some cases. Endoscopic FB removal is performed in 20% of patients following FB ingestion. Generally, these are safe procedures, and very effective in extracting ingested FBs. We report, a 25-year-old male patient with a metal ingestion predominant Pica, requiring multiple prior extraction procedures (including open gastrostomy). He developed a splenic artery pseudoaneurysm following his latest endoscopic FB removal, that was successfully treated with transarterial coil embolization. The unique circumstances leading to this rare complication and its successful endovascular management make this case worthy of report.
Collapse
Affiliation(s)
- Jasraj Marjara
- University of Missouri-Columbia School of Medicine, One Hospital Drive, Columbia, MO 65212, USA
| | - Alhareth Al Juboori
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
| | - Arpit Aggarwal
- Department of Psychiatry, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
| | - Ryan M Davis
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
| | - Ambarish P Bhat
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
| |
Collapse
|
28
|
Abstract
True splenic artery aneurysms (SAA) are a rare, but potentially fatal, pathology. They are the third most common type of abdominal aneurysm, after aneurysms of the aorta and of the iliac artery, and account for almost the all aneurysms of visceral arteries. True aneurysms account for 60% of SAA and affect four times as many women as men, generally related to increased incidental or symptomatic findings that coincide with use of ultrasonography in pregnancy. Among pregnant patients, mortality after rupture is 65-75%, with fetal mortality exceeding 90%. There are multiple etiologies and it is believed that hormonal influences and changes in portal flow during gestation play an important role in development of SAA. This review discusses their history, epidemiology, pathophysiology, and diagnosis and current treatment techniques.
Collapse
|
29
|
Kamalanathan KC, Barnacle AM, Holbrook C, Rees C. Splenic Rupture Secondary to Vascular Ehlers-Danlos Syndrome Managed by Coil Embolization of the Splenic Artery. European J Pediatr Surg Rep 2019; 7:e83-e85. [PMID: 31763130 PMCID: PMC6874507 DOI: 10.1055/s-0039-3399555] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/22/2019] [Indexed: 11/01/2022] Open
Abstract
Aim Atraumatic splenic rupture is uncommon and life-threatening. It may be related to underlying pathology and be the initial manifestation of the condition. Vascular Ehlers-Danlos syndrome (V-EDS) is a rare autosomal dominant collagen vascular disorder, associated with vessel fragility and rupture. We describe a child presenting with splenic rupture managed by embolization of the splenic artery. She was subsequently diagnosed with V-EDS. Case Description A 11-year-old girl with thalassemia trait presented with sudden onset of abdominal pain and hypovolemic shock. There was no history of trauma. Following resuscitation, abdominal computed tomography showed hemoperitoneum and active splenic arterial extravasation. Angiography demonstrated four bleeding points, from irregular vessels supplying the upper two-thirds of the spleen. These were not amenable to supraselective embolization. Therefore, coil embolization of the main splenic artery was performed, with no splenic supply seen on the postembolization angiogram. Her postoperative recovery was complicated by pancreatitis secondary to partial ischemia of the pancreatic tail. Subsequent extensive investigations excluded hematological, myeloproliferative, and infective causes for her splenic rupture. A safeguarding investigation was completed, with no pertinent factors identified. Findings of thin skin, abnormal bruising, and hypermobile joints raised a clinical suspicion of a connective tissue disorder. Genetic testing revealed a de novo mutation of the COL3A1 gene. Conclusions There are only four reports of V-EDS causing splenic rupture in the literature to date. These patients were all adults and only one had not previously been diagnosed with V-EDS. All underwent splenectomy. While V-EDS presenting with abdominal visceral rupture in children has been reported, this is the first report of a child with V-EDS presenting with splenic rupture. It is the only case of splenic rupture secondary to V-EDS that has been managed minimally invasively by embolization.
