Saccular Splenic Artery Aneurysm with Narrow Neck (Type I): When Endovascular Embolization Does Not Achieve Complete Exclusion
Clinical Scenario
This protocol addresses Type I splenic artery aneurysm — saccular morphology with a narrow neck, defined by a neck-to-aneurysm width ratio of <0.5. An initial endovascular approach has been attempted but the required treatment endpoint was not reached.
Prior Treatment — Goal Not Met
Endovascular sac embolization (coil packing, with or without stent assistance) was performed as the first-line intervention. The required endpoint — complete exclusion of the aneurysm confirmed on immediate postoperative angiography — was not achieved, triggering escalation to this protocol.
Next-Line Approach (Partial Overview)
The next-line strategy involves a covered stent-based endovascular technique directed across the aneurysm, combined with intraprocedural anticoagulation. Procedural criteria, technical requirements, and the full periprocedural algorithm are detailed in the complete regimen.
Full protocol and procedural details accessible via the link below.
Treatment Goal
Complete exclusion of the splenic artery aneurysm, confirmed on immediate postoperative angiography.
References
DOI: 10.1016/j.jvs.2024.05.030
- Type I aneurysms are defined as saccular with a narrow neck, characterized by a neck-to-aneurysm width ratio of <0.5.
- Covered stent implantation is also recommended when the aneurysm's landing zone is adequate and the parent artery lacks tortuosity.
- 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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