This protocol applies to an unruptured splenic artery aneurysm that is anatomically located at the opening (ostium) of the splenic artery, or that arises from an aberrant splenic artery originating from the superior mesenteric artery — and where prior endovascular treatment failed to fully exclude the aneurysm.
The aneurysm is classified as Type IVa: sited at the ostium of the splenic artery, or involving an aberrant splenic artery that originates from the superior mesenteric artery (SMA). This anatomical configuration is distinct from other splenic artery aneurysm subtypes and directly affects intervention strategy.
Endovascular dense packing of the aneurysm sac — sac embolization by sac packing or stent-assisted packing — was performed as the initial intervention. The defined success criterion for that approach was complete exclusion of the splenic artery aneurysm confirmed on immediate postoperative angiography. When that endpoint is not met, this surgical protocol is the designated next step.
DOI: 10.1016/j.jvs.2024.05.030
Type IVa is located at the opening of the splenic artery or an aberrant splenic artery originating from the superior mesenteric artery (SMA), type IVb is a giant SAA (GSAA) defined by an aneurysm diameter of >5 cm, and type IVc is characterized by severe tortuosity or tandem aneurysms of the main splenic artery.
One SAA located on splenic artery ostial was performed sac coil packing, and the other was performed using laparoscopic SAA resection and splenic artery reconstruction owing to a wide neck and the close proximity of the inflow and outflow artery.
Technical success was defined as complete exclusion of the aneurysm via immediate postoperative angiography and complete occlusion or resection of the aneurysm under endoscopy or direct visualization.
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