Endovascular Treatment of Aneurysm of Splenic Artery Arising from Splenomesentric Trunk Using Stent Graft
A 35-year-old man presented with recurrent upper abdominal pain. Physical examination and laboratory investigations did not reveal any abnormality. Abdominal ultrasound showed an aneurysm arising from the splenic artery. CT angiography revealed a 2.2 cm saccular aneurysm arising from splenic artery close to its anomalous origin from the SMA. The aneurysm was located posterior to the body of pancreas (). The CT angiography showed that the splenic artery was the first branch of SMA and there was only a 5 mm distance between the ostium of splenic artery and the aneurysm. The next branch from the SMA was the first jejunal branch, 1 cm distal to the splenic artery ostium. The proximal SMA measured 7 mm and the distal splenic artery 6 mm in diameter. An endovascular therapy was planned. It was decided to 'trap' the aneurysm by occluding the splenic artery distal to the aneurysm with coils and placing a stent graft in the SMA to block the inflow into the aneurysm. Under conscious sedation and local anesthesia the left axillary artery was punctured and a 45 cm long 8 Fr sheath (Flexor, Cook, Bloomington, IN, USA) was placed into the upper abdominal aorta. In addition, a pigtail catheter was introduced from a right femoral route and placed at the level of SMA ostium to enable angiography prior to stent deployment. A 4 Fr vertebral Glide catheter and 0.35" hydrophilic wire (Terumo, Tokyo, Japan) combination was used to engage the splenic ostium and the catheter was negotiated through the aneurysm into the normal segment just distal to aneurysm. Four 0.38" steel coils (Tornado, Cook, Bloomington, IN, USA) with diameters ranging from 7 mm to 4 mm were delivered through the catheter to occlude the splenic artery (). The catheter was then withdrawn into the SMA and exchanged for a stiff Amplatz wire. An 8 mm × 4 cm Fluency Plus stent graft (Bard, Tempe, Arizona, USA) was negotiated over the wire and deployed with its proximal end at the SMA ostium and distal end just short of the first jejunal branch. Angiography showed complete exclusion of aneurysm and good filling of all SMA branches (). Distal splenic artery was seen reforming through left gastric and right gastroepiploic collaterals. The patient made an uneventful recovery and was discharged on the third day after procedure. There were no splenic infarcts. Follow-up CT scans at one month and three years showed patent SMA and complete thrombosis of the aneurysm. There were no splenic infarcts.