Nemoto Hidehiko, Mori Kensaku, Takei Yohei, Kikuchi Shunsuke, Hoshiai Sodai, Yamamoto Yoshiyuki, Nakajima Takahito
Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, 305-8576, Japan.
Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Japan.
CVIR Endovasc. 2022 Aug 4;5(1):37. doi: 10.1186/s42155-022-00317-y.
Superior rectal artery (SRA) aneurysms are rare. Although melena is the most common symptom, it has not been observed in cases of aneurysms located in the SRA trunk. Here, we report a case of a ruptured SRA trunk aneurysm successfully treated with coil embolization. Including our case, three of the four reported cases of SRA trunk aneurysms were related to neurofibromatosis type 1 (NF1).
A 52-year-old woman with NF1 was referred to our hospital for the investigation of an abdominal mass with back pain. She had previously undergone a blood transfusion at another hospital for anemia without melena. Computed tomography angiography revealed a ruptured SRA trunk aneurysm measuring 3 cm in diameter and surrounded by a retroperitoneal hematoma. The aneurysm was isolated by embolizing the SRA trunk distally and proximally. Distal embolization was performed retrogradely from the internal iliac artery (IIA) via the middle rectal artery (MRA)-SRA anastomosis because the antegrade approach from the inferior mesenteric artery (IMA) failed. To our knowledge, this is the first case of successful coil embolization of an IMA branch through the IIA.
SRA trunk aneurysms are rare; however, they are frequently associated with NF1. Antegrade distal embolization beyond the aneurysm is sometimes difficult to achieve. In such cases, a retrograde approach via MRA-SRA anastomosis can be the choice for isolating SRA trunk aneurysms.
直肠上动脉（SRA）动脉瘤较为罕见。尽管黑便是最常见的症状，但在位于SRA主干的动脉瘤病例中尚未观察到。在此，我们报告一例经弹簧圈栓塞成功治疗的SRA主干动脉瘤破裂病例。包括我们的病例在内，已报道的4例SRA主干动脉瘤病例中有3例与1型神经纤维瘤病（NF1）相关。
一名患有NF1的52岁女性因腹部肿块伴背痛被转诊至我院。她此前曾因贫血在另一家医院输血，无黑便症状。计算机断层血管造影显示一个直径3 cm的SRA主干动脉瘤破裂，周围有腹膜后血肿。通过在动脉瘤的远端和近端栓塞SRA主干将动脉瘤隔离。由于从肠系膜下动脉（IMA）进行顺行入路失败，故经直肠中动脉（MRA）-SRA吻合口从髂内动脉（IIA）逆行进行远端栓塞。据我们所知，这是首例通过IIA成功对IMA分支进行弹簧圈栓塞的病例。
SRA主干动脉瘤罕见；然而，它们常与NF1相关。有时难以实现动脉瘤远端的顺行栓塞。在这种情况下，经MRA-SRA吻合口逆行入路可作为隔离SRA主干动脉瘤的选择。
