Abstract: Introduction: aneurysms of splenic arteries have a fairly high prevalence in relation to the total number of all visceral aneurysms. According to modern clinical guidelines, both symptomatic and asymptomatic aneurysms are subject to treatment. Recently, the priority direction in treatment of visceral aneurysms is endovascular surgery, which is characterized by minimal invasiveness and high efficiency, which makes it possible to consider transcatheter endovascular embolization of splenic artery aneurysms as the preferred method of treatment. Aim: was to estimate the role and possibilities of endovascular methods of treatment in a patient with a false aneurysm of splenic artery (ASA) formed after pancreatic necrosis and complicated by gastrointestinal bleeding. Materials and methods: a case report of transcatheter embolization of splenic artery aneurysm using the «front-to-back-door» technique using coils and telescopic system, is presented. Results: patient was discharged on the 3rd day after embolization. The postoperative period proceeded calmly, there was no abdominal pain, indicators of clinical and biochemical blood tests were within acceptable limits. Conclusions: studies devoted to treatment of giant aneurysms of splenic artery are not described in the modern literature, there are only few reports. Treatment of this type of ASA can lead to an increase in the cost of procedure, but minimal invasiveness, technical success, almost no deaths and early activation of patients make it possible to consider transcatheter endovascular embolization as the only possible method of treatment. References 1. Chaer RA, Abularrage CJ, Coleman DM, et al. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg. 2020; 72: 3-39. https://doi.org/10.1016/j.jvs.2020.01.039 2. Wang W, Chang H, Liu B, et al. Long-term outcomes of elective transcatheter dense coil embolization for splenic artery aneurysms: a two-center experience. J Int Med Res. 2020; 48: 300060519873256. https://doi.org/10.1177/0300060519873256 3. Musselwhite CC, Mitta M, Sternberg M. Splenic Artery Pseudoaneurysm. J Emerg Med. 2020; 58: 231-232. https://doi.org/10.1016/j.jemermed.2020.02.014 4. Rhusheet P, Mark G. Splenic artery pseudoaneurysm with hemosuccus pancreaticus requiring multimodal treatment. J. Vasc. Surg. 2019; 69: 592-595. https://doi.org/10.1016/j.jvs.2018.06.198 5. Venturini M, Piacentino F, Coppola A, et al. Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives. J Clin Med. 2021; 10: 2520. https://doi.org/10.3390/jcm10112520 6. Hemp JH, Sabri SS. Endovascular management of visceral arterial aneurysms. Tech. Vasc. Interv. Radiol. 2015; 18: 14-23. https://doi.org/10.1053/j.tvir.2014.12.003 7. Regus S, Lang W. Management of true visceral artery aneurysms in 31 cases. J. Visc. Surg. 2016; 153: 347-352. https://doi.org/10.1016/j.jviscsurg.2016.03.008 8. Kok HK, Asadi H, Sheehan M, et al. Systematic review and single center experience for endovascular management of visceral and renal artery aneurysms. J. Vasc. Interv. Radiol. 2016; 27: 1630-1641. https://doi.org/10.1016/j.jvir.2016.07.030 9. Gorsi U, Agarwal V, Nair V, et al. Endovascular and percutaneous transabdominal embolisation of pseudoaneurysms in pancreatitis: An experience from a tertiary-care referral centre. Clin. Radiol. 2021; 76(314): 17-23. https://doi.org/10.1016/j.crad.2020.12.016 10. Barrionuevo P, Malas MB, Nejim B, et al. A systematic review and meta-analysis of the management of visceral artery aneurysms. J. Vasc. Surg. 2020; 72: 40-45. https://doi.org/10.1016/j.jvs.2020.05.018 11. Vemireddy LP, Majlesi D, Prasad S, et al. Early Thrombosis of Splenic Artery Stent Graft. Cureus. 2021; 13: 16285. https://doi.org/10.7759/cureus.16285 12. Kapranov MS, Kulikovskiy VF, Karpachev AA, et al. A Case Report of Successful Endovascular Treatment of «Sentinel Bleeding» in Patient with Adverse Anatomy. EJMCM. 2020; 7(2): 146-150. https://doi.org/10.31838/ejmcm.07.02.24 13. Саховский С.А., Абугов С.А., Вартанян Э.Л. и др. Эндоваскулярная коррекция структурной патологии клапанов и аорты у реципиентов сердца. Эндоваскулярная хирургия. 2021; 8(1): 53-9. Sakhovskii SA, Abugov SA, Vartanyan EL, et al. Transcatheter correction of structural valve and aortic diseases in heart recipients. Endovaskulyarnaya khirurgiya. 2021; 8(1): 53-9 [In Russ]. https://doi.org/10.24183/2409-4080-2021-8-1-53-59 14. Tipaldi MA, Krokidis M, Orgera G, et al. Endovascular management of giant visceral artery aneurysms. Sci Rep. 2021; 11: 700.
