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Fang G, Lu Y, Zou L, Wang Y, Fu W, Dong Z. Endovascular Strategies and Outcomes for Aberrant Splenic Artery Aneurysms. J Endovasc Ther 2024:15266028231224165. [PMID: 38197227 DOI: 10.1177/15266028231224165] [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: 01/11/2024]
Abstract
OBJECTIVES Aberrant splenic artery aneurysms (ASAAs) located at the splenomesenteric trunk (SMT) and the celiacomesenteric trunk have a close anatomical relationship with the superior mesenteric artery (SMA). The aim of this study was to review our institutional experience of endovascular treatment for ASAAs and evaluate the long-term outcomes. METHODS A retrospective review of patients with ASAAs who underwent endovascular treatment between December 2006 and December 2022 was performed. The demographics of the patients, aneurysm characteristics, treatment strategies, perioperative and long-term outcomes, and complications were analyzed. RESULTS A total of 29 patients with ASAAs were endovascularly treated at our institution. The SMT variant occurred in the majority of the patients. All ASAAs were characterized by eccentric growth and extremely short inflow arteries. Only 1 patient's inflow artery of the aneurysm exceeded 1 cm in length. Thirteen patients were treated by coil embolization alone. Four patients received bare stent-assisted coil embolization. A combination of coil embolization and covered stent placement across the orifice of the aberrant splenic artery was performed in the remaining 12 cases. Coil migration into the SMA occurred in 2 patients during the operation. Technical success was achieved in all patients. With a median duration of 63 (34-101) months of follow-up, no intestinal ischemia, aneurysm-related death, aneurysm rupture, or sac enlargement occurred. Three cases of aneurysm sac reperfusion were observed, and 1 patient underwent reintervention with secondary embolization. Asymptomatic occlusion of the covered stent was detected in 1 patient at 2 years. CONCLUSIONS Endovascular treatment is a safe, effective, and durable option for ASAAs. Inflow embolization might be difficult to achieve in ASAAs and poses a high risk of coil migration into the SMA. Long-term observation indicates that reasonable use of the covered stent could achieve reliable inflow artery exclusion in ASAAs without intestinal complications. CLINICAL IMPACT Aberrant splenic artery aneurysm (ASAA) is an extremely rare entity. This study reported a large sample size of ASAAs treated by endovascular techniques with long-term follow-up. The ASAA was characterized by an extremely short inflow artery and a close anatomical relationship with the superior mesenteric artery (SMA). Endovascular treatment is a safe, effective, and durable option for ASAAs. Inflow embolization might be difficult to achieve in ASAAs and pose a high risk of coil migration into the SMA. Long-term observation indicates that reasonable use of the covered stent could achieve reliable inflow artery exclusion in ASAAs without intestinal complications.
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Affiliation(s)
- Gang Fang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Vascular Surgery, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yige Lu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Vascular Surgery, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Lingwei Zou
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Vascular Surgery, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yuning Wang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Vascular Surgery, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Vascular Surgery, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhihui Dong
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Vascular Surgery, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
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Orel YH, Orel HY, Khorkavyi YZ, Slabyy OM. Features of Surgical Treatment of Patients with Splenic Artery Aneurysms (Case Report and Literature Review). UKRAINIAN JOURNAL OF CARDIOVASCULAR SURGERY 2022. [DOI: 10.30702/ujcvs/22.30(04)/oo055-8893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Despite the insigniϐicant prevalence, aneurysms of the splenicartery take a dominant share among all visceral aneurysms with a predominance of morbidity in women of childbearing age. Taking into account the mostly asymptomatic course and the high risk of mortality due to its rupture, timely diagnosis and correct treatment strategy remain extremely important. Questions regarding the choice of surgical treatment tactics for patients with this pathology remain debatable.
The aim. Demonstration of a clinical case, improvement of diagnosis andsurgical treatment of patients with splenic artery aneurysms.