Collapse
Affiliation(s)
- Keisha C Kamalanathan
- Department of Interventional Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Alex M Barnacle
- Department of Interventional Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Charlotte Holbrook
- Department of Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Clare Rees
- Department of Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
30
|
Interventional treatment options in pseudoaneurysms: different techniques in different localizations. Pol J Radiol 2019; 84:e319-e327. [PMID: 31636766 PMCID: PMC6798774 DOI: 10.5114/pjr.2019.88021] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/10/2019] [Indexed: 01/17/2023] Open
Abstract
Pseudoaneurysms are commonly experienced vascular abnormalities. The increase in the number of surgical and arteriographic procedures has caused a higher prevalence of pseudoaneurysms. Conventional angiography is still the gold standard method for diagnosis, but other imaging modalities such as duplex Doppler ultrasonography, magnetic resonance angiography and computed tomographic angiography are useful in noninvasive detection. Over the past few years, interventional radiological treatment has evolved and taken the place of surgery in management. There are different kinds of percutaneous and endovascular treatment methods in pseudoaneurysm management. Treatment options depend on certain conditions. We used a case-based approach to discuss pseudoaneurysms and their appropriate treatment by interventional radiological methods in this article.
Collapse
|
31
|
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: 0.8] [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.
Collapse
Affiliation(s)
- A. Borzelli
- Department of Interventional Radiology, AORN ``A. Cardarelli'', Via A. Cardarelli 9, 80131 Naples, Italy
- Corresponding author.
| | - 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
| |
Collapse
|
32
|
Hosn MA, Xu J, Sharafuddin M, Corson JD. Visceral Artery Aneurysms: Decision Making and Treatment Options in the New Era of Minimally Invasive and Endovascular Surgery. Int J Angiol 2019; 28:11-16. [PMID: 30880885 PMCID: PMC6417896 DOI: 10.1055/s-0038-1676958] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The abdominal viscera blood supply is derived from anterior branches of the abdominal aorta. Visceral artery aneurysms (VAAs) include aneurysms of the following arteries and their branches: the celiac artery, the hepatic artery, the splenic artery, the superior mesenteric artery, the inferior mesenteric artery, the pancreaticoduodenal artery, and the gastroduodenal artery. Overall VAAs comprise < 2% of all types of arterial aneurysms. Asymptomatic VAAs are now being encountered more frequently due to the widespread use of advanced diagnostic abdominal imaging. The incidental finding of a VAA frequently leaves clinicians with a dilemma as to the best course of management. The focus of this review is on current treatment options and management guidelines for both symptomatic and asymptomatic VAAs.
Collapse
Affiliation(s)
- Maen Aboul Hosn
- Department of Surgery, Division of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | - Jun Xu
- Department of Surgery, Division of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | - Mel Sharafuddin
- Department of Surgery, Division of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | - John D. Corson
- Department of Surgery, the University of New Mexico, Albuquerque, New Mexico
| |
Collapse
|
33
|
Wojtaszek M, Lamparski K, Wnuk E, Ostrowski T, Maciąg R, Rix T, Maj E, Milczarek K, Korzeniowski K, Rowiński O. Selective occlusion of splenic artery aneurysms with the coil packing technique: the impact of packing density on aneurysm reperfusion correlated between contrast-enhanced MR angiography and digital subtraction angiography. Radiol Med 2019; 124:450-459. [PMID: 30712163 DOI: 10.1007/s11547-019-00993-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 01/23/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim was to evaluate the relationship between coil packing densities after splenic artery aneurysm (SAA) treatment using detachable microcoils and rates of SAA reperfusion and to suggest a post-treatment surveillance protocol using contrast-enhanced MRA. MATERIALS AND METHODS Evaluated were 16 patients (4 men; mean age 46.7), who underwent true SAA embolization using detachable microcoils (Concerto, Medtronic). SAAs were treated by selective coil packing (CP) or stent-assisted coil exclusion (SAC). Contrast-enhanced magnetic resonance angiography (CE-MRA) and digital subtraction angiography (DSA) were performed at 3 months post-procedure and correlated. RESULTS Primary CP was used in 13 patients, while SAC was used in three patients. On follow-up, complete aneurysm occlusion was seen in seven patients (43.8%). Sac reperfusion occurred in nine patients (56.2%) and was demonstrated in all CE-MRA and six DSA studies. Mean aneurysm packing density was 20.10 ± 8.05% for the CP group and 32.90 ± 11.95% for the SAC group (p = 0.038). There was a significant difference in the incidence of aneurysm sac reperfusion on CE-MRA study between CP and SAC (9 vs. 0). No sac reperfusion was seen in aneurysms with packing densities ≥ 29%, irrespective of either embolization method. CONCLUSION Favorable midterm results for coil packing of SAAs seem to depend on the coil packing density with a coil volume approximately a quarter of the aneurysm volume being most effective. Follow-up should involve the use of CE-MRA as this modality has been shown to be superior over DSA in detecting aneurysm reperfusion and coil compaction. LEVEL OF EVIDENCE Level IV, therapeutic study.
