PMC8449560_01
Computed tomography (CT) scan showing, in arterial phase, a giant pseudoaneurysm of the splenic artery (A, B) secondary to a huge pseudocyst (C) with concomitant invasion of upper pole spleen parenchyma and arterio-venous fistulas (D) (red arrows)
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F1
A contrast-enhanced CT scan revealed the presence of 2 huge pseudocysts, and, into the major one, localized close to pancreatic tail, the presence of a giant pseudoaneurysm of the splenic artery, with a maximum diameter of 80 mm, with associated spleen invasion and concomitant arterio-venous fistulas (Figures 1 and 2A-B).
Computed tomography (CT) scan 3D-VR (A) and MIP sagittal (B) reconstructions showing a huge pseudoaneurysm of the splenic artery secondary to pancreatic pseudocyst and concomitant invasion of spleen (yellow arrow) and arterio-venous fistulas (red arrows); CT coronal (C) and axial (D) scan in portal venous phase showing chronic occlusion of splenic vein (C) (red circle) and concomitant development of many mesenteric and omental venous collaterals (D) (red oval)
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F2
A contrast-enhanced CT scan revealed the presence of 2 huge pseudocysts, and, into the major one, localized close to pancreatic tail, the presence of a giant pseudoaneurysm of the splenic artery, with a maximum diameter of 80 mm, with associated spleen invasion and concomitant arterio-venous fistulas (Figures 1 and 2A-B). Moreover, the splenic vein was occluded with development of many renal, mesenteric, and omental collaterals (Figure 2C-D).In the angiography suite, a selective celiac trunk and then super-selective splenic artery angiography were performed through a standard percutaneous right transfemoral approach, confirming the CT findings and showing the pseudoaneurysm's origin distal to the great pancreatic artery ostium (Figure 3A).
Digital angiography. Selective angiography of splenic artery confirming a giant pseudoaneurysm (A) and selective catheterization, employing a microcatheter, of distal portion of splenic artery (B). Endovascular embolization releasing multiple metallic microcoils into the in-flow and out-flow tracts of the giant pseudoaneurysm (C). Final angiographic control confirming successful endovascular exclusion of the pseudoaneurysm with opacification of the great pancreatic artery (D)
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F3
Moreover, the splenic vein was occluded with development of many renal, mesenteric, and omental collaterals (Figure 2C-D).In the angiography suite, a selective celiac trunk and then super-selective splenic artery angiography were performed through a standard percutaneous right transfemoral approach, confirming the CT findings and showing the pseudoaneurysm's origin distal to the great pancreatic artery ostium (Figure 3A). Tokyo, Japan) for super-selective catheterisation, occluding the entire spleen artery segment involved but preserving the great pancreatic artery's ostium (Figure 3B-C). The final angiographic control showed successful and complete exclusion of the pseudoaneurysmal sac and of the intrasplenic arterio-venous fistula, with patency of the great pancreatic artery (Figure 3D). The patient was asymptomatic after the procedure and was discharged 3 days later, when a contrast-enhanced CT scan confirmed the technical success, with evidence of only minimum and neglectable ischaemic portions of splenic parenchyma, which was regularly vascularized due to collateral arterial supply to the organ coming from the gastric arteries and gastroduodenal arch through the left gastroepiploic artery (Figure 4).
Computed tomography (CT) scan performed 3 days after the procedure, confirming in arterial phase (A-C) successful endovascular embolization with multiple metallic microcoils and no opacification of the giant pseudoaneurysm, with evidence of collateral arterial supply towards the spleen (yellow arrows); portal venous phase (D) confirming no opacification of the pseudoaneurysmal sac and subsequent minimum ischaemic areas in the context of spleen parenchyma (red arrow)
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Tokyo, Japan) for super-selective catheterisation, occluding the entire spleen artery segment involved but preserving the great pancreatic artery's ostium (Figure 3B-C). The final angiographic control showed successful and complete exclusion of the pseudoaneurysmal sac and of the intrasplenic arterio-venous fistula, with patency of the great pancreatic artery (Figure 3D). The patient was asymptomatic after the procedure and was discharged 3 days later, when a contrast-enhanced CT scan confirmed the technical success, with evidence of only minimum and neglectable ischaemic portions of splenic parenchyma, which was regularly vascularized due to collateral arterial supply to the organ coming from the gastric arteries and gastroduodenal arch through the left gastroepiploic artery (Figure 4).