Successful endovascular management of giant splenic artery aneurysms

Abstract

Giant pseudoaneurysms of the splenic artery, with a diameter of 5 cm or more, are rare surgical emergencies, and conventional open surgery usually involves splenectomy. The aim of this study is to report two cases from our institution and to review the world's literature on successful endovascular treatment of patients with giant splenic artery pseudoaneurysms. A retrospective review of a prospectively entered departmental computerized database was performed for the two patients from our institution. Articles were searched electronically from PubMed and Medline, using the terms 'giant splenic artery', 'endovascular' and 'embolization'; and relevant cases were reviewed from the world's literature. We hereby report two patients with giant splenic artery pseudoaneurysms who were treated successfully with endovascular procedures. In addition to the two patients from our institution, there were five patients with giant splenic artery pseudoaneurysms in the published literature who underwent successful endovascular management. The first patient of our series had the largest pseudoaneursym size of 7.2 × 8.1 cm, which is the largest documented pseudoaneursym in the current literature. We report two cases of giant splenic artery pseudoaneurysm with one being the largest pseudoaneurysm treated with endovascular technique in the current literature. Endovascular coil embolization of main trunk of splenic artery is less invasive than open surgical treatment for giant splenic artery pseudoaneurysm, and circumvents the problem of difficult exposure, especially in those patients with significant co-morbidity.

Management of Giant Splenic Artery Aneurysm

“… 7 , 26 , 69 Although some authors define aneurysms greater than 10 cm in diameter as giant lesions, most use 5 cm as the threshold, which was also the threshold used in this study. 1 , 5 , 12 , 16 , 19 , 22 , 26…”

“…In comparison, the rupture risk for pseudoaneurysms is not related to their dimensions and all pseudoaneurysms should be treated. 5 …”

“…Endovascular treatment options are becoming more favored due to their acceptable technical success and low morbidity rates. 5 , 9 , 13 The most frequent endovascular techniques are transcatheter embolization, percutaneous injection, and endovascular stent graft. 15 Transcatheter embolization was initially introduced by Probost et al in 1978.…”

“…The language of the publication was not a limitation criterion. Despite the lack of a consensus definition on the dimensions of a giant aneurysm, most of the studies defined a giant aneurysm as being bigger than 5 cm 5 ; therefore, aneurysms of that size were included in this study. All of the case reports, letters to editors, review articles, and original studies of SAAs were reviewed, and their reference lists were evaluated.…”

Giant splenic artery aneurysm in a pregnant patient: a case report and literature review

“…To note, two‐third of SAA rupture occurs in the third trimester . SAA rarely exceeds 3 cm and most studies consider aneurysms ≥5 cm as giant splenic artery aneurysms and those are usually symptomatic with a higher risk of rupture .…”