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Riaz A, Entezari P, Malik A, Badar W, Scheller S, Gabr A, Thornburg B, Seedial S, Boike J, Resnick S, Sato K, Ladner D, Moore C, Ganger D, Donaldson J, Kulik L, Lewandowski RJ, Funaki BS, Ahmed O, Caicedo JC, Salem R. Impact of Portal Hypertension on Adverse Events after Splenic Arterial Aneurysm Embolization. J Vasc Interv Radiol 2022; 33:1519-1526.e1. [PMID: 35985557 DOI: 10.1016/j.jvir.2022.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate the outcomes of splenic artery aneurysm (SAA) embolization and compare adverse event (AE) rates after embolization in patients with and without portal hypertension (PHTN). MATERIALS AND METHODS A retrospective review of all patients who underwent embolization of SAAs at 2 institutions was performed (34 patients from institution 1 and 7 patients from institution 2). Baseline demographic characteristics, preprocedural imaging, procedural techniques, and postprocedural outcomes were evaluated. Thirty-day postprocedural severe and life-threatening AEs were evaluated using the Society of Interventional Radiology guidelines. Thirty-day mortality and readmission rates were also evaluated. t test, χ2 test, and/or Fisher exact test were used for the statistical analysis. RESULTS There was no statistically significant difference between patients with and without PHTN in the location, number, and size of SAA(s). All procedures were technically successful. There were 13 (32%) patients with and 28 (68%) patients without PHTN. The 30-day mortality rate (31% vs 0%; P = .007), readmission rates (61% vs 7%; P < .001), and severe/life-threatening AE rates (69% vs 0%; P < .001) were significantly higher in patients with PHTN than in those without PHTN. CONCLUSIONS There was a significantly higher mortality and severe/life-threatening AE rate in patients with PHTN than in those without PHTN. SAAs in patients with PHTN need to be managed very cautiously, given the risk of severe/life-threatening AEs after embolization.
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Affiliation(s)
- Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois.
| | - Pouya Entezari
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Asad Malik
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Wali Badar
- Department of Radiology, Section of Interventional Radiology, University of Chicago, Chicago, Illinois
| | - Stephen Scheller
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Ahmed Gabr
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Bartley Thornburg
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Stephen Seedial
- Department of Radiology, St Joseph Mercy Oakland Hospital, Pontiac, Michigan
| | - Justin Boike
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, Illinois
| | - Scott Resnick
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Kent Sato
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Daniela Ladner
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, Illinois
| | - Christopher Moore
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, Illinois
| | - Daniel Ganger
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, Illinois
| | - James Donaldson
- Department of Radiology, Section of Interventional Radiology, Lurie Children's Hospital, Chicago, Illinois
| | - Laura Kulik
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, Illinois
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Brian S Funaki
- Department of Radiology, Section of Interventional Radiology, University of Chicago, Chicago, Illinois
| | - Osman Ahmed
- Department of Radiology, Section of Interventional Radiology, University of Chicago, Chicago, Illinois
| | - Juan Carlos Caicedo
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, Illinois
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
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Phan D, Furtado R, Laurence JM, Pleass H. Splenic Artery Aneurysm Management in the Cirrhotic Patient Listed for Liver Transplantation: A Systematic Review. Transplant Proc 2022; 54:706-714. [PMID: 35272877 DOI: 10.1016/j.transproceed.2022.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/17/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Splenic artery aneurysms (SAA), although rare in the general population, occur more commonly in liver transplant candidates owing to cirrhosis-induced portal hypertension. In this population, particularly in the perioperative period, SAAs are at heightened risks of rupture with potentially fatal consequences. There is no consensus regarding optimal management of asymptomatic SAA diagnosed before liver transplantation. MATERIALS AND METHODS We performed a systematic review of the literature to investigate the management options and outcomes of asymptomatic SAAs in liver transplant candidates. The EMBASE and MEDLINE electronic databases were used to identify articles. RESULTS Eleven articles met the criteria for analysis and included 159 patients with SAAs, among whom 121 had asymptomatic aneurysms diagnosed pre transplant and subsequently underwent liver transplantation. The majority of SAAs were located distally or intrahilar (80%) and more than half of the patients had multiple SAAs. In 121 patients diagnosed pre transplant, 37 patients had treatment instigated (28 treated surgically and 8 treated radiologically). Post-transplant rupture was noted in 2 patients treated surgically (2/28) with no fatality. No rupture was observed in the radiologically treated group, although 1 patient died of splenic abscess and sepsis after embolization. In 86 untreated patients, 4 cases of post-transplant rupture were recorded (2/4 resulted in fatality). CONCLUSION Asymptomatic SAAs are at risks of rupture post transplant and treatment should be considered, regardless of aneurysm size. Both surgical and radiological treatments offer adequate control, and choice of treatment is dependent on location and number of SAA present.
