Tratamiento endovascular urgente de aneurisma esplénico roto

Resumen

Introducción

Los aneurismas de arteria esplénica (AAE) son los aneurismas viscerales más frecuentes. Su rotura provoca una mortalidad elevada. Existen técnicas endovasculares alternativas a la cirugía abierta. Se presenta un caso de AAE roto tratado de urgencia mediante embolización con coils.

Caso clínico

Mujer de 58 años, con hepatopatía crónica por virus de la hepatitis C. Acudió a Urgencias por dolor abdominal de dos días de evolución. Al ingreso estaba consciente y aquejaba dolor en hipocondrio izquierdo. Constantes vitales: ritmo sinusal a 90/minuto, tensión arterial: 110/60 mmHg. Exploración vascular: normal. Hemograma: leucocitos 12.000, hematócrito 22%. Radiografía de abdomen: gran calcificación circular en hipocondrio izquierdo. Tomografía axial computarizada: hematoma retroperitoneal izquierdo. Arteriografía diagnóstica: aneurisma sacular de arteria esplénica de 8 cm. A las 3 horas de su llegada a Urgencias, se procedió a embolizar con coils los segmentos proximal y distal al aneurisma, hasta su exclusión. La paciente no tuvo complicaciones postintervención. En la angiografia de control, a las 24 horas, el aneurisma permanecía excluido. Al tercer día, tenía un mínimo relleno procedente de una colateral, que no se detectaba en el eco-Doppler previo al alta. Dos meses más tarde, la paciente continuaba bien y en una nueva angiografia el aneurisma seguía trombosado.

Conclusiones

El tratamiento endovascular con coils de los aneurismas de AAE es eficaz, sin los riesgos de la cirugía abierta. Pueden obtenerse buenos resultados, incluso en situaciones de urgencia, en aneurismas rotos. La correcta exclusión del aneurisma debe comprobarse mediante imagen en sucesivos controles.

Summary

Introduction

Splenic artery aneurysms (SAA) are the most frequently occurring visceral aneurysms. The mortality rate resulting from their rupture is high. A number of endovascular techniques can be used as alternatives to open surgery. We report a case of a ruptured SAA that was treated urgently by coil embolisation.

Case report

Here, we describe the case of a 58-year-old female patient with chronic liver disease caused by hepatitis C virus who visited the Emergency department after a 2-day history of abdominal pain. On arrival she was conscious and suffering from pain in the left hypochondriac region. Vital signs: sinus rhythm 90/minute, arterial blood pressure: 110/60 mmHg. Vascular exploration: normal. Blood count: leukocytes 12,000, haematocrit 22%. X-ray of the abdomen: large circular calcification in the left hypochondriac region. Computerised axial tomography: haematoma in the left retroperitoneal region. Diagnostic arteriography: 8 cm saccular aneurysm in the splenic artery. Three hours after arrival at the Emergency department, coil embolisation of the segments lying proximal and distal to the aneurysm was carried out, until it was excluded. The patient had no post-operative complications. In the follow-up angiography performed at 24 hours, the aneurysm remained excluded. On the third day, she had a very small filling from a collateral vessel, which was not detected in the Doppler ultrasound recording carried out before her discharge from hospital. Two months later, the patient was still well and in a new angiography study the aneurysm was seen to be still thrombosed.

Conclusions

Endovascular treatment of SAA with coils is effective and does not entail the risks involved in open surgery. Good results can be observed in ruptured aneurysms, even in urgent situations. Proper exclusion of the aneurysm must be confirmed by means of imaging techniques in later follow-ups.