Clinical case. Female patient G., 32 years old, with complaints of periodic pain in the left hypochondrium, signs of portal hypertension against the background of cavernous transformationof the portal vein, history of recurrent bleeding from the esophageal veins, hypersplenism admitted with a pre-diagnosed aneurysm of the splenic artery of giant dimensions (diameter 8x5 cm). The patient was qualified for open surgery and aneurysm resection with splenectomy and spleen autotransplantation by N. Roth. The postoperative period was complicated by the occurrence of reactive pancreatitis on day 7, which was successfully treated conservatively. In the future, the course was unremarkable. The remote follow-up lasted two years, and no recurrence of the aneurysm was detected. The performed immunogram showed normal results.
Conclusion. The timely diagnosis makes it possible to establish the correct diagnosis, justify the treatment tactics and prevent fatal complications. Open surgical intervention in somecases remains the method of choice in the treatment of this pathology. Autotransplantation of the spleen has shown good long-term results and can be performed in patients of this category for the prevention of immunodeficiency states.
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Endovascular coil embolization for an anomalous splenic artery aneurysm with a splenomesenteric trunk. J Vasc Surg Cases Innov Tech 2022; 8:576-579. [PMID: 36248400 PMCID: PMC9556584 DOI: 10.1016/j.jvscit.2022.07.021] [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: 04/22/2022] [Revised: 07/06/2022] [Accepted: 07/27/2022] [Indexed: 11/21/2022] Open
Abstract
We present a case of a splenic artery (SA) aneurysm (SAA) that had arisen abnormally from the superior mesenteric artery in a 63-year-old man who underwent successful endovascular treatment. Although SAAs characterized by this anatomic abnormality are rare, in all 46 reported cases, the SAAs were located at the root of the SA and had originated abnormally from the superior mesenteric artery. This location is different from that of orthotopic SAAs, which are mostly located in the distal third of the SA. The differences in hemodynamics due to the anatomic abnormalities might play an important role in the formation of the anomalous SAAs.
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Ishida H, Ishikawa Y, Akahoshi K, Ueda H, Morimoto K, Yamashita H, Ogawa K, Ono H, Kudo A, Tanaka S, Tanabe M. Laparoscopic distal pancreatectomy in a patient with aberrant splenic artery originating from the superior mesenteric artery: A case report. Medicine (Baltimore) 2021; 100:e25704. [PMID: 33950952 PMCID: PMC8104267 DOI: 10.1097/md.0000000000025704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/08/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Splenic artery originating from the superior mesenteric artery is extremely rare. Because of this, its significance in laparoscopic distal pancreatectomy has never been reported. Here, we present the first case of laparoscopic distal pancreatectomy in a patient with a splenic artery arising from the superior mesenteric artery. PATIENT CONCERNS A 46-year-old Japanese woman with type 2 diabetes mellitus presented with worsening glycemic control. Abdominal ultrasonography revealed a pancreatic tail mass. DIAGNOSES The patient was diagnosed with pancreatic neuroendocrine tumor by endoscopic ultrasound-guided fine needle aspiration. Preoperative computed tomography showed that the splenic artery with branches of dorsal pancreatic artery originated from the superior mesenteric artery. INTERVENTIONS The patient underwent laparoscopic distal pancreatectomy. Prior to pancreatectomy, the splenic artery and its dorsal pancreatic branches were clamped using the superior and inferior approaches, respectively, to avoid bleeding and congestion. OUTCOMES The postoperative course was uneventful. LESSONS Preoperative evaluation of anatomical variants and development of strategies are important to avoid intraoperative complications in pancreatic surgery. Our results revealed that laparoscopic distal pancreatectomy can be performed safely by strategic approach even in a patient with a rare aberrant splenic artery.