Abstract: To show possibilities to diagnose and treat toxic complications of continuous hepatic artery chemoinfusion using percutaneous implanted catheter-port system. Materials and methods: Between May 2005 and March 2007, 20 patients (pts) underwent percutaneous transfemoral implantation of the catheter-port system for treatment of unresectable colorectal liver metastases. Toxic complications (gastritis, pancreatits or stomach ulcer) occurred in three pts (each in one). Endoscopy (after arterial injection of methylene blue) and scintigraphy (after arterial injection of technetium-99m macroaggregated albumin) showed abnormal liver perfusion. Visceral angiography was performed for verification and embolization of non-targeted vessels. Angiography with embolization of collateral arteries resulted in normalization of liver perfusion and resolution of complications. At present, all pts continue to receive intraarterial chemotherapy. Transcatheter coil embolization of non-targeted arteries is effective for the management of the catheter-port system misperfusion. Reference 1. Таразов П.Г. Артериальная химиоинфузия в лечении нерезектабельных злокачественных опухолей печени (обзор литературы). Вопр. онкол. 2000; 46 (5): 521-528. 2. Балахнин П.В., Генералов М.И., Полысалов В.Н. и др. Применение чрескожных имплантируемых инфузионных систем для регионарной химиотерапии метастазов колоректального рака. Анн. хир. гепатол. 2006; 11 (2): 41-48. 3. Таразов П.Г. Роль методов интервенционной радиологии в лечении больных с метастазами колоректального рака в печень. Практ. онкол. 2005; 6 (2): 119-126. 4. Herrmann К., Waggershauser Т., Heinemann V, Reiser М. Interventional radiological procedures in impaired function of surgically implanted catheter-port systems. Cardiovasc. Intervent. Radiol. 2001; 24: 31-36. 5. Venturini M., Angeli E., Salvioni M. et al. Complications after percutaneous transaxillary implantation of a catheter for intraarterial chemotherapy of liver tumors: Clinical relevance and management in 204 patients. Am. J. Roentgenol. 2004; 182: 1417-1426. 6. Chuang V, Wallace S., Stroehlein J. et al. Hepatic artery infusion chemotherapy: Gastroduodenal complication. Am.]. Roentgenol. 1981; 137: 347-350. 7. Cohen A., Kemeny N., К hne C. et al. Is intra-arterial chemotherapy worthwhile in the treatment of patients with unresectable hepatic colorectal cancer metastases? Eur.J. Cancer. 1996; 32: 2195-2205. 8. Doria M., Doria L., Faintuch J., Levin B. Gastric mucosal injury after hepatic arterial infusion chemotherapy with floxuridine: A clinical and pathologic study. Cancer. 1994; 73 (8): 2042-2047. 9. Bledin A., Kantarjian H., Kim E. et al. 99mTc-labeled macroaggregated albumin in intrahepatic arterial chemotherapy. Am.]. Roentgenol. 1982; 139:711-715. 10. Kaplan W, Ensminger W, Come S. et al. Radionuclide angiography to predict patient response to hepatic artery chemotherapy. Cancer Treat. Rep. 1980; 64: 1217-1222. 11. Frye J., Venook A., Ostoff J. et al. Hepatic intra-arterial methylene blue injection during endoscopy: A method of detecting gastroduodenal misperfusion in patients re ceiving hepatic intra-arterial chemotherapy via implan ted pump. Gastrointestinal Endoscopy. 1992; 38 (1): 52-54. 12. Tanaka Т., Arai Y, Inaba Y. et al. Radiologic placement of side-hole catheter with tip fixation for hepatic arterial infusion chemotherapy. J. Vase. Interv. Radiol. 2003; 14: 63-68. 13. Yamagami Т., Kato Т., Iida S. et al. Value of transcatheter arterial embolization with coils and n-butyl cyanoacrylate for long-term hepatic arterial infusion chemotherapy. Radiology. 2004; 230: 792-802. 14. Herrmann K., Waggershauser Т., Sittek H. et al. Liver intraarterial chemotherapy: Use of the femoral artery for percutaneous implantation of catheter-port systems. Radiology. 2000; 215: 294-299.
