✯✯✯ Splenic Artery Aneurysm Case Study

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Splenic Artery Aneurysm Case Study

Cilingiroglu, and W. Giant splenic artery aneurysm is Splenic Artery Aneurysm Case Study seen Character Analysis Of Hiero Or Tyrannicus? is at a high risk of rupture. Selo-Ojeme and Splenic Artery Aneurysm Case Study. Google Scholar. SAAs are usually saccular as opposed to Splenic Artery Aneurysm Case Study.

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True splenic artery aneurysms SAAs involve all layers of the wall, each of which is intact and thinning. Pseudoaneurysms are the result of a tear in the vessel wall intima with subsequent blood dissection into a false lumen and periarterial hematoma formation. They develop secondary to trauma or inflammation of the splenic artery, such as in cases of pancreatitis.

The SAA is the most common visceral artery aneurysm reported. Modifiable risk factors include atherosclerosis, portal hypertension, liver transplantation, pregnancy, and connective tissue disorders such as Marfan or Ehler-Danlos syndrome. Non-modifiable risk factors include advanced age and female gender. Splenic artery pseudoaneurysms have been associated with blunt and penetrating trauma as well as iatrogenic trauma during instrumentation. The exact etiology of visceral aneurysms is not established. Recent literature has suggested that true aneurysms develop secondary to arterial wall weakness due to several causes. Pseudoaneurysms are periarterial hematomas that develop as a consequence of iatrogenic trauma or inflammatory processes such as chronic pancreatitis.

Pseudoaneurysms lack a true wall hence they are more prone to rupture. The splenic artery is one of the major branches of the celiac axis. It courses along the superior aspect of the body, and the tail of the pancreas towards the splenic hilum arises, but its course can be variable. The artery is commonly tortuous, dividing into separate branches that provide a segmental blood supply to the spleen. Aneurysms arise in the middle or distal third of the splenic artery near its bifurcation. SAAs are usually saccular as opposed to fusiform. The most common presenting symptom is vague epigastric or left upper quadrant abdominal pain that may radiate toward the left shoulder.

Other symptoms include gastrointestinal hemorrhage with subsequent hematemesis or hematochezia, or hemorrhage into the pancreatic duct with subsequent hemobilia. True aneurysms can be silent and asymptomatic; however, pseudoaneurysms are always symptomatic. Rupture is a rare but serious complication of SAA which may manifest by acute diffuse abdominal pain and hypovolemic shock with signs and symptoms of an acute surgical abdomen. Rupture incidence increases in multiparous women and patients with portal hypertension due to increased portal blood flow. Multi-slice abdominal computerized tomography CT scan with IV contrast is the ideal diagnostic imaging modality to diagnose SAA and other visceral aneurysms.

CT is useful in detecting small SAAs and assessing anatomy for operative planning. Magnetic resonance imaging MRI is an alternative to CT, especially in patients with chronic renal insufficiency. Contrast angiography CA is the most specific imaging test to identify SAAs and may also be therapeutic. Endoscopic ultrasound can reliably distinguish SAAs from other extrinsic lesions such as pancreatic pseudocysts. Due to the increased risk of aneurysmal rupture, intervention rather than a watchful waiting is advised for aneurysms greater than 2 cm in diameter. Other indications for intervention include: symptomatic patients, women of childbearing years, concomitant pregnancy, and cirrhotic patients planning to undergo orthotopic liver transplantation or Porto venous shunting procedures.

Open surgical approach: Open surgical intervention is considered the gold standard approach for SAA repair. Techniques involving resection of an aneurysm with interposition bypass are ideal for aneurysms located in the proximal to the mid-splenic artery. Resection of an aneurysm can be combined with splenectomy in cases of a hostile abdomen or distal aneurysms located near the splenic hilum. Patients with ruptured splenic aneurysms should undergo urgent laparotomy and control of hemorrhage with ligation of an aneurysm.

Preservation of the spleen is encouraged when possible, but splenectomy should be performed if adequate hemostasis is impossible to achieve otherwise. Endovascular approach: Endovascular intervention has gained a lot of popularity recently in managing aneurysms. Techniques vary according to the type of an aneurysm, location, whether preserving the splenic artery will be preserved, and the condition of collaterals. Fusiform true aneurysms are better treated with a stent graft covered stent , while tortuous, saccular aneurysms are treated with aneurysmal coiling techniques.

Pseudoaneurysms can be treated with embolization using liquid embolic agents to thrombose the inflow and outflow arteries or filling the sac itself. Distal splenic embolization should be avoided. Minimally invasive laparoscopic approach: The laparoscopic approach is a safe therapeutic alternative for cases of elective splenic aneurysm repair. Different techniques have been employed including ligation of the mid-splenic artery via stapling or clipping to splenectomy alone for distal SAAs near the hilum.

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Splenic artery aneurysm is a challenging diagnosis that needs Interact Cardiovasc Thorac Surg ;8 3 —6. Rupture of a splenic artery aneurysm into the factors. Prompt treatment is detrimental to patient survival. Case report. Acta Chirurg Scand ; 5 —3. Hemosuc- cus pancreaticus from intraductal rupture of a primary splenic artery aneurysm. J Vasc Surg ;19 1 — J Post- grad Med ;46 3 —2.

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Ruptured splenic artery aneurysm. Pressure can Splenic Artery Aneurysm Case Study from coughing, vomiting, straining during a bowel movement, heavy lifting, or physical Splenic Artery Aneurysm Case Study. Log In Sign Up. Hybrid surgery was the next plan. When a portion of this artery balloons or widens because of Splenic Artery Aneurysm Case Study in its walls, an aneurysm develops. This case report is unique endovascular treatment by vascular plug of giant SAA in the literature. CT and MRI scans Elijah Anderson Biography useful for 3D evaluation of aneurysms, Splenic Artery Aneurysm Case Study even X-ray can detect Splenic Artery Aneurysm Case Study artery aneurysms with calcifications [ 5 ].

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