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Affiliation(s)
| | | | | | - Hiroki Ueda
- Department of Hepatobiliary and Pancreatic Surgery
| | | | | | - Kosuke Ogawa
- Department of Hepatobiliary and Pancreatic Surgery
| | - Hiroaki Ono
- Department of Hepatobiliary and Pancreatic Surgery
| | - Atsushi Kudo
- Department of Hepatobiliary and Pancreatic Surgery
| | - Shinji Tanaka
- Department of Molecular Oncology, Tokyo Medical and Dental University, Tokyo, Japan
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Tijani Y, Zahdi O, Hormat-Allah M, Zaid Y, Raux M, Gouëffic Y. [Embolization of splenic artery aneurysms: Treatment of choice. About a case and review of the literature]. Ann Cardiol Angeiol (Paris) 2020; 71:108-111. [PMID: 33267947 DOI: 10.1016/j.ancard.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
Splenic artery aneurysms constitute 60% of digestive artery aneurysms. They are often discovered incidentally and by imaging. Currently, endovascular treatment is considered the first-line treatment, as it is less invasive with less morbidity and mortality than surgery. An aggressive approach in their management is certainly justified because the overall mortality of ruptured splenic aneurysms is 25%. False splenic aneurysms have a greater potential for rupture than true aneurysms because they grow faster. Endovascular treatment is generally indicated for aneurysms larger than 2cm or with an increase in size of more than 0.5cm/year. Embolization is rarely associated with an infarction of the spleen due to the good supply of short gastric vessels. Embolization is performed using different materials including coils, which can be used alone or with other embolic agents. Post-embolization syndrome can be seen with persistent pain, fever and other systemic symptoms. Endovascular treatment compared to open surgery is associated with better quality of life and appears to be the most cost-effective strategy. Endovascular treatment and especially coil embolization are starting to be the standard treatment. Surgical and laparoscopic treatment are reserved for ruptured aneurysms which are burdened with significant mortality, especially in pregnant women. We report the case of a 66-year-old female patient in whom a splenic artery aneurysm was discovered incidentally during an ultrasound for an ovarian cyst.
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Affiliation(s)
- Y Tijani
- Département de chirurgie vasculaire et endovasculaire, Hôpital Universitaire International Cheikh Khalifa Ben Zaid, Faculté de Médecine, Université Mohammed VI des sciences de santé (UM6SS), Casablanca, Maroc.
| | - O Zahdi
- Service de chirurgie vasculaire, Centre hospitalo-universitaire Ibn Sina, Université Mohammed V, Rabat, Maroc
| | - M Hormat-Allah
- Service de chirurgie vasculaire, Centre hospitalo-universitaire Ibn Sina, Université Mohammed V, Rabat, Maroc
| | - Y Zaid
- Faculty of Sciences, Mohammed V University, Rabat, Maroc; Research Center of Abulcasis University of Health Sciences, Rabat, Maroc
| | - M Raux
- Department of vascular and endovascular surgery, hôpital Paris St Joseph, Paris, France
| | - Y Gouëffic
- Department of vascular and endovascular surgery, hôpital Paris St Joseph, Paris, France
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Laparoscopic and Robotic Surgery for Splenic Artery Aneurysm: A Systematic Review. Ann Vasc Surg 2020; 68:527-535. [DOI: 10.1016/j.avsg.2020.05.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 01/27/2023]
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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]
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Nasser HA, Kansoun AH, Sleiman YA, Mendes VM, Van Vyve E, Kachi A, Berjawi T, Hamdan WS, El Nakadi I. Different laparoscopic treatment modalities for splenic artery aneurysms: about 3 cases with review of the literature. Acta Chir Belg 2018; 118:212-218. [PMID: 29631508 DOI: 10.1080/00015458.2018.1459363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The first laparoscopic treatment of splenic artery aneurysm (SAA) was performed in 1993. Since then, many papers have been published mentioning different laparoscopic treatment modalities, including splenectomy, aneurysmectomy, ligation or even occlusion. PATIENTS AND METHODS An updated literature review of the English medical literature using the following MeSH, 'Lapaorscopic splenic artery aneurysm', 'laparoscopic aneurysectomy', 'Laparoscopic Splenic artery Aneurysm Ligation' and 'Laparoscopic Splenic artery aneurysm excision' was done. Also three cases performed at our institutions are discussed, in terms of techniques, morbidity, mortality and postoperative outcomes. RESULTS About eight case series and 16 case reports were retrieved from the literature. Different techniques were described by the authors, including splenectomy, aneurysmectomy, splenic aneurysm ligation or even occlusion. Few morbidity cases were reported and none of the authors has mentioned a single mortality case. In our three cases, the postoperative course was uneventful, with good long-term results. CONCLUSIONS Despite the variations in the adopted operative techniques, the laparoscopic approach seems to be harmless. However, no treatment algorithm or consensus has been published.
