Endovascular management of splenic vascular pathologies – A review

Congress:

2019 ASM

Poster Number:

R-0053

Type:

Educational Exhibit

Keywords:

Interventional vascular, Catheter arteriography, Embolisation, Aneurysms, Haemorrhage

Authors:

E. Leung¹, J. Maingard¹, M. J. Lee², D. M. Brooks¹, H. Asadi¹, D. Burrows¹, H. K. Kok¹; ¹VIC/AU, ²Dublin/IE

DOI:

10.26044/ranzcr2019/R-0053

DOI-Link:

https://dx.doi.org/10.26044/ranzcr2019/R-0053

Fig. 1: Splenic artery aneurysm in fibromuscular dysplasia. (A) CT angiogram shows an...

Fig. 2: Acute intra-abdominal haemorrhage secondary to splenic artery pseudoaneurysm....

Fig. 3: (A) CT angiogram showing an incidental 3 cm aneurysm of the distal splenic...

Fig. 4: Chronic pancreatitis with recurrent haemosuccus pancreaticus secondary to a...

Fig. 6: Stent assisted coiling. (A) Selective DSA demonstrating a splenic artery...

Learning objectives

To review the common vascular pathologies affecting thesplenic circulation including aneurysms and traumatic injuries. To review contemporary endovascular techniques and strategiesin the mangement of splenic vascular pathologies.

Background

Background The spleen is commonly injured in abdominal trauma. In addition, the splenic vasculature can be affected by inflammatory, degenerative and traumatic pathologies, most often resulting in aneurysm or pseudoaneurysm formation. Splenic artery aneurysms (SAA) Splenic artery aneurysms are the most common visceral aneurysm in the body and are often asymptomatic with an estimated prevalence of 0.8% in the general population.1-2 True SAA Involves all three layers of thearterial wall Predominantly located in the distal third of the splenic artery (approximately 74-87% of all cases).3...

Imaging findings OR Procedure details

Conventional endovascular management techniques for SAA Goal of endovascular treatment is to exclude aneursym while preserving splenic perfusion. Difficulties arise due the tortuosity of the splenic artery and that most lesions are located in the distal part of the splenic artery. Direct coil embolisation Suitable for the management of true SAA with favourable anatomy eg. aneurysm neck

Conclusion

Advances in endovascular equipment and techniques has led to a shift in the management in splenic vascular pathologies including splenic injuries. Endovascular management has become the first line treatment option in haemodynamically stable patients, allowing for the preservation of splenic function.

Personal information

Dr Eddie Leung1 MBBS, BRadMedImag(Hons) Dr Julian Maingard2,3 MBBS, BBiomedSci, FRANZCR Prof. Michael J Lee4 MB BCh BAO, FRCPI, FFRRCSI, FRCR, EBIR A/Prof. Duncan Mark Brooks3,5 MBBS, FRANZCR, CCINR, EBIR A/Prof. Hamed Asadi2,3,5 MD, PhD, FRANZCR, CCINR, EBIR Dr David A Burrows1, MBChB, FRANZCR Dr Hong Kuan Kok1,3 MB BCh BAO, FFRRCSI, FRCR, FRANZCR, EBIR Institutional Affiliations: 1 Interventional Radiology Service – Department of Radiology, Northern Health, Melbourne, Australia. 2 Interventional Neuroradiology Service – Monash Imaging, Monash Health, Melbourne, Australia. 3 School of Medicine, Faculty...

References

Kok HK, Asadi H, Sheehan M, Given MF, Lee MJ. Systematic Review and Single-Center Experience for Endovascular Management of Visceral and Renal Artery Aneurysms. J Vasc Interv Radiol. 2016;27(11):1630-41. Berceli S. Hepatic and splenic artery aneurysms. Seminars in Vascular Surgery. 2005;18(4):196-201. Akbulut S, Otan E. Management of Giant Splenic Artery Aneurysm: Comprehensive Literature Review. Medicine. 2015;94(27):e1016. Pitton MB, Dappa E, Jungmann F, Kloeckner R, Schotten S, Wirth GM, et al. Visceral artery aneurysms: Incidence, management, and outcome analysis in a tertiary care center over one...