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[脾动脉瘤栓塞术:首选治疗方法。附1例报告并文献复习]

[Embolization of splenic artery aneurysms: Treatment of choice. About a case and review of the literature].

作者信息

Tijani Y, Zahdi O, Hormat-Allah M, Zaid Y, Raux M, Gouëffic Y

机构信息

Département de chirurgie vasculaire et endovasculaire, Hôpital Universitaire International Cheikh Khalifa Ben Zaid, Faculté de Médecine, Université Mohammed VI des sciences de santé (UM6SS), Casablanca, Maroc.

Service de chirurgie vasculaire, Centre hospitalo-universitaire Ibn Sina, Université Mohammed V, Rabat, Maroc.

出版信息

Ann Cardiol Angeiol (Paris). 2022 Apr;71(2):108-111. doi: 10.1016/j.ancard.2020.11.002. Epub 2020 Nov 29.

Abstract

Splenic artery aneurysms constitute 60% of digestive artery aneurysms. They are often discovered incidentally and by imaging. Currently, endovascular treatment is considered the first-line treatment, as it is less invasive with less morbidity and mortality than surgery. An aggressive approach in their management is certainly justified because the overall mortality of ruptured splenic aneurysms is 25%. False splenic aneurysms have a greater potential for rupture than true aneurysms because they grow faster. Endovascular treatment is generally indicated for aneurysms larger than 2cm or with an increase in size of more than 0.5cm/year. Embolization is rarely associated with an infarction of the spleen due to the good supply of short gastric vessels. Embolization is performed using different materials including coils, which can be used alone or with other embolic agents. Post-embolization syndrome can be seen with persistent pain, fever and other systemic symptoms. Endovascular treatment compared to open surgery is associated with better quality of life and appears to be the most cost-effective strategy. Endovascular treatment and especially coil embolization are starting to be the standard treatment. Surgical and laparoscopic treatment are reserved for ruptured aneurysms which are burdened with significant mortality, especially in pregnant women. We report the case of a 66-year-old female patient in whom a splenic artery aneurysm was discovered incidentally during an ultrasound for an ovarian cyst.

摘要

脾动脉瘤占消化系动脉瘤的60%。它们常为偶然发现,通过影像学检查确诊。目前,血管内治疗被视为一线治疗方法,因为与手术相比,它的侵入性较小,发病率和死亡率较低。对其进行积极治疗是合理的,因为破裂脾动脉瘤的总体死亡率为25%。假性脾动脉瘤比真性动脉瘤有更大的破裂风险,因为它们生长更快。血管内治疗一般适用于直径大于2cm或每年增大超过0.5cm的动脉瘤。由于胃短血管供血良好,栓塞很少导致脾梗死。栓塞可使用不同材料,包括弹簧圈,弹簧圈可单独使用或与其他栓塞剂联合使用。栓塞后综合征可表现为持续性疼痛、发热及其他全身症状。与开放手术相比,血管内治疗可带来更好的生活质量,似乎是最具成本效益的策略。血管内治疗,尤其是弹簧圈栓塞正开始成为标准治疗方法。手术和腹腔镜治疗适用于破裂动脉瘤,尤其是对孕妇,这类患者死亡率很高。我们报告一例66岁女性患者,她在因卵巢囊肿行超声检查时偶然发现脾动脉瘤。

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