Splanchic Aneurysms

Question 1

What is the rate of association between splanchnic aneurysm and other aneurysms?

Answer 1

One-third of patients with a splanchnic artery aneurysm will have an associated aortic, renal, iliac, lower extremity, or cerebral artery aneurysm, signifying the importance of screening these individuals.

Question 2

What is the overall incidence in of splenchnic aneurysms in the adult population?

Answer 2

Estimated to range from 0.1% to 2%.

Increases to 10% in the elder population.

Question 3

What arteries are with the highest rate of splenchnic aneurysm?

Answer 3

Splenic artery aneurysms (SAAs) encompass the majority 60%

Hepatic Artery Aneurysms (HAA) - 20%

superior mesenteric artery aneurysms (SMAAs) 6%

celiac artery aneurysms (CAAs), 4%

gastric artery aneurysms (GAAs), 4%

jejunal, ileal, and colic artery aneurysms (4%)

pancreaticoduodenal artery aneurysms (PDAAs), 2%

gastroduodenal artery aneurysms (GDAAs) 1.5%

inferior mesenteric artery aneurysms (IMAAs), less than 1%

Question 4

What is the success rate of Endovascular treatment and 30 days mortality?

Answer 4

98% success rate

30 day mortality of 3.4% - 8.3% all required urgent treatment.

Question 5

What are the indication for intervantion in splenchnic artery aneurysms?

Answer 5

SAAs > 2 cm or symptomatic.
Pregnant women or of childbearing age regardless of size.

All pseudoaneurysms treated irrespective of size or location.

Evidence support intervention in all SMAAs, GDAAs, and PDAAs because of their high rupture rate and the associated mortality.

Question 6

In a frank rupture what is the treatment of choice?

Answer 6

A pateint with ruptured splenchnic aneurysm should be taken to the OR.
Arterial ligation is the procedure of choice without reconstruction.
Vein graft sould be used in cases of suspected infection or bowel ischemia.

Question 7

What are the limitations of using covered self expanding stents for treatment of SAA’s?

Answer 7

• Rigid delivery devices which are hard to navigate in to secondary branches.
• May occlude flow to side branches.

Question 8

What are the risk factors for Splenic Artery aneurysms

Answer 8

Female
Multiparity (nearly 50% of female with > 6 pregnancies had Splenic Artery aneurysms).
Portal Hypertension or cirrhosis (10-20%)

Question 9

What are the risk factors for Splenic Artery pseudoaneurysm?

Answer 9

Blunt trauma
Infcetion
Pancreatitis

Question 10

What is the most common location of splanchnic aneurysms?

Answer 10

Splenic Artery 60%

Question 11

What is the second most common location of splanchnic aneurysms?

Answer 11

Hepatic Artery 20%

Question 12

What are the most common location of aneurysms in the Hapatic Artery?

Answer 12

63% common hepatic
28% Right hepatic
5% Left hepatic
4% Both right and left hepatic

Question 13

What is the rate of extraparenchymal hepatic aneurysms?

Answer 13

75-80% extraparenchymal.
20% intraparenchymal.
<5% Liver

Question 14

What is the retio of male-to-female in hepatic aneurysms?

Answer 14

3:2

Question 15

What is the rate of ruptured hepatic aneurysms?

Answer 15

20-80%

Question 16

What is the risk when right or proper hepatic artery are ligated?

Answer 16

Gallbladder necrosis.

Cholecystectomy should be performed.

Question 17

What should be concidered in Common HAA?

Answer 17

Location proximal or distal to GDA.
HAA proximal to GDA can be ligated if the GDA is patent.
HAA distal to GDA, arterial reconstruction or other restoration of blood flow should be made.

Question 18

What is the rate of HAA after liver transplantation, what is the presentation and timing of this complication?

Answer 18

The incidence of hepatic artery pseudoaneurysm formation after liver transplantation is relatively low, ranging from 0.3% to 2%.
The rupture risk is higher in these cases.
They present with intra-abdominal or gastrointestinal bleeding within 2 months of transplantation.
In many cases, there is intra-abdominal infection.