Posttraumatic Intrasplenic Pseudoaneurysm with High-Flow Arteriovenous Fistula: New Lessons to Learn

Fernández, Eudaldo López-Tomassetti; Delgado‐Plasencia, Luciano; Arteaga-González, I J; Carrillo-Pallares, Ángel; Díaz-Romero, Francisco

doi:10.1007/s00068-007-7106-5

Eur J Trauma Emerg Surg

2008

DOI: 10.1007/s00068-007-7106-5

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Posttraumatic Intrasplenic Pseudoaneurysm with High-Flow Arteriovenous Fistula: New Lessons to Learn

Eudaldo López-Tomassetti Fernández

Luciano Delgado‐Plasencia

I J Arteaga-González

et al.

Abstract: Intrasplenic pseudoaneurysm is a potentially lethal complication of abdominal trauma. We present the case of a 33-year-old patient with this particular complication diagnosed by CT-scan. Selective embolization was not possible due to its extraordinarily large size and finally splenectomy was performed. We review the English literature and discuss the particular role of the interventional radiologist to treat this entity. The interventional radiologist is the specialist who better estimates the success of embol… Show more

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Cited by 3 publications

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Komplikationsbeherrschung bei Körperhöhlentrauma

Vogelsang

2016

Trauma Berufskrankh

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Komplikationsbeherrschung bei Körperhöhlentrauma Abdominelle und thorakale Fisteln Abdominelle und thorakale Fisteln als Komplikation eines Körperhöhlentraumas bedürfen einer konservativen, interventionellen oder operativen Therapie in Abhängigkeit zahlreicher Einzelfaktoren. Eine Antizipation ihres Auftretens, die frühzeitige Deutung der Symptome sowie eine behandlungsrelevante Systematik ermöglichen rationelle Therapieentscheidungen. Ziele sind die Vermeidung einer Fistel, die unmittelbare Fistelbeseitigung, ihre konservative Therapie oder eine Beherrschung der Komplikationen und die Bahnung einer interventionellen oder operativen Sanierung. Die fachliche Umsetzung erfolgt durch eine interdisziplinäre Kooperation der allgemeinen Traumachirurgie, spezialisierter chirurgischer Disziplinen (Viszeral-, Thorax-, Gefäßchirurgie), der Intensivmedizin sowie interventioneller Spezialisten (Radiologie, Gastroenterologie, Gefäßmedizin). Jede abdominelle oder thorakale Verletzung kann unmittelbar, kurzfristig zeitversetzt oder mittel-bis langfristig zu einer Fistel im Sinne einer röhrenförmigen oder fuchsbauartigen Verbindung von Organstrukturen untereinander oder zur Körperoberfläche führen.

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Komplikationsbeherrschung bei Körperhöhlentrauma

Vogelsang

2016

Trauma Berufskrankh

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A rare case of non-traumatic intrasplenic pseudoaneurysms in a patient with acute T-cell lymphoblastic leukemia

et al. 2019

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Endovascular and Open Surgical Treatment of Ruptured Splenic Artery Aneurysms: A Case Report and a Systematic Literature Review

Rinaldi,

Brioschi,

Marone

2023

JCM

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Background: Ruptured splenic artery aneurysms (r-SAA), although rare, are burdened by high morbidity and mortality, even despite emergent surgical repair. It is suggested that endovascular treatment can achieve reduction in peri-operative death and complication rates, as in other vascular diseases, but evidence of such benefits is still lacking in this particular setting. We report a case of an r-SAA treated by trans-arterial embolization and then converted to open surgery for persistent bleeding, and we provide a systematic review of current results of open and endovascular repair of r-SAAs. Materials and Methods: A 50-year-old male presenting in shock for a giant r-SAA underwent emergent coil embolization and recovered hemodynamic stability. On the following day, he underwent laparotomy for evacuation of the huge intraperitoneal hematoma, but residual bleeding was noted from the splenic artery, which was ligated after coil removal, and a splenectomy was performed. A systematic literature review of the reported mortality and complications of r-SAA undergoing open (OSR) or endovascular (EVT) treatment was performed using the main search databases. All primary examples of research published since 1990 were included regardless of sample size. The main outcome measures were mortality and reinterventions. Secondary outcomes were post-operative complications. Results: We selected 129 studies reporting on 350 patients—185 treated with OSR and 165 with EVT. Hemodynamically unstable patients and ruptures during pregnancy were more frequently treated with open repair. Overall, there were 37 deaths (mortality: 10.6%)—24 in the OSR group and 13 in the EVTr group (mortality: 12.9% and 7.8% respectively, p-value: 0.84). There were 37 reinterventions after failed or complicated endovascular repair —6 treated with endovascular re-embolization and 31 with laparotomy and splenectomy (22.4%); there were 3 (1.6%) reinterventions after open repair. Overall complication rates were 7.3% in the EVT group (n: 12) and 4.2% in the OSR group (n: 7), and did not require reintervention. No significant differences in overall complications or in any specific complication rate were observed between the two groups. Conclusions: Current results of r-SAA treatment show equipoise terms of morbidity and mortality between open and endovascular repair; however, in case of hemodynamic instability and rupture during pregnancy, open surgery might still be safer. Moreover, endovascular repair is still burdened by a significantly higher rate of reinterventions, mostly with conversions to open surgery.

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Posttraumatic Intrasplenic Pseudoaneurysm with High-Flow Arteriovenous Fistula: New Lessons to Learn

Cited by 3 publications

References 13 publications

Komplikationsbeherrschung bei Körperhöhlentrauma

Komplikationsbeherrschung bei Körperhöhlentrauma

A rare case of non-traumatic intrasplenic pseudoaneurysms in a patient with acute T-cell lymphoblastic leukemia

Endovascular and Open Surgical Treatment of Ruptured Splenic Artery Aneurysms: A Case Report and a Systematic Literature Review

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