Sandwich embolization of a giant splenic artery aneurysm

ABSTRACT

Clinical history/pre-treatment imaging Male, 75 years old, multimorbidity, hospitalized for respiratory failure related to SARS-COV2. A CECT demonstrated a splenic artery aneurism of 7.5 cm. Treatment options/results Given the severe conditions of the patient (ASA-4), an IR treatment was decided instead of a surgical approach. Possible treatments we considered in the pre-procedural planning were the insertion of an endovascular covered stent, splenic artery embolization using a vascular Amplatzer plug or coil embolization using a "sandwich technique". Discussion We selectively catheterized the splenic artery and confirmed the aneurysmal dilatation, without evidence of contrast medium extravasation. The complex vascular anatomy allowed us to reach the site of the aneurysm only with a microcatheter, excluding the possibility of using an Amplatzer plug. The considerable size of the aneurysm prevented us from positioning an endovascular stent, forcing us to use coils and surgical glue. We catheterized the efferent branch of the aneurysm sac and embolization was carried out using a 'sandwich technique' with detachable microcoils (8x30 mm;9x30 mm and three 12x30 mm) and surgical glue emulsified with ultra-fluid oil. Postprocedural DSA demonstrated complete exclusion of the aneurysmal sac with occlusion of the splenic artery upstream. Take-home points In patients with multimorbidity, an IR treatment often offers a safer option. A careful study of the pre-procedural images is essential to plan the most suitable approach for each case.