Öz
Amaç: Splenik arter psödoanevrimaları (SAPA) nadir görülen ancak rüptüre olduğunda yüksek mortalite oranı olan akut batın nedenlerindendir. Travma sonrası splenik arterde yaralanma ve aktif kanamanın olması da mortalitesi yüksek ve acil tedavi gerektiren bir durumdur. Çalışmamızın amacı SAPA’larda ve splenik arter yaralanmalarında endovasküler tedavinin etkinliğini kendi tecrübemiz ve literatür bilgileri eşliğinde tartışmaktır.
Gereç ve Yöntem: 2002-2016 tarihleri arasında çeşitli nedenlerle kontrastlı bilgisayarlı tomografi ile SAPA tanısı konan 3’ü kadın, 6’sı erkek toplam 9 hastanın endovasküler tedavileri yapıldı. Endovasküler tedavi splenik arter veya anevrizmanın platin mikrosarmallarla embolizasyonu (n=8) veya kaplı stent implantasyonu (n=1) şeklinde gerçekleştirildi.
Bulgular: Dokuz hastanın %33.3’u kadın (n=3), %66.7’i erkek (n=6), ortalama yaşları 44.8 (23-66 yaş) idi. En sık semptom gastrointestinal kanama olup tüm hastalarda mevcuttu. SAPA nedenleri; travma (n=5), iyatrojenik (n=2), ve akut pankreatit (n=2) idi. Hastaların bilgisayarlı tomografi ve dijital substraksiyon anjiyografisinde psödoanevrizma (PA) (n=9) ve bir hastada splenik arterde PA'ya ek olarak splenik arter ve ven arası fistül (AVF) de gözlendi. Yedi hasta splenik arter embolizasyonu [parent arter oklüzyonu (PAO)] yapıldı, diğer 2 hasta kaplı stent ve koilleme ile tedavi edilmiştir. Tedavi sonrası sonuçlar iyi olup takip periyodunda (1 ay-14 yıl) komplikasyon gözlenmedi.
Sonuç: SAPA nadir ancak ölümcül sonuçlar doğurabilen akut batın nedenleri olup endovasküler yöntemlerle tedavileri güvenlidir ve iyi sonuçlar vermektedir.
Anahtar Kelimeler
Akut abdomen splenik arter psödoanevrizması endovasküler tedavi.
Kaynakça
- McDermott VG, Shlansky-Goldberg R, Cope C. Endovascular management of splenic artery aneurysyms. Cardiovasc Intervent Radiol 1994;17(4):179-84.
- Stabile BE, Wilson SE, Debas HT. Reduced mortality from bleeding pseudocysts and pseudoaneurysms caused by pancreatitis. Arch Surg 1983;118(1):45-51.
- Guillon R, Garcier JM, Abergel A, et al. Management of splenic artery aneurysyms and false aneurysyms with endovascular treatment in 12 patients. Cardiovasc Intervent Radiol 2003;26(3):256-60.
- Rebonato A, Maiettini D, Krokidis M, Graziosi L, Rossi M. Late migration of a covered stent into the stomach after repair of a splenic artery pseudoaneurysym. Radiology Case 2016;10(2):26-32.
- Rossi M, Rebonato A, Citone M, La Torre M, David V. Common hepatic artery aneurysm successfully treated with a celiac axis stent graft. Two years of follow up. Eur J Radiol Extra 2010;75(3):125-8.
- Ikeda O, Tamura Y, Nakasone Y, Iryou Y, Yamamshita Y, Kumamoto H. Nonoperative management of unruptured visceral artery aneurysms: Treatment by transcatheter coil embolization. J Vasc Surg 2008; 47:1212-9.
- Agrawal GA, Johnson PT, Fishman EK. Splenic artery aneurysyms and pseudoaneurysyms: Clinical distinctions and CT appearances. AJR 2007;188(4):992-9.
- LiPuma JP, Sachs PB, Sands MJ, Stuhlmiller S, Herbener TE. Angiography/interventional case of the day: Splenic artery pseudoaneurysm associated with pancreatitis. AJR 1997;169(1):262-3.
- Parihar ML, Kumar A, Gamanagatti S et al. Role of splenic artery embolization in management of traumatic splenic injuries: A prospective study. Indian J Surg 2013;75(5):361-7.
- Bessoud B, Denys A, Calmes JM et al. Nonoperative management of traumatic splenic injuries: Is there a role for proximal splenic artery embolization? AJR Am J Roentgenol 2006;186(3):779-85.
