Aneurysm of the Splenic Vein

Aneurysms of the portal venous system are increasingly reported in the past five years. Congenital weakness of the venous wall, trauma, pancreatitis and portal hypertension are possible etiologies. Surgical intervention is indicated in case of symptomatic aneurysms with or without progressive expansion of the aneurysm diameter. The treatment of asymptomatic splenic vein aneurysms remains debated. We report the case of an asymptomatic and uncomplicated splenic vein aneurysm for which a conservative approach was advocated with regular follow-up by means of Doppler ultrasonography. After six years of follow-up the aneurysm diameter has not changed and no complications were observed.     

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目的总结9例脾动脉瘤的临床治疗经验。方法1999年12月至2003年3月上海第二医科大学附属仁济医院经多普勒B超、CT、数字减影血管造影术(DSA)或磁共振成像(MRI)检查9例病人术前确诊为脾动脉瘤。手术方法包括动脉瘤体近远端动脉结扎术2例，动脉瘤切除脾动脉重建2例，动脉瘤切除、动脉瘤-门静脉内瘘关闭、脾切除1例，动脉瘤伴胰体尾部切除加脾切除4例。结果随访5个月至3年所有病人均手术治愈。无死亡及严重并发症。随访期间无动脉瘤复发或上消化道出血，腹水消失。结论脾动脉瘤一般起病隐匿．很少有临床症状。选择性内脏动脉造影最具有诊断价值。手术切除是脾动脉瘤最可靠的治疗方法，由于动脉瘤有破裂可能，有症状的脾动脉瘤是手术治疗的绝对指征。     

直径>5 cm的真性巨大脾动脉瘤诊治分析

目的探讨直径>5 cm的真性巨大脾动脉瘤的临床诊治特点。方法回顾性分析2013年5月至2019年11月收治的3例直径>5 cm的真性巨大脾动脉瘤患者的临床资料,并回顾相关文献。结果男性1例,女性2例,平均年龄60岁。腹痛、腹胀表现1例,左上腹部搏动性包块1例,查体发现1例;2例合并门脉高压症,女性患者均有2次妊娠史,1例左上腹触及搏动性包块,3例患者均行腹部强化CT检查。1例行介入支架腔内隔绝+瘤腔弹簧圈栓塞术;1例行开腹脾动脉瘤切除+脾切除术,术中出血少,未输血;1例行开腹脾动脉瘤切除+脾切除+脾静脉瘤切除+胆囊切除术,术中出血约400 ml,输注红细胞6 U,血浆600 ml。3例均治疗成功,无围术期死亡发生。介入治疗者随访2年3个月,无不适。手术者1例随访6年,预后较好,另1例失访。结论直径>5 cm的真性巨大脾动脉瘤罕见,具有独特的临床特征,手术切除仍是其主要且有效的治疗方法,预后较好。     

Liver Transplantation: Does Prolonged Storage Promote Non-Anastomatic Biliary Structures?

A case of a 70 year old man who was found to have an extrahepatic portal vein aneurysm during an evaluation for hematuria is reported. Extrahepatic portal vein aneurysms are rare with only twenty cases reported in the literature. Typically, patients present with hemorrhage requiring surgical exploration or the aneurysm is discovered during evaluation of another abdominal process. Management includes careful follow-up in the asymptomatic patient without underlying liver disease or portal hypertension.     

Superior mesenteric venous aneurysm

The case of a 50-year-old woman with an extremely rare venous malformation of the portal venous system is reported. The patient presented with a true aneurysm of the superior mesenteric vein, which has thus far been reported in no more than eight cases worldwide. This malformation may be congenital or acquired. Secondary aneurysms are thought to be due to liver disease, portal hypertension, trauma, or inflammation. Aneurysms of the portomesenteric venous system may be asymptomatic or give rise to severe, often dramatic conditions such as crampy abdominal pain, jaundice, and upper gastrointestinal hemorrhage secondary to portal hypertension. The diagnosis is usually made by ultrasound (B-mode or color flow Doppler), CT scan, and MRI. Invasive procedures such as venous phase mesenteric arteriography or splenoportography may be helpful in confirming it. In our opinion aneurysms of the portal venous system, even if they are congenital and (still) asymptomatic, require early surgical control because the prognosis for patients with these aneurysms is unpredictable and potential complications (e.g., portal hypertension, fistula, contained perforation, or rupture) may be fatal. In the case presented the mesenteric venous aneurysm was resected and the confluent veins were reconstructed. Supported by Boerhaave Gesellschaft e.V. Augsburg.     

