RESUMEN
We present a case of atraumatic splenic rupture secondary to Epstein-Barr virus (EBV) infection in a woman in her early 50s. The patient initially presented with sepsis secondary to pneumonia but then developed abdominal pain and distension. CT revealed splenic rupture with a significant perisplenic hematoma. Laboratory tests confirmed an EBV infection. Owing to frailty, she underwent fluoroscopy-guided splenic artery embolisation. This case highlights the rare risk of splenic rupture following EBV infection, even in the absence of typical symptoms of infectious mononucleosis.
Asunto(s)
Embolización Terapéutica , Infecciones por Virus de Epstein-Barr , Rotura del Bazo , Humanos , Femenino , Rotura del Bazo/etiología , Rotura del Bazo/diagnóstico por imagen , Rotura del Bazo/virología , Infecciones por Virus de Epstein-Barr/complicaciones , Infecciones por Virus de Epstein-Barr/diagnóstico , Persona de Mediana Edad , Rotura Espontánea , Embolización Terapéutica/métodos , Tomografía Computarizada por Rayos X , Hematoma/diagnóstico por imagen , Hematoma/etiología , Hematoma/virología , Arteria Esplénica/diagnóstico por imagen , Dolor Abdominal/etiologíaRESUMEN
INTRODUCTION: Splenic artery aneurysm (SAA) is a focal dilation of the splenic artery with varying etiologies including atherosclerosis, arteritis, or trauma. Giant SAAs with a diameter of 10 cm is rare and can lead to severe complications like rupture and fistulas. Therefore, an accurate and timely diagnosis and treatment are important. PATIENT CONCERNS: A 50-year-old male presented with acute epigastric pain and hemorrhagic shock. Considering his symptoms and examination, ultrasound, multi-slice computed tomography and digital subtraction angiography results, a ruptured giant splenic artery aneurysm complicated with an exceptional gastric and transverse colonic fistula was suspected. DIAGNOSIS: Ruptured giant splenic artery aneurysm. INTERVENTIONS: Left anterolateral thoracotomy to control the severe aortic bleeding just above the diaphragm, aneurysmectomy, splenectomy, and closing the gastric and transverse colon perforations. OUTCOMES: Multi-slice computed tomography demonstrated the presence of splenic artery aneurysm in the distal third measuring (10â ×â 12 cm) in diameter with a true lumen measuring (7â ×â 3.5 cm) and a large hematoma extending to the greater and lesser gastric curvature. Intraoperatively, a large pulsating mass was detected occupying the epigastrium and the left hypochondrium with severe adhesions with the stomach and transverse colon. CONCLUSION: Giant SAA with a diameter of 10 cm is rare and is associated with severe complications. Therefore, successful treatment of splenic artery aneurysms involves prompt diagnosis, immediate surgical intervention to control bleeding, and tailored approaches like thoracotomy to control the thoracic aorta for better hemodynamic stabilization, aiming to eliminate the aneurysm and reduce complications effectively.
Asunto(s)
Aneurisma Roto , Arteria Esplénica , Humanos , Masculino , Arteria Esplénica/diagnóstico por imagen , Arteria Esplénica/cirugía , Persona de Mediana Edad , Aneurisma Roto/cirugía , Aneurisma Roto/complicaciones , Aneurisma Roto/diagnóstico por imagen , Aneurisma Roto/diagnóstico , Enfermedades del Colon/cirugía , Enfermedades del Colon/etiología , Enfermedades del Colon/diagnóstico por imagen , Fístula Gástrica/etiología , Fístula Gástrica/cirugía , Fístula Gástrica/diagnóstico , Fístula Intestinal/cirugía , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/diagnóstico , Fístula Intestinal/complicaciones , Colon Transverso/cirugía , Colon Transverso/diagnóstico por imagenRESUMEN
We present a compelling case of an elderly male with a complex medical history who presented with sepsis secondary to a urinary tract infection. During admission, changes in his abdominal exam prompted imaging studies, which revealed a grade IV splenic laceration with a giant splenic artery pseudoaneurysm containing a suspected arteriovenous fistula component. Multidisciplinary discussion was had regarding patient management which resulted in the decision to perform an emergent splenectomy. Learning points from this case underscore the crucial role of interdisciplinary collaboration in the treatment of this pathology. Additionally, we discuss the decision-making process to support surgical intervention in the absence of clear guidelines in this exceedingly rare condition.
