From the Guidelines
Splenic vein pseudoaneurysms should be treated with angioembolization as first-line therapy due to their high risk of rupture and life-threatening hemorrhage, as recommended by recent guidelines 1. The management of splenic vein pseudoaneurysms is crucial to prevent morbidity and mortality.
Diagnosis and Treatment
- The diagnosis of splenic vein pseudoaneurysms typically involves contrast-enhanced CT angiography, which is the diagnostic modality of choice.
- The treatment of splenic vein pseudoaneurysms usually involves endovascular treatment with coil embolization or stent placement, which offers a minimally invasive approach with high success rates 1.
- In cases where endovascular techniques are not feasible, surgical options including aneurysmectomy, splenectomy, or distal pancreatectomy may be necessary.
- Immediate consultation with interventional radiology and vascular surgery is essential upon diagnosis.
Follow-up and Monitoring
- Following treatment, patients require close monitoring with follow-up imaging at 1,3, and 6 months to ensure complete resolution and detect any recurrence.
- Ultrasound (US) or contrast-enhanced ultrasound (CEUS) follow-up seems reasonable to minimize the risk of life-threatening hemorrhage and its associated complications 1.
Risks and Complications
- Pseudoaneurysms lack all three vessel wall layers, making them particularly prone to expansion and rupture, which justifies their aggressive management approach.
- The risk of pseudoaneurysm after splenic trauma is low, and in most cases, it resolves spontaneously, but angioembolization should be taken into consideration when a pseudoaneurysm is found 1.
- Post-embolization syndrome (PES) is a potential complication of angioembolization, but it is usually self-limited and resolves spontaneously in 6 to 9 days 1.
From the Research
Diagnosis of Splenic Vein Pseudoaneurysm
- The diagnosis of splenic vein pseudoaneurysm is crucial due to its potential for rupture and high mortality rate if left untreated 2
- Imaging techniques such as CT angiography can be used to establish the diagnosis, especially in cases where endoscopy and ultrasound results are negative 2
- A high index of suspicion is necessary, especially in patients with a history of trauma or pancreatitis, as splenic artery pseudoaneurysms can be asymptomatic until rupture occurs 3, 2
Treatment of Splenic Vein Pseudoaneurysm
- Treatment options for splenic vein pseudoaneurysm include open repair with or without splenectomy, endovascular approach, and percutaneous embolization 3, 4, 5
- Endovascular treatment using stent grafts or coil embolization is a minimally invasive approach that can preserve splenic function and has a faster recovery time compared to open repair 3, 4
- Percutaneous embolization with thrombin can be considered a viable technique in patients who fail endovascular embolization or have lesions inaccessible to endovascular repair 5
- Surgical ligation of the bleeding vessel and suture of the ulcer can be performed in cases where the pseudoaneurysm is caused by a penetrating gastric ulcer, with preservation of the spleen and pancreas 2
- The choice of treatment depends on the size and location of the pseudoaneurysm, as well as the patient's overall condition and medical history 3, 4, 6
Considerations for Treatment
- Pseudoaneurysms of the splenic artery are nearly always symptomatic and carry a high risk of rupture, making prompt diagnosis and treatment essential 2
- The spleen and pancreas should be preserved when treating asymptomatic true aneurysms, but management of ruptured aneurysms and pseudoaneurysms of the splenic artery usually consists of splenectomy or splenopancreatectomy 6
- Endovascular repair of splenic artery pseudoaneurysms using stent grafts appears to be safe and effective, with a potential advantage over simple coil embolization in preserving the patient from the risk of end-organ ischemia 4