Splenic artery

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Giant pseudoaneurysm of the splenic artery.

Giant pseudoaneurysm of the splenic artery.

Splenic artery pseudoaneurysm larger than 10 cm is a rare condition. The risk of rupture is probably high and surgical treatment is necessary. The objective of this article is to report a case of a patient with giant pseudoaneurysm of the splenic artery submitted to surgical resection. A 26-year-old man complaining of gastrointestinal hemorrhage and abdominal pain The patient’s medical history revealed that one year before he had an abdominal blunt trauma. The angiography showed a giant pseudoaneurysm of the splenic artery with compression of the stomach. The patient was operated on by abdominal access and the spleen and pseudoaneurysm were resected. The postoperative course was uneventful and the patient was discharged 13 days after surgery without problems.
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Splenic artery pseudoaneurysm as a complication of pancreatic pseudocyst

Splenic artery pseudoaneurysm as a complication of pancreatic pseudocyst

/L, sedi- mentation (SE) 79 mm/Lh, international normalized ratio (INR) 1, and the value of urinary amylase of 1,129 IU/L. Esophagogastroduodenoscopy (EGDS) verified the existence of outside pressure on the fundus area and back wall of the stomach body. Ultrasonography (US) of the abdomen showed the presence of massive calcification, particularly in the area of the pancreatic tail with the existence of pulsating tumefaction with thickened wall in the area of the tail of pancreas. Endoscopic ultrasonography (EUS) showed col- lection of fluid in the bursa omentalis, close to the region of the tail of the pancreas and in the exact region there was a large partially septated collection with flow. Multislice com- puted tomography (MSCT) angiography of the portal basin showed the number of calcification in the pancreas, enlarged spleen and thrombosis of the splenic vein. Drainage of the spleen was made through the well-developed collaterals around cardio and fundus region of the gizzard and the net- work of blood vessels which partially went through the frontal abdominal wall. The superior mesenteric vein and portal vein were viable without signs of thrombosis. In the arterial phase there was normal arborization of truncus coe- liacus and arterial plexus of the liver. Pseudoaneurysm was found in the splenic artery of the size 85 mm × 60 mm which was pulsating (Figure 1).
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Ruptured splenic artery aneurysm: tomographic snapshot of bleeding.

Ruptured splenic artery aneurysm: tomographic snapshot of bleeding.

The splenic artery aneurysm is a rare entity and its rupture is the most feared complication. The tomographic computed scan is a potential tool in the diagnosis, and can be used to patients with a suspicion of intra-abdominal bleeding, after adequate resuscitation. A case of a 68-year old male, hypertense patient, with a ruptured splenic artery aneurysm is reported. The diagnosis and treatment were given successfully by the abdominal computed tomographic scan and conventional surgery. The tomographic computed scan can be useful to the diagnosis of ruptured splenic artery aneurism, after the hemodynamic stabilization.
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GIANT SPLENIC ARTERY PSEUDO ANEURYSM MASQUERADING AS BLEEDING PER RECTUM - A RARE CASE

GIANT SPLENIC ARTERY PSEUDO ANEURYSM MASQUERADING AS BLEEDING PER RECTUM - A RARE CASE

Pseudo aneurysms of the splenic artery are rare and fewer than 200 cases are reported in English literature till now. Giant pseudo aneurysms (more than 5 cm in size) of splenic artery are also extremely rare and about 20 cases have been reported, largest being 19 cm as reported by Goldberg et al. in 2010. [19,20] The most common cause is considered to be chronic pancreatitis. Pancreatic enzymes are thought to cause necrotizing arteritis with destruction of vessel architecture and fragmentation of elastic tissue leading to pseudo aneurysm formation.[11] Risk of rupture is higher in pseudo aneurysms as compared to true aneurysms and can be as high as 37% with mortality approaching 90% when untreated. Besides rupture, aneurysms can also be complicated by splenic infarction or compression of adjacent biliary tree causing pseudo-obstructive jaundice. Thus once the diagnosis is made immediate definite intervention is mandatory [19, 20].
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Rev. Col. Bras. Cir.  vol.43 número5

Rev. Col. Bras. Cir. vol.43 número5

0.8% in the population. Generally asymptomatic, its incidence is four times higher in women than in men. Most aneurysms are small, less than 2cm in diameter, saccular and located at the fork situated in the middle of the splenic artery or in its distal segment 1,2 .