Asunto(s)
Aneurisma Falso , Fístula Arteriovenosa , Esplenectomía , Arteria Esplénica , Humanos , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/terapia , Aneurisma Falso/etiología , Aneurisma Falso/diagnóstico , Aneurisma Falso/cirugía , Masculino , Arteria Esplénica/diagnóstico por imagen , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/complicaciones , Fístula Arteriovenosa/cirugía , Fístula Arteriovenosa/terapia , Fístula Arteriovenosa/etiología , Bazo/irrigación sanguínea , Bazo/diagnóstico por imagen , Bazo/lesiones , Anciano , Tomografía Computarizada por Rayos XRESUMEN
Abstract: During the routine dissection classes for undergraduate medical students, we encountered a rare anatomical variation concerning the aberrant origin and course of the accessory splenic artery. The splenic artery is one of the direct branches of the coeliac trunk. During its tortuous course, it supplies the pancreas with greater curvature of the stomach and spleen. The accessory splenic artery originating from the main trunk of splenic artery, too, follows the same tortuous course while running through the lesser sac and supplies the posterior part of the spleen via the splenophrenic ligament. The accessory splenic artery is gaining clinical importance during various GI surgeries and some radiological procedures. The unnoticed accessory splenic artery damage may result in tremendous bleeding while performing GI-based surgery or radiological investigation like angiography. In our case report, the accessory splenic artery is an aberrant origin from the initial part of the actual splenic artery. Knowledge regarding the origin, course and termination is of utmost importance to GI surgeons, radiologists, and anatomists.
Asunto(s)
Arteria Esplénica , Humanos , Arteria Esplénica/anomalías , Arteria Esplénica/diagnóstico por imagen , Masculino , Cadáver , Femenino , Variación AnatómicaRESUMEN
OBJECTIVES: Nonoperative management (NOM) of blunt splenic injury (BSI) is well accepted in appropriate patients. Splenic artery embolization (SAE) in higher-grade injuries likely plays an important role in increasing the success of NOM. We previously implemented a protocol requiring referral of all BSI grades III-V undergoing NOM for SAE. It is unknown the risk of complications as well as longitudinal outcomes. We aimed to examine the splenic salvage rate and safety profile of the protocol. We hypothesized the splenic salvage rate would be high and complications would be low. METHODS: A retrospective study was performed at our Level 1 trauma center over a 9-year period. Injury characteristics and outcomes in patients sustaining BSI grades III-V were collected. Outcomes were compared for NOM on protocol (SAE) and off protocol (no angiography or angiography but no embolization). Complications for angiographies were examined. RESULTS: Between January 2010 and February 2019, 570 patients had grade III-V BSI. NOM was attempted in 359 (63 %) with overall salvage rate of 91 % (328). Of these, 305 were on protocol while 54 were off protocol (41 no angiography and 13 angiography but no SAE). During the study period, for every grade of injury a pattern was seen of a higher salvage rate in the on-protocol group when compared to the off-protocol group (Grade III, 97 %(181/187) vs. 89 %(32/36), Grade IV, 91 %(98/108) vs. 69 %(9/13) and Grade V, 80 %(8/10 vs. 0 %(0/5). The overall salvage rate was 94 %(287) on protocol vs. 76 %(41) off protocol (p < 0.001, Cochran-Mantel-Haenszel test). Complications occurred in only 8 of the 318 who underwent angiography (2 %). These included 5 access complications and 3 abscesses. CONCLUSION: The use of a protocol requiring routine splenic artery embolization for all high-grade spleen injuries slated for non-operative management is safe with a very low complication rate. NOM with splenic angioembolization failure rate is improved as compared to non-SAE patients' at all higher grades of injury. Thus, SAE for all hemodynamically stable patients of all high-grade types should be considered as a primary form of therapy for such injuries.