Splenic vein aneurysm: is it a surgical indication?

Splenic vein aneurysms are rare and are usually caused by portal hypertension. Symptoms are unusual, but may include rupture or abdominal pain. Diagnosis can usually be made either by means of duplex ultrasonography or computed tomography scanning. Treatment varies from noninvasive follow-up to aneurysm excision. We report an expanding splenic vein aneurysm in a young woman with abdominal and back pain and no history of portal hypertension. She was treated with aneurysm excision and splenectomy.     

Aneurysm of the splenic artery

Two cases of multiple aneurysms of the splenic artery are reported. The aneurysms themselves were asymptomatic and the patients were operated upon for other reasons. In the first case the aneurysm was of an arteriosclerotic nature and in the second it coexisted with portal hypertension. The literature on this subject is briefly reviewed.     

Endovascular management of a splenic artery aneurysm

Splenic artery aneurysms represent the third most common aneurysm in the abdomen. The majority are asymptomatic and discovered incidentally by abdominal imaging. The overall rupture rate is low but the associated mortality rate is high, especially in pregnant women and patients with portal hypertension. Traditionally, open surgical modalities represented the only viable treatments. More recently, laparoscopic and endovascular techniques have been applied to these vascular lesions. We report a case of a giant splenic artery aneurysm that was diagnosed incidentally and managed successfully by percutaneous splenic artery embolization. The case is presented and general considerations regarding the presentation, diagnosis, and management of splenic artery aneurysms are reviewed.     

Popliteal vein aneurysm

Although popliteal venous aneurysms are uncommon, they are also potentially fatal because they can cause a pulmonary embolism. The authors report a case of a popliteal vein aneurysm in a healthy, asymptomatic 32-year-old patient as well as a review of the literature. Popliteal venous aneurysms are a rare but treatable cause of recurrent pulmonary embolism, with their true incidence probably being underestimated. Whenever possible, we recommend early surgical repair of both symptomatic and asymptomatic popliteal venous aneurysms because they are associated with an ill-defined risk of pulmonary embolism and death if left untreated.     

Splenic artery aneurysm--a rare cause for extrahepatic portal venous obstruction: a case report

Splenic artery aneurysm is a rare yet very important clinical entity because of its potential for rupture with fatal consequences. Most of the splenic artery aneurysms are found in the middle and distal third of the splenic artery and are usually small (< or = 2 cm) at the time of diagnosis. We describe a rare case of large (5x4 cm) juxta-ostial splenic artery aneurysm causing compression of the splenoportal confluence and adjoining proximal portal vein in a 40-year-old woman.     

Das venöse Popliteaaneurysma

Popliteal venous aneurysms are very rare. Due to the risk of a venous thrombosis or pulmonary embolism, aneurysms of the popliteal vein are treated primarily surgically. Indications for surgery are a previous venous aneurysm, in case of large aneurysms, flow irregularities on duplex sonography and sac-like aneurysms. Popliteal venous aneurysms are most often resected tangentially and the popliteal vein closed with a continuous suture, however, more complex reconstructions may also be necessary. Monitoring of the patient is only possible in cases of small, fusiform and asymptomatic aneurysms. Continuous anticoagulation may be required in individual cases when a reconstruction is not possible due to previous thrombosis and repeated pulmonary embolisms.     