Collapse
Affiliation(s)
- Mikołaj Wojtaszek
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland. .,Vascular Unit, Kent & Canterbury Hospital, East Kent Hospital University NHS Trust, Canterbury, Kent, CT1 3NG, UK.
| | - Krzysztof Lamparski
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| | - Emilia Wnuk
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| | - Tomasz Ostrowski
- Department of General and Endocrine Surgery, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| | - Rafał Maciąg
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| | - Thomas Rix
- Vascular Unit, Kent & Canterbury Hospital, East Kent Hospital University NHS Trust, Canterbury, Kent, CT1 3NG, UK
| | - Edyta Maj
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| | - Krzysztof Milczarek
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| | - Krzysztof Korzeniowski
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| | - Olgierd Rowiński
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| |
Collapse
|
34
|
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
|
35
|
Cho SB, Park SE, Lee CM, Park JH, Baek HJ, Ryu KH, Moon JI, Choi BH, Ha JY, Lee S. Splenic artery pseudoaneurysm with splenic infarction induced by a benign gastric ulcer: A case report. Medicine (Baltimore) 2018; 97:e11589. [PMID: 30024561 PMCID: PMC6086524 DOI: 10.1097/md.0000000000011589] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Splenic artery pseudoaneurysm induced by benign gastric ulcer is extremely rare and can lead to a fatal clinical situation. To the best of our knowledge, there are only five cases in the literature review. Therefore, it can be a diagnostic challenge for radiologists and clinicians because of rare incidence. PATIENT CONCERNS The patient visited our hospital due to melena and dizziness. DIAGNOSES The patient showed a huge ulcer and an exposed vessel in the posterior wall of the gastric high body during endoscopy. Angiography revealed a pseudoaneurysm of the splenic artery and contrast extravasation into the gastric lumen. INTERVENTIONS We performed coil embolization of splenic artery and gastrectomy. OUTCOMES Postprocedural course was uneventful and led to patient discharge on day 8. LESSONS We suggest that the splenic artery pseudoaneurysm should be considered differential diagnosis in the patients with acute upper gastrointestinal bleeding, and the presence of a splenic infarction may provide a diagnostic clue.
Collapse
Affiliation(s)
- Soo Buem Cho
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon
| | - Sung Eun Park
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon
| | | | | | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon
| | - Kyeong Hwa Ryu
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon
| | - Jin Il Moon
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon
| | - Bo Hwa Choi
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon
| | - Ji Young Ha
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon
| | - Sangmin Lee
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| |
Collapse
|
36
|
Bajaj D, Manyevitch R, Gray Still G. Not All Gastric "Masses" Need a Biopsy-A Cautionary Tale. Am J Med Sci 2018; 355:e17. [PMID: 29891048 DOI: 10.1016/j.amjms.2018.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/30/2018] [Accepted: 02/06/2018] [Indexed: 11/27/2022]
Affiliation(s)
| | - Roni Manyevitch
- St. George's University, School of Medicine, Great River, New York.
