Korean J Radiol.  2013 Dec;14(6):931-934. 10.3348/kjr.2013.14.6.931.

Endovascular Treatment of Aneurysm of Splenic Artery Arising from Splenomesentric Trunk Using Stent Graft

• Kulkarni C
• Moorthy S
• Pullara SK
• Kannan RR

• KMID: 1711460
• DOI: http://doi.org/10.3348/kjr.2013.14.6.931

Abstract

We report a rare case of aneurysm of splenic artery arising anomalously from the superior mesenteric artery (SMA). The aneurysm was treated successfully by coil embolization of the splenic artery distal to aneurysm and then deploying a stent graft in the SMA. A combination of stent graft and coil embolization for the treatment of aberrant splenic artery aneurysm has been reported only once. We describe the imaging findings and the endovascular procedure in this patient.

Keyword

Aberrant splenic artery; Aneurysm; Stent graft

MeSH Terms

Adult
Aneurysm/radiography/*surgery
Angiography/*methods
*Blood Vessel Prosthesis
Endovascular Procedures/*methods
Humans
Male
Mesenteric Artery, Superior/radiography/*surgery
*Splenic Artery
*Stents
Tomography, X-Ray Computed/*methods
Treatment Outcome

Figure

• 

  Fig. 1 CT findings and endovascular treatment of spenic artery aneurysm. A. CT angiogram volume rendered technique (VRT) image showing splenic artery arising from superior mesenteric artery (SMA) trunk. Aneurysm is located very close to ostium. Splenic artery distal to aneurysm (white arrowhead) runs parallel to aorta. B. Axial CT image in arterial phase shows aneurysm (black arrow) located posterior to body of pancreas. C. SMA angiogram through 4 Fr Glide catheter introduced from brachial route. SMA (white arrowhead) and splenic artery distal to aneurysm (white arrow) are seen. Note first jejunal branch arising from SMA distal to aneurysm (black arrow). D. Post coil embolization angiogram showing occlusion of splenic artery and filling of aneurysm. Later frames of angiogram (not shown) showed filling of distal splenic artery through collaterals. E. Lateral view showing stent graft in position in SMA and being deployed (black arrowhead). Pigtail catheter introduced from femoral route (black arrow). F. SMA angiogram after stent graft deployment. Aneurysm is not filling. Guide wire induced vasospasm of ileal branches of SMA seen (white arrow). G. Follow-up CT angiogram after one month. VRT image showing stent graft in proximal SMA, good filling of SMA branches and complete exclusion of aneurysm. Artifacts from coils are visible on image.

Reference

1. Michels NA, Siddharth P, Kornblith PL, Parke WW. Routes of collateral circulation of the gastrointestinal tract as ascertained in a idssection of 500 bodies. Int Surg. 1968; 49:8–28.

2. Jiang J, Ding X, Su Q, Zhang G, Wang Z, Hu S. Endovascular stent-graft placement and coil embolization for an anomalous splenic artery aneurysm. J Vasc Surg. 2011; 54:208–211.

3. Sato M, Anno I, Yamaguchi M, Iida H, Orii K. Splenic artery aneurysm of the anomalous splenomesenteric trunk: successful treatment by transcatheter embolization using detachable coils. Cardiovasc Intervent Radiol. 2006; 29:432–434.

4. Graham JM, McCollum CH, DeBakey ME. Aneurysms of the splanchnic arteries. Am J Surg. 1980; 140:797.

5. Abbas MA, Stone WM, Fowl RJ, Gloviczki P, Oldenburg WA, Pairolero PC, et al. Splenic artery aneurysms: two decades experience at Mayo clinic. Ann Vasc Surg. 2002; 16:442–449.

6. Settembrini PG, Jausseran JM, Roveri S, Ferdani M, Carmo M, Rudondy P, et al. Aneurysms of anomalous splenomesenteric trunk: clinical features and surgical management in two cases. J Vasc Surg. 1996; 24:687–692.

7. Mastracci TM, Cadeddu M, Colopinto RF, Cinà C. A minimally invasive approach to the treatment of aberrant splenic artery aneurysms: a report of two cases. J Vasc Surg. 2005; 41:1053–1057.

8. Kasirajan K, Greenberg RK, Clair D, Ouriel K. Endovascular management of visceral artery aneurysm. J Endovasc Ther. 2001; 8:150–155.

9. Carrafiello G, Laganà D, Dizonno M, Mangini M, Fugazzola C. Endovascular ligature of splenic artery aneurysm with Amplatzer Vascular Plug: a case report. Cardiovasc Revasc Med. 2007; 8:203–206.

10. Kim BS, Do HM, Razavi M. N-butyl cyanoacrylate glue embolization of splenic artery aneurysms. J Vasc Interv Radiol. 2004; 15(1 Pt 1):91–94.

11. Basile A, Lupattelli T, Magnano M, Giulietti G, Privitera G, Battaglia G, et al. Treatment of a celiac trunk aneurysm close to the hepato-splenic bifurcation by using hepatic stent-graft implantation and splenic artery embolization. Cardiovasc Intervent Radiol. 2007; 30:126–128.

12. Tielliu IF, Zeebregts CJ, Vourliotakis G, Bekkema F, van den Dungen JJ, Prins TR, et al. Stent fractures in the Hemobahn/Viabahn stent graft after endovascular popliteal aneurysm repair. J Vasc Surg. 2010; 51:1413–1418.