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Endovascular Treatment of Giant Splenic Artery Aneurysm

DOI: 10.1155/2012/964093

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Abstract:

Introduction. Visceral artery aneurysms are uncommon. Among them, splenic artery is the most common (46–60%). Most splenic artery aneurysms are asymptomatic and diagnosed incidentally, but its rupture, potentially fatal, occurs in up to 8% of cases. Presentation of Case. A female patient, 64 years old, diagnosed with a giant aneurysm of the splenic artery (approximately 6.5?cm in diameter) was successfully submitted to endovascular treatment by stent graft implantation. Discussion. Symptomatic aneurysms and those larger than 2?cm represent some of the main indications for intervention. The treatment may be by laparotomy, laparoscopy, or endovascular techniques. Among the various endovascular methods discussed in this paper, there is stent graft implantation, a method still few reported in the literature. Conclusion. Although some authors still consider the endovascular approach as an exception to the treatment of SAA, in major specialized centers these techniques have been consolidated as the preferred choice, reserving the surgical approach in cases where this cannot be used. For being a less aggressive approach, it offers an opportunity of treatment to patients considered “high risk” for surgical treatment by laparotomy/laparoscopy. 1. Introduction Visceral artery aneurysms (VAAs) are uncommon. Among them, splenic artery is the most common (46–60%), followed by hepatic artery (20%) and superior mesenteric artery (5-6%) [1–6]. Seventy-five percent of VAAs are asymptomatic. The most common symptom is pain in the upper left quadrant of the abdomen or in the epigastrium, radiating to left shoulder, nausea, and vomiting. [1, 2, 7, 8]. The rupture occurs in 3% to 8% of cases, is manifested by hypovolemic shock, and is potentially fatal [1, 2, 4, 7, 8]. The splenic artery aneurysms can be approached by laparotomy, laparoscopy, or endovascular techniques. The endovascular option, less invasive, has less morbidity and faster postoperative recovery [1–4, 8]. Among the various endovascular techniques, covered stent implantation has been little reported in the literature. The authors present a case of splenic artery aneurysm treated by this method. 2. Presentation of Case A female patient, 64 years old, controlled hypertension, and 2 previous pregnancies, presented as main complaint episodes of mild pain in the epigastrium and left hypochondrium, evolving for about 12 months. Physical examination of the abdomen was nonspecific, with ill-defined pain on palpation of the mesogastrium and left hypochondrium. In the hospital of origin she was submitted to

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