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: Introduction: treatment of splenic artery aneurysms is a complex and urgent task of modern surgery. With the development of endovascular techniques, it became possible to use fundamentally new minimally invasive methods for correction of this pathology, the essence of which is to exclude the aneurysm from the blood flow by embolization. Case report: the article presents a case report of a young female patient without previous anamnesis, during regular examination, in which ultrasound examination, subsequent CT examination and angiography revealed saccular aneurysm of the proximal third of the splenic artery sized 22?24 mm. Patient underwent successful endovascular embolization of aneurysm with microcoils and Onyx adhesive composition using balloon assistance performed through the transradial vascular access. Conclusion: world experience and presented case report indicate high efficiency and relative safety of endovascular embolization of splenic artery aneurysms even under the condition of pathological vessel tortuosity, which significantly complicates the intervention, and also demonstrate the advantages of using transradial access in such anatomically difficult situations. References 1. Pitton MB, Dappa E, Jungmann F, et al. Visceral artery aneurysms: Incidence, management, and outcome analysis in a tertiary care center over one decade. Eur. Radiol. 2015; 25: 2004-2014. 2. Kassem MM, Gonzalez L. Splenic Artery Aneurysm. StatPearls Publishing. 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430849/ 3. Mesbahi M, Zouaghi A, Zaafouri H, et al. Surgical management of splenic artery aneurysm. Ann Med Surg (Lond). 2021; 69: 102712. 4. Lakin RO, Bena JF, Sarac TP, et al. The contemporary management of splenic artery aneurysms. Journal of Vascular Surgery. 2011; 53: 958-965. 5. Veluppillai C, Perreve S, de Kerviler B, Ducarme G. Splenic arterial aneurysm and pregnancy: A review. Presse Med. 2015; 44(10): 991-4. 6. T?treau R, Beji H, Henry L, et al. Arterial splanchnic aneurysms: Presentation, treatment and outcome in 112 patients. Diagn. Interv. Imaging. 2016; 97: 81-90. 7. Patel A, Weintraub JL, Nowakowski FS, et al. Single-center experience with elective transcatheter coil embolization of splenic artery aneurysms: technique and midterm follow-up. J. Vasc. Interv. Radiol. 2012; 23: 893-899. 8. Hogendoorn W, Lavida A, Hunink MG, et al. Open repair, endovascular repair, and conservative management of true splenic artery aneurysms. J. Vasc. Surg. 2014; 60: 1667-1676. 9. Reed NR, Oderich GS, Manunga J, et al. Feasibility of endovascular repair of splenic artery aneurysms using stent grafts. J Vasc Surg. 2015; 62(6): 1504-10. 10. Posham R, Biederman DM, Patel RS, et al. Transradial approach for noncoronary interventions: a single-center review of safety and feasibility in the first 1,500 cases. J. Vasc. Interv. Radiol. 2015; 27(2): 159-166.
Abstract: Treatment of massive hemoptysis represents a major and important medical problem in surgery. Development of endovascular surgery allows to introduce principle new methods of minimally invasive treatment of this pathology Current review represents information about bronchial artery anatomy, pathologic features of the bronchial artery, material used during embolization procedure and possible complications of treatment.
