Nanette R. Reed, MD, Gustavo S

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Presentation transcript:

Feasibility of endovascular repair of splenic artery aneurysms using stent grafts Nanette R. Reed, MD, Gustavo S. Oderich, MD, Jesse Manunga, MD, Audra Duncan, MD, Sanjay Misra, MD, Leonardo R. de Souza, MD, Mark Fleming, MD, Randall de Martino, MD Journal of Vascular Surgery Volume 62, Issue 6, Pages 1504-1510 (December 2015) DOI: 10.1016/j.jvs.2015.07.073 Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 1 Left brachial access is preferred in most of the patients. A, A 9F sheath is advanced to the descending thoracic aorta, and a buddy catheter is used to gain selective catheterization of the celiac axis. B, To overcome tortuosity in selected cases, through-and-through access is gained with a 0.014-inch wire, which is snared through a femoral artery access. C and D, A 6F hydrophilic sheath is advanced into the distal splenic artery over a 0.018-inch wire. In some patients with a tortuous splenic artery, the advancement is done over an undersized angioplasty balloon. E, After deployment of the low-profile stent grafts, (F) additional self-expandable uncovered stents may be needed to prevent kinking. (Reprinted by permission of the Mayo Foundation for Medical Education and Research. All rights reserved.) Journal of Vascular Surgery 2015 62, 1504-1510DOI: (10.1016/j.jvs.2015.07.073) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 2 A, After positioning a 9F sheath in the descending thoracic aorta, a buddy catheter was used to gain selective catheterization to the celiac axis. B, Catheterization of the distal splenic artery may be difficult, especially when tortuosity occurs. C, A 6F hydrophilic sheath was advanced into the distal splenic artery over a 0.018-inch wire. D, The stent-graft was advanced and positioned protected by the 6F sheath, (E) which was then retracted. F, After deployment of the stent graft, angiography showed patency of the splenic artery, and no flow into the aneurysm sac. Journal of Vascular Surgery 2015 62, 1504-1510DOI: (10.1016/j.jvs.2015.07.073) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 3 A, A 42-year-old woman presented with an incidentally diagnosed 5-cm splenic artery aneurysm (SAA). B and C, Endovascular treatment was performed. D, The volume-rendered image from the computed tomography scan performed 6 months after the treatment shows the patency of the stent graft and no flow into the aneurysm sac. Journal of Vascular Surgery 2015 62, 1504-1510DOI: (10.1016/j.jvs.2015.07.073) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 4 A, A 48-year-old woman presented with an asymptomatic 2.3-cm splenic artery aneurysm (SAA). B, A volume-rendered image of the computed tomography scan performed 6 months after the endovascular treatment shows the patency of the stent graft and no flow into the aneurysm sac. Details of this treatment are presented in Fig 2. Journal of Vascular Surgery 2015 62, 1504-1510DOI: (10.1016/j.jvs.2015.07.073) Copyright © 2015 Society for Vascular Surgery Terms and Conditions