Endovascular coil embolization for a giant anomalous splenic artery aneurysm

Abstract

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...

Endovascular Treatment of Aberrant Splenic Artery Aneurysm Presenting With Painless Progressive Jaundice: A Case Report and Literature Review

“…Moreover, coil embolization alone requires a high packing density in the aneurysm sac for the short-necked aberrant SAAs, which may cause the persistent compression of the surrounding structures. [13][14][15] In our case, the aneurysm at the root of aberrant SA had a short and wide neck. Thus, deploying a stent-graft in SA or coil embolization alone was not feasible.…”

“…9 Some authors reported that performing coil embolization alone with detachable coils was possible on the aberrant SAAs. 6,13,14 Nevertheless, dislodgment or misplacement of coils into SMA with consequent bowel ischemia is a potential complication. Considering that aberrant SAA usually has an insufficient aneurysm neck, the high blood flow of SMA may lead to incomplete thrombosis or late recanalization.…”

“…Moreover, coil embolization alone requires a high packing density in the aneurysm sac for the short-necked aberrant SAAs, which may cause the persistent compression of the surrounding structures. 13-15…”