Giant Splenic Aneurysm with Arteriovenous (A-V) Shunt, Portal Hypertension, and Ascites

Ktenidis, Kiriakos; Manaki, Vasiliki; Kapoulas, Konstantinos; Kourtellari, Eleni; Gionis, Michalis

doi:10.12659/ajcr.911106

Cited by 4 publications

(1 citation statement)

References 7 publications

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“…Chadha et al [ 35 ] reported the case of a 66-year-old male with an acquired SV aneurysm and described novel use of a “ Sundt external carotid endarterectomy shunt ” as a temporary portacaval shunt to control portomesenteric hypertension, before transplantation of the liver. A giant SV aneurysm 98 mm in size developed as a consequence of a splenectomy, an arteriovenous fistula and portal hypertension; this aneurysm was treated successfully with open surgery[ 36 ].…”

Section: Etiology Multimodal Imaging and Current Managementmentioning

confidence: 99%

Portal vein aneurysm-etiology, multimodal imaging and current management

Kurtcehajic¹,

Zerem²,

Alibegovic³

et al. 2023

World J Clin Cases

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Portal vein aneurysm (PVA) is a rare vascular abnormality, representing 3% of all venous aneurysms in the human body, and is not well understood. It can be congenital or acquired, located mainly at the level of confluence, main trunk, branches and bifurcation. A PVA as an abnormality of the portal venous system was first reported in 1956 by Barzilai and Kleckner. A review from 2015 entitled “Portal vein aneurysm: What to know” considered fewer than 200 cases. In the last seven years, there has been an increase in the number of PVAs diagnosed thanks to routine abdominal imaging. The aim of this review is to provide a comprehensive update of PVA, including aetiology, epidemiology, and clinical assessment, along with an evaluation of advanced multimodal imaging features of aneurysm and management approaches.

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Section: Etiology Multimodal Imaging and Current Managementmentioning

confidence: 99%

Portal vein aneurysm-etiology, multimodal imaging and current management

Kurtcehajic¹,

Zerem²,

Alibegovic³

et al. 2023

World J Clin Cases

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A systematic review on clinical features and management of true giant splenic artery aneurysms

Hamid¹,

Suliman²,

Piffaretti

et al. 2020

Journal of Vascular Surgery

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Endovascular and Open Surgical Treatment of Ruptured Splenic Artery Aneurysms: A Case Report and a Systematic Literature Review

Rinaldi,

Brioschi,

Marone

2023

JCM

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Background: Ruptured splenic artery aneurysms (r-SAA), although rare, are burdened by high morbidity and mortality, even despite emergent surgical repair. It is suggested that endovascular treatment can achieve reduction in peri-operative death and complication rates, as in other vascular diseases, but evidence of such benefits is still lacking in this particular setting. We report a case of an r-SAA treated by trans-arterial embolization and then converted to open surgery for persistent bleeding, and we provide a systematic review of current results of open and endovascular repair of r-SAAs. Materials and Methods: A 50-year-old male presenting in shock for a giant r-SAA underwent emergent coil embolization and recovered hemodynamic stability. On the following day, he underwent laparotomy for evacuation of the huge intraperitoneal hematoma, but residual bleeding was noted from the splenic artery, which was ligated after coil removal, and a splenectomy was performed. A systematic literature review of the reported mortality and complications of r-SAA undergoing open (OSR) or endovascular (EVT) treatment was performed using the main search databases. All primary examples of research published since 1990 were included regardless of sample size. The main outcome measures were mortality and reinterventions. Secondary outcomes were post-operative complications. Results: We selected 129 studies reporting on 350 patients—185 treated with OSR and 165 with EVT. Hemodynamically unstable patients and ruptures during pregnancy were more frequently treated with open repair. Overall, there were 37 deaths (mortality: 10.6%)—24 in the OSR group and 13 in the EVTr group (mortality: 12.9% and 7.8% respectively, p-value: 0.84). There were 37 reinterventions after failed or complicated endovascular repair —6 treated with endovascular re-embolization and 31 with laparotomy and splenectomy (22.4%); there were 3 (1.6%) reinterventions after open repair. Overall complication rates were 7.3% in the EVT group (n: 12) and 4.2% in the OSR group (n: 7), and did not require reintervention. No significant differences in overall complications or in any specific complication rate were observed between the two groups. Conclusions: Current results of r-SAA treatment show equipoise terms of morbidity and mortality between open and endovascular repair; however, in case of hemodynamic instability and rupture during pregnancy, open surgery might still be safer. Moreover, endovascular repair is still burdened by a significantly higher rate of reinterventions, mostly with conversions to open surgery.

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Giant Splenic Aneurysm with Arteriovenous (A-V) Shunt, Portal Hypertension, and Ascites

Cited by 4 publications

References 7 publications

Portal vein aneurysm-etiology, multimodal imaging and current management

Portal vein aneurysm-etiology, multimodal imaging and current management

A systematic review on clinical features and management of true giant splenic artery aneurysms

Endovascular and Open Surgical Treatment of Ruptured Splenic Artery Aneurysms: A Case Report and a Systematic Literature Review

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