Vascular: Splanchnic Artery Aneurysm

Splanchnic Artery Aneurysm

Basics

  • Definition: 1.5x Dilation of a Splanchnic Artery
  • Sites:
    • Splenic Artery (60%) – Most Common
    • Hepatic Artery (20%) – Second Most Common
    • Celiac Artery
    • Superior Mesenteric Artery
    • Inferior Mesenteric Artery
    • Gastroduodenal Artery
    • Pancreaticoduodenal Artery
    • Gastric Arteries
    • Gastroepiploic Arteries
  • One-Third Have an Additional Aneurysm Elsewhere
  • Most Common Complication: Rupture
    • Opposed to Thrombus/Emboli in Peripheral Aneurysms
    • High Rupture/Mortality Risk in 3rd Trimester of Pregnancy
  • Most Common Cause: Atherosclerosis
    • SMA Aneurysms Most Commonly Mycotic Due to Infection

Splenic Artery Aneurysm

  • True Aneurysm
    • Most Common Visceral Aneurysm
    • Most Common in Women
      • High Mortality in Pregnancy
    • Most Common in the Middle/Distal Portion
    • “Double Rupture” Phenomenon:
      • Herald Bleed into Lesser Sac Contained with Tamponade
      • Then Rupture into Peritoneal Cavity
      • Accounts for 20-30% of Presentations for Perforation
      • May Also Be Seen in Celiac Artery Aneurysms
      • If Repairing Give Splenic Vaccines Prior – Risk for Splenectomy
  • Pseudoaneurysm
    • Most Common Cause: Pancreatitis

Treatment Indications

  • Size:
    • Splenic Artery: > 2 cm
    • Hepatic Artery: > 2 cm
    • SMA: > 2.5 cm
    • Celiac: > 2.5 cm
  • Symptomatic
  • Repair All Splenic Artery Aneurysms in Women Who are Pregnant or of Child-Bearing Age
  • Pseudoaneurysm – Rapid Growth & High Risk of Rupture
  • Repair All (High Rupture/Mortality Risk):
    • Inferior Mesenteric Artery
    • Gastroduodenal Artery
    • Pancreaticoduodenal Artery
    • Gastric Arteries
    • Gastroepiploic Arteries

Treatment Options

  • Rupture: Surgical Arterial Ligation
  • Endovascular Approach (Generally Preferred if Able):
    • Coil Embolization
      • Most Common Endovascular Intervention
      • Gastric/Gastroepiploic Arteries Require Both Proximal & Distal Embolization (May Recruit Retrograde Blood Supply)
    • Stenting
      • In Spleen, Only for Proximal Lesions – Too Tortuous for Distal Lesions
  • Surgical Approach:
    • Aneurysmorrhaphy
    • Ligation (With/Without Bypass)
    • Resection

Splenic Artery Aneurysm 1

Hepatic Artery Aneurysm 2

Celiac Artery Aneurysm 3

References

  1. Ali S, Verma V, R S, Wani I. Giant splenic artery aneurysm: case report. ISRN Surg. 2011;2011:383450. (License: Creative Commons – Unspecified)
  2. Jaunoo SS, Tang TY, Uzoigwe C, Walsh SR, Gaunt ME. Hepatic artery aneurysm repair: a case report. J Med Case Rep. 2009 Jan 21;3:18. (License: CC BY-2.0)
  3. Rama Krishnan R, Murali K, Madan R, Francis G. CT imaging findings and endovascular management of isolated spontaneous dissecting aneurysm of celiac artery. Indian J Radiol Imaging. 2013 Jul;23(3):234-7. (License: CC BY-NC-SA-3.0)