Splenic artery aneurysms

Nine aneurysms of the splenic artery are reported. The most remarkable etiopathogenic factors are female predominance, pregnancy, portal hypertension, and arteriosclerosis. Histologic findings are significant in woman: subendothelial thickening, internal elastic lamina fragmentation, medial fibrodysplasia, and accumulation of acid glycosaminoglycans in both subintimal and medial layers. In addition to these changes, two women suffering rupture during pregnancy presented microcystic degeneration. Six patients were operated and in 5 instances aneurysmectomy with splenectomy was performed; in the remaining patients the spleen was preserved. All six patients survived the operation and the postoperative period was free of problems in 5 instances. A woman suffering from gestational rupture required reoperation because the preserved spleen was bleeding and the fetus dead. The utility of arteriography in all patients with portal hypertension and the need to include this problem in the diagnostic methodology of shock occurring during pregnancy are emphasized.     

Splenic artery aneurysms

The cause of splenic artery aneurysms and the indications for their treatment remain controversial. Splenic artery aneurysms occur more frequently in women and are associated with pregnancy and multiparity. Whether arteriosclerosis is the cause of the aneurysm or is a secondary phenomenon is unknown. Patients not treated do well, especially if the aneurysm is less than 2 cm in diameter. The rate of rupture is approximately 3%, and it appears to be decreasing as more patients are found to have this type of aneurysm. The mortality rate for ruptured splenic artery aneurysm is greatly increased if the patient is pregnant. Indications for removal include presence of symptoms, pregnancy or plan to become pregnant, increasing size, and a diameter of 2 cm or greater. Depending on the medical condition of the patient, aneurysms that are less than 2 cm in diameter can be removed electively, or they can be left and the patient followed closely. The risk of elective removal is extremely low and has minimal morbidity. In the treatment of this type of aneurysm, the spleen should be preserved if possible; splenectomy is reserved for those aneurysms found in the hilus of the spleen or during emergency situations.

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Resumen La causa de los aneurismas de la arteria esplénica y las indicaciones para su tratamiento son todavía motivo de controversia. Estos aneurismas ocurren con mayor frecuencia en las mujeres y se hallan asociados con el embarazo y la multiparidad. No se sabe si la arterioesclerosis es la causa del aneurisma o si es sólo un fenómeno secundario. Pacientes no tratados evolucionan bien, especialmente cuando el aneurisma es de menos de 2 cm de diámetro. La tasa de ruptura es aproximadamente de 3%, y aprece estar decreciendo en la medida que más pacientes son diagnosticados con este tipo de aneurisma. La tasa de mortalidad en los aneurismas rotos de la arteria esplénica se ve muy aumentada durante el embarazo. Las indicaciones para resección incluyen la presencia de síntomas, el embarazo actual o planeado, el aumento en el tamaño, y un diámetro de 2 cm o mayor. Dependiendo de las condiciones del paciente, los aneurismas de menos de 2 cm de diámetro pueden ser removidos en forma electiva o, alternativamente, no operados y ser sometidos a observación cuidadosa. El riesgo de la resección electiva es extremadamente bajo y hay una minima morbilidad. En el tratamiento de estos aneurismas el bazo debe ser preservado, en lo posible; se reserva la esplenectomía para aquellos aneurismas que están ubicados en el hilio esplénico o los hallados en situaciones de emergencia.

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Résumé L'etiologie et les indications du traitement chirurgical des anévrysmes de l'artère splénique prêtent à discussion. Les anévrysmes de l'artère splénique se voient le plus souvent chez la femme enceinte ou multipare. Que l'artériosclérose ou qu'un phénomène secondaire soit à son origine reste inconnu. Si le diamètre de l'anévrysme est inférieure à 2 cm, la lésion est généralement bien supportée. La fréquence de la rupture était d'environ 3 mais elle paraît de moins en moins importante depuis que cette lésion est découverte plus tôt avec une plus grande fréquence. Le taux de la mortalité en cas de rupture de l'anévrysme est plus important lorsque la malade est enceinte. L'indication du traitement chirurgical se pose lorsque la lésion détermine des troubles pathologiques, que la femme est enceinte ou qu'elle devient enceinte. Il en est de même lorsque l'anévrysme se développe ou que son diamètre est supérieur à 2 cm. Lorsque le diamètre de l'anévrysme est inférieur à 2 cm, l'exérèse élective peut être indiquée si la condition générale du patient le permet; de toutes façons l'anévrysme laissé en place doit être gardé sous une surveillance stricte. Les risques de la chirurgie élective sont très faible et la morbidité est minime. Lorsque l'anévrysme est traité chirurgicalement la rate doit être respectée. La splénectomie est réservée au anévrysmes spléniques situés au niveau du hile de la rate ou en cas d'urgence.