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Affiliation(s)
- Haydar A. Nasser
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
- Department of General and Digestive Surgery, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Alaa H. Kansoun
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
| | - Youssef A. Sleiman
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
| | - Vanessa Marron Mendes
- Department of General and Digestive Surgery, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Etienne Van Vyve
- Department of General and Digestive Surgery, Clinique Saint-Jean, Brussels, Belgium
| | - Antoine Kachi
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
| | - Tarek Berjawi
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
| | - Wajdi S. Hamdan
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
| | - Issam El Nakadi
- Department of General and Digestive Surgery, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Illuminati G, Pizzardi G, Pasqua R. Open surgery for aneurysms of the splenic artery at the hilum of the spleen: Report of three cases. Int J Surg Case Rep 2018; 48:47-49. [PMID: 29803194 PMCID: PMC6026722 DOI: 10.1016/j.ijscr.2018.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/08/2018] [Accepted: 05/13/2018] [Indexed: 01/12/2023] Open
Abstract
Aneurysms of the splenic artery at the hilum of the spleen are rare. Endovascular or laparoscopic treatment may not be advised. Surgical resection through subcostal incisioni s a viable treatment.
Introduction Aneurysms of the splenic artery (SAA) located at the hilum of the spleen are not well fit for endovascular or laparoscopic treatment. Open surgery may still be the best option of treatment. Presentation of cases We report the cases of 3 female patients of a mean age of 59 years (range, 45–68 years) with a hilar (n = 2) or parahilar (n = 1) SAA undergoing successful open surgical resection, through a short left subcostal access. Recovery was uneventful and mean, postoperative length of stay was 4 days (range, 3–5 days). Discussion Results of this report support surgical resection and splenectomy for the treatment of SAA located at the hilum of the spleen. For this particular location endovascular treatment may not be advised, as coil embolization can be followed by a massive splenic infarction precipitating the need for splenectomy, due to the exclusion of backflow from the left gastroepiploic artery through the short gastric vessels. As well, endovascular exclusion through insertion of an endograft may not be feasible due to the absence of a distal landing zone, as stent grafting requires a normal caliber artery of sufficient length on each side of the aneurysm. Conclusion Surgical excision and splenectomy, through a short subcostal incision, remains a viable option of treatment for hilar SAA.
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Affiliation(s)
- Giulio Illuminati
- The Department of Surgical Sciences, University of Rome "La Sapienza", Rome, Italy.
| | - Giulia Pizzardi
- The Department of Surgical Sciences, University of Rome "La Sapienza", Rome, Italy
| | - Rocco Pasqua
- The Department of Surgical Sciences, University of Rome "La Sapienza", Rome, Italy
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Dong SL, Chen X, Tu ZX, Ai X, Zhang ZW, Guan Y, Chen H, Yang J. Aneurysm of the Anomalous Splenic Artery Arising from Superior Mesenteric Artery Treated by Coil Embolization: A Report of Two Cases and Literature Review. Ann Vasc Surg 2017; 48:251.e5-251.e10. [PMID: 29221838 DOI: 10.1016/j.avsg.2017.09.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/26/2017] [Accepted: 09/27/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Aneurysm of splenic artery (SA) which arises from the superior mesenteric artery (SMA) is a very rare condition. The aim of this study was to present our experience with 2 such patients treated by coil embolization. METHODS A 33-year-old man and a 61-year-old woman were incidentally identified with aneurysms of the SA which arose from the SMA. Endovascular therapy of coil embolization was chosen to treat the aneurysm. RESULTS Follow-up computed tomography showed no change in the location of the coils and occlusion of majority of the aneurysm sac. The 2 patients have been doing well during a 26-month and 10-month follow-up period, respectively. CONCLUSIONS Combined with the experience of the previous literature, we think coil embolization can be cost-effective and minimally invasive in selected cases, depending on the morphology and site of the lesion.