Asunto(s)
Embolización Terapéutica , Bazo , Centros Traumatológicos , Heridas no Penetrantes , Humanos , Heridas no Penetrantes/terapia , Heridas no Penetrantes/diagnóstico por imagen , Estudios Retrospectivos , Embolización Terapéutica/métodos , Masculino , Bazo/lesiones , Bazo/diagnóstico por imagen , Femenino , Adulto , Persona de Mediana Edad , Resultado del Tratamiento , Angiografía , Radiología Intervencionista , Puntaje de Gravedad del Traumatismo , Arteria Esplénica/lesiones , Arteria Esplénica/diagnóstico por imagen , Traumatismos Abdominales/terapia , Traumatismos Abdominales/diagnóstico por imagen , Terapia RecuperativaAsunto(s)
Aneurisma , Endosonografía , Arteria Esplénica , Humanos , Aneurisma/diagnóstico por imagen , Medios de Contraste , Diagnóstico Diferencial , Endosonografía/métodos , Neoplasias Intraductales Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico por imagen , Arteria Esplénica/diagnóstico por imagenRESUMEN
This case report and review describes a 31-year-old man with a history of chronic pancreatitis who presented to the hospital with shortness of breath and left-sided chest pain. Three days prior, he underwent mid-splenic artery embolization due to hematemesis attributed to a splenic artery pseudoaneurysm associated with a peripancreatic pseudocyst. Upon this presentation, the patient reported increasing shortness of breath, left-sided pleuritic chest pain, and epigastric and left upper quadrant abdominal pain. Imaging revealed left pleural effusion, splenic infarcts, and adjacent fluid collections. Thoracentesis confirmed an exudative effusion. The pleural effusion was attributed to recent splenic artery embolization, and the patient was discharged on appropriate medications in stable condition on the sixth day of hospitalization. This case underscores the importance of considering embolization-related complications in the differential diagnosis of pleural effusions following such procedures. The etiology, diagnosis, and management of splenic artery aneurysms are discussed in this review.
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Aneurisma Falso , Embolización Terapéutica , Derrame Pleural , Arteria Esplénica , Humanos , Masculino , Arteria Esplénica/diagnóstico por imagen , Adulto , Embolización Terapéutica/métodos , Derrame Pleural/terapia , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/etiología , Aneurisma Falso/terapia , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/complicaciones , Pancreatitis Crónica/complicaciones , Pancreatitis Crónica/terapiaRESUMEN
Interventions for portal hypertension are continuously evolving and expanding beyond the realm of medical management. When complications such as varices and ascites persist despite conservative interventions, procedures including transjugular intrahepatic portosystemic shunt creation, transvenous obliteration, portal vein recanalization, splenic artery embolization, surgical shunt creation, and devascularization are all potential interventions detailed in this article. Selection of the optimal procedure to address the underlying cause, treat symptoms, and, in some cases, bridge to liver transplantation depends on the specific etiology of portal hypertension and the patient's comorbidities.
Asunto(s)
Embolización Terapéutica , Hipertensión Portal , Derivación Portosistémica Intrahepática Transyugular , Humanos , Hipertensión Portal/cirugía , Hipertensión Portal/terapia , Hipertensión Portal/etiología , Derivación Portosistémica Intrahepática Transyugular/métodos , Embolización Terapéutica/métodos , Vena Porta/cirugía , Várices Esofágicas y Gástricas/cirugía , Várices Esofágicas y Gástricas/etiología , Várices Esofágicas y Gástricas/terapia , Arteria Esplénica/cirugía , Arteria Esplénica/diagnóstico por imagen , Derivación Portosistémica Quirúrgica/métodos , Trasplante de HígadoRESUMEN
Prevention of postoperative splenic infarction in the robotic Warshaw technique requires rigorous evaluation of blood flow to the spleen. Shibuya and colleagues recommend checking: (1) conventional splenic color change, (2) intrasplenic artery waveform by ultrasound Doppler examination, (3) blood flow using indocyanine green, and (4) pulsatile regurgitation from the splenic artery.
