Endovascular management of pseudoaneurysms of the splenic artery: experience with six patients

Abstract

The purpose of this paper was to describe our experience with the endovascular management of splenic artery pseudoaneurysms (SAPA). Seven patients with documented SAPA on CT and/or angiography were considered for endovascular treatment. The pseudoaneurysms were located in the main splenic artery (n = 4) or its branches (n = 3). In one patient in whom the pseudoaneurysm was located in a hilar branch, selective catheterization of splenic artery failed. Metallic coils (n = 1), gelfoam and hydrogel particles (n = 1), metallic coils and gelfoam (n = 2), metallic coil, gelfoam and acrylic glue (n = 2) were used as embolization material in the remaining six patients. These patients were followed for a mean period of 11.3 months. Transcatheter embolization was successful in five patients with no procedure-related complications. In one patient, embolization was incomplete and the patient underwent surgery, but died on the 10th postoperative day because of irreversible shock. Another patient, after successful embolization, underwent surgery for management of an associated pseudocyst. Endovascular treatment is a safe and effective method of management of SAPA.

Coil migration – a rare complication of endovascular exclusion of visceral artery pseudoaneurysms and aneurysms

“…A combination of materials, including metallic coils, gelfoam, hydrogel particles, acrylic glue or a combination of these, can now be used for embolisation. 1 Afferent arterial embolisation can be employed in instances of pseudoaneurysm or aneurysm formation from visceral arteries with no significant collateral supply. 3 However, VAPAs with a well-established collateral supply 3 and high flow 14 usually require embolisation of proximal and distal branches to enable successful exclusion and prevent backflow from the collateral circulation and thus may be capable of preventing the subsequent migration of coils.…”

“…3 Low-flow VAPAs can often be treated with percutaneous thrombin injection alone. 14 Literature review reveals that percutaneous endovascular embolisation techniques are generally safe and effective, 1,14 and are capable of achieving definitive haemostasis in 80-95% of emergency cases, 8,9,11,24 particularly when early recognition and treatment takes place.…”

“…Visceral artery pseudoaneurysms or aneurysms (VAPA) of the splenic, 1 gastroduodenal, 2, 3 hepatic, 2 gastroepiploic, 4 superior mesenteric 5 or inferior mesenteric 6 (or any visceral branch of the coeliac axis, inferior mesenteric, superior mesenteric or renal arteries) arteries can form secondary to a variety of congenital, traumatic and inflammatory pathologies. Visceral artery aneurysms are found in 0.01-0.2% of routine autopsies but are being increasingly found incidentally in our ageing population; 7 whereas visceral artery pseudoaneurysm formation is a rare but potentially fatal complication occurring in less than 2% of cases of chronic pancreatitis (CP), 8 and even less frequently following acute pancreatitis and hepatopancreaticobiliary (HPB) surgery, 9 vasculitis or other inflammatory processes.…”

Pseudoaneurysm of the Splenic Artery Presenting with Gastrointestinal Bleeding

“…The SAPA may develop within the wall of a pseudocyst, or a pseudocyst may cause erosion into an adjacent artery with potential conversion into a pseudoaneurysm (3). Angiography remains the reference for the demonstration of aneurysms and also allows for therapeutic embolization (2). We report a new case of a SAPA complicated with bleeding into the pancreatic duct (hemosuccus pancreaticus) successfully treated by coil embolization.…”

“…Splenic artery pseudoaneurysm (SAPA) commonly develops secondary to chronic or acute pancreatitis (2). The SAPA may develop within the wall of a pseudocyst, or a pseudocyst may cause erosion into an adjacent artery with potential conversion into a pseudoaneurysm (3).…”