|
|
 |
Back to Annual Meeting Posters
An Endovascular-First Approach for the Treatment of Splenic Artery Aneurysms is Safe and Efficacious
Mikel Sadek, MD, H. Leon Pachter, MD, Todd L. Berland, MD, Firas F. Mussa, MD, Neal S. Cayne, MD, Caron B. Rockman, MD, Glenn R. Jacobowitz, MD, Mark A. Adelman, MD, Thomas S. Maldonado, MD.
New York University Langone Medical Center, New York, NY, USA.
OBJECTIVES:
Splenic artery aneurysms may be treated using endovascular, laparoscopic or open approaches. This study sought to assess the safety and efficacy of an endovascular-first approach for the treatment of splenic artery aneurysms.
METHODS:
This study was a retrospective, single-center review of consecutive patients treated for splenic artery aneurysms from 7/2001 to 2/2012. Sixteen patients were identified who underwent treatment of splenic artery aneurysms that met size criteria for repair, were symptomatic, or were present in women of child-bearing age. The procedural technique was left to the discretion of the operator. Whenever feasible, covered stenting to exclude the aneurysm sac was used preferentially or as an adjunct to aneurysm coiling. Open repair was used after a failed attempt at endovascular repair or after angiography demonstrated a prohibitive risk for endovascular repair. The primary outcome evaluated was long-term aneurysm sac exclusion or repair. Secondary outcomes included technical success, conversion to open repair, and the need for a splenectomy.
RESULTS:
Of the 17 patients evaluated, the average follow-up was 2.5years (range 0-8.1years). Four patients did not have any follow-up. The average age was 58.8±9.9years, and women comprised 69% of the population. With regards to aneurysm morphology, the average splenic artery aneurysm size was 2.7±0.8cm. 56% of aneurysms were located in the middle portion of the artery, and 38% were located distally, at or beyond the first branchpoint of the splenic artery. One aneurysm was fusiform and at the origin of the celiac artery, and the remaining aneurysms were saccular. Overall technical success was 81%. Of the three patients that were not treated, two patients had tortuous anatomy and were lost to follow-up, and the third had tortuous anatomy but was treated with laparoscopic ligation and aneurysm sac excision. Two of the referrals for open repair were patient’s for whom endovascular coiling had failed previously (total of 19% conversion to laparoscopic/open repair). There were no splenectomies. With regards to long-term outcome, 85% of patients demonstrated successful long-term repair, all of the patients for whom the treatment was technically successful.
CONCLUSIONS:
This study suggests that an endovascular-first approach for the treatment of splenic artery aneurysms is safe, effective, and does not preclude future laparoscopic or open surgical treatment. Ongoing evaluation is required to validate this approach.
Back to Annual Meeting Posters
|