Asunto(s)
Procedimientos Quirúrgicos Robotizados , Infarto del Bazo , Humanos , Infarto del Bazo/prevención & control , Infarto del Bazo/diagnóstico por imagen , Infarto del Bazo/etiología , Procedimientos Quirúrgicos Robotizados/métodos , Complicaciones Posoperatorias/prevención & control , Bazo/irrigación sanguínea , Bazo/cirugía , Bazo/diagnóstico por imagen , Esplenectomía/métodos , Arteria Esplénica/cirugía , Arteria Esplénica/diagnóstico por imagen , Verde de IndocianinaRESUMEN
El embarazo, especialmente el tercer trimestre, incrementa notablemente el riesgo de rotura de los aneurismas esplénicos. Cuando esto ocurre, se desencadena un cuadro clínico grave manifestado principalmente como un dolor abdominal agudo acompañado de inestabilidad hemodinámica. A pesar de la gran morbimortalidad tanto materna como fetal que esto conlleva, no existe hoy en día consenso sobre su manejo óptimo. Se presenta el caso de una secundigesta a la que se diagnostica de manera incidental un aneurisma en la arteria esplénica durante el segundo trimestre de gestación. Tras confirmarse dicho diagnóstico mediante resonancia magnética, se decide realizar una esplenectomía programada vía laparotómica en semana 24+2. La evolución maternofetal posterior fue favorable hasta la semana 40 en la que se produjo un parto eutócico. Los aneurismas esplénicos deben tratarse en todas las gestantes, independientemente de su tamaño o sintomatología, pues el beneficio supera los riesgos que supone una cirugía programada.
Pregnancy, especially the third trimester, significantly increases the risk of splenic aneurysm rupture. When this occurs, it results in a severe clinical presentation primarily characterized by acute abdominal pain accompanied by hemodynamic instability. Despite the substantial maternal and fetal morbidity and mortality associated with this condition, there is currently no consensus on its optimal management. We present the case of a second-time pregnant woman who incidentally received a diagnosis of a splenic artery aneurysm during the second trimester of gestation. After confirming this diagnosis through magnetic resonance imaging, it was decided to perform a scheduled laparotomic splenectomy at 24+2 weeks of gestation. Subsequent maternal and fetal evolution was favorable until the 40th week when a eutocic delivery occurred. Splenic aneurysms should be treated in all pregnant women, regardless of their size or symptomatology, as the benefits outweigh the risks associated with elective surgery.
Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Arteria Esplénica/cirugía , Arteria Esplénica/diagnóstico por imagen , Aneurisma/cirugía , Complicaciones del Embarazo/diagnósticoRESUMEN
BACKGROUND: Splenic artery pseudoaneurysm is a rare complication of recurrent pancreatitis usually presenting as an incidental finding on abdominal computed tomography. CASE PRESENTATION: We present the case of a 66-year-old north African male with a known history of previous pancreatitis who presented with upper gastrointestinal bleeding along with recurrent epigastric pain for 3 days. Investigations did not reveal any particular pancreatitis etiology. Computed tomography of the abdomen with contrast showed splenic artery pseudoaneurysm along with findings suggestive of acute pancreatitis. Upper and lower endoscopies failed to identify gastrointestinal the bleed source. The patient underwent intervention radiology embolization of the aneurysm sac with multiple coils via right retrograde common femoral artery-celiac access. The patient was discharged with a plan for capsule endoscopy in outpatient setting. CONCLUSION: Splenic artery pseudoaneurysm is a life-threatening complication and carries a high mortality rate if left untreated. Prompt identification through various imaging modalities, followed by urgent intervention, is crucial to avoid adverse outcomes.
