Endovascular Treatment of Giant Splenic Artery Aneurysm

Abstract

Introduction. Visceral artery aneurysms are uncommon. Among them, splenic artery is the most common (46–60%). Most splenic artery aneurysms are asymptomatic and diagnosed incidentally, but its rupture, potentially fatal, occurs in up to 8% of cases. Presentation of Case. A female patient, 64 years old, diagnosed with a giant aneurysm of the splenic artery (approximately 6.5 cm in diameter) was successfully submitted to endovascular treatment by stent graft implantation. Discussion. Symptomatic aneurysms and those larger than 2 cm represent some of the main indications for intervention. The treatment may be by laparotomy, laparoscopy, or endovascular techniques. Among the various endovascular methods discussed in this paper, there is stent graft implantation, a method still few reported in the literature. Conclusion. Although some authors still consider the endovascular approach as an exception to the treatment of SAA, in major specialized centers these techniques have been consolidated as the preferred choice, reserving the surgical approach in cases where this cannot be used. For being a less aggressive approach, it offers an opportunity of treatment to patients considered “high risk” for surgical treatment by laparotomy/laparoscopy.

Management of Giant Splenic Artery Aneurysm

“…SAAs are the most frequent splanchnic artery aneurysms, constituting 50–70% of these aneurysms. 7 , 9 , 15 In addition, SAAs are the third most frequent intraabdominal aneurysms, following abdominal aorta and iliac artery aneurysms. 13 , 17 SAAs were first defined by Beaussier in 1770 in a cadaver study.…”

“…13 , 17 SAAs were first defined by Beaussier in 1770 in a cadaver study. 15 , 17 , 69 Hoegler diagnosed these lesions preoperatively with radiologic interventions in 1920. 69 Although the true incidence of SAA is unclear, various studies of autopsies, angiography findings, and autopsies of individuals ≥60 years revealed rates of 0.01–0.2%, 0.78–0.80%, and 10.4%, respectively.…”

Aneurysm resection and vascular reconstruction for true aneurysm at the initial segment of splenic artery

“…The aneurysm mostly lies at the distal portion of splenic artery and near the splenic hilum and true aneurysm originating from the initial part of splenic artery is extremely rare [6] . The size of an aneurysm is usually 2-5 cm, and few are larger than 10 cm [4,11] . Aneurysms tend to be fusiform, capsular, spherical and even bead-like shape [12,13] .…”

“…Obuchi et al [12] and Wei et al [2] believed that, for aneurysms greater than 5 cm, or with a wide neck, or in the vicinity of hepatic artery or celiac trunk, interventional therapy is very difficult and tend to cause complications. In these cases, traditional open surgery, consisting of aneurysmectomy and vascular reconstruction, are the treatment of choice because they relatively safe and reliable in these cases [4,[18][19][20] .…”

“…The splenic artery aneurysm is the most common form of visceral artery aneurysms, accounting for 40%-60% of all cases of visceral artery aneurysms. The aneurysms are mostly located in the middle and distal segments of splenic artery or near splenic hilum [1][2][3][4] , while the true aneurysm at the initial segment of splenic artery is very different and rare [1-3, 5, 6] . Since few clinical data on the disease are available, etiological and epidemiological studies concerning the aneurysms are scanty.…”