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Affiliation(s)
- Du Phan
- Department of Surgery, Westmead Hospital, Sydney, Australia
| | - Ruelan Furtado
- Department of transplantation, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jerome M Laurence
- Department of Surgery, Westmead Hospital, Sydney, Australia; Department of transplantation, Royal Prince Alfred Hospital, Sydney, Australia; University of Sydney, Specialty of Surgery, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney, Australia
| | - Henry Pleass
- Department of Surgery, Westmead Hospital, Sydney, Australia; Department of transplantation, Royal Prince Alfred Hospital, Sydney, Australia; University of Sydney, Specialty of Surgery, Sydney, Australia.
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Rocha MA, Marques ESS, Leão LRDS, Magdalena TRF, Dórea AA, Yamauchi FI, Wolosker N, Tachibana A. Prevalence, growth rate and complications of splenic artery aneurysms in chronic liver disease patients. VASA 2020; 50:139-144. [PMID: 33115387 DOI: 10.1024/0301-1526/a000915] [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: 11/19/2022]
Abstract
Background: Chronic liver disease (CLD) patients are at greater risk for developing splenic artery aneurysm (SAA). Treatment for aneurysms > 2.5 cm in this population is considered. However, the procedure might be challenging in CLD patients, and complications may interfere in liver transplantation. We, therefore, sought to estimate the prevalence, growth rate and complications of SAA in patients with CLD. As secondary objective, we sought to evaluate whether those features differ in pre and post transplantation follow-up and among aneurysms with diameters greater or less than 2.5 cm at diagnosis. Patients and methods: We searched for the terms "SAA" and "CLD" on CT or MRI reports from January 2009 to December 2016. Patients with single examination or less than 6 months follow-up were excluded. Results: Fifty nine out of 2050 CLD patients presented SAA (prevalence of 2.9%). Fifteen patients were excluded (due to exclusion criteria). Forty-four CLD patients (mean age 55.9 years) presented 76 SAA (follow-up median of 27.2 months). Aneurysms presented mean size of 1.5 ± 0.74 cm at diagnosis and growth rate of 0.12 ± 0.14 cm/y. Two (4.5%) patients presented mild complications (aneurysm thrombosis). No significant differences were observed in the growth rates of aneurysms < 2.5 cm and ≥ 2.5 cm or in the initial size and growth rates of aneurysms of patients submitted to and not submitted to liver transplantation. Conclusions: The estimated prevalence of SAA in patients with DLC in the Brazilian population is 2.9% (CI95% 2.2-3.6%). Although SAA in CLD patients are less likely to remain stable and grow faster than in general population, aneurysms are usually diagnosed at smaller size and complications are rare. These findings might support conservative management with close surveillance, especially in smaller aneurysms.