| | | |
Collapse
|
37
|
Delayed Traumatic Aortic Pseudoaneurysm Formation Causing Vertebral Body Erosion and Back Pain: Case Report and Literature Review. World Neurosurg 2018; 110:232-239. [DOI: 10.1016/j.wneu.2017.11.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/04/2017] [Accepted: 11/07/2017] [Indexed: 11/21/2022]
|
38
|
Björck M, Koelemay M, Acosta S, Bastos Goncalves F, Kölbel T, Kolkman JJ, Lees T, Lefevre JH, Menyhei G, Oderich G, Kolh P, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Sanddal Lindholt J, Vega de Ceniga M, Vermassen F, Verzini F, Geelkerken B, Gloviczki P, Huber T, Naylor R. Editor's Choice - Management of the Diseases of Mesenteric Arteries and Veins: Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 53:460-510. [PMID: 28359440 DOI: 10.1016/j.ejvs.2017.01.010] [Citation(s) in RCA: 351] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
39
|
Song C, Dong J, Yu G, Zhou J, Xiang F, Pei Y, Lu Q, Jing Z. Comparison of open surgery and endovascular procedures as a therapeutic choice for visceral artery aneurysms. Vascular 2017; 26:387-392. [PMID: 29228875 DOI: 10.1177/1708538117744102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objectives Visceral arterial aneurysms may be treated using open surgery or endovascular repair, but the best approach remains controversial. This was a retrospective study aiming to compare open surgery and endovascular treatment strategies for visceral arterial aneurysms. Methods The study included all 93 patients who were admitted with visceral artery aneurysms between January 2001 and January 2011 at the Department of Vascular Surgery, Changhai Hospital, Shanghai, China. All cases underwent either open or endovascular procedures. Overall survival and adverse events were compared between the groups. Success rate, blood loss, length of surgery, and length of hospital stay were also compared. The patients were followed up at three, six, and 12 months then every year until April 2014. Results Open surgery was performed on 34 patients and endovascular procedures on 59. There were no differences in characteristics of the patients between the open surgery and endovascular groups. The perioperative complication rate was 52.9 and 13.6% in the open surgery and endovascular groups, respectively. Mean follow-up was 36.8 months (range: 11 months to 10 years). The one- and five-year survival rates were 100 and 60.6%, respectively, in the open surgery group, compared to 100 and 84.5% in the endovascular group. Multivariate analysis for factors related to overall survival showed that there was a significant relationship with the treatment approach (HR = 0.479, 95%CI: 0.278-0.825; P = 0.008) and the presence of false aneurysm (HR = 2.929, 95%CI: 1.388-6.180, P = 0.005). Conclusions Endovascular repair could be considered as an effective method for visceral artery aneurysm. Endovascular repair showed lower perioperative complication rates and better long-term survival.
Collapse
Affiliation(s)
- Chao Song
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Jian Dong
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Guanyu Yu
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Feng Xiang
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Yifei Pei
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| |
Collapse
|
40
|
Maki H, Kaneko J, Arita J, Akamatsu N, Sakamoto Y, Hasegawa K, Tamura S, Takao H, Shibata E, Kokudo N. Proximal total splenic artery embolization for refractory hepatic encephalopathy. Clin J Gastroenterol 2017; 11:156-160. [PMID: 29196972 DOI: 10.1007/s12328-017-0805-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/24/2017] [Indexed: 10/18/2022]
Abstract
A Japanese woman with a history of Kasai operation for biliary atresia had living-donor liver transplantation at the age of 22. The first episode of refractory HE and late cellular rejection was treated by a high dose of methylprednisolone. The second episode of refractory HE was treated by balloon-occluded retrograde transvenous obliteration for a spleno-renal shunt. However, the third episode of refractory HE occurred 11 years after liver transplantation. The liver cirrhosis and hypersplenism were present with a Child-Pugh score of C-10. Although portal vein flow was hepatopetal, superior mesenteric vein flow regurgitated. We performed proximal total splenic artery embolization (TSAE). Superior mesenteric vein flow changed to a hepatopetal direction and she became clear. At a year after proximal TSAE, her spleen volume had decreased to 589 mL (20% decrease) on computed tomography. She is well and has a Child-Pugh score of 8 without overt HE. We report the first case of refractory HE treated by proximal TSAE that is a possible less invasive treatment option for a selected patient.
