[Endovascular embolization of a splenic aneurysm and of a false aneurysm of the splenic artery]. / Traitement d'un anévrisme et d'un faux anévrisme spléniques par embolisation artérielle percutanée.

Splenic artery aneurysms, once considered rare entities are now being reported with increasing frequency. Rupture may be the presenting and only symptom and can be fatal. The authors present two cases of splenic aneurysms treated by endovascular embolization. The initial imaging work-up included sonography, angiography and helical computed tomography with multiplanar and 3D reformations. This enabled comprehensive evaluation of the aneurysms, including their configuration, essential for coil selection. Embolization was uneventful. Post-embolization angiograms confirmed exclusion of the aneurysms. Follow-up CT at 9 months showed complete thrombosis of the aneurysms and no evidence of pancreatic or splenic complication. Endovascular management for definitive treatment of splenic aneurysms is technically possible and should be considered.

[Percutaneous treatment of a common iliac aneurysm extending to the hypogastric artery with embolization and a covered endoprosthesis]. / Traitement percutané d'un anévrisme iliaque primitif étendu à l'artère hypogastrique par embolisation et endoprothèse couverte.

A case of iliac aneurysm treated percutaneously by endovascular stent graft (Wallgraft - Boston) and transcatheter embolization of internal iliac artery in order to prevent retrograde filling of the aneurysm from the patent hypogastric artery is presented. The initial radiographic evaluation included arteriography, and 2D and 3D spiral CT angiograms. This enabled analysis of the extent of mural thrombus, flow direction, as well as selection of stent graft and coil size. The procedure of embolization and implantation was technically uneventful. Post procedure 3D CT and arteriography demonstrated exclusion of the aneurysm, and return to a normal flow pattern. Follow-up at 6 and 12 months confirmed the stability of the results. Percutaneous treatment of common iliac artery aneurysms involving the hypogastric artery can be performed easily, especially in elderly patients. 3D CT is essential in assessing the endo and extra luminal characteristics of the aneurysm to insure optimal results and to detect complications.

[Intra-arterial fibrinolytic therapy for acute mesenteric ischemia]. / Traitement d'une ischémie mésentérique aiguë par fibrinolyse intra-artérielle.

We report a case of mesenteric ischemia secondary to embolic occlusion treated by percutaneous intra-arterial thrombolysis. Early initial radiographic evaluation included abdominal plain film, ultrasonography, abdominal CT, and arteriography. Only selective superior mesenteric artery angiography provided definite diagnosis. The duration of ischemic symptoms before thrombolysis was 6 hours. Post procedure angiogram at 12 hours showed complete resolution of the mesenteric arterial thrombus with clinical improvement. The most important criteria for patient survival is early diagnosis and immediate treatment. Direct infusion of urokinase into the superior mesentric artery may be an alternative to surgery in selected patients and particularly in patients without evidence of frank bowel necrosis.

[Percutaneous treatment of a superficial femoral artery aneurysm using an intravascular stent-prosthesis]. / Traitement percutané d'un anévrisme de l'artère fémorale superficielle par endoprothèse couverte.

One case of superficial femoral aneurysm treated percutaneously by endovascular stent graft (Passager Boston) is reported. The initial radiographic evaluation included arteriography and color doppler sonography which enable analysis of the flow path, the extent of the wall thrombus, the choice of stended graft size. The procedure of implantation was technically trouble free. The post-procedure 3D CT and arteriography demonstrated occlusion of the aneurysm and resaturation of normal flow path. The six and twelve month check confirmed the stability of the results locally and the integrity of run off vessels. In weakened and specially elderly patient percutaneous treatment of superficial femoral artery aneurysm can be carried out easily. The contribution of 3D CT is essential in follow up to ensure an optimal result and to detect any complication.