Treatment of Ruptured Splenic Artery Aneurysm When Endovascular Embolization Has Failed
This protocol addresses the specific high-acuity scenario in which emergency endovascular splenic artery embolization has failed to achieve complete aneurysm exclusion, or hemodynamic collapse has rendered endovascular management inadequate — encompassing splenic artery pseudoaneurysm and ruptured or impending ruptured true splenic artery aneurysm.
Clinical Scenario
The patient presents with a Type V splenic artery aneurysm: a splenic artery pseudoaneurysm, or a ruptured or impending ruptured true aneurysm. This is the highest-acuity sub-type, requiring immediate intervention.
Previous Line — Failure Condition Triggering Escalation
The preceding intervention — emergency endovascular splenic artery embolization — did not meet its primary goal: complete exclusion of the splenic artery aneurysm confirmed on immediate postoperative angiography. Technical failure of endovascular therapy or hemodynamic collapse is the escalation trigger for this protocol.
Next-Step Approach (Overview)
When endovascular therapy fails or hemodynamic collapse occurs, this protocol calls for immediate conversion to emergency surgical intervention. The specific surgical approach and its scope are defined in the full protocol.
Goal: Complete exclusion of the splenic artery aneurysm
References
DOI: 10.1016/j.jvs.2024.05.030
Type V includes pseudoaneurysm and either ruptured or impending ruptured true aneurysm.
If endovascular therapy technical failure or hemodynamic collapse occur, an immediate conversion to emergency open or laparoscopic surgery is necessary.
Complete exclusion of the aneurysm is crucial for treating this type of SAAs; endovascular splenic artery embolization or surgical approaches include SAA resection and ligation, with or without splenectomy.
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