Kagaya H, Miyata T, Koshina K, Kimura H, Okamoto H, Shigematsu K, Akahane M, Nagawa H
Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan.
Int Angiol. 2011 Aug;30(4):359-65.
The aim of this paper was to evaluate our single-center experience of the management of splenic artery aneurysm (SAA), with particular attention to the long-term results of endovascular treatment.
Thirty-eight patients with the diagnosis of SAA at the Tokyo University Hospital during the past 23 years were retrospectively reviewed. Interventions were considered for patients with SAA>2 cm in diameter. Nine patients were treated by transcatheter embolization (TE), and 8 by open surgical repair (SR). Twenty-one patients were observed (OB). TE was performed with microcoils placed distal and proximal to the aneurysm in the afferent artery to isolate the aneurysm.
In the TE group, the primary technical success rate was 100%. No 30-day mortality or any catheter-related complication was observed. The median length of hospital stay after TE, excluding one patient who required further surgery, was shorter than that after SR (8 versus 16 days, P=0.001). During follow-up (median =45 months), no patient died and no recurrence of SAA was observed. In the SR group, all aneurysms were repaired successfully without any severe complication, and no aneurysm-related death occurred during follow-up (median =57 months). In the OB group, no aneurysm rupture or increase in aneurysm size was observed during follow-up (median =35 months).
TE provided good early and long-term results, comparable to those obtained with conventional SR. In addition, TE had several advantages associated with its minimal invasiveness. TE by the isolation technique could be the first-line strategy for all SAA requiring treatment.
本文旨在评估我们单中心治疗脾动脉瘤（SAA）的经验，尤其关注血管内治疗的长期效果。
回顾性分析东京大学医院在过去23年中诊断为SAA的38例患者。直径>2 cm的SAA患者考虑进行干预。9例患者接受经导管栓塞术（TE）治疗，8例接受开放手术修复（SR）。21例患者进行观察（OB）。TE通过在动脉瘤近端和远端的传入动脉中放置微线圈来隔离动脉瘤。
TE组的主要技术成功率为100%。未观察到30天死亡率或任何与导管相关的并发症。TE后住院时间中位数（不包括1例需要进一步手术的患者）短于SR后（8天对16天，P=0.001）。在随访期间（中位数=45个月），无患者死亡，未观察到SAA复发。在SR组，所有动脉瘤均成功修复，无任何严重并发症，随访期间（中位数=57个月）未发生与动脉瘤相关的死亡。在OB组，随访期间（中位数=35个月）未观察到动脉瘤破裂或动脉瘤大小增加。
TE提供了良好的早期和长期效果，与传统SR相当。此外，TE具有微创性的诸多优点。隔离技术的TE可能是所有需要治疗的SAA的一线策略。
