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Management of Spontaneously Ruptured Splenic Artery Aneurysm in Pregnancy with Endovascular Stent-Graft: A Case Report
Issa Mirmehdi, MD, Michael Fabian, MD.
Halifax Health, Daytona Beach, FL, USA.
OBJECTIVES:
Rupture of splenic artery aneurysm (SAA) is a rare condition that mostly occurs during pregnancy and carries a high maternal and fetal mortality. Initial hemorrhage into the lesser sac sometimes provides a very short window of opportunity for the diagnosis and treatment. Urgent or emergent surgical management is usually warranted. An endovascular approach was employed in the case presented here.
METHODS:
A 24 year-old female in her 20th week of gestation presented with epigastric abdominal pain and hemorrhagic shock related to spontaneous rupture of a large SAA in the mid portion of the splenic artery. She was emergently taken to the endovascular suite and the ruptured aneurysm was successfully excluded from circulation with the use of a balloon-expandable stent-graft.
RESULTS:
The patient regained hemodynamic stability following the procedure and was discharged home after 10 days of hospitalization. The fetus, unfortunately, did not survive. At one-year follow up, the patient remained asymptomatic.
CONCLUSIONS:
Endovascular placement of a stent-graft is a less invasive alternative to open surgical repair in hemodynamically unstable patients with ruptured SAA. This technique also allows the maintenance of native blood flow through the splenic artery, which is preferred over endovascular embolization.
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