Laganà Domenico, Carrafiello Gianpaolo, Mangini Monica, Fontana Federico, Dizonno Massimiliano, Castelli Patrizio, Fugazzola Carlo
Università degli Studi dell'Insubria, Varese.
Radiol Med. 2005 Jul-Aug;110(1-2):77-87.
To assess the feasibility and effectiveness of endovascular treatment of splenic artery aneurysms (SAAs).
Between May 2000 and June 2003 we treated 11 true SAAs in 9 patients (7 females and 2 males; mean age 58 years), 8 saccular and 3 fusiform, 4 located at the middle tract of the splenic artery, 5 at the distal tract and 2 intra-parenchymal. The diagnosis was performed with colour-Doppler ultrasound and/or CT-angiography; 7 patients were symptomless, 1 had left hypochondriac pain, and 1 had acute abdomen caused by a ruptured SAA. Four SAAs were treated by microcoil embolization of the aneurysmal sac with preservation of splenic artery patency; in 2 cases this was associated with transcatheter injection of N-butyl-2-cyanoacrylate. Four cases were treated by endovascular ligature, with sectoral spleen ischaemia. One ruptured SAA received emergency treatment with splenic artery cyanoacrylate embolization. Two intra-parenchymal SAAs were excluded, one by cyanoacrylate embolization of the afferent artery and the other by transcatheter thrombin injection in the aneurysmal sac.
Technical success was observed in all cases (in 10/11 at the end of the procedure; in 1/11 at CT performed 3 days after the procedure). The follow-up (mean 18 months; range 6-36) was performed by colour-Doppler ultrasound and/or CT-angiography 3, 6 and 12 months after the procedure and subsequently once a year; the complete exclusion of the aneurysms was confirmed in 11/11 cases. The complications were: 4 cases of mild left pleuritis; fever and left hypochondriac pain 1 day after the procedure (in the same 4 patients and in one other case); 5 cases of sectoral spleen ischaemia and 1 case of diffuse spleen infarction with partial revascularization by collateral vessels. No alteration of the levels of pancreatic enzymes was found; a transitory increase in platelet count occurred only in the patient with diffuse spleen infarction.
Using different techniques, endovascular treatment is feasible in nearly all SAAs. It ensures good immediate and long term results, and no doubt presents some advantages in comparison to surgical treatment, as it is less invasive and allows the preservation of splenic function.
评估脾动脉瘤（SAA）血管内治疗的可行性和有效性。
2000年5月至2003年6月期间，我们对9例患者（7例女性，2例男性；平均年龄58岁）的11个真性SAA进行了治疗，其中8个为囊状，3个为梭形，4个位于脾动脉中段，5个位于远端，2个位于实质内。通过彩色多普勒超声和/或CT血管造影进行诊断；7例患者无症状，1例有左季肋部疼痛，1例因SAA破裂导致急腹症。4个SAA通过微线圈栓塞动脉瘤囊并保留脾动脉通畅进行治疗；2例同时进行了经导管注射N-丁基-2-氰基丙烯酸酯。4例通过血管内结扎治疗，导致节段性脾缺血。1例破裂的SAA接受了脾动脉氰基丙烯酸酯栓塞的紧急治疗。2个实质内SAA被排除，1个通过传入动脉氰基丙烯酸酯栓塞，另1个通过经导管向动脉瘤囊内注射凝血酶。
所有病例均取得技术成功（10/11例在手术结束时成功；1/11例在术后3天的CT检查时成功）。随访（平均18个月；范围6 - 36个月）在术后3、6和12个月通过彩色多普勒超声和/或CT血管造影进行，随后每年进行一次；11/11例均证实动脉瘤完全闭塞。并发症包括：4例轻度左胸膜炎；术后1天发热和左季肋部疼痛（同一4例患者及另外1例）；5例节段性脾缺血和1例弥漫性脾梗死伴侧支血管部分再血管化。未发现胰酶水平改变；仅在弥漫性脾梗死患者中出现血小板计数短暂升高。
采用不同技术，血管内治疗几乎适用于所有SAA。它能确保良好的近期和长期效果，与手术治疗相比无疑具有一些优势，因为它侵入性较小且能保留脾功能。