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Affiliation(s)
- Shui-Lin Dong
- Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen-Xiao Tu
- Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Ai
- Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhi-Wei Zhang
- Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Guan
- Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Chen
- Department of Operation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Yang
- Division of Vascular Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Bhoil R, Tomar A, Makhaik S, Sood RG, Nayyar N. Aneurysm of an aberrant splenic artery: An extremely rare occurrence. Vascular 2015. [DOI: 10.1177/1708538115597372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An aberrant splenic artery arising from the superior mesenteric artery, also known as the splenomesenteric trunk, is a rare anatomical variant seen in less than 1% of the population and is more common in females. Aneurysms of the splenic artery originating anomalously from the superior mesenteric artery are extremely rare; only 35 cases of aneurysm of an aberrant splenic artery have been described so far in the English medical literature. We report an extremely rare case of aneurysm of aberrant splenic artery in a 28-year-old man in whom the lesion was detected during routine abdominal scanning and confirmed on computed tomography angiography. Aneurysms of an anomalous splenic artery originating from the superior mesenteric artery are extremely rare; however, they are clinically important because possible rupture could be catastrophic. Exploring these variations is important especially if surgical intervention is contemplated. This could greatly affect the surgical planning and avoid injuries to major arteries and organs intraoperatively.
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Affiliation(s)
- Rohit Bhoil
- Department of Radiodiagnosis, IGMC Shimla, Himachal Pradesh, India
| | - Ashwani Tomar
- Department of Radiodiagnosis, IGMC Shimla, Himachal Pradesh, India
| | - Sushma Makhaik
- Department of Radiodiagnosis, IGMC Shimla, Himachal Pradesh, India
| | - RG Sood
- Department of Radiodiagnosis, IGMC Shimla, Himachal Pradesh, India
| | - Nishant Nayyar
- Department of Radiodiagnosis, IGMC Shimla, Himachal Pradesh, India
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12
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Zhang HY, Chai DZ. Endovascular coil embolization for a giant anomalous splenic artery aneurysm. J Vasc Surg Cases 2015; 1:141-143. [PMID: 31724615 PMCID: PMC6849910 DOI: 10.1016/j.jvsc.2015.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 03/01/2015] [Indexed: 11/21/2022] Open
Abstract
Splenic arteries arising from superior mesenteric arteries, also known as splenomesenteric trunks, are uncommon entities. Aneurysms in relation to these variant splenic arteries are even rarer. Open surgery, laparoscopic technique, or endovascular management could be chosen. We report a patient with an anomalous splenic arteries aneurysm that was excluded with coil embolization in a minimally invasive endovascular way. A follow-up contrast-enhanced computed tomography angiogram performed 1 year after the procedure showed total exclusion of the aneurysm sac, patency of the superior mesenteric artery, and the patient was in good condition.
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Affiliation(s)
- Hua Yi Zhang
- Department of Vascular Surgery, The Second Affiliated Hospital of Jiaxing Medical College, Jiaxing, Zhejiang, China
| | - Dong Zhe Chai
- Department of Vascular Surgery, The Second Affiliated Hospital of Jiaxing Medical College, Jiaxing, Zhejiang, China
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13
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Successful treatment of aberrant splenic artery aneurysm with a combination of coils embolization and covered stents. BMC Surg 2014; 14:62. [PMID: 25176112 PMCID: PMC4167310 DOI: 10.1186/1471-2482-14-62] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 08/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aneurysms of an aberrant splenic artery originating from the superior mesenteric artery (SMA) are extremely rare; however, they are clinically important because possible rupture could be catastrophic. The methods of treatment for this condition include surgical resection, minimally invasive techniques (include laparoscopic technique) and endovascular therapy. The purpose of this study is to evaluate the efficacy of coils embolization combined with covered stents to treat aberrant splenic artery aneurysm (SAA). CASES PRESENTATION We report four consecutive cases of aberrant SAA that the aberrant splenic artery was embolized with coils and the superior mesenteric artery was excluded with a covered stent and an up-to-date review of all previous cases in the field. A follow-up computed tomography performed 6 to 12 months postoperatively showed persistent exclusion with marked shrinkage of the aneurysm sac. CONCLUSIONS The authors believe although early results are promising, further careful follow-up will be needed to determine the long-term clinical efficacy, safety and applicability of this approach.
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14
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Kulkarni CB, Moorthy S, Pullara SK, Kannan RR. Endovascular treatment of aneurysm of splenic artery arising from splenomesentric trunk using stent graft. Korean J Radiol 2013; 14:931-4. [PMID: 24265569 PMCID: PMC3835641 DOI: 10.3348/kjr.2013.14.6.931] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 10/17/2012] [Indexed: 11/29/2022] Open
Abstract
We report a rare case of aneurysm of splenic artery arising anomalously from the superior mesenteric artery (SMA). The aneurysm was treated successfully by coil embolization of the splenic artery distal to aneurysm and then deploying a stent graft in the SMA. A combination of stent graft and coil embolization for the treatment of aberrant splenic artery aneurysm has been reported only once. We describe the imaging findings and the endovascular procedure in this patient.