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Kawachi S, Chiba N, Nakagawa M, Kobayashi T, Hikita K, Sano T, Tomita K, Hirano H, Abe Y, Obara H, Shimazu M. Living donor liver transplantation for idiopathic portal hypertension with extrahepatic portal vein stenosis and splenic artery aneurysms: a case report and review of the literature. BMC Surg 2020; 20:257. [PMID: 33121468 PMCID: PMC7597044 DOI: 10.1186/s12893-020-00921-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/22/2020] [Indexed: 01/08/2023] Open
Abstract
Background Idiopathic portal hypertension (IPH) generally has a good prognosis and rarely results in liver transplantation. Furthermore, there are few reports of living donor liver transplantation (LDLT) for IPH with extrahepatic portal vein stenosis. Case presentation We report the case of a 51-year-old female patient diagnosed with IPH more than 20 years ago. She suffered severe jaundice, massive ascites, and encephalopathy at the time of her visit to our hospital. The patient’s extrahepatic portal vein showed a scar-like stenosis, and the portal flow was completely hepatofugal. Collateral circulation such as the splenorenal shunt was well developed, and multiple splenic artery aneurysms up to 2 cm were observed in the splenic hilum. Her Model for End-Stage Liver Disease score increased to over 40 because of renal dysfunction, requiring temporary dialysis. We performed LDLT using her husband’s right lobe graft and splenectomy. The extrahepatic stenotic portal vein was completely resected, and the superficial femoral vein (SFV) graft collected from the recipient’s right leg was used for portal reconstruction as an interposition graft. Although the clinical course after LDLT had many complications, the patient was discharged on postoperative day 113 and has been fine for 2 years after LDLT. Histopathologically, the explanted liver had obliterative portal venopathy, nodular regenerative hyperplasia, and incomplete septal cirrhosis. Conclusion This case showed that severe IPH is occasionally associated with extrahepatic portal vein stenosis and can be treated with LDLT with portal vein reconstruction using an interposition graft. It was also suggested that the SFV is a useful choice for the interposition graft.
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Affiliation(s)
- Shigeyuki Kawachi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 1930998, Japan.
| | - Naokazu Chiba
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 1930998, Japan
| | - Masashi Nakagawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 1930998, Japan
| | - Toshimichi Kobayashi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 1930998, Japan
| | - Kosuke Hikita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 1930998, Japan
| | - Toru Sano
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 1930998, Japan
| | - Koichi Tomita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 1930998, Japan
| | - Hiroshi Hirano
- Departmet of Diagnostic Pathology, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 1930998, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 1608582, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 1608582, Japan
| | - Motohide Shimazu
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 1930998, Japan
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Lozano Sánchez FS, García-Alonso J, Torres JA, Velasco L, Salvador R, Peña R, González-Porras JR. Decision-making and therapeutic options in intact splenic artery aneurysms: single-center experience and literature review. INT ANGIOL 2020; 39:241-251. [PMID: 32057214 DOI: 10.23736/s0392-9590.20.04304-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Splenic artery aneurysms are rare, potentially serious, and usually asymptomatic. Several methods are currently available to treat them, each with their own advantages and drawbacks. Therefore, its therapeutic paradigm has changed. METHODS We review our database of splenic aneurysms (2009-2019) and undertake an exhaustive literature review. Demographic, clinical, diagnostic, therapeutic, early and follow-up outcome data were examined. Our experience comprised: 15 patients with 19 splenic aneurysms. 11 women (average age, 59.4 years) and 4 men (average age, 61.7 years). All asymptomatic. RESULTS At diagnosis, aneurysms had a mean cross-sectional diameter of 3.4 cm (3.2 and 3.9 for women and men, respectively), the largest measuring 8.5 cm. Two independent aneurysms were detected in four patients. Diagnoses were always incidental to a CT scan. Treatments consisted of open surgery (2 patients), endovascular surgery (10 patients: 7 embolizations, 3 covered stent) and observation/follow-up (3 patients). The cases of open surgery (with splenectomy) were carried out without postoperative morbidity. One embolization failed (requiring subsequent open surgery) and two suffered localized splenic infarction, but without further complications. In patients treated with a covered stent, the aneurysm was always excluded, without complications. There was no 30-day or follow-up (average 26.2 months) mortality. Splenic aneurysms are diagnosed more frequently and earlier (in the asymptomatic phase), albeit incidentally, than in the past. CONCLUSIONS The correct indication (identifying patients at risk) and individualization of treatment, in which endovascular techniques are the first-line option, have significantly improved morbidity and mortality outcomes in our hospital.