Popliteal vein aneurysm causing pulmonary embolus

A case of pulmonary embolus arising from a popliteal vein aneurysm is reviewed. These aneurysms are believed to be developmental in origin; with the exception of embolic phenomenon, these venous anomalies are generally asymptomatic. To our knowledge, only six cases have been previously reported. Physical examination was not helpful, and noninvasive studies were of no value in detecting the aneurysm. Venography was the only reliable diagnostic test. Because popliteal vein aneurysms are a potential source of emboli, surgical intervention is recommended. Venous aneurysmorrhaphy or excision of the aneurysm with a venous bypass are the surgical procedures most often carried out. Aneurysmorrhaphy appears to be associated with an unacceptably high rate of thrombosis; excision with placement of a vein graft may be a more satisfactory alternative.     

Extrahepatic Portal Vein Aneurysm—Report of Six Patients and Review of the Literature

Extrahepatic portal vein aneurysm is a rare condition. We report six patients with extrahepatic portal vein aneurysm, four of whom were surgically treated. In addition, a review of the literature was performed to examine natural history, management, and outcomes regarding portal vein aneurysm. Patients seen at our institution with extrahepatic portal vein aneurysm greater than 1.9 cm in diameter were reviewed (1998 to 2006). There were five females and one male; median age was 66.5 (30–77). Computed tomography (CT) scan was utilized for diagnosis in all cases. The median diameter of the aneurysm was 4.7 cm (2.7–6.0). Indications for surgery included gallstone pancreatitis, mass effect on the adjacent duodenum, a peripancreatic mass, and liver cirrhosis. Three patients underwent aneurysm resection, and one patient had an orthotropic liver transplant. Two patients were managed with observation. The median follow-up from first presentation and surgery was 50 months (9–181) and 5 months (2–73), respectively. At last follow-up, five patients were alive with radiologically proven portal vein patency. One patient died 2 months after liver transplantation. There was no case of aneurysmal rupture. One patient had intramural thrombus at presentation that resolved with conservative treatment. This report suggests that symptomatic aneurysms can be safely resected with excellent patency. This paper was presented at the AHPBA Meeting, April 19–22, 2007, Las Vegas, Nevada USA.     

Aneurysm of superior mesenteric vein: case report with 5-year follow-up and review of the literature

Venous aneurysms are less common than arterial aneurysms in clinical practice, and the occurrence of isolated cases is a topic for publication. Aneurysms of the superior mesenteric vein are rare, and their origin is unknown. Many aneurysms are asymptomatic, and the diagnosis is established from radiologic findings. Others are diagnosed after complications such as gastrointestinal bleeding or thrombosis with associated abdominal pain. Because of the rarity of this disease and consequent absence of standard treatment, therapy must be adapted to fit each case. We present a case report of an aneurysm of the superior mesenteric vein. The diagnosis of this anomaly was made after investigation of abdominal pain. Computed tomography (CT) scans demonstrated the mass. Clinical treatment was administered, and no aneurysm growth was observed after 5 years of follow-up.     

Extra-hepatic portal vein aneurysm: A case report, overview of the literature and suggested management algorithm

INTRODUCTIONPortal venous aneurysms are a rare finding. The reported incidence is on the rise with increasing use of modern imaging techniques in clinical practice. However, there is still much to be elicited regarding their aetiology, natural history, and management.PRESENTATION OF CASEAn 80-year-old woman presented with abdominal pain and nausea. Investigations showed a hypoechoic area in the region of the head of pancreas on ultrasound, which was found to be a portal venous aneurysm on CT. In view of her multiple comorbidities, a conservative approach was taken.DISCUSSIONPortal venous aneurysms represent approximately 3% of all venous aneurysms with a reported prevalence of 0.43%. They may be congenital, due to failure of complete regression of the right vitelline vein, or acquired secondary to portal hypertension. The primary presentation of portal vein aneurysm is abdominal pain, followed by incidental detection on imaging, with a minority of patients presenting with gastrointestinal bleeding. Complications of PVA include thrombosis, biliary tract obstruction, inferior vena cava obstruction, and duodenal compression. On the whole PVAs are stable and have a low risk of complications with 88% of patients showing no progression of aneurysm size or complications on subsequent follow up scans.CONCLUSIONWe recommend that portal venous aneurysms be assessed using colour Doppler ultrasonography in the first instance with CT scans reserved for indeterminate cases or symptomatic patients. Due to the slow progression of such aneurysms, surgery is recommended only for symptomatic patients or those with complications secondary to portal venous aneurysms.     

