Endoscopic ultrasound-guided coil and glue for treatment of splenic artery pseudo-aneurysm: new kid on the block!

Abstract

Background and study aims Pseudoaneurysm most commonly involves the splenic artery and is conventionally treated with angioembolization or surgery. Herein we describe six patients with splenic artery pseudoaneurysm who were treated using a new technique of endoscopic ultrasound (EUS)-guided glue and coil injection.

Patients and methods Six patients (median age 36.7, range: 19 – 60, M: F = 5:1) with splenic artery pseudoaneurysm who had failed angiographic embolization underwent EUS-guided transgastric injection of coil and glue injection between July 2016 and September 2017.

Results The diameter of the splenic artery pseudoaneurysms varied from 2.5 cm to 6.5 cm. The size (8, 14 and 16 mm) and number (1 to 5) of coils and amount of glue (1 – 2 mL) injected all were greater in larger aneurysm. All six patients had complete occlusion of the pseudoaneurysm as determined by using computed tomography at 4 weeks and EUS at 12 weeks. No complication was encountered.

Conclusion EUS-guided coil and glue injection for obliteration of splenic artery pseudoaneurysm is a feasible, highly effective and safe technique.

• References

• 1 Berceli SA. Hepatic and splenic artery aneurysms. Semin Vasc Surg 12/2005; 18: 196-201
• 2 Nosher JL, Chung J, Brevetti LS. et al. Visceral and renal artery aneurysms: A pictorial essay on endovascular therapy. RadioGraphics 2006; 26: 1687-1704
• 3 Cordova AC, Sumpio BE. Visceral artery aneurysms and pseudoaneurysms – Should they all be manage by endovascular techniques?. Ann Vasc Dis 2013; 6: 687-693
• 4 Muscari F, Barret A, Chaufour X. et al. Management of visceral artery aneurysms. Retrospective study of 23 cases. Ann Chir 2002; 127: 281-288
• 5 Saltzberg SS, Maldonado TS, Lamparello PJ. et al. Is endovascular therapy the preferred treatment for all visceral arteryaneurysms?. Ann Vasc Surg 2005; 19: 507-515
• 6 Hogendoorn W, Lavida A, Hunink MG. et al. Open repair, endovascular repair, and conservative management of true splenic artery aneurysms. J Vasc Surg 2014; 60: 1667-1676 
• 7 Abbas MA, Stone WM, Fowl RJ. et al. Splenic artery aneurysms: two decades experience at Mayo Clinic. Ann Vasc Surg 2002; 16: 442-449
• 8 Sessa C, Tinelli G, Porcu P. et al. Treatment of visceral artery aneurysms: description of a retrospective series of 42 aneurysms in 34 patients. Ann Vasc Surg 2004; 18: 695-703
• 9 Rai P, Bhera B, Sharma M. First report of successful treatment of splenic artery pseudoaneurysm with endoscopic ultrasound-guided coil and glue. Endoscopy 2017; 49: E179-E180
• 10 Lakin RO, Bena JF, Sarac TP. et al. The contemporary management of splenic artery aneurysms. J Vasc Surg 2011; 53: 958-964