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
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 the arterial wall
- Predominantly located in the distal third of the splenic artery (approximately 74-87% of all cases).3
- Usually less than 3cm
- Considered giant SAA if greater than 5cm
- Rupture risk associated with size, increased rupture risk in pregnancy
Risk factors:
- Atherosclerosis / degenerative
- Pregnancy
- Cirrhosis
- Portal hypertension
- Liver transplatation
- Connective tissue disorders eg. Marfan or Ehlers-Danlos syndrome
- Fibromuscular dysplasia
Splenic artery pseudoaneurysms
- Breach of inner layer of vessel wall, essentially a contained haematoma
- High rupture risk of approximately 76.3%.4
- Rupture risk not associated with size of aneurysm
- Should all be treated regardless of size or symptoms
Risk factors:
Splenic Trauma
The American Association for the Surgery of Trauma (AAST) spleen injury scale is often used to allow for consistency in describing splenic injuries and subsequent management strategies.5 Grade I and II injuries are considered low grade injuries while grade III to V injuries are considered high grade injuries as outlined in Table 1.
Table 1. AAST spleen injury scale6
Grade |
Injury type |
Description |
I |
Haematoma
Laceration
|
Subcapsular, <10% surface area
Capsular tear,
|
II |
Haematoma
Laceration
|
Subcapsular, 10-50% surface area
Capsular tear, 1-3cm parenchymal depth not involving trabecular vessels
|
III |
Haematoma
Laceration
|
Subcapsular, >50% surface area or expanding/ruptured
>3cm parenchymal depth or involving trabecular vessels
|
IV |
Laceration
|
Involving segmental or hilar vessels causing >25% devascularisation of the spleen
|
V |
Laceration
Vascular
|
Completely shattered spleen
Vascular injury at the hilar with devascularisation of the spleen
|
Note: Increase injury grade by one if multiple injuries present, up to grade III |