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Affiliation(s)
- Chinmay Bhimaji Kulkarni
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Lane, Ponekkara, Cochin, Kerala State 682041, India
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15
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Abstract
Aneurysms of the splenic artery are the most common visceral aneurysm. A splenomesenteric trunk, which involves the splenic artery arising from the superior mesenteric artery (SMA), is rare and occurs in less than 1% of patients. Thus splenic artery aneurysms (SAAs) with an anomalous origin from the SMA are quite rare. We report our experience with the surgical management of a 2.6-cm aneurysm involving a splenic artery arising from the SMA in a 40-year-old woman. This was treated with surgical resection with preservation of the spleen. A discussion about SAAs and the management of aneurysms arising from a splenomesenteric trunk follows.
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Affiliation(s)
- Sydney S N Wong
- Department of Vascular Surgery, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4.
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Tiberio GAM, Bonardelli S, Gheza F, Arru L, Cervi E, Giulini SM. Prospective randomized comparison of open versus laparoscopic management of splenic artery aneurysms: a 10-year study. Surg Endosc 2012. [PMID: 22752279 DOI: 10.1007/s00464-012-2413-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 05/21/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND: The literature does not support the choice between open and laparoscopic management of splenic artery aneurysms (SAA). METHODS: We designed a prospective, randomized comparison between open and laparoscopic surgery for SAA. Primary end points were types of surgical procedures performed and clinical outcomes. Analysis was developed on an intention-to-treat basis. RESULTS: Fourteen patients were allocated to laparotomy (group A) and 15 to laparoscopy (group B). Groups displayed similar patient- and aneurysm-related characteristics. The conversion rate to open surgery was 13.3 %. The type of surgical procedure performed on the splenic artery was similar in the two groups: aneurysmectomy with splenic artery ligature or direct anastomosis was performed in 51 % and 21 % of patients in group A and in 60 % and 20 % in group B, respectively. The splenectomy rate was similar (14 % vs. 20 %). Postoperative splenic infarction was observed in one case in each group. Laparoscopy was associated with shorter procedures (p = 0.0003) and lower morbidity (25 % vs. 64 %, p = 0.045). Major morbidity requiring interventional procedures and blood transfusion was observed only in group A. Laparoscopy was associated with quicker resumption of oral diet (p < 0.001), earlier drain removal (p = 0.046), and shorter hospital stay (p < 0.01). During a mean follow-up of 50 months, two patients in group A required hospital readmission. In group B, two patients developed a late thrombosis of arterial anastomoses. CONCLUSIONS: Our study demonstrates that laparoscopy permits multiple technical options, does not increase the splenectomy rate, and reduces postoperative complications. It confirms the supposed clinical benefits of laparoscopy when ablative procedures are required but laparoscopic anastomoses show poor long-term results.
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Affiliation(s)
- Guido A M Tiberio
- General Surgery, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy,
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17
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Higashiyama H, Yamagami K, Fujimoto K, Koshiba T, Kumada K, Yamamoto M. Open surgical repair using a reimplantation technique for a large celiac artery aneurysm anomalously arising from the celiomesenteric trunk. J Vasc Surg 2011; 54:1805-7. [PMID: 21803520 DOI: 10.1016/j.jvs.2011.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 05/02/2011] [Accepted: 05/07/2011] [Indexed: 10/17/2022]
Abstract
Celiac artery aneurysms anomalously arising from the celiomesenteric trunk (hepatosplenomesenteric trunk) are rare, with only four patients reported thus far. Surgical intervention for this condition is challenging, particularly when the aneurysm is large and in a retropancreatic location. We report an open repair surgery in a 54-year-old asymptomatic man who presented with a saccular calcified aneurysm (diameter, 4.0 cm) of the celiac artery originating from the celiomesenteric trunk. Our technique involved minimal dissection of the surrounding vessels and complete aneurysm resection, along with revascularization of the hepatic, splenic, and superior mesenteric arteries with a single anastomosis.