Asunto(s)
Aneurisma Falso , Embolización Terapéutica , Arteria Esplénica , Tomografía Computarizada por Rayos X , Humanos , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/terapia , Masculino , Arteria Esplénica/diagnóstico por imagen , Anciano , Pancreatitis/complicaciones , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Dolor Abdominal/etiología , Resultado del TratamientoRESUMEN
OBJECTIVE: The incidence of splenic artery aneurysms (SAAs) has increased with advances in imaging techniques, necessitating a comprehensive classification to guide treatment strategies. This study aims to propose a novel classification system for SAAs based on aneurysm characteristics and to review treatment outcomes at our center. METHODS: This retrospective study included 113 patients with SAAs admitted to Peking Union Medical College Hospital from January 2019 to December 2023, assessed using computed tomography angiography or digital subtraction angiography. A new classification system was devised based on the aneurysm location, morphology, integrity, and parent artery anatomy. Treatment strategies were determined based on these characteristics, with interventions ranging from endovascular therapy to laparoscopic and open surgery. Patients were followed up after the intervention to assess mortality, complications, reinterventions, and aneurysm-related outcomes. RESULTS: The study cohort of 113 patients with 127 SAAs had a predominance of female patients (63.7%) and a mean age of 52.7 years. The SAAs were classified into five types, with type I being the most common. The intervention techniques varied across types, with sac embolization, covered stent implantation, and artery embolization being the most frequently used. The overall technical success rate was 94.7%, with perioperative complication and reintervention rates of 25.0% and 0.9%, respectively, and no deaths within 30 days after the intervention. The median follow-up duration was 21 months, with overall complications rate of 3.5% and no aneurysm-related complications or deaths. CONCLUSIONS: The proposed classification system effectively guides the selection of treatment strategies for SAAs, incorporating key anatomical and morphological features. This system facilitated high technical success and low complication rates, underscoring the importance of tailored techniques in managing SAAs.
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Aneurisma , Angiografía de Substracción Digital , Angiografía por Tomografía Computarizada , Embolización Terapéutica , Procedimientos Endovasculares , Arteria Esplénica , Humanos , Femenino , Arteria Esplénica/diagnóstico por imagen , Persona de Mediana Edad , Masculino , Aneurisma/diagnóstico por imagen , Aneurisma/clasificación , Aneurisma/cirugía , Aneurisma/terapia , Aneurisma/mortalidad , Estudios Retrospectivos , Resultado del Tratamiento , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Adulto , Anciano , Embolización Terapéutica/efectos adversos , Valor Predictivo de las Pruebas , Factores de Riesgo , Stents , Factores de Tiempo , Toma de Decisiones ClínicasRESUMEN
Venous stasis ulcers are nonhealing lesions due to venous hypertension secondary to valvular dysfunction or deep venous outflow obstruction. We describe a case of a 71-year-old male with a history of polycythemia vera, secondary myelofibrosis, and massive splenomegaly up to 38 cm who presented with chronic, perimalleolar venous stasis ulcers and pain on the left lower extremity. CT showed significant compression of the left common iliac vein due to mass effect from the spleen. He was managed medically while being evaluated for partial splenic artery embolization but expired due to other chronic conditions before any intervention could be performed. Partial splenic artery embolization may be considered as a treatment option for patients with symptomatic iliac vein compression due to massive splenomegaly secondary to myelofibrosis, as long as extramedullary hematopoiesis is not compromised.
Asunto(s)
Vena Ilíaca , Mielofibrosis Primaria , Esplenomegalia , Humanos , Masculino , Anciano , Esplenomegalia/etiología , Esplenomegalia/diagnóstico por imagen , Mielofibrosis Primaria/complicaciones , Mielofibrosis Primaria/diagnóstico por imagen , Vena Ilíaca/diagnóstico por imagen , Constricción Patológica , Resultado Fatal , Embolización Terapéutica , Úlcera Varicosa/etiología , Úlcera Varicosa/terapia , Úlcera Varicosa/diagnóstico por imagen , Resultado del Tratamiento , Arteria Esplénica/diagnóstico por imagen , Flebografía/métodos , Angiografía por Tomografía Computarizada , Policitemia Vera/complicacionesRESUMEN
Autosomal dominant polycystic kidney disease (ADPKD) is an important cause of renal dysfunction. It is the most common genetic disorder leading to end-stage kidney disease requiring dialysis. ADPKD is a multisystem disease and is linked to several extra renal abnormalities. Splenic artery aneurysms are rare in the general population. ADPKD is associated with cerebral artery aneurysms. However, splenic artery aneurysms are not a well-recognised complication of ADPKD. We report an unusual case of a splenic artery aneurysm found incidentally on abdominal CT imaging of a woman with known ADPKD.
