Niu Hongtao, Junfeng Sha, Jianli An, Zibo Zou, Yanchao Dong
Department of Interventional Radiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, P.R. China.
Medicine (Baltimore). 2019 May;98(19):e15205. doi: 10.1097/MD.0000000000015205.
Portal hypertension (PHT) is either a significant risk factor of development of splenic artery aneurysm (SAA), or predisposing factor of rupture.
A 57-year-old patient was admitted to our hospital because of multiple SAAs with PHT, suffered from episodes of haematemesis.
Emergency ultrasound of the abdomen showed remarkable cirrhosis and splenomegaly. Two days later, CT angiography reveal two SAA located in the splenic artery, as well as splenomegaly and features of PHT.
Transjugular intrahepatic portosystemic shunt (TIPS) was performed to decrease portal venous pressure and control esophagogastric variceal hemorrhage. Coil embolization of the main splenic artery was performed to complete thrombosis of the two SAAs and relieve critical hypersplenism.
After 3 months, follow-up enhanced CT confirmed complete thrombosis of the main splenic artery and the two aneurysm sac, and partial splenic infarction (approximately 50%).
TIPS can control easophagogastric variceal hemorrhage and decrease portal venous pressure, coil embolization of the main splenic artery can promote permanent thrombosis of aneurysm sac and relieve hypersplenism.
门静脉高压（PHT）是脾动脉瘤（SAA）发生的重要危险因素，或是其破裂的诱发因素。
一名57岁患者因多发SAA合并PHT入院，曾有呕血发作。
腹部急诊超声显示明显肝硬化和脾肿大。两天后，CT血管造影显示脾动脉有两个SAA，以及脾肿大和PHT特征。
进行经颈静脉肝内门体分流术（TIPS）以降低门静脉压力并控制食管胃静脉曲张出血。对脾动脉主干进行弹簧圈栓塞以促使两个SAA完全血栓形成并缓解严重脾功能亢进。
3个月后，随访增强CT证实脾动脉主干和两个动脉瘤囊完全血栓形成，以及部分脾梗死（约50%）。
TIPS可控制食管胃静脉曲张出血并降低门静脉压力，脾动脉主干弹簧圈栓塞可促使动脉瘤囊永久血栓形成并缓解脾功能亢进。
