**3.6. Results of different treatment options for splenic artery aneurysms:**

The results of open operative therapy are dependent on whether the procedure is an elective or emergency one, in addition to the anatomical complexity of the lesion and the nature of the required repair. Elective procedures have significantly lower perioperative morbidity and mortality compared to the emergency techniques for ruptured aneurysms which carries death rate greater than 50% in many reported series. (42).

#### **Figure 8.**

Technical success after percutaneous coil embolization of SAAs is acceptable and ranges from 81% to 98%, although some studies showed that the presence of hemodynamic instability should not preclude endovascular management. (43,44).

End-organ ischaemia is an especial concern with regard to endovascular repair. Direct complications can result from this option of treatment such as arterial dissection, acute thrombosis, or embolization to nontarget tissues, or inadequate collateral circulation after deliberate vessel occlusion. It has been concluded that cases with aneurysmal lesion at the splenic hilum may be better managed by open repair and splenectomy.(45).

Although initial technical success rates with an endovascular procedure for treating SAAs approach 100%, the long-term success is less well defined.(46).

Ultrasound-guided percutaneous thrombin injection appears to be a viable method for treating failed endovascular interventions or even an alternative to initial endovascular treatment.(47). Actually, this technique is similar to thrombin injections for femoral artery pseudoaneurysms, were ultrasound or CT guidance or both are used to help delivering thrombin to the nidus of an aneurysm, thus facilitating thrombosis. This is particularly applicable to saccular aneurysms with a narrow neck arising from the parent vessel. Continued studies, even after secondary technical success, are imperative due to the natural history of SAAs after endovascular treatment remains unclear. This is true for saccular aneurysms treated by coil or thrombin embolization. Reports of reperfusion and even rupture after successful embolization support that a thrombosed aneurysm may not represent the definitive treatment in all cases.(47,48).

#### **Author details**

146 Aneurysm

**Figure 8.**

proximal SAAs as well. (41).

However, other authors have reported splenic infarction after embolization of even more

The results of open operative therapy are dependent on whether the procedure is an elective or emergency one, in addition to the anatomical complexity of the lesion and the nature of the required repair. Elective procedures have significantly lower perioperative morbidity and mortality compared to the emergency techniques for ruptured aneurysms which carries

Technical success after percutaneous coil embolization of SAAs is acceptable and ranges from 81% to 98%, although some studies showed that the presence of hemodynamic

End-organ ischaemia is an especial concern with regard to endovascular repair. Direct complications can result from this option of treatment such as arterial dissection, acute thrombosis, or embolization to nontarget tissues, or inadequate collateral circulation after deliberate vessel occlusion. It has been concluded that cases with aneurysmal lesion at the

Although initial technical success rates with an endovascular procedure for treating SAAs

instability should not preclude endovascular management. (43,44).

approach 100%, the long-term success is less well defined.(46).

splenic hilum may be better managed by open repair and splenectomy.(45).

**3.6. Results of different treatment options for splenic artery aneurysms:** 

death rate greater than 50% in many reported series. (42).

Ahmad Alsheikhly *Hamad Medical Corporation, Doha, Qatar*

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