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Aneurisma , Riñón Poliquístico Autosómico Dominante , Arteria Esplénica , Tomografía Computarizada por Rayos X , Humanos , Riñón Poliquístico Autosómico Dominante/complicaciones , Femenino , Arteria Esplénica/diagnóstico por imagen , Aneurisma/etiología , Aneurisma/diagnóstico por imagen , Persona de Mediana Edad , Hallazgos IncidentalesRESUMEN
BACKGROUND: Splenic sequestration crisis is a potentially fatal complication of sickle cell disease, mainly seen in young children. Only a few case series describe the acute splenic sequestration crisis in adults and its management, which primarily consists of supportive care and, in some cases, splenectomy. Splenic artery embolization has seldom been described in sickle cell disease. This is probably the first case in which an adult with sickle cell disease presented with an acute splenic sequestration crisis was managed successfully through splenic artery embolization. RESULTS: This 22-year-old female, a known case of sickle cell disease, presented with severe pain in the abdomen and low-grade intermittent fever for two days, secondary to an acute splenic sequestration crisis. The diagnosis of acute splenic sequestration was made based on clinical and blood parameters, ultrasonography, and computed tomography. Even with adequate supportive care and blood transfusions, the patient's condition worsened with a rapid fall in the hemoglobin and total platelet count. Considering splenectomy to be a high-risk procedure for this patient, a decision of rescue splenic artery embolization was taken, which was successful. CONCLUSION: Splenic artery embolization may be considered a lifesaving procedure in patients with acute splenic sequestration, where the risk of splenectomy can be high. Adequate post-procedure supportive care is vital for preventing complications.
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Anemia de Células Falciformes , Embolización Terapéutica , Arteria Esplénica , Humanos , Embolización Terapéutica/métodos , Femenino , Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/terapia , Arteria Esplénica/diagnóstico por imagen , Adulto Joven , Enfermedades del Bazo/diagnóstico por imagen , Enfermedades del Bazo/terapia , Enfermedades del Bazo/etiología , Enfermedad Aguda , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: This systematic review aims to elucidate the diagnostic capabilities of imaging techniques in identifying Non-Occlusive Hepatic Artery Hypoperfusion Syndrome (NOHAH) and to evaluate the efficacy and outcomes of splenic artery embolization (SAE), including the choice and placement of embolic agents. MATERIALS AND METHODS: A comprehensive literature search was conducted using PubMed, CINAHL, and Scopus databases, adhering to PRISMA guidelines. Fifteen studies encompassing 240 patients treated with embolization (using coils or Amplatzer Vascular Plugs (AVP)) were analyzed. Key metrics assessed included patient demographics, embolization techniques, embolic agents, technical success, radiologic findings pre- and post-embolization, and complication rates. RESULTS: Among the 240 patients studied, 177 (73.8%) were reported by gender, with a majority being male (127/177, 71.7%). Doppler ultrasonography (DUS) emerged as the primary initial screening tool in 80% of studies. The hepatic arterial resistive index (RI) was a critical parameter, with mean values significantly decreasing from 0.84 pre-embolization to 0.70 post-embolization (p < 0.001). All cases confirmed technical success via digital subtraction angiography, revealing delayed hepatic arterial filling without stenosis or thrombosis. Coils were the predominant embolic agent, used in 80.8% of patients, followed by AVP in 16.3%. The overall mortality rate was 4.58%, with 29 major and 3 minor complications noted. Notably, proximal placement of coils in the splenic artery was associated with lower mortality rates compared to distal placement and showed comparable complication rates to AVPs. CONCLUSION: DUS is a reliable screening modality for NOHAH, with post-SAE assessments showing significant improvements. The choice and location of embolization significantly impact patient outcomes, with proximal placement of coils emerging as a preferable strategy due to lower mortality rates and comparable complication profiles to alternative methods.
