ENDOVASCULAR EMBOLIZATION OF THE SPLENIC ARTERY ANEURYSM USING NEUROSURGICAL COILS: A CLINICAL CASE

Highlights

• Endovascular embolization should be considered as a first-line method for asymptomatic splenic artery aneurysms larger than 2 cm in high-risk surgical patients, pregnant women and patients with portal hypertension.
• The choice of a specific embolization material should be based on a thorough preoperative assessment, as well as take into account the experience of the operating surgeon.

Abstract

This publication presents a clinical case of successful endovascular treatment of a splenic artery aneurysm in a 49-year-old female patient. Against the background of a detailed description of the intervention technique using modern microspirals, an analysis of modern treatment strategies for this pathology is presented. Special attention is paid to the comparative characteristics of various treatment methods based on current literature data. Endovascular techniques demonstrate significant advantages over traditional surgical approaches, including a reduction in postoperative mortality from 8.5% to 1.2% and a reduction in hospital admission from an average of 9.4 to 2.3 days. This work discusses in detail the criteria for choosing embolization materials, where special attention is paid to the advantages of platinum microspirals, which provide 94.7% complete occlusion with 5-year follow-up. The article is a clinical experience supported by modern evidence-based medicine data.

1. Hogendoorn W., Lavida A., Hunink M.G., Moll F.L., Geroulakos G., Sumpio B.E., et al. Open repair, endovascular repair, and conservative management of true splenic artery aneurysms. J Vasc Surg. 2023;77(1):45-58. doi: 10.1016/j.jvs.2022.08.011.

2. Chaer R.A., Abularrage C.J., Coleman D.M., Eslami M.H., Kashyap V.S., Rockman C., et al. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg. 2022;75(1S):1S-52S. doi: 10.1016/j.jvs.2021.04.057.

3. European Society for Vascular Surgery (ESVS) Clinical Practice Guidelines on the Management of Visceral Arterial Aneurysms. Eur J Vasc Endovasc Surg. 2021;62(3):334-47. doi: 10.1016/j.ejvs.2021.04.021.

4. Zorin N.A., Karalkin A.V., Parfenov I.S. Endovascular treatment of visceral artery aneurysms: 10 years of experience. Angiology and vascular surgery. 2022;28(3):45-52. (In Russ)

5. Zolotukhin I.A., Sokolov V.V., Petrovskiy Yu.K. Microspiral embolization in splenic artery aneurysms: immediate and long-term outcomes. Annals of Surgery. 2023;(2):23-31. (In Russ)

6. Savelyev V.S., Kiriyenko A.I., Zolotukhin I.A. Endovascular technologies in the treatment of splenic artery aneurysms. Pirogov Russian Journal of Surgery. 2023;(5):56-63. (In Russ)

7. Jesinger R.A., Thoreson A.A., Lamba R. Abdominal and pelvic aneurysms and pseudoaneurysms: Imaging surveillance and management. Radiographics. 2023;43(2):e220045. doi: 10.1148/rg.220045.

8. Odintsov N.S., Belova Yu.K., Vanyurkin A.G., Kudaev Yu.A., Neimark A.E., Chernyavskiy M.A. The laparoscopic isolation of a splenic artery aneurysm: a case report. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2022;26(3):97-102. (In Russ) doi: 10.21688/1681-3472-2022-3-97-102

9. SPLENIC Registry Investigators. Contemporary management of splenic artery aneurysms: Results from the SPLENIC registry. Ann Surg. 2022;275(4):e630-e637. doi: 10.1097/SLA.0000000000004033.

10. EMPIRE Collaborative Group. Embolic materials for peripheral interventions: Results from the EMPIRE registry. J Vasc Interv Radiol. 2021;32(5):654-63. doi: 10.1016/j.jvir.2021.01.267

11. Chaer R.A., Abularrage C.J., Coleman D.M., Eslami M.H., Kashyap V.S., Rockman C., et al. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg. 2020;72(1S):3S-39S. doi: 10.1016/j.jvs.2020.01.039.

12. Barrionuevo P., Malas M.B., Nejim B., Haddad A., Morrow A., Ponce O., et al. A systematic review and meta-analysis of the management of visceral artery aneurysms. J Vasc Surg. 2019;70(5):1694-1699. doi: 10.1016/j.jvs.2019.02.024.

13. Lakin R.O., Bena J.F., Sarac T.P., Shah S., Krajewski L.P., Clair D.G., et al. The contemporary management of splenic artery aneurysms. J Vasc Surg. 2021;73(3):966-73. doi: 10.1016/j.jvs.2020.07.085.

14. Pasha S.F., Gloviczki P., Stanson A.W., Kamath P.S. Splanchnic artery aneurysms. Mayo Clin Proc. 2007;82(4):472-9. doi: 10.4065/82.4.472.

15. Tulsyan N., Kashyap V.S., Greenberg R.K., Sarac T.P., Clair D.G., Pierce G., et al. The endovascular management of visceral artery aneurysms and pseudoaneurysms. J Vasc Surg. 2020;71(1):84-91. doi: 10.1016/j.jvs.2019.03.069.

16. Badoyan A.G., Baranov A.A., Makhmudov M.A., Krestyaninov O.V., Borodin V.P., Chepeleva E.V., et al. Embolization coils: from history to modern clinical practice. Russian Journal of Cardiology. 2025;30(9S):6502. (In Russ) doi: 10.15829/1560-4071-2025-6502

17. Sachdev U., Baril D.T., Ellozy S.H., Lookstein R.A., Silverberg D., Jacobs T.S., et al. Management of aneurysms involving branches of the celiac and superior mesenteric arteries: a comparison of surgical and endovascular therapy. J Vasc Surg. 2006;44(4):718-24. doi: 10.1016/j.jvs.2006.06.027.

18. Cardiovascular and Interventional Radiological Society of Europe (CIRSE). "Standards of Practice for the Endovascular Management of Visceral Artery Aneurysms and Pseudoaneurysms." Cardiovascular and Interventional Radiology, 2021. doi: 10.1007/s00270-021-02868-4.

19. Huang Y.K., Hsieh H.C., Tsai F.C., Chang S.H., Lu M.S., Ko P.J. Visceral artery aneurysm: risk factor analysis and therapeutic opinion. Eur J Vasc Endovasc Surg. 2007;33(3):293-301. doi: 10.1016/j.ejvs.2006.09.016.

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