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Strategies for endovascular treatment of complicated splenic artery aneurysms
Gang Fang1, Bin Chen1, Weiguo Fu1
1Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Insights
Endovascular treatment (ET) offers a safe and effective approach for complicated splenic artery aneurysms (SAAs). This study defines optimal ET strategies for various SAA types, achieving high success rates and favorable long-term outcomes.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Aneurysm Treatment
Background:
- Splenic artery aneurysms (SAAs) are increasingly managed with endovascular treatment (ET).
- Systematic treatment strategies for complicated SAAs (CSAAs) remain undefined.
- CSAAs present diverse anatomical challenges requiring tailored approaches.
Purpose of the Study:
- To investigate and define optimal endovascular treatment (ET) strategies for complicated splenic artery aneurysms (CSAAs).
- To analyze the feasibility, safety, and effectiveness of ET in managing CSAAs.
Main Methods:
- Retrospective review of 154 SAAs treated over a decade, focusing on 24 CSAAs.
- Classification of CSAAs into three types based on rupture risk and anatomical location.
- Analysis of patient demographics, clinical presentation, aneurysm characteristics, ET strategies, and outcomes.
Main Results:
- Endovascular treatment (ET) was performed in 22 of 24 CSAAs, with a 95.5% technical success rate.
- The aneurysms remained thrombosed and unenlarged in 95.5% of patients during a mean follow-up of 33.7 months.
- No perioperative or long-term hepatic or intestinal ischemia or death occurred.
Conclusions:
- Endovascular treatment (ET) is a feasible, safe, and effective management option for complicated splenic artery aneurysms (CSAAs).
- Tailored ET strategies, considering urgency and anatomical complexity, are crucial for successful outcomes.
- ET provides durable aneurysm exclusion with a low reintervention rate.
Objective:
Endovascular treatment (ET) is being increasingly used for splenic artery aneurysms (SAAs), but systematic treatment strategies have not been defined. We set out to investigate the optimal strategies for ET of complicated SAAs (CSAAs).
Methods:
CSAAs were classified into three types: type I, rupture or impending rupture; type II, at the origin of the splenic artery; and type III, having an aberrant splenic artery from the splenomesenteric trunk (type IIIA) or celiacomesenteric trunk (type IIIB). SAAs treated at our center during the last decade were reviewed, and CSAAs were selected for analysis. Patients' demographics, clinical manifestations, aneurysm characteristics, ET strategies, and outcomes were analyzed.
Results:
A total of 154 SAAs were identified, with 24 (15.6%) being CSAAs. Open surgery was employed in two patients, whereas 22 patients underwent ET. There were 3 patients with type I (type IIIA co-occurred in one of them), 5 with type II, and 15 with type III CSAAs. Treatment strategies included the following: immediate and thorough exclusion with embolization of the collaterals for type I; and dense embolization of the sac and outflow artery, with or without embolization of the inflow artery, or covered stent placement in the splenomesenteric trunk or celiacomesenteric, for types II and III. Technical success was achieved in 21 patients (95.5%). Mean follow-up was 33.7 ± 31.2 months (range, 1.5-117.0 months). The aneurysms remained completely thrombosed and unenlarged in 21 patients (95.5%). Reintervention was needed in one patient (4.5%) for persistent sac enlargement. The covered stent was asymptomatically occluded in one patient (11.1%). No hepatic or intestinal ischemia or death developed perioperatively or during the follow-up period.
Conclusions:
With reasonable strategies toward the urgency and thoroughness needed for aneurysm exclusion as well as the anatomic challenges, ET appeared to be feasible, safe, and effective in the management of CSAAs.
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