Transcatheter embolization for giant splenic artery aneurisms: still an open question

Abstract

Transcatheter embolization is the mainstay of the therapy of splenic artery aneurysms (SAAs) in patients with portal hypertension. It is indicated when the SAA diameter reaches 20 mm. Although endovascular techniques are effective and safe for the treatment of medium-sized SAAs, little is known about their applicability to large-sized SAAs. Herein, we report a case of giant SAA, which was treated with transcatheter coil embolization. The case was not considered suitable for surgery because of the presence of severe portal hypertension. The procedure was complicated by bacterial infection of the coils within the aneurismatic sac, leading to the development of hepatic failure. A liver transplant was then successfully performed despite the presence of a nonresponsive infection.

Figure 1

Computed tomography (CT) of the abdomen showing a tortuous and ectasic splenic artery with some widely dilated sections (max 24 mm calibre) and massive aneurysmal dilation in the middle tract (90 mm of maximum diameter) with partly calcified walls, inducing a cranial displacement of the tail and the body of the pancreas.

Figure 2

The placement of 11 guidewires and 75 coils within the aneurysmal sac.

Figure 3

Abdominal ultrasound confirming the exclusion of the SAAs with complete preservation of distal flow to the spleen.

Figure 4

Tc-99m labelled white cells scintigraphy showing a progressive accumulation of circular leucocytes (90 × 90 mm) with sonolucent halo surrounding the aneurysm wall.