Collapse
Affiliation(s)
- Harufumi Maki
- Hepato-Biliary-Pancreatic Surgery Division, and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Junichi Kaneko
- Hepato-Biliary-Pancreatic Surgery Division, and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Junichi Arita
- Hepato-Biliary-Pancreatic Surgery Division, and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Nobuhisa Akamatsu
- Hepato-Biliary-Pancreatic Surgery Division, and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshihiro Sakamoto
- Hepato-Biliary-Pancreatic Surgery Division, and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Sumihito Tamura
- Hepato-Biliary-Pancreatic Surgery Division, and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hidemasa Takao
- Hepato-Biliary-Pancreatic Surgery Division, and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Radiology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Eisuke Shibata
- Hepato-Biliary-Pancreatic Surgery Division, and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Radiology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| |
Collapse
|
41
|
Major P, Kowalczuk A, Wysocki M, Osadnik S, Pędziwiatr M, Głuszewska A, Pisarska M, Małczak P, Lasek A, Kisielewski M, Budzyński A. Effects of bariatric surgery on cardiovascular risk factors among morbidly obese patients. POLISH JOURNAL OF SURGERY 2017; 89:41-49. [PMID: 28522788 DOI: 10.5604/01.3001.0009.7176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM OF THE STUDY The aim of this study was to evaluate the influence of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric by-pass on risk factors of cardiovascular diseases. MATERIAL AND METHODS We analyzed prospectively collected data of patients operated for morbid obesity who were qualified for laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric by-pass (LRYGB). Risk factors for wyłączecardiovascular diseases were assessed with the SCORE scale and both full and hard Framingham cardiovascular risk scores (FCRs). The data were collected on admission and one year after the procedures. We enrolled 264 patients (119 females, 116 males, 40.2±9.9 years old), of whom 117 underwent LRYGB and 118 LSG, respectively. RESULTS Preoperatively, 12% of patients were in the high-risk category of the SCORE scale, 65% were in the moderate risk category, and 24% were in the low-risk category. The median score of the SCORE scale was 1 (1-2). Lipid-based full FCR was 34.5% (24%-68%) and the hard FCR was 17.5% (10%-52%), while the respective BMI-based FCRs were 59% (31%-84%) and 37% (15%-67%). One year after the procedures, the mean %EBMIL (62.88%±20.02%) and %EWL (53.18%±15.87) were comparable between both procedures. Hypertension treatment was not necessary in 33 patients after LSG and in 55 after LRYGB. Diabetes mellitus remitted in 9 and 29 patients, respectively. Both procedures significantly reduced high and moderate risk prevalence in the SCORE scale in favor of the low risk category. Surgical interventions resulted in significant reductions of FCRs 1 year after surgery ( p<0.001). CONCLUSIONS Both LSG and LRYGB lead to a significant and comparable body mass reduction. Both procedures significantly decrease of the risk of cardiovascular diseases, based on SCORE and Framingham scales.