Treatment of three pancreaticoduodenal artery aneurysms associated with coeliac artery occlusion and splenic artery aneurysm: a case report and review of the literature.

A case of three pancreaticoduodenal artery (PDA) aneurysms associated with coeliac artery occlusion and a concomitant splenic arterial aneurysm is described. Surgical treatment was used because it was anticipated that the hepatic blood supply would be obstructed completely if percutaneous transluminal embolization for three PDA aneurysms were performed. Splenectomy in continuity with the splenic artery aneurysm and PDA aneurysmectomies were performed, and infrarenal abdominal aorto-splenic artery bypass was accomplished using a 6mm ringed expanded polytetrafluoroethylene graft. The postoperative course was uneventful. Graft patency and successful aneurysm ablation were confirmed using MRA and intravenous DSA. Arterial histology revealed segmental arterial mediolysis. At 2-year follow-up, the patient was well and asymptomatic. A literature review of PDA aneurysms is presented.     

A case report of extrahepatic portal vein aneurysm with thrombosis

Extrahepatic portal vein aneurysm (PVA) is very rare with only 17 previously reported cases.Methods of treatment include resection,thrombectomy,and portal venous decompression.We report herein the first case of large PVA with thrombosis which has been managed without surgical treatment over a long period.A PVA was detected in a 78-year-old woman by abdominal ultrasonography.Computed tomography revealed an aneurysm of 6 cm in a diameter in the porta hepatis.Portal venography showed obstruction of the portal vein and developed collateral vessels around the aneurysm.Since the patient had no symptoms of portal hypertension,we decided to carefully manage her clinical course without surgical treatment.At present,this patient is healthy and has developed no complications over the 5 years since leaving our hospital.This case suggests that surgical treatment is not required for PVA without portal hypertension.     

Splenic artery aneurysms: postembolization syndrome and surgical complications

BACKGROUND: This study assessed the endovascular embolization of splenic artery aneurysms and false aneurysms with special consideration given to postoperative complications. METHODS: Fifteen patients (11 women; mean age, 56 y; range, 39-80 y) with splenic artery aneurysm (n = 13) or false aneurysm (n = 2) were treated with coil embolization. The lesion was asymptomatic in 9 patients, symptomatic in 5 patients, and ruptured in 1 patient. The mean aneurysm diameter was 33 +/- 23 mm (range, 15-80 mm). Postoperative follow-up evaluation included a clinical visit and spiral computed tomography at 1, 4, and 12 months, and yearly thereafter. RESULTS: Endovascular treatment was possible in 14 patients (93%) (1 failure: neck cannulation). Perioperative mortality was not observed. Morbidity included postembolization syndrome in 5 patients (30%). Neither pancreatitis nor spleen abscess occurred. The mean follow-up period was 36 months (range, 3-60 mo). During follow-up evaluation we detected 1 sac reperfusion that was sealed successfully with additional coils. Surgical conversion or open repair were never required. CONCLUSIONS: At our institute, endovascular treatment represents the first-line treatment for splenic artery aneurysms. Postembolization syndrome and infarcts are common events but generally resolve without sequelae.     

Case Report: Primäres venöses Aneurysma der medialen Mittelfussvene als seltene Differentialdiagnose zu Ganglien am Fuss

During the last years, the aneurysms of the superficial venous system become diagnosed more frequently because of the frequent use of vascular ultrasound. The main trunks of the great or small saphenous veins are mostly affected as a consequence of pathologic venous reflux and degenerative changes of the venous wall in patients with varicose veins. Superficial venous aneurysms of the upper extremities (cephalic and basilica veins) and neck (external jugular vein) were seen often. However, superficial venous aneurysms located on the dorsum of the foot are rare and there were only several case reports published in the literature about them. We present the case of a young woman with a primary aneurysm of the medial marginal vein of the foot.