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Rev. Soc. Bras. Med. Trop.  vol.43 número2

Rev. Soc. Bras. Med. Trop. vol.43 número2

A 66-year-old woman had been living in an area endemic for schistosomiasis in the northeast of the State of Minas Gerais, Brazil, since childhood. Over the last 10 years, she presented two episodes of hematemesis (1999 and 2008). Small-caliber esophageal and gastric varices were observed during upper digestive endoscopy. She has been receiving beta-blockers for prophylaxis of digestive tract hemorrhage since 2008. Liver function tests were normal. Abdominal ultrasound revealed that the liver surface was slightly lobular. Magnetic resonance imaging of the liver showed hyperintense periportal thickening compatible with Symmers fibrosis. The serological markers for hepatitis B and C tested negative. An intrahepatic venous shunt with communication between the right portal branch and the right hepatic vein was documented (Figure A - arrow). Saccular aneurysmal dilatation of the splenic artery was also observed. A helical CT scan with 3D reconstruction showed the splenic artery aneurysm and the intrahepatic venous shunt (Figures B and C - arrows). Out of 82 patients with hepatosplenic schistosomiasis evaluated in our hospital using imaging techniques, this was the irst case (1.2%) of splenic artery aneurysm and intrahepatic shunt. hese indings were not seen during ultrasound examination. he patient refused surgical treatment and is being followed up in the outpatient clinic.
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Endovascular correction of splenic

Endovascular correction of splenic

Splenic artery aneurysms, although they are the most common splanchnic aneurysms, they have a prevalence of only 0,01%. In this context the authors present a case report of a 41 years female patient with a splenic artery aneurysm of 20x29mm, treated by deploy- ment of a covered self-expandable stent (Gore ®

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Rev. Col. Bras. Cir.  vol.38 número3

Rev. Col. Bras. Cir. vol.38 número3

Objective: To study the distribution of the branches of the splenic artery and relate it to the radiological study of its intraparenchymal distribution, aiming to use this knowledge in partial splenectomy. Methods Methods Methods Methods Methods: In the macroscopic study, we used 60 human spleens which the splenic artery dissected from its origin to observe the division and the terminal branches directed to the spleen. We measured the distance between the visceral surface of the spleen and the terminal division of the splenic artery and the emergence of the polar branches. In the radiological study, we used 30 human spleens in which contrast was injected in the splenic artery to perform an arteriography and study the terminal division and polar branches. Results Results Results Results Results: 93.34% of the spleens showed bifurcation and terminal pattern of division and 6.66% trifurcation. We identified secondary and tertiary side branches, having a relative frequency of 10% for type I, 17% for type II and 8.33% for both. The distance between the visceral surface of the spleen and terminal division was on average 2.89 cm and the emergence of type I polar artery was 4.85 cm and 2.39 cm for type II. In the 30 arteriographies we assessed the terminal division and bifurcation was observed in 90% of spleens and trifurcation in 10%, and the presence of polar arteries in 16% type I and type II in 20%. Conclusion
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J. vasc. bras.  vol.15 número3

J. vasc. bras. vol.15 número3

During dissection classes for medical undergraduates, we observed the following variations of abdominal blood vessels in an adult male cadaver aged approximately 60-65 years, with a height of approximately 1.65 m, and body weight of 60 kg. The celiac trunk was absent. The left gastric artery, splenic artery and common hepatic artery all arose directly from the abdominal aorta (Figure 1). The superior mesenteric artery had a high origin, very close to the three arteries speciied above. The splenic artery and left gastric artery had normal course and distribution. However, the common hepatic artery had a variant branching pattern. The common hepatic artery coursed upwards and to the right and trifurcated into the right hepatic, left hepatic and gastroduodenal arteries. This resulted in absence of the hepatic artery proper (Figure 2). The common hepatic artery trifurcated 2 cm above the irst part of the duodenum. The right gastric artery arose from the left hepatic artery (Figure 3). The left hepatic artery entered the liver through the issure for the ligamentum venosum. The right hepatic artery had a normal course.
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Dissecção espontânea do tronco celíaco: qual a melhor abordagem terapêutica?