Collapse
Affiliation(s)
- Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College1 II Katedra Chirurgii Ogólnej, Uniwersytet Jagielloński Collegium Medicum1 Head: prof. dr hab. med. Kazimierz Rembiasz, Kraków, Poland
| | - Aleksandra Kowalczuk
- 2'nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Michał Wysocki
- Students' Scientific Group at 2'nd Department of Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Sonia Osadnik
- Students' Scientific Group at 2'nd Department of Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College1 II Katedra Chirurgii Ogólnej, Uniwersytet Jagielloński Collegium Medicum1 Head: prof. dr hab. med. Kazimierz Rembiasz, Kraków, Poland
| | - Anna Głuszewska
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College2 Katedra Chorób Wewnętrznych i Gerontologii, Uniwersytet Jagielloński Collegium Medicum2, Head: prof. dr hab. med. Tomasz Grodzicki, Kraków, Poland
| | - Magdalena Pisarska
- 2nd Department of General Surgery, Jagiellonian University Medical College1 II Katedra Chirurgii Ogólnej, Uniwersytet Jagielloński Collegium Medicum1 Head: prof. dr hab. med. Kazimierz Rembiasz, Kraków, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College1 II Katedra Chirurgii Ogólnej, Uniwersytet Jagielloński Collegium Medicum1 Head: prof. dr hab. med. Kazimierz Rembiasz, Kraków, Poland
| | - Anna Lasek
- 2'nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Michał Kisielewski
- 2'nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College1 II Katedra Chirurgii Ogólnej, Uniwersytet Jagielloński Collegium Medicum1 Head: prof. dr hab. med. Kazimierz Rembiasz, Kraków, Poland
| |
Collapse
|
42
|
Baalaaji M, Choudhary A, Ismail J, Bansal A, Kumar A, Nallasamy K. Needle Aspiration for Neck Swellings: Think Before You Prick! Clin Pediatr (Phila) 2017; 56:1060-1063. [PMID: 28366019 DOI: 10.1177/0009922817701175] [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: 11/17/2022]
Affiliation(s)
- Mullai Baalaaji
- 1 Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhijit Choudhary
- 1 Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Javed Ismail
- 1 Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Bansal
- 1 Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Kumar
- 2 Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karthi Nallasamy
- 1 Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
43
|
Gastroduodenal Artery Psuedoaneurysm Bleed through a Spontaneous Pancreaticoduodenal Fistula as a Result of Acute Necrotizing Pancreatitis. ACG Case Rep J 2017; 4:e105. [PMID: 28879210 PMCID: PMC5577032 DOI: 10.14309/crj.2017.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/27/2017] [Indexed: 11/17/2022] Open
Abstract
Spontaneous pancreaticoduodenal fistulization and arterial psuedoaneurysm formation are both complications of acute pancreatitis. We present a 27-year-old man with hematemesis who was found to be bleeding from a gastroduodenal artery psuedoaneurysm through a spontaneous pancreaticoduodenal fistula as a result of severe alcohol-related necrotizing pancreatitis. This is the first reported case in the literature to describe this occurrence.
Collapse
|
44
|
Małczak P, Wysocki M, Major P, Pędziwiatr M, Lasek A, Stefura T, Radkowiak D, Zub-Pokrowiecka A, Budzyński A. Laparoscopic approach to splenic aneurysms. Vascular 2016; 25:346-350. [PMID: 27903932 DOI: 10.1177/1708538116682164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Splenic artery aneurysm is a rare disease with possibly mortal complications. For years, the main method of treatment was excision of aneurysm with spleen. In recent years, several methods have been developed in order to salvage the spleen such endovascular techniques and aneurysmectomy. Objective The aim of our study was to determine the feasibility of laparoscopic aneurysmectomy with spleen salvage in cases of splenic artery aneurysm. Materials Analysis of prospectively gathered data containing records of patients operated laparoscopically due to diseases of the spleen in 1998-2016 in our department. Inclusion criteria were attempted laparoscopic aneurysmectomy with intent to salvage spleen. Results Out of 11 patients, seven patients underwent aneurysmectomy with spleen preservation, one patient had partial-splenectomy, two patients had intra-operative splenectomies and one patient had a re-operation on post-op day 1 with splenectomy. Re-operation with splenectomy was the only recorded complication. Conclusions Laparoscopic aneurysmectomy of SAA may be considered as a safe treatment method, with good short- and long-term results; however, a complete evaluation requires further research on a larger study group. It allows permanent treatment of SAA with maintaining spleen function.
