Tratamiento endovascular urgente de aneurisma esplénico roto

Hernández-Lahoz, I.; Vilariño-Rico, J.; Vidal-Insua, J.J.; Beraza-Milicua, A.; Segura-Iglesias, R.J.

doi:10.1016/s0003-3170(05)74930-0

Cited by 8 publications

(3 citation statements)

References 11 publications

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“…None of the cases of the review had an endovascular repair.Recently, we reported the treatment of a ruptured giant SAA with coil embolization (Fig) . Good results were obtained, and the spleen was preserved. 2 The pattern of our case was the common one for small SAAs: female in the sixth decade of life with portal hypertension; however, the aneurysm was situated in the middle third of the artery.As Pescarus et al 3 remarked in their review, giant SAAs have a more difficult surgical exposure and Ͼ50% of the cases require splenectomy. By contrast, small aneurysms require splenectomy in Ͻ30%.…”

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confidence: 57%

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Regarding “Giant splenic artery aneurysms: Case report and review of the literature”

Hernández-Lahoz

García-Casas

2006

Journal of Vascular Surgery

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We have read with interest the article by Radu Pescarus et al. 1 The authors report an unusual case of a giant splenic artery aneurysm (SAA) treated by open surgical repair with good results and provide a review of the 12 giant SAAs published to date.They find a different pattern with respect to the small SAAs: male predominance, absence of a clear etiologic factor, situation in the middle third of the artery, and a higher presentation with rupture (25%). At the same time, the surgery in their case needed a medial visceral rotation for the artery control and splenectomy. Possible endovascular options were not considered because of the tortuosity of the artery for a stent -raft deployment and the lack of experience and likelihood of failure of coil embolization. None of the cases of the review had an endovascular repair.Recently, we reported the treatment of a ruptured giant SAA with coil embolization (Fig) . Good results were obtained, and the spleen was preserved. 2 The pattern of our case was the common one for small SAAs: female in the sixth decade of life with portal hypertension; however, the aneurysm was situated in the middle third of the artery.As Pescarus et al 3 remarked in their review, giant SAAs have a more difficult surgical exposure and Ͼ50% of the cases require splenectomy. By contrast, small aneurysms require splenectomy in Ͻ30%. This is an important issue, because after splenectomy, patients are considered immunodeficient.In the light of our experience, we believe that giant SAAs should be considered for endovascular repair as a first line of treatment if anatomically suitable. Endovascular stent-graft exclusion of SAA could be carried out if the tortuosity of the artery is not extreme. Proximal and distal coil embolization is preferable in the proximal and middle third of the artery, preserving the short gastric arteries to feed the spleen. The size of the coils should be bigger than the diameter of the distal artery to avoid spleen migration. Recurrences with embolization are not infrequent, and subsequent contrast helicoidal computed tomography scans of the abdomen should be performed to detect them.Percutaneous coil embolization with ultrasound-Doppler scan guidance has been performed in postcatheterization arterial femoral pseudoaneurysms 4 and could be considered when the giant SAA is easily accessible to puncture. This has not yet been tested, however, and requires further discussion.

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confidence: 57%

“…Recently, we reported the treatment of a ruptured giant SAA with coil embolization (Fig) . Good results were obtained, and the spleen was preserved. 2 The pattern of our case was the common one for small SAAs: female in the sixth decade of life with portal hypertension; however, the aneurysm was situated in the middle third of the artery.…”

mentioning

confidence: 57%

Regarding “Giant splenic artery aneurysms: Case report and review of the literature”

Hernández-Lahoz

García-Casas

2006

Journal of Vascular Surgery

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“…However, there is little follow-up information for this method and recurrence is a possible long-term hazard. When embolization is difficult or contraindicated by the proximity of the aneurysm to the spleen (with risk of splenic infarction) the options are open or laparoscopic surgery with ligation of the splenic artery, excision of the aneurysm with anastomosis of the artery or splenectomy with removal of the aneurysm (5,7,8). In conclusion; giant SAA are a rare clinical entity.…”

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confidence: 98%