Splenic arteries arising from superior mesenteric arteries, also known as splenomesenteric trunks, are uncommon entities. Aneurysms in relation to these variant splenic arteries are even rarer. Open surgery, laparoscopic technique, or endovascular management could be chosen. We report a patient with an anomalous splenic arteries aneurysm that was excluded with coil embolization in a minimally invasive endovascular way. A follow-up contrast-enhanced computed tomography angiogram performed 1 year after the procedure showed total exclusion of the aneurysm sac, patency of the superior mesenteric artery, and the patient was in good condition. (J Vasc Surg Cases 2015;1:141-3.) The splenic artery (SA) arising from the superior mesenteric artery (SMA) is an uncommon anatomical variant that is seen in <1% of the population.1 Aneurysms in relation to these variant SAs are even rarer, with limited cases reported.2-4 Considering the inherent risk of rupture, which may cause disastrous consequence, the anomalous SA aneurysm (SAA) should be treated properly. Preprocedural planning and selection of optimal tools are of the utmost importance. We report the successful endovascular treatment of an anomalous SAA using coils embolization in an 88-year-old patient. Written consent to publish was obtained from the patient. CASE REPORTAn 88-year-old man with a chief compliant of abdominal discomfort was admitted to our vascular center. He denied any history of abdominal surgery, trauma, or portal hypertension. Concurrent comorbidities included chronic cardiac dysfunction, chronic obstructive pulmonary disease, and hypertension. Physical examination showed a pulsatile mass on the abdomen. A contrastenhanced computed tomography angiogram (CTA) demonstrated a 44.2-mm  40.4-mm aneurysm arising close to the origin of the SA, which originated from the proximal SMA (Fig 1). Considering his age, the concurrent risk factors, and the anatomical variation of this patient, a less-invasive endovascular repair was planned.Under local anesthesia, right common femoral artery access was obtained. After administration of 3000 IU of heparin, a 4F pigtail catheter was introduced for an angiogram, which confirmed the giant SAA arising from the SMA. Then, selective catheterization of the SMA was performed with a 4F Cobra catheter (Cordis/Johnson & Johnson, Miami, Fla) via a 0.035-inch hydrophilic Terumo wire (Terumo Medical Corp, Somerset, NJ). A 7 F, 45-cm guiding catheter was placed into the splenomesenteric trunk. The distal SA was catheterized selectively with the 4F Cobra catheter over the 0.035-inch hydrophilic Terumo wire. Two 0.015-inch, 5-cm-long stainless steel coils (Cook Inc, Bloomington, Ind) forming loops with an 8-mm diameter were placed into the outflow vessel. Then, the Cobra catheter was retracted into the sac of the aneurysm in which six 0.035-inch, 5-cm-long stainless coils (Cook Inc) with a 12-mm diameter were deployed. Because of the extremely short proximal part, no coil was implanted in the inflow vessel of the SAA. A completion...
Axillary artery aneurysms are rare, with limited cases reported. 1,2 Coiling of the axillary arteries with formations of aneurysms are extremely uncommon. 3 Symptoms can include acute vascular insufficiency and neurologic deficits. Treatment should address the coiling vessels and the aneurysms.An 86-year-old woman complaining of increasing right shoulder pain and swelling was transferred to our hospital's Department of Vascular Surgery. She had been diagnosed with advanced liver cancer, with multiple systemic metastases, and had been hospitalized 7 days earlier in the oncology department for support therapy.The physical examination revealed a pulsatile mass on her right upper extremity. She had no history of trauma or connective tissue disorders and denied long-term use of crutches. A contrast-enhanced computed tomography angiogram showed a corkscrew axillary artery with giant saccular aneurysm formation, reaching 35 mm by 62 mm in size (A and B). Considering its corkscrew course, an endovascular intervention using stent grafts was not suitable. Resection of the coiled part of the axillary artery and an end-to-end anastomosis were planed. However, the patient's general condition was not ideal either, with liver function grade classified as Child C, which placed her at extremely high-risk for an open operation. The patient died of hepatic failure 10 days later during the hospitalization.
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