Selective embolization of splenic artery aneurysm – case report

Abstract

Zusammenfassung. Grundlagen: Die Embolisation von Viszeralarterienaneurysmata wird zunehmend als sinnvolle und nützliche Alternative zur Operation gewertet.Methodik: Im vorgestellten Fall wurde das sakkuläre Aneurysma der Milzarterie an ihrer ersten Bifurkation therapeutisch mit einer supraselektiven Katheterembolisation mit Mikrospiralen ausgeschaltet.Ergebnisse: Nach einem Intervall von 4 Wochen wurde angiographisch noch eine Restperfusion (0,3 mal 0,6 mm groß) im Halsbereich des vorherigen Aneurysmas nachgewiesen. Eine erneute supraselektive Katheterembolisation mit Mikrospiralen wurde jedoch wegen angiographisch nachgewiesener Gefäßspasmen in der A. lienalis nicht durchgeführt. Weitere 8 Wochen später zeigte eine Kontrollangiographie eine Thrombose des vorher diagnostizierten Aneurysmas, bestätigte nur noch geringe Kontrastmittelanfärbung des ehemaligen Aneurysmahalses und zeigte keinerlei Anhaltspunkt für rheologische Abnormitäten der arteriellen Milzdurchblutung.Schlussfolgerungen: Die supraselektive Katheterembolisation mit Mikrospiralen als "First-line"-Therapie ist geeignet, um ein sakkuläres Milzarterienaneurysma zu behandeln.Schlüsselwörter: A. lienalis, Aneurysma, Embolisation, Spirale.Summary. Background: Embolization of visceral artery aneurysms has been increasingly accepted as a beneficial alternative to surgery.Methods: The aim of this case report was to evaluate the feasibility of the endovascular therapy of a saccular aneurysm of the splenic artery at its first bifurcation. We approached the aneurysm with a supraselective catheter embolization using coils.Results: After an interval of 4 weeks, we found a residual perfusion (0.3 by 0.6 mm) within the former neck in the control angiography. A repeat supraselective embolization was not favored because of catheter-induced vascular spasms of the splenic artery. A further 8 weeks later, control angiography revealed thrombosis of the previously diagnosed aneurysmatic sac, confirmed only minor residual flow through the thrombosed neck of the former aneurysm, and indicated sustained spleen blood supply as further revealed in later duplex ultrasonography follow-up.Conclusions: Selective coil embolization as first-line therapy to treat saccular splenic artery aneurysm is feasible.

Urgent Superselective Segmental Renal Artery Embolization in the Treatment of Life-Threatening Renal Hemorrhage

“…Indications for intervention include aneurysm diameter 1 2.5 cm, renovascular hypertension with lateralizing renin values, symptomatic aneurysm, documented expansion, renal embolization, and current or anticipated pregnancy [8] . Embolization is considered more limited and more precise in terms of anatomic boundaries than surgical intervention, thus leaving more functional kidney tissue.…”

Bilateral renal artery aneurysm rupture in a man with leukemia: Report of a case

“…4,5 Renal artery aneurysms may be extraparenchymal or intraparenchymal, with a prevalence of 90% and 10%, respectively. 6 Although bilateral renal artery aneurysms are thought to be seen in less than 7% of cases, 3 Henke and colleague found an incidence of 19% in a retrospective review of 168 patients with renal artery aneurysms over a 35-year-period. 7 Pfeiffer and coworkers showed a similar incidence (14%) for bilateral aneurysms in their retrospective study of 94 patients between 1980 and 2001.…”

Embolization of splenic artery aneurysm associated with gastrointestinal bleeding: case report

“…The incidence of rupture ranges from 3 to 10% and risk is higher during physical effort, including labor, leading to major bleeding and fatality rates of 10 to 25. 9 Mortality among pregnant women can reach 70% and among portal hypertension patients it can reach 90%. 10 The pathogenesis of splenic artery aneurysms is related to vessel wall fragility and increased blood pressure and/or flow through the vessel.…”

“…Treatment in emergency cases can be by open surgery or using endovascular techniques. 9 If open surgery is used, aneurysmectomy with proximal and distal ligation can be performed, with or without reconstruction of the artery after removal of the aneurysm. In some cases splenectomy, pancreatectomy or both may be necessary.…”