- Jesinger RA, Thoreson AA, Lamba R. Abdominal and pelvic aneurysyms and pseudoaneurysyms: Imaging review with clinical, radiologic, and treatment correlation. Radiographics 2013;33(3):E71-E96.
Öz
Aim: Although splenic artery pseudoaneuryms (SAPA) are rare cause of acute abdomen, when they rupture they have high mortality rates. Posttraumatic splenic artery injury and/or active bleeding have also high mortality rates and they require immediate treatment. In our study we aim to discuss the endovascular treatment option for SAPA with our experience and literature.
Materials and Methods: Between 2002-2016 there were 9 patients (6 male,3 female) who had endovascular treatment for SAPA diagnosed with abdominal CT. Endovascular treatment options were platinum coil embolization (n=8) or covered stent implantation (n=1).
Results: Mean age for 9 patients (6 male, 3 female) was 44.8 (in the range between 23-66 years). The only clinical symptom was massive gastrointestinal bleeding (9 patients). Etiologies for SAPAs were; trauma (n=5), iatrogenic (n=2) and acute pancreatitis (n=2). From CT scans and angio images there were pseudoaneurysms (PA) (n=9) and in one patient there were both PA and splenic arterio-venous fistula (AVF) between splenic artery and vein. Seven patients were treated with splenic artery embolization [parent artery occlusion (PAO)]. Other two patients with PA were treated with PA coiling and covered stent implantation. After treatment, results were good and in follow-up period (1-14 months) no complications were occured. Conclusion: Splenic artery injury is rare cause of acute abdomen with high mortality rate, and it can be treated safely with endovascular technics with good results.
Anahtar Kelimeler
Acute abdomen splenic artery pseudoaneursym endovascular treatment.
Kaynakça
- McDermott VG, Shlansky-Goldberg R, Cope C. Endovascular management of splenic artery aneurysyms. Cardiovasc Intervent Radiol 1994;17(4):179-84.
- Stabile BE, Wilson SE, Debas HT. Reduced mortality from bleeding pseudocysts and pseudoaneurysms caused by pancreatitis. Arch Surg 1983;118(1):45-51.
- Guillon R, Garcier JM, Abergel A, et al. Management of splenic artery aneurysyms and false aneurysyms with endovascular treatment in 12 patients. Cardiovasc Intervent Radiol 2003;26(3):256-60.
- Rebonato A, Maiettini D, Krokidis M, Graziosi L, Rossi M. Late migration of a covered stent into the stomach after repair of a splenic artery pseudoaneurysym. Radiology Case 2016;10(2):26-32.
- Rossi M, Rebonato A, Citone M, La Torre M, David V. Common hepatic artery aneurysm successfully treated with a celiac axis stent graft. Two years of follow up. Eur J Radiol Extra 2010;75(3):125-8.
- Ikeda O, Tamura Y, Nakasone Y, Iryou Y, Yamamshita Y, Kumamoto H. Nonoperative management of unruptured visceral artery aneurysms: Treatment by transcatheter coil embolization. J Vasc Surg 2008; 47:1212-9.
- Agrawal GA, Johnson PT, Fishman EK. Splenic artery aneurysyms and pseudoaneurysyms: Clinical distinctions and CT appearances. AJR 2007;188(4):992-9.
- LiPuma JP, Sachs PB, Sands MJ, Stuhlmiller S, Herbener TE. Angiography/interventional case of the day: Splenic artery pseudoaneurysm associated with pancreatitis. AJR 1997;169(1):262-3.
- Parihar ML, Kumar A, Gamanagatti S et al. Role of splenic artery embolization in management of traumatic splenic injuries: A prospective study. Indian J Surg 2013;75(5):361-7.
- Bessoud B, Denys A, Calmes JM et al. Nonoperative management of traumatic splenic injuries: Is there a role for proximal splenic artery embolization? AJR Am J Roentgenol 2006;186(3):779-85.
- Jesinger RA, Thoreson AA, Lamba R. Abdominal and pelvic aneurysyms and pseudoaneurysyms: Imaging review with clinical, radiologic, and treatment correlation. Radiographics 2013;33(3):E71-E96.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 14 Eylül 2018 |
| Gönderilme Tarihi | 8 Mart 2017 |
| Yayımlandığı Sayı | Yıl 2018 |