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Feasibility of endovascular splenic artery aneurysm repair using low-profile self-expandable stent-grafts
Nanette R. Reed, MD, Gustavo Oderich, MD, Jesse Manunga, MD, Audra Duncan, MD, Manju Kalra, MBBS, Thomas Bower, MD, Mark Fleming, MD, Randall de Martino, MD, Peter Gloviczki, MD.
Mayo Clinic, Rochester, MN, USA.
Objective: Percutaneous trans-catheter embolization has been widely accepted as the first line treatment for most patients with symptomatic or large splenic artery aneurysms (SAAs). Embolization can be done safely, but carries a predictable rate of ischemic complications, which may result in in splenic infarct or abscess formation. Recent advances in endovascular technology have allowed use of self-expandable, flexible, lower profile stent-grafts. The aim of this study was to evaluate the technical feasibility and early outcomes of endovascular SAA repair using self-expandable stent-grafts.
Methods: Endovascular SAA repair (ESAAR) was performed using 0.018-inch Viabahn stent-grafts (WL Gore, Flagstaff, AZ). Brachial access was used preferentially except for patients with proximal SAAs and favorable angle of origin from the aorta. To overcome tortuosity and provide support, a co-axial system with hydrophilic sheath was used. Low profile 0.018-inch stent-grafts were used for distal SAAs and smaller (<7mm) target vessel landing zones. Follow up included clinical examination and imaging at dismissal, every 6 months during the first year and yearly thereafter. End-points were morbidity, stent-graft patency, freedom from endoleak, aneurysm sac changes, and re-interventions.
Results: ESAAR was attempted in 8 patients, 3 males and 5 females, with median age was 64 years (range 48-77 years). Median SSA size was 2.2 cm (range 1.5-4.2 cm). Seven patients were asymptomatic and one presented with pancreatitis and gastrointestinal bleeding. Primary access site was brachial artery in 5 patients and femoral in 3. Technical success of ESAAR using stent-grafts was 80% (6/8); two patients with excessive vessel tortuosity and distal SAAs failed stent-graft placement and required coil embolization. One patient developed brachial artery thrombosis treated surgically. There were no ischemic complications in patients treated by ESAAR with stent-grafts. Median length of stay was 1 day. One patient treated by coil embolization developed splenic infarct, which required readmission. Median follow-up of 4.1 months. Follow-up imaging revealed patent stent grafts and no aneurysm sac enlargement. No
re-interventions were required.
Conclusions: ESAAR using low-profile stent-grafts offers a viable treatment alternative to coil embolization in select patients with SAAs. Vessel tortuosity and distal aneurysm location may result in technical failure with currently available technology. Patients who underwent successful ESAAR with stent-grafts had no ischemic complications, stent-graft occlusions, endoleak, or sac enlargement.
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