Collapse
Affiliation(s)
- Piotr Małczak
- 1 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,2 Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Wysocki
- 3 Students' Scientific Group, 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Major
- 1 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,2 Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Pędziwiatr
- 1 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,2 Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Lasek
- 1 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,2 Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Stefura
- 3 Students' Scientific Group, 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Dorota Radkowiak
- 1 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,2 Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Zub-Pokrowiecka
- 1 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,2 Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Budzyński
- 1 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,2 Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
45
|
Rebleeding of a Splenic Artery Aneurysm after Coil Embolisation. Case Rep Surg 2016; 2016:1858461. [PMID: 27872785 PMCID: PMC5107856 DOI: 10.1155/2016/1858461] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/11/2016] [Indexed: 01/17/2023] Open
Abstract
Background. Splenic artery aneurysm (SAA) is an uncommon and difficult diagnosis. SAA is more common in females. Only 20% of SAA is symptomatic and may present as a rupture. A ruptured SAA is associated with a 25% mortality rate. Case Presentation. We present a case of a male patient with a bleeding SAA that rapidly increased in size. Distal coiling was technically impossible and despite proximal coil embolisation the SAA continued to bleed. A laparotomy including splenectomy and partial pancreatectomy was performed with an uneventful patient recovery. Discussion. Endovascular management is currently considered the optimal treatment of SAA. However, careful monitoring and follow-up is needed after embolisation as rapid recanalization of the SAA may possibly occur, especially when distal coiling of the aneurysm is unsuccessful. Conclusion. Endovascular treatment of an SAA is not necessarily effective. Surgeons must be prepared to perform open procedures to further reduce mortality rates.
Collapse
|
46
|
Haematochezia from a Splenic Artery Pseudoaneurysm Communicating with Transverse Colon: A Case Report and Literature Review. Case Rep Vasc Med 2016; 2016:8461501. [PMID: 27559488 PMCID: PMC4983343 DOI: 10.1155/2016/8461501] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 06/22/2016] [Indexed: 12/28/2022] Open
Abstract
Splenic artery aneurysms (SAA) are the third most common intra-abdominal aneurysm. Complications include invasion into surrounding structures often in association with preexisting pancreatic disease. We describe an 88-year-old female, with no history of pancreatic disease, referred with lower gastrointestinal bleeding. CT angiography showed a splenic artery pseudoaneurysm with associated collection and fistula to the transverse colon at the level of the splenic flexure. The pseudoaneurysm was embolised endovascularly with metallic microcoils. Rectal bleeding ceased. The patient recovered well and follow-up angiography revealed no persistence of the splenic artery pseudoaneurysm. SAA rupture results in 29%–50% mortality. Experienced centres report success with the endovascular approach in haemodynamically unstable patients, as a bridge to surgery, and even on a background of pancreatic disease. This case highlights the importance of prompt CT angiography, if endoscopy fails to identify a cause of gastrointestinal bleeding. Endovascular embolisation provides a safe and effective alternative to surgery, where anatomical considerations and local expertise permit.
Collapse
|
47
|
Zeidenberg J, Durso AM, Caban K, Munera F. Imaging of Penetrating Torso Trauma. Semin Roentgenol 2016; 51:239-55. [DOI: 10.1053/j.ro.2016.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
48
|
Guo B, Guo D, Xu X, Chen B, Shi Z, Luo J, Jiang J, Fu W. Early and intermediate results of endovascular treatment of symptomatic and asymptomatic visceral artery aneurysms. J Vasc Surg 2016; 64:140-8. [DOI: 10.1016/j.jvs.2016.02.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
|
49
|
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: 0.9] [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.
Collapse
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
| |
Collapse
|
50
|
Madhusudhan KS, Venkatesh HA, Gamanagatti S, Garg P, Srivastava DN. Interventional Radiology in the Management of Visceral Artery Pseudoaneurysms: A Review of Techniques and Embolic Materials. Korean J Radiol 2016; 17:351-63. [PMID: 27134524 PMCID: PMC4842855 DOI: 10.3348/kjr.2016.17.3.351] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 01/25/2016] [Indexed: 12/15/2022] Open
Abstract
Visceral artery pseudoaneurysms occur mostly as a result of inflammation and trauma. Owing to high risk of rupture, they require early treatment to prevent lethal complications. Knowledge of the various approaches of embolization of pseudoaneurysms and different embolic materials used in the management of visceral artery pseudoaneurysms is essential for successful and safe embolization. We review and illustrate the endovascular, percutaneous and endoscopic ultrasound techniques used in the treatment of visceral artery pseudoaneurysm and briefly discuss the embolic materials and their benefits and risks.
Collapse
Affiliation(s)
| | | | - Shivanand Gamanagatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Pramod Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| |
Collapse
|