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Embolization with onyx liquid embolic agent of a ruptured splenic artery aneurysm

2010; Elsevier BV; Volume: 81; Issue: 2 Linguagem: Inglês

10.1016/j.resuscitation.2010.09.348

1873-1570

Marcin Javier, Jokerst Clint, Iñigo Insausti, Tomás Belzunegui Otano, F Urtasun,

Liver Disease and Transplantation

Purpose of study: Management of the ruptured splenic aneurysms (RSA) has been surgical though endovascular treatment is currently an alternative option with lower morbidity and mortality. Trans-catheter arterial embolization has gained widespread acceptance as the first line treatment of a ruptured aneurysm. To demonstrate that the application of liquid embolic agent (Onyx) can be applied to ruptured splenic aneurysms. Material and methods: A 47-year-old man presented to the emergency department with an episode of dizziness, and a sudden onset of continuous abdominal pain in the left hypocondrium. Emergent aortography and selective splenic arteriography revealed the splenic aneurysm and extravasation, indicating rupture and active bleeding. We attempted to insert the tip of the microcatheter into the distal side of the aneurysm to embolize the artery on the distal and proximal sides of the aneurysm. However, it was tedious to catheterize the distal portion, so we inserted the microcatheter into the aneurysm and injected liquid embolic agent (Onyx ev3, Plymouth, USA) until the small segment of distal and proximal artery were occluded. Results: Splenic arteriography after Onyx injection demonstrated complete embolization of the aneurysm with the disappearance of extravasation. At the same time permeability of the spleen was observed through pancreatic and gastric branches that opened the distal segment of the splenic artery. After embolization, the patient's general condition stabilized and his blood pressure increased. Conclusions: Urgent embolization with a liquid agent (Onyx) was performed and may prove a valid alternative in occluding active bleeding and can avoid splenectomy while maintaining the organs circulation.