Borghese Ottavia, Pisani Angelo, Luparelli Antonio, Sica Simona, Minelli Fabrizio, Donati Tommaso, Tshomba Yamume
Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Rome, Italy.
Post Doctoral School Angio-Cardio-Thoracic Pathophysiology and Imaging, Sapienza University, 00185 Rome, Italy.
J Clin Med. 2024 May 9;13(10):2802. doi: 10.3390/jcm13102802.
In treatment of aneurysms (SAAs) and pseudoaneurysms (SAPs) of the splenic artery, endovascular coil embolization is the approach most commonly used as it is minimally invasive and safe. However, it carries a significant rate of primary failure (up to 30%) and might be complicated by splenic infarction. The use of stent grafts might represent a valuable alternative when specific anatomical criteria are respected. We report a comprehensive review on technical and clinical outcomes achieved in this setting. We performed a comprehensive review of the literature through the MedLine and Cochrane databases (from January 2000 to December 2023) on reported cases of stenting for SAAs and SAPs. Outcomes of interest were clinical and technical success and related complications. The durability of the procedure in the long-term was also investigated. Eighteen papers were included in the analysis, totalling 41 patients (n = 20 male 48.8%, mean age 55.5, range 32-82 years; n = 31, 75.6% SAAs). Mean aneurysm diameter in non-ruptured cases was 35 mm (range 20-67 mm), and most lesions were detected at the proximal third of the splenic artery. Stent grafting was performed in an emergent setting in n = 10 (24.3%) cases, achieving immediate clinical and technical success rate in 90.2% (n = 37) of patients regardless of the type of stent-graft used. There were no procedure-related deaths, but one patient died in-hospital from septic shock and n = 2 (4.9%) patients experienced splenic infarction. At the last available follow-up, the complete exclusion of the aneurysm was confirmed in 87.8% of cases (n = 36/41), while no cases of aneurysm growing nor endoleak were reported. None of the patients required re-intervention during follow-up. When specific anatomical criteria are respected, endovascular repair of SAAs and SAAPs using stent grafts appears to be safe and effective, and seems to display a potential advantage in respect to simple coil embolization, preserving the patient from the risk of end-organ ischemia.
在治疗脾动脉瘤（SAAs）和脾动脉假性动脉瘤（SAPs）时，血管内弹簧圈栓塞术是最常用的方法，因为它微创且安全。然而，其原发性失败率较高（高达30%），且可能并发脾梗死。当符合特定解剖学标准时，使用支架移植物可能是一种有价值的替代方法。我们报告了对此种情况下所取得的技术和临床结果的全面综述。我们通过MedLine和Cochrane数据库（从2000年1月至2023年12月）对已报道的脾动脉瘤和脾动脉假性动脉瘤支架置入病例进行了全面的文献综述。感兴趣的结果是临床和技术成功以及相关并发症。还对该手术的长期耐久性进行了研究。分析纳入了18篇论文，共41例患者（n = 20例男性，占48.8%，平均年龄55.5岁，范围32 - 82岁；n = 31例，占75.6%为脾动脉瘤）。未破裂病例的平均动脉瘤直径为35毫米（范围20 - 67毫米），大多数病变位于脾动脉近端三分之一处。10例（24.3%）病例在紧急情况下进行了支架置入，无论使用何种类型的支架移植物，90.2%（n = 37）的患者均取得了即刻临床和技术成功。无手术相关死亡，但1例患者因感染性休克在医院死亡，2例（4.9%）患者发生脾梗死。在最后一次可获得的随访中，但1例患者因感染性休克在医院死亡，2例（4.9%）患者发生脾梗死。在最后一次可获得的随访中，87.8%（n = 36/41）的病例证实动脉瘤完全闭塞，未报告动脉瘤增大或内漏病例。随访期间无患者需要再次干预。当符合特定解剖学标准时，使用支架移植物对脾动脉瘤和脾动脉假性动脉瘤进行血管内修复似乎是安全有效的，并且相对于单纯弹簧圈栓塞术似乎具有潜在优势，可使患者避免终末器官缺血的风险。
