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Abstract：
OBJECTIVE: In treatment of aneurysms (SAAs) and pseudoaneurysms (SAPs) of the splenic artery, endovascular coil embolization is the approach most commonly used as it is minimally invasive and safe. However, it carries a significant rate of primary failure (up to 30%) and might be complicated by splenic infarction. The use of stent grafts might represent a valuable alternative when specific anatomical criteria are respected. We report a comprehensive review on technical and clinical outcomes achieved in this setting. Methods: We performed a comprehensive review of the literature through the MedLine and Cochrane databases (from January 2000 to December 2023) on reported cases of stenting for SAAs and SAPs. Outcomes of interest were clinical and technical success and related complications. The durability of the procedure in the long-term was also investigated. Results: Eighteen papers were included in the analysis, totalling 41 patients (n = 20 male 48.8%, mean age 55.5, range 32-82 years; n = 31, 75.6% SAAs). Mean aneurysm diameter in non-ruptured cases was 35 mm (range 20-67 mm), and most lesions were detected at the proximal third of the splenic artery. Stent grafting was performed in an emergent setting in n = 10 (24.3%) cases, achieving immediate clinical and technical success rate in 90.2% (n = 37) of patients regardless of the type of stent-graft used. There were no procedure-related deaths, but one patient died in-hospital from septic shock and n = 2 (4.9%) patients experienced splenic infarction. At the last available follow-up, the complete exclusion of the aneurysm was confirmed in 87.8% of cases (n = 36/41), while no cases of aneurysm growing nor endoleak were reported. None of the patients required re-intervention during follow-up. Conclusions: When specific anatomical criteria are respected, endovascular repair of SAAs and SAAPs using stent grafts appears to be safe and effective, and seems to display a potential advantage in respect to simple coil embolization, preserving the patient from the risk of end-organ ischemia.
摘要：
目的：在治疗脾动脉动脉瘤（SAAs）和假性动脉瘤（SAP）时，血管内弹簧圈栓塞是最常用的方法，因为它是微创和安全的。然而,它具有显著的原发性失败率(高达30%),并可能并发脾梗死.当遵守特定的解剖学标准时，使用支架移植物可能代表有价值的替代方案。我们报告了在这种情况下取得的技术和临床结果的全面审查。方法：我们通过MedLine和Cochrane数据库（2000年1月至2023年12月）对SAA和SAP支架置入报告病例进行了全面的文献综述。感兴趣的结果是临床和技术成功以及相关并发症。还研究了该程序的长期耐久性。结果：18篇论文被纳入分析，共有41名患者(n=20名男性48.8%，平均年龄55.5岁，范围32-82岁；n=31，SAA为75.6%)。未破裂病例的平均动脉瘤直径为35mm（范围20-67mm），大多数病变在脾动脉的近端三分之一处发现。支架移植在紧急情况下进行，n=10（24.3％）例，无论使用哪种类型的支架移植物，均可在90.2％（n=37）的患者中获得即时临床和技术成功率。没有手术相关的死亡,但1例患者死于感染性休克,2例(4.9%)患者出现脾梗死.在最后一次可用的后续行动中，87.8%的病例（n=36/41）证实了动脉瘤的完全排除，而没有报告动脉瘤生长或内漏的病例。随访期间没有患者需要再次干预。结论：当尊重特定的解剖学标准时，使用支架移植物进行SAAs和SAAP的血管内修复似乎是安全有效的，并且似乎在简单的线圈栓塞方面显示出潜在的优势，保护患者免受终末器官缺血的风险。
