Unruptured Splenic Artery Aneurysm
ICD-10 I72.8 · ICD-11 BD51.Y&XA0R02

Splenic Artery Aneurysm with Severe Tortuosity or Tandem Aneurysms — After Laparoscopic Surgery Has Not Achieved Complete Occlusion

This protocol addresses the management of unruptured splenic artery aneurysm in patients with Type IVc anatomy — severe tortuosity or tandem aneurysms along the main trunk of the splenic artery — where prior laparoscopic surgical intervention did not result in confirmed complete occlusion or resection.

Previous Treatment — Criteria for Escalation

The preceding line was laparoscopic splenic artery aneurysm resection or ligation (with or without splenectomy). Escalation to this protocol is indicated when that approach did not achieve the required goal: complete occlusion or resection of the aneurysm confirmed under direct visualisation.

Clinical Scenario

Type IVc splenic artery aneurysms are characterised by severe tortuosity or tandem aneurysms along the main trunk of the splenic artery — an anatomical subtype (CSAA) that presents particular technical challenges for surgical access and endovascular navigation alike.

Approach at This Line

An endovascular strategy may be considered when the anatomy permits adequate catheter access to the target site and splenic circulation remains sufficient. The complete procedural sequence, patient selection criteria, and intraprocedural management details are available in the full protocol.

Full regimen, selection algorithm, and procedural steps are behind the link below.

Treatment Goal

Complete exclusion of the splenic artery aneurysm, confirmed on immediate postoperative angiography.

Instant Access to Structured Evidence-Based Regimens

References

  1. Type IVc SAAs are characterized by severe tortuosity or tandem aneurysms along the main trunk of the splenic artery, identifying them as a subtype of CSAAs.
  2. Nonetheless, coil embolization may also be considered, depending on individual patient characteristics and adequate splenic circulation, if the guidewire can reach the target site within the splenic artery.
  3. K.S. patients received heparinization during procedures (heparin sodium 80e100 IU/kg, intravenous injection).
  4. 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.
DOI: 10.1016/j.jvs.2024.05.030
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