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Embolización Terapéutica , Arteria Hepática , Humanos , Arteria Hepática/diagnóstico por imagen , Embolización Terapéutica/métodos , Síndrome , Arteria Esplénica/diagnóstico por imagenRESUMEN
PURPOSE: To examine the natural history of splenic artery aneurysms (SAAs) at a single institution and assess the effect of patient factors and aneurysm characteristics on aneurysm growth. MATERIALS AND METHODS: This single-center retrospective study included patients with SAAs who underwent serial imaging over 30 years (1990-2020). Data regarding patient demographics and aneurysm characteristics were collected. The variables contributing to aneurysm growth were assessed using nonparametric tests for continuous variables and chi-square test for categorical variables. Multivariable linear regression was performed using aneurysm growth rate as a continuous dependent variable. RESULTS: A total of 132 patients were included in this study. The median maximum diameter of the SAAs was 15.8 mm (range, 4.0-50.0 mm). Growth over time was observed in 39% of the aneurysms, whereas the remaining 61% were stable in size. Of aneurysms that increased in size, the median aneurysm growth rate was 0.60 mm/y (range, 0.03-5.00 mm/y). Maximum aneurysm diameter of >2 cm and the presence of >50% mural thrombus were significant positive predictors for aneurysm growth (P = .020 and P = .022, respectively). Greater than 50% rim calcification was a significant negative predictor for aneurysm growth (P = .009) in multivariate analysis. CONCLUSIONS: A larger baseline SAA size, presence of mural thrombus, and lack of rim calcification are associated with increased aneurysm growth rate.
Asunto(s)
Aneurisma , Progresión de la Enfermedad , Arteria Esplénica , Humanos , Arteria Esplénica/diagnóstico por imagen , Aneurisma/diagnóstico por imagen , Estudios Retrospectivos , Femenino , Masculino , Persona de Mediana Edad , Factores de Riesgo , Anciano , Adulto , Factores de Tiempo , Valor Predictivo de las Pruebas , Anciano de 80 o más Años , Calcificación Vascular/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Adulto Joven , Trombosis/diagnóstico por imagen , Trombosis/etiología , Medición de RiesgoRESUMEN
BACKGROUND: Neurofibromatosis type 1 is an autosomal-dominant disease characterized by café-au-lait spots and neurofibromas, as well as various other symptoms in the bones, eyes, and nervous system. Due to its connection with vascular fragility, neurofibromatosis type 1 has been reported to be associated with vascular lesions, such as aneurysms. However, there have been few reports of abdominal visceral aneurysms associated with neurofibromatosis type 1. Furthermore, there have been no reports of robotic treatment of aneurysms associated with neurofibromatosis type 1. In this report, we describe the case of a patient with neurofibromatosis type 1 with a splenic artery aneurysm who was successfully treated with robotic surgery. CASE PRESENTATION: This report describes a 41-year-old Asian woman with a history of neurofibromatosis type 1 who was referred to our hospital for evaluation of a 28 mm splenic artery aneurysm observed on abdominal ultrasound. The aneurysm was in the splenic hilum, and transcatheter arterial embolization was attempted; however, this was difficult due to the tortuosity of the splenic artery. Thus, we suggested minimally invasive robotic surgery for treatment and resection of the splenic artery aneurysm with preservation of the spleen. The postoperative course was uneventful, and the patient was discharged on the eighth day after surgery. At 1 year of follow-up, the patient was doing well, with no evidence of recurrence. CONCLUSION: We encountered a rare case of splenic artery aneurysm in a patient with neurofibromatosis type 1 who was successfully treated with robotic surgery. There is no consensus on treatment modalities for neurofibromatosis-related aneurysms, and endovascular treatment is considered safe and effective; however, surgery remains an important treatment modality. Especially in patients with stable hemodynamic status, robotic surgery may be considered as definitive treatment. To our knowledge, this is the first successfully treated case of a splenic artery aneurysm in a patient with neurofibromatosis type 1.