[MP-23] The challenge of the endovascular approach to large splenic artery aneurysm with
tortuosity
Introduction
Symptomatic splenic artery aneurysms are usually treated when no other causes for abdominal pain are found. The endovascular approach to aneurysm repair is most preferred, if technically feasible, in the elective setting. We present a challenging endovascular case to treat 40mm splenic artery aneurysm.
Case Description
A 36yo uniparous lady with no significant medical history, trauma or family history presents with 3 week history of vague left upper quadrant pain. Investigations included abdominal computed tomography which identified 40mm splenic artery aneurysm, significant tortuosity of splenic artery, chronic dissection of coeliac artery with aneurysm and small left renal artery aneurysm.
Discussion
Despite open surgical approach being the most common technique to treat visceral artery aneurysms, it’s associated morbidity lent us to prefer the endovascular approach to splenic artery stenting. Retrograde approach from right femoral artery was initially attempted, however the coeliac dissection made engaging the ostium a challenge. With the use of a Sim catheter, a Progreat wire could be passed into the origin of the splenic artery, however, tortuosity precluded advancement of the wire. We changed to the antegrade approach from left axillary artery and were able to achieve cannulation that reached the aneurysm, allowing successful embolization. There were no other complications and the patient made a full recovery. Her coeliac and renal arteries remain under observation.
Symptomatic splenic artery aneurysms are usually treated when no other causes for abdominal pain are found. The endovascular approach to aneurysm repair is most preferred, if technically feasible, in the elective setting. We present a challenging endovascular case to treat 40mm splenic artery aneurysm.
Case Description
A 36yo uniparous lady with no significant medical history, trauma or family history presents with 3 week history of vague left upper quadrant pain. Investigations included abdominal computed tomography which identified 40mm splenic artery aneurysm, significant tortuosity of splenic artery, chronic dissection of coeliac artery with aneurysm and small left renal artery aneurysm.
Discussion
Despite open surgical approach being the most common technique to treat visceral artery aneurysms, it’s associated morbidity lent us to prefer the endovascular approach to splenic artery stenting. Retrograde approach from right femoral artery was initially attempted, however the coeliac dissection made engaging the ostium a challenge. With the use of a Sim catheter, a Progreat wire could be passed into the origin of the splenic artery, however, tortuosity precluded advancement of the wire. We changed to the antegrade approach from left axillary artery and were able to achieve cannulation that reached the aneurysm, allowing successful embolization. There were no other complications and the patient made a full recovery. Her coeliac and renal arteries remain under observation.