     

Splenic artery aneurysms in liver transplant patients

We found splenic artery aneurysms in 6 of 71 consecutive patients who underwent orthotopic liver transplantation at the Mayo Clinic. The incidence of splenic artery aneurysms in cirrhotic patients with portal hypertension was 10%. Five of the aneurysms were found in patients suffering from chronic active hepatitis, whereas no aneurysms were encountered in patients with primary sclerosing cholangitis or primary biliary cirrhosis. One patient ruptured a splenic artery aneurysm shortly after liver transplantation, and 1 patient developed an aneurysm 3 months after transplantation. We recommend coeliac angiography to be performed prior to liver transplantation, and if splenic artery aneurysms are found, ligation of the splenic artery should be performed at the time of transplantation to prevent possible rupture.     

Splenic artery aneurysms in pregnancy--a systematic review

Visceral artery aneurysm is an uncommon pathology, with a potential for rupture. Splenic artery aneurysms (SAA) are most commonly (60%) associated with a high mortality rate of 25% in case of aneurysm rupture. This increases disproportionately to 75% among pregnant women with fetal mortality of 95%. Although this is a rare event, because of the associated catastrophic consequences, prompt management of splenic artery aneurysms (SAA) is of prime importance. This systematic review provides up-to-date information about the management of splenic artery aneurysms in pregnancy.     

Splenic artery aneurysms: postembolization syndrome and surgical complications

BACKGROUND: This study assessed the endovascular embolization of splenic artery aneurysms and false aneurysms with special consideration given to postoperative complications. METHODS: Fifteen patients (11 women; mean age, 56 y; range, 39-80 y) with splenic artery aneurysm (n = 13) or false aneurysm (n = 2) were treated with coil embolization. The lesion was asymptomatic in 9 patients, symptomatic in 5 patients, and ruptured in 1 patient. The mean aneurysm diameter was 33 +/- 23 mm (range, 15-80 mm). Postoperative follow-up evaluation included a clinical visit and spiral computed tomography at 1, 4, and 12 months, and yearly thereafter. RESULTS: Endovascular treatment was possible in 14 patients (93%) (1 failure: neck cannulation). Perioperative mortality was not observed. Morbidity included postembolization syndrome in 5 patients (30%). Neither pancreatitis nor spleen abscess occurred. The mean follow-up period was 36 months (range, 3-60 mo). During follow-up evaluation we detected 1 sac reperfusion that was sealed successfully with additional coils. Surgical conversion or open repair were never required. CONCLUSIONS: At our institute, endovascular treatment represents the first-line treatment for splenic artery aneurysms. Postembolization syndrome and infarcts are common events but generally resolve without sequelae.     

Splenic artery aneurysms: methods of laparoscopic repair.

PURPOSE: Surgical therapy for splenic artery aneurysms (SAAs) has traditionally consisted of a laparotomy with resection of the aneurysm and possibly a splenectomy. Our early experience with the laparoscopic approach to treat SAAs is reported. METHODS: A retrospective review of medical records was conducted on all patients who underwent laparoscopic resection of SAAs at the Cleveland Clinic Foundation from May 1996 to August 1997. RESULTS: Four patients with SAAs, three women and one man, with an average age of 55 years (range, 37 to 63 years), underwent successful laparoscopic SAA repair. The average size of the aneurysm was 3.2 cm (range, 2.5 to 5.0 cm). Three patients underwent an aneurysm resection, whereas one patient underwent simple ligation. Intraoperative ultrasound scanning with Doppler was used in three cases as a means of localizing the aneurysm and identifying all feeding vessels; the complete cessation of flow within the aneurysm in the case in which the feeding vessels were simply ligated was also documented. The average intraoperative time was 150 minutes (range, 100 to 190 minutes). The mean estimated blood loss was 105 mL (range, 20 to 300 mL). There were no intraoperative complications. The average hospital stay was 2.2 days (range, 1 to 4 days). CONCLUSION: The laparoscopic approach to splenic artery aneurysm by aneurysmectomy or splenic artery ligation can be safe and effective. The laparoscopic approach affords a short hospital stay and an effective result.     

Splenic artery aneurysms: two decades experience at Mayo clinic

Although rare, splenic artery aneurysms (SAAs) have a definite risk of rupture. The optimal management of these aneurysms remains elusive. A retrospective chart review of all patients treated at our institutions with the diagnosis of SAA from January 1980 until December 1998 was undertaken. Follow-up was obtained via chart review and by direct phone contact of the patient or relative. No specific protocol was followed for management. From analysis of the patient data we concluded that although SAAs may rupture, not all intact aneurysms need intervention. Calcification does not appear to protect against rupture, although beta-blockade may be protective. Growth rates of SAA are slow and growth is infrequent. Selective management of SAAs is safe. Open ligation or transcatheter embolization should be considered for symptomatic aneurysms, for aneurysms > or = 2 cm in size, or for any SAA in women of childbearing years.     

