Unit of Angiology and Vascular Surgery, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain -
Unit of Interventional Radiology, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain.
Int Angiol. 2020 Jun;39(3):241-251. doi: 10.23736/S0392-9590.20.04304-7. Epub 2020 Feb 13.
Splenic artery aneurysms are rare, potentially serious, and usually asymptomatic. Several methods are currently available to treat them, each with their own advantages and drawbacks. Therefore, its therapeutic paradigm has changed.
We review our database of splenic aneurysms (2009-2019) and undertake an exhaustive literature review. Demographic, clinical, diagnostic, therapeutic, early and follow-up outcome data were examined. Our experience comprised: 15 patients with 19 splenic aneurysms. 11 women (average age, 59.4 years) and 4 men (average age, 61.7 years). All asymptomatic.
At diagnosis, aneurysms had a mean cross-sectional diameter of 3.4 cm (3.2 and 3.9 for women and men, respectively), the largest measuring 8.5 cm. Two independent aneurysms were detected in four patients. Diagnoses were always incidental to a CT scan. Treatments consisted of open surgery (2 patients), endovascular surgery (10 patients: 7 embolizations, 3 covered stent) and observation/follow-up (3 patients). The cases of open surgery (with splenectomy) were carried out without postoperative morbidity. One embolization failed (requiring subsequent open surgery) and two suffered localized splenic infarction, but without further complications. In patients treated with a covered stent, the aneurysm was always excluded, without complications. There was no 30-day or follow-up (average 26.2 months) mortality. Splenic aneurysms are diagnosed more frequently and earlier (in the asymptomatic phase), albeit incidentally, than in the past.
The correct indication (identifying patients at risk) and individualization of treatment, in which endovascular techniques are the first-line option, have significantly improved morbidity and mortality outcomes in our hospital.
脾动脉瘤罕见且严重，通常无症状。目前有多种方法可用于治疗脾动脉瘤，每种方法都有其优点和缺点。因此，其治疗模式已经发生了变化。
我们回顾了 2009 年至 2019 年的脾动脉瘤数据库，并进行了全面的文献回顾。检查了人口统计学、临床、诊断、治疗、早期和随访结果数据。我们的经验包括：15 例 19 个脾动脉瘤患者，其中 11 例为女性（平均年龄 59.4 岁），4 例为男性（平均年龄 61.7 岁），均为无症状患者。
诊断时，动脉瘤的平均横截面积为 3.4cm（女性和男性分别为 3.2 和 3.9cm），最大的为 8.5cm。四名患者中有两名发现了两个独立的动脉瘤。诊断总是偶然通过 CT 扫描发现的。治疗包括开腹手术（2 例）、血管内手术（10 例：7 例栓塞，3 例覆膜支架）和观察/随访（3 例）。开腹手术（脾切除术）病例术后无并发症。一例栓塞失败（需要随后进行开腹手术），两例发生局限性脾梗死，但无进一步并发症。接受覆膜支架治疗的患者，动脉瘤始终被排除，无并发症。30 天内或随访期（平均 26.2 个月）无死亡。脾动脉瘤的诊断较以往更为频繁和更早（在无症状阶段），尽管是偶然发现的。
正确的适应证（确定有风险的患者）和个体化治疗，其中血管内技术是首选方法，显著改善了我们医院的发病率和死亡率。
