Splenic Artery Sacrifice for Aneurysm Embolization

Raj Pyne, MD, FSIR

Interventional Radiology

Rochester Regional Health

A 55-year-old female with a known history of HTN and hypothyroidism presented for evaluation of a splenic artery aneurysm.
This led to a CT angiography of the abdomen, which confirmed a 2.2 cm splenic artery aneurysm that was partially thrombosed.
Although it was partially thrombosed, the aneurysm demonstrated internal patent flow through a tortuous tubular channel directly subjacent to the thinned, dilated splenic artery wall.
A LOBO-7 vascular occluder was selected for placement.
Deployment of the LOBO-7 vascular occluder was advantageous given the process of simply unsheathing it as opposed to pushing it out and hoping it forms in proper position.
Follow-up CTA demonstrated complete and successful embolization of the distal splenic artery with occlusion of the aneurysm but sparing of nearly all the splenic parenchyma.

Figure 1: Axial and coronal CTA images demonstrate a 2.2 cm fusiform aneurysm in the distal splenic artery near the splenic hilum which is partially thrombosed (yellow arrows). The aneurysm demonstrates internal flow through a tortuous tubular channel directly subjacent to the thinned, dilated splenic artery wall. This has demonstrated interval growth over 3 years.

Figure 2: Angiography just proximal to the splenic hilar aneurysm after advancing the Envoy catheter (left) confirms optimal position for LOBO deployment. Magnified view (right) while advancing the LOBO-7 vascular occluder (ends of the LOBO denoted by two radiopaque markers near the arrow) shows great trackability of the device to the desired location.

Figure 3: Completion angiography 3 minutes later (left) demonstrating the LOBO-7 remaining in precise position without forward migration, full expansion of both discs allowing for lumen wall apposition, and complete occlusion requiring only a single device. Magnified view (right) shows the shape of the device within the occluded vessel (brackets) with radiopaque markers.

LOBO occluders are a newer option which provide significant advantages in the splenic artery vasculature.