Splenic artery aneurysm rupture

BACKGROUND: Splenic artery aneurysms are uncommon even though they are second only to those of the aorto-iliac system. There is also controversy regarding their management. METHODS: We report the case of a 50-year-old patient with ruptured splenic artery aneurysm and review the literature regarding its diagnosis and management. RESULTS: The patient underwent emergency laparotomy and splenectomy was performed. CONCLUSION: Resuscitation and an aggressive surgical approach should be taken in order to save the life of the patients.     

Splenic artery aneurysm rupture

This is the report of a case with an atherosclerotic splenic artery aneurysm ruptured into the peritoneal cavity which presented with hypovolaemic shock. The patient underwent successfully emergency laparotomy and splenectomy. A brief review of the the literature follows.     

Visceral artery aneurysms

Visceral artery aneurysms (VAA) are relatively rare disease patterns. With regard to the aetiology two different entities of VAA can be distinguished: (i) real VAA, where arteriosclerosis plays an important role, particular in elderly patients, and (ii) pseudo-aneurysms. Here, previous abdominal trauma or former inflammatory processes are considered to be the responsible factors for their occurrence. Most frequently, VAA are located in the splenic (60%) and common hepatic artery (20-50%). The common hepatic artery (80%) and the pancreatico-duodenal artery (75%) feature the highest rupture rates. Generally all VAA with a diameter exceeding 2 cm should be treated. Special attention has to be paid to young pregnant women (particularly multipara) who bear the highest risk of VAA rupture, especially during the third trimenon. Early therapy is essential to avoid fatal consequences for mother and foetus. Basically, interventional, endovascular (embolisation, stent) or surgical (resection with direct vessel anastomosis, graft interposition, aneurysmorraphy, ligature) therapy options exist. The choice of the intervention should be adapted to the patient's individual risk profile. In our own series of VAA (n=19; 1996-2007), we evaluated both interventional and surgical procedures as valid therapy regimens with regard to the patients clinical condition.     

Visceral artery aneurysms

Visceral artery aneurysms (VAAs) are a rare condition, in case of a rupture they have a high mortality rate up to 70%. Visceral artery aneurysms are seen more often these days with the more widespread use of computed tomography and angiography. There are various options for treating VAAs; open surgical repair, endovascular treatment, and laparoscopic surgery. We report 5 cases of visceral aneurysms, all treated differently--ligation, aneurysmectomy (with splenectomy), emergency and elective coil embolization, and conservatively. We will further give a review of the literature on etiology, diagnosis, and treatment options.     

Splenic artery aneurysm-pancreatic duct fistula

Massive hemorrhage as a sequela of chronic pancreatitis may originate from many sources. This report documents a rare case of communication between the pancreatic ductal system and a pseudoaneurysm of the splenic artery. The multidisciplinary management of this unusual case required the combined expertise of the endoscopist, radiologist and surgeon.     

Hepatic artery aneurysms

AIM OF THE STUDY: The aim of this retrospective study was to report a series of nine aneurysms of the hepatic arteries, including real aneurysms (n = 4), pseudoaneurysms (n = 3) and false aneurysms (n = 2) observed from 1987 to 1999. PATIENTS: There were 7 men and 2 women (mean age: 58 years). In 3 cases, the aneurysm was asymptomatic and detected by sonography; in 4 cases it was revealed by rupture with a severe hemorrhage and in 2 cases by cholestasis. The aneurysm was located on right (n = 3), proper and common (n = 3), proper (n = 2), and common (n = 1) hepatic arteries. The aneurysm was associated with hepatocellular carcinoma (n = 1), carcinoma of the head of the pancreas (n = 1) and liver metastases (n = 1). METHODS AND RESULTS: Eight patients were operated and one of them was operated three times. Hepatic arterial blood supply was restored in 6 patients with simple suture (n = 1), Goretex graft (n = 2), allograft (n = 2) and autologous vein (n = 1), with one failure which required liver retransplantation. Only one of the three attempts of embolization was successful. One patient with surgical contraindications died from hemobilia after embolization failure. During follow-up, there was one thrombosis of the common hepatic artery which had been excluded and two late deaths: one from rupture of a false aneurysm after bypass with an allograft and one by terminal progression of the cancer. The other 6 patients were alive at the time of this study. CONCLUSION: Clinical characteristics and therapeutic indications of hepatic arterial aneurysm are variable. Management is usually surgical, while embolization is reserved for special circumstances. Restoration of the hepatic arterial blood supply is necessary in aneurysms located on the proper hepatic artery.