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Affiliation(s)
- Francisco S Lozano Sánchez
- Unit of Angiology and Vascular Surgery, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain -
| | - Jesus García-Alonso
- Unit of Interventional Radiology, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain
| | - José A Torres
- Unit of Angiology and Vascular Surgery, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain
| | - Luis Velasco
- Unit of Interventional Radiology, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain
| | - Roberto Salvador
- Unit of Angiology and Vascular Surgery, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain
| | - Ruben Peña
- Unit of Angiology and Vascular Surgery, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain
| | - José R González-Porras
- Unit of Thromobosis and Hemostasis, Department of Hematology, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain
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Sakamoto K, Ogawa K, Tamura K, Ueno Y, Inoue H, Nakamura T, Watanabe J, Takai A, Tohyama T, Senba H, Yoshida O, Abe M, Hiasa Y, Kitazawa R, Kitazawa S, Takada Y. Wilson Disease With Giant Splenic Artery Aneurysms Caused by Fibromuscular Dysplasia During Living Donor Liver Transplantation: A Case Report. Transplant Proc 2019; 51:3131-3135. [PMID: 31611120 DOI: 10.1016/j.transproceed.2019.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 06/24/2019] [Indexed: 11/19/2022]
Abstract
Liver cirrhosis can cause splenic artery aneurysms (SAA) that pose a threat to patients undergoing liver transplantation. However, liver transplantation with multiple visceral artery aneurysms including giant SAA caused by arterial fragility has never been reported. We describe a 36-year-old man with decompensated liver cirrhosis due to Wilson disease that was complicated by giant SAA and multiple aneurysms in the bilateral renal arteries caused by fibromuscular dysplasia (FMD). The maximal diameter of the triple snowball-shaped SAA was 11 cm. We planned a 2-stage strategy consisting of a splenectomy with distal pancreatectomy to treat the SAA and subsequent living donor liver transplantation (LDLT) to address the liver cirrhosis. This strategy was selected to prevent fatal postoperative infectious complications caused by the potential development of pancreatic fistula during simultaneous procedures and to histopathologically diagnose the arterial lesion before LDLT to promote safe hepatic artery reconstruction. However, a postoperative pancreatic fistula did not develop after a splenectomy with distal pancreatectomy, and the pathologic findings of the artery indicated FMD. The patient underwent ABO-identical LDLT with a right lobe graft donated by his brother. Other than postoperative rupture of the aneurysm in the left renal artery requiring emergency interventional radiology, the patient has remained free of any other arterial complications and continues to do well at 2 years after LDLT.
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Affiliation(s)
- Katsunori Sakamoto
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kohei Ogawa
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan.
