075 - Percutaneous access of the spleen for embolization of a tortuous splenic artery aneurysm
Purpose: Percutaneous transparenchymal access is an unconventional access technique when barriers are present to traditional radial/femoral access. We present a case illustrating the usage of transsplenic access to allow for stenting of a splenic artery aneurysm after traditional approaches were unsuccessful.
Material and Methods: A 69-year-old woman presented for embolization of an incidentally detected splenic artery aneurysm. Preprocedural imaging showed a 3cm distal splenic artery aneurysm with a single arterial inflow and two outflows. An initial attempt at embolization through a traditional radial artery approach was unsuccessful, as marked tortuosity of the splenic artery proximal to the aneurysm prevented stent delivery. The patient was brought back for a repeat procedure with planned percutaneous access of the intrasplenic branches of the splenic artery.
Results: Brachial artery access was obtained to begin the procedure, and a splenic artery angiogram confirmed the patient’s anatomy. Afterwards, ultrasound-guided percutaneous access of a branch of the intraparenchymal splenic artery was obtained. A wire-microcatheter system was advanced retrograde through the distal splenic artery and aneurysm sac into the proximal splenic artery. This wire was snared from the brachial access site to obtain through-and-through access, providing stability to the artery and allowing for stent deployment across the aneurysm neck. Another wire-microcatheter system was advanced through the stent interstices into the aneurysm sac, which was then packed with multiple microcoils. A repeat arteriogram demonstrated filling of the aneurysm sac and preserved arterial flow into the spleen. After removal of the through-and-through wire, gelfoam slurry was deployed through the microcatheter to occlude the intraparenchymal access site. A final arteriogram demonstrated preserved antegrade flow into the spleen and successful occlusion of the splenic artery aneurysm. The patient was followed for three years without significant complications related to the percutaneous splenic access.
Conclusions: Percutaneous transsplenic access was successfully used to stent and embolize a splenic artery aneurysm when tortuosity of the artery prevented stenting via traditional methods. This case demonstrates the safety and viability of this alternative access technique.