目的:脾动脉瘤(SAAs)的发病率随着影像学技术的进步而增加,需要全面的分类来指导治疗策略。本研究旨在基于动脉瘤特征提出一种新的SAA分类系统,并回顾我们中心的治疗结果。
方法:这项回顾性研究纳入了北京协和医院于2019年1月至2023年12月收治的113例SAA患者,使用计算机断层扫描血管造影(CTA)或数字减影血管造影(DSA)进行评估。基于动脉瘤的位置设计了一种新的分类系统,形态学,完整性,和母体动脉解剖结构。根据这些特点确定治疗策略,从血管内治疗到腹腔镜和开腹手术的干预措施。干预后对患者进行随访以评估死亡率,并发症,再干预,和动脉瘤相关结果。
结果:研究队列中的113例患者有127例SAA,其中女性患者占主导地位(63.7%),平均年龄为52.7岁。SAA分为五种类型,类型I是最常见的。干预技术因类型而异,囊栓塞,覆膜支架植入,动脉栓塞是最常用的。总体技术成功率为94.7%,围手术期并发症和再干预率分别为25%和0.9%,分别,干预后30天内没有死亡。中位随访时间为21个月,总并发症率为3.5%,无动脉瘤相关并发症或死亡。
结论:提出的分类系统有效地指导了SAA治疗策略的选择,结合关键的解剖和形态特征。该系统促进了较高的技术成功率和较低的并发症发生率。强调定制技术在管理SAA中的重要性。需要进一步的研究来验证该分类系统并优化治疗算法。
OBJECTIVE: The incidence of splenic artery aneurysms (SAAs) has increased with advances in imaging techniques, necessitating a comprehensive classification to guide treatment strategies. This study aims to propose a novel classification system for SAAs based on aneurysm characteristics and to review treatment outcomes at our center.
METHODS: This retrospective study included 113 patients with SAAs admitted to Peking Union Medical College Hospital from January 2019 to December 2023, assessed using computed tomography angiography or digital subtraction angiography. A new classification system was devised based on the aneurysm location, morphology, integrity, and parent artery anatomy. Treatment strategies were determined based on these characteristics, with interventions ranging from endovascular therapy to laparoscopic and open surgery. Patients were followed up after the intervention to assess mortality, complications, reinterventions, and aneurysm-related outcomes.
RESULTS: The study cohort of 113 patients with 127 SAAs had a predominance of female patients (63.7%) and a mean age of 52.7 years. The SAAs were classified into five types, with type I being the most common. The intervention techniques varied across types, with sac embolization, covered stent implantation, and artery embolization being the most frequently used. The overall technical success rate was 94.7%, with perioperative complication and reintervention rates of 25.0% and 0.9%, respectively, and no deaths within 30 days after the intervention. The median follow-up duration was 21 months, with overall complications rate of 3.5% and no aneurysm-related complications or deaths.
CONCLUSIONS: The proposed classification system effectively guides the selection of treatment strategies for SAAs, incorporating key anatomical and morphological features. This system facilitated high technical success and low complication rates, underscoring the importance of tailored techniques in managing SAAs.