| | - Kei Tamura
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yoshitomo Ueno
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hitoshi Inoue
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Taro Nakamura
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Jota Watanabe
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Akihiro Takai
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Taiji Tohyama
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hidenori Senba
- Department of Lifestyle-related Medicine and Endocrinology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Osamu Yoshida
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Masanori Abe
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Riko Kitazawa
- Department of Molecular Pathology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Sohei Kitazawa
- Department of Molecular Pathology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yasutsugu Takada
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
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Aseni P, Di Domenico SL, Barbosa F, Rampoldi A, Berry C. Hemoperitoneum in cirrhotic patients in the absence of abdominal trauma. Expert Rev Gastroenterol Hepatol 2019; 13:867-876. [PMID: 31204541 DOI: 10.1080/17474124.2019.1631159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Hemoperitoneum can be a life-threating condition in cirrhotic patients who have a limited compensatory reserve during hemorrhagic shock. We aim to review the literature on the different etiologies associated with non-traumatic hemoperitoneum (NTH), summarizing the most relevant conditions associated with spontaneous and iatrogenic peritoneal and retroperitoneal bleeding that may occur in cirrhotic patients and to illustrate the most relevant diagnostic strategies and optimal management. Area covered: This review encompasses the current literature in hemoperitoneum in cirrhotic patients in the absence of abdominal trauma. Established diagnostic procedures, therapeutic interventions and potential novel targets are reported and discussed. Expert opinion: To ensure the optimal management regardless of the underlying etiology of NTH, the first goal for the clinician is to obtain immediate hemodynamic stabilization with supportive measures and to control the source of bleeding. The latter can be achieved with angiographic embolization, which is usually the first choice, or with open surgery. Other therapeutic options according to specific etiologies include transjugular intrahepatic portosystemic shunt (TIPS), balloon-occluded retrograde transvenous obliteration (BRTO), balloon-occluded anterograde transvenous obliteration (BATO) or intra operative radio frequency (RF).
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Affiliation(s)
- Paolo Aseni
- Department of Emergency, ASST Grande Ospedale Metropolitano Niguarda , Milan , Italy
| | | | | | | | - Cherisse Berry
- Department of Surgery, Division of Acute Care Surgery, New York University School of Medicine , New York , NY , USA
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8
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Prevalence and predictive factors for development of splenic artery aneurysms in cirrhosis. Indian J Gastroenterol 2016; 35:201-6. [PMID: 27256433 DOI: 10.1007/s12664-016-0670-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/10/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Splenic artery aneurysm (SAA) rarely occurs in the general population. Its increased incidence has been reported in cirrhosis. The aim of this retrospective study was to identify prevalence and predictive factor development of SAA in patients with cirrhosis. METHODS All patients with cirrhosis who were treated in our clinics between 2010 and 2014 were included in the study. Demographic features and clinical and laboratory findings were reviewed. Four-phase computerized tomography (CT) was used for identifying SAA. Imaging was reviewed for the presence of SAA as well as hepatic artery, portal vein, splenic artery, splenic vein, liver parenchyma, and intraabdominal cavity were evaluated. RESULTS A total of 171 patients (age 55±13.9, 109 men) were included in the study. There was SAA in 27 (15.7 %) patients. Mean diameter of aneurysm was 11.66 (range, 6.06-27.1) mm. Aneurysm was located in the distal part of splenic artery in 20 (74 %) patients and solitary in 24 (88.8 %), and asymptomatic in all patients. Patients with SAA had larger portal vein and splenic vein compared to patients without SAA (15.3±3.9 vs. 13.1±2.9 mm, p=0.001; and 12.5±4.4 vs. 9.6±2.7 mm, p<0.001, respectively). We identified positive correlation between development of SAA and splenic vein diameter [hazard ratio (HR) =1.23; 95 % confidence interval (CI) 0.97-1.57; p = 0.009] and negative correlation between hepatic artery diameter and development of SAA HR = 0.46; 95 % CI 0.25-0.85; p = 0.002). CONCLUSION SAA occurred in a significant proportion of patients with cirrhosis, and enlargement of the splenic vein seemed to be a predictive factor for the development of SAA.
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Maggi U, Dondossola D, Consonni D, Gatti S, Arnoldi R, Bossi M, Rossi G. Visceral artery aneurysms in liver transplant candidates and in patients after liver transplantation. PLoS One 2011; 6:e29544. [PMID: 22216310 PMCID: PMC3244466 DOI: 10.1371/journal.pone.0029544] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 11/30/2011] [Indexed: 02/07/2023] Open
Abstract
There are only few reviews concerning visceral aneurysms in cirrhotics, and a small number of papers on visceral aneurysms in liver transplant patients. The present paper investigates this condition in both groups of patients in a 10-year-retrospective study.
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Affiliation(s)
- Umberto Maggi
- U.O. Chirurgia Generale e Trapianti di Fegato - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
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