Splanchnic Artery Aneurysms

Front 1

What are the most common splanchnic artery aneurysms?

Back 1

Most common splanchnic artery aneurysm:

1. Splenic artery 60%
2. Hepatic artery 20%
3. SMA 5.5%
4. Celiac/gastric/gastroepiploic 4%
5. IMA is least common

Front 2

_______ of splanchnic artery aneurysms are associated with non-visceral aneurysms.

Back 2

One-third of splanchnic artery aneurysms are associated with non-visceral aneurysms.

Front 3

What are the risk factors for the develoment of splenic artery aneurysms?

Back 3

Risk factors for splenic artery aneurysm:

1. Female gender (4:1)
2. multiple pregnancies
3. portal HTN with splenomegaly
4. medial fibrodysplasia
5. trauma
6. inflammation

Front 4

What are the most common presenting signs and symptoms of splenic artery aneurysms?

Back 4

Most common presenting s/sx of splenic artery aneurysms:

1. asymptomatic, most common, calcification in the LUQ on plain radiograph
2. LUQ/epigastric pain
3. rupture with hypotension, shock

Front 5

what is the double rupture phenomenon?

Back 5

Splenic artery aneurysm first ruptures into the lesser sac, which provides temporary tamponade. Later rupture spreads to the intraperitoneal space via the foramen of Winslow

Front 6

When is the highest incidence of splenic artery aneurysm rupture?

Back 6

The highest incidence of splenic artery aneurysm rupture occurs during pregnancy.

Front 7

What are the indications for operative repair of splenic artery aneurysms?

Back 7

Indications for operative repair of splenic artery aneurysms:

1. any symptoms
2. discovery during pregnancy or in a woman of child-bearing age
3. good risk patient with splenic artery aneurysm > 2 cm, have to have an operative mortality less than 0.5%

Front 8

What determines the type of operation performed for splenic artery aneurysms?

Back 8

The type of operation depends on the location and the shape of the anuerysm. Distal aneurysms are treated with excision and splenectomy. Proximal saccular anuerysm are treated with coil embolization. Proximal fusiform aneurysms treated with excision.

Front 9

What the risk factors for the development of hepatic artery aneurysms?

Back 9

Risk factors for the development of hepatic artery aneurysms:

1. mycotic
2. IVDA
3. medial degeneration
4. trauma
5. inflammation

Front 10

Where do hepatic artery aneurysm most commonly occur?

Back 10

Locations of hepatic artery aneurysm, 80% are extrahepatic

1. Common hepatic 63%
2. right hepatic 28%
3. left hepatic 4%
4. right and left hepatic 4%

Front 11

For common hepatic artery aneurysms what determines operative procedure?

Back 11

For the common hepatic artery aneurysms, ligation may be performed depending upon the state of collateral flow from the GDA. To test collateral circulation, the common hepatic is clamped proximal to the aneurysm for five mminutes to determine to impact on the liver.

Front 12

In the absence of sufficient collateral circulation, what operative procedure are performed?

Back 12

For saccular anuerysms, aneurysmorrhaphy with vein patch

For fusiform aneurysms, resection with saphenous vein reconstruction

Create collateral circulation with extended Kocher manuever and right medial visceral rotation to perfrom interposition graft from the aorta to the hepatic proper

Front 13

What are the s/sx of SMA aneurysm?

Back 13

S/sx of SMA aneurysm:

1. Epigastric pain
2. palpable pulsatile abdominal mass