Splenic artery angiography: clinical classification of origin and branching variations of splenic artery by multi-detector computed tomography angiography method

Abstract

Background: The splenic artery (SA) variations are rarely reported in the literature. Knowledge of the range of the SA and other arterial anomalies and their specific frequencies is very important ever for every visceral surgeon as well as for treatment of gastrointestinal bleeding, organ transplantation, transarterial chemoembolisation of neoplasm, infusion therapy, therapeutic arterial ligation, iatrogenic injuries. At the literature, there are more studies on the coeliac trunk, superior mesenteric artery and hepatic artery variations, but studies on the SA variations are uncommon. The studies on the SA variations are mostly in the form of case reports, but there are not many studies with large population on this issue. The purpose of this study was to evaluate the SA alone and to determine the variations determined separately from the other arteries. Accurate awareness of all the possible anatomic variations is crucial in the upper abdomen surgery. Materials and methods: Seven hundred fifty patients undergoing multi-detector computed tomography angiography between 2015 and 2017 were retrospectively evaluated for the SA variations. We created a new classification system to determine anatomic variations of the SA. Results: Twenty-three different types were identified related to anatomic variations in the origin and branching pattern of the SA. While 596 (79.47%) patients had standard SA anatomy, 154 (20.53%) patients had variant SA anatomy. Conclusions: The SA has quite different variation types and the practical context of the issue is of primary importance in surgery, gastroenterology, oncology and radiology. Liver and pancreas transplantation, splenectomy, embolisation of tumours of the abdominal organs, as well as other numerous diagnostic and therapeutic procedures, require detailed anatomical knowledge.

Morphological Evaluation of the Splenic Artery, Its Anatomical Variations and Irrigation Territory

“…All of these procedures are based on a deep understanding of both the anatomy of the organ and the region as a whole. Knowing the variants of the splenic artery is particularly important for visceral surgeons, due to its frequent involvement in gastrointestinal bleeding, organ transplantation, trans-arterial chemoembolization of neoplasms, infusion therapy and iatrogenic injuries [ 10 ].…”

“…The trajectory of the splenic artery is variable. There are three main types of trajectories: straight, sinuous and spiral [ 10 ]. One or more loops are observed in up to 83–86% of spleens [ 11 , 12 ].…”

Endovascular Stent Graft Placement and Coil Embolization for Splenic Artery Aneurysm with an Anatomical Variant

“…3,4 The risk factors for SAA include portal hypertension, female hormones such as estrogen, and severe flexion. 5 It was observed that SAAs are four times more frequent in women. Although an indication for treatment of SAA has not been generally established, surgery is usually adopted for ruptured or symptomatic aneurysms, pseudoaneurysms, rapid enlargement, and aneurysms with a diameter over 2 cm as well as for women with childbearing potential.…”

Aneurysm of the aberrant splenic artery arising from the superior mesenteric artery

“…Ekingen et al 1 published a new classification system documenting 22 different splenic artery types by computed tomography angiography. The splenic artery arising from the superior mesenteric artery (SMA), known as the splenomesenteric trunk, occurred in 0.13% of 750 patients (type 8).…”

“…The splenic artery arising from the superior mesenteric artery (SMA), known as the splenomesenteric trunk, occurred in 0.13% of 750 patients (type 8). 1 Few case reports have described treatment of these aberrant SAA with coil embolization, 2 endovascular exclusion with a covered stent, 3 or a combination of the 2, depending on aneurysm morphology and origin.…”