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18
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Jiang J, Ding X, Su Q, Zhang G, Wang Z, Hu S. Endovascular stent-graft placement and coil embolization for an anomalous splenic artery aneurysm. J Vasc Surg 2011; 54:208-11. [DOI: 10.1016/j.jvs.2010.11.116] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Revised: 11/24/2010] [Accepted: 11/24/2010] [Indexed: 10/18/2022]
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19
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Giulianotti PC, Buchs NC, Coratti A, Sbrana F, Lombardi A, Felicioni L, Bianco FM, Addeo P. Robot-Assisted Treatment of Splenic Artery Aneurysms. Ann Vasc Surg 2011; 25:377-83. [DOI: 10.1016/j.avsg.2010.09.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 06/08/2010] [Accepted: 09/26/2010] [Indexed: 01/17/2023]
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20
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Tanigawa N, Kariya S, Kojima H, Tokuda T, Komemushi A, Sawada S. Transcatheter coil embolization of an aneurysm of an anomalous splenic artery : Usefulness of double microcatheter method. MINIM INVASIV THER 2009; 18:311-4. [DOI: 10.1080/13645700903201365] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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22
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Kourabi M, Reibel N, Perez M, Grosdidier G. [A serious late complication of non-operative management of splenic trauma: rupture of splenic artery aneurysm]. JOURNAL DE CHIRURGIE 2008; 145:605-607. [PMID: 19106895 DOI: 10.1016/s0021-7697(08)74695-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Over the last five past years, three patients required urgent operation in our institution for hemorrhagic shock after rupture of a post-traumatic splenic artery aneurysm. Those patients had undergone non- operative management (NOM) of grade III, IV (AAST classification) splenic injury 9, 13, and 22 months earlier. Two of them had a CT scan 30 days after initial trauma with no evidence of a developing splenic artery aneurysm. All three patients survived after proximal ligature of splenic artery and hemostatic splenectomy. Our experience with these three cases suggests that a delayed follow-up for patients at high risk is indicated in order to prevent this dramatic complication by early intervention. The modality of this follow-up should be determined by a prospective multicenter study.
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Affiliation(s)
- M Kourabi
- Service de chirurgie générale et urgences, Hôpital central, CHU de Nancy - Nancy
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23
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Liu Q, Lu JP, Wang F, Wang L, Jin AG, Wang J, Tian JM. Detection of anomalous splenic artery aneurysms with three-dimensional contrast-enhanced MR angiography. ACTA ACUST UNITED AC 2008; 34:772-6. [DOI: 10.1007/s00261-008-9467-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Accepted: 09/26/2008] [Indexed: 11/30/2022]
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24
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Aneurisma de arteria esplénica aberrante. ANGIOLOGIA 2008. [DOI: 10.1016/s0003-3170(08)05007-4] [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]
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25
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Illuminati G, LaMuraglia G, Nigri G, Vietri F. Surgical repair of an aberrant splenic artery aneurysm: report of a case. Ann Vasc Surg 2007; 21:216-8. [PMID: 17349366 DOI: 10.1016/j.avsg.2006.06.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Revised: 05/24/2006] [Accepted: 06/09/2006] [Indexed: 12/13/2022]
Abstract
Aneurysms of the splenic artery are the most common splanchnic aneurysms. Aneurysms of a splenic artery with an anomalous origin from the superior mesenteric artery are however rare, with eight previously reported cases. Their indications for treatment are superposable to those of aneurysms affecting an orthotopic artery. Methods of treatment of this condition include endovascular, minimally invasive techniques and surgical resection. We report one more case of aneurysm of an aberrant splenic artery, treated with surgical resection, and preservation of the spleen.
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Affiliation(s)
- Giulio Illuminati
- The Francesco Durante Department of Surgery, University of Rome La Sapienza, Rome, Italy.
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26
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Varnagy D, Sendzischew M, Hertz JA, Sendzischew H. Endovascular management of a ruptured splenic artery aneurysm. Vasc Endovascular Surg 2007; 41:68-72. [PMID: 17277246 DOI: 10.1177/1538574406290209] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- David Varnagy
- Mount Sinai Medical Center, Greater Miami Beach, Florida, USA.
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