Dissecção espontânea do tronco celíaco: qual a melhor abordagem terapêutica?

upper abdomen for 3 days, together with sweating, nauseas, vomits and discrete abdominal distension, without any relief, but worsened by eating. His pain worsened at palpation of the epigastrium and right hypochondrium, but there were no signs of peritonitis. Laboratory tests did not reveal any abnormalities, and magnetic resonance imaging (MRI) of the abdomen revealed dissection with fusiform dilatation of the celiac trunk, with a diameter of 1.3 cm, and abnormal signal of adjacent adipose planes. Dissection extended to the splenic artery up to the splenic hilum, and also affected the hepatic arteries up to the intrahepatic branches (Figure 1).
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Rev. Col. Bras. Cir.  vol.40 número3

Rev. Col. Bras. Cir. vol.40 número3

Angiography with splenic artery angioembolization (AE) has become an integral adjunct in the management of splenic trauma with multiple studies reporting increased success rate of SNOM of high-grade splenic injuries after AE. What is less clear however, is the presence of residual splenic function after AE and whether these patients would benefit from immunization against encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae type B, and Neisseria meningitidis to decrease the risk of overwhelming postsplenectomy sepsis. The present study was performed to evaluate splenic function and the need for immunization after splenic artery AE of high-grade splenic injuries (AAST III-V).
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Splenic implant preservation after conservation in lactated Ringer´s solution

Splenic implant preservation after conservation in lactated Ringer´s solution

Objective: to evaluate the morphology and function of autogenous splenic tissue implanted in the greater omentum, 24 hours after storage in Ringer-lactate solution. Methods: we divided 35 male rats into seven groups (n=5): Group 1: no splenectomy; Group 2: total splenectomy without implant; Group 3: total splenectomy and immediate autogenous implant; Group 4: total splenectomy, preservation of the spleen in Ringer-lactate at room temperature, then sliced and implanted; Group 5: total splenectomy, spleen sliced and preserved in Ringer-lactate at room temperature before implantation; Group 6: total splenectomy with preservation of the spleen in Ringer- lactate at 4°C and then sliced and implanted; Group 7: total splenectomy and the spleen sliced for preservation in Ringer-lactate at 4°C before implantation. After 90 days, we performed scintigraphic studies with Tc99m-colloidal tin (liver, lung, spleen or implant and clot), haematological exams (erythrogram, leucometry, platelets), biochemical dosages (protein electrophoresis) and anatomopathological studies. Results: regeneration of autogenous splenic implants occurred in the animals of the groups with preservation of the spleen at 4ºC. The uptake of colloidal tin was higher in groups 1, 3, 6 and 7 compared with the others. There was no difference in hematimetric values in the seven groups. Protein electrophoresis showed a decrease in the gamma fraction in the group of splenectomized animals in relation to the operated groups. Conclusion: the splenic tissue preserved in Ringer-lactate solution at 4ºC maintains its morphological structure and allows functional recovery after being implanted on the greater omentum.
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Splenic implant preservation after conservation in lactated Ringer´s solution

Splenic implant preservation after conservation in lactated Ringer´s solution

Objective: to evaluate the morphology and function of autogenous splenic tissue implanted in the greater omentum, 24 hours after storage in Ringer-lactate solution. Methods: we divided 35 male rats into seven groups (n=5): Group 1: no splenectomy; Group 2: total splenectomy without implant; Group 3: total splenectomy and immediate autogenous implant; Group 4: total splenectomy, preservation of the spleen in Ringer-lactate at room temperature, then sliced and implanted; Group 5: total splenectomy, spleen sliced and preserved in Ringer-lactate at room temperature before implantation; Group 6: total splenectomy with preservation of the spleen in Ringer- lactate at 4°C and then sliced and implanted; Group 7: total splenectomy and the spleen sliced for preservation in Ringer-lactate at 4°C before implantation. After 90 days, we performed scintigraphic studies with Tc99m-colloidal tin (liver, lung, spleen or implant and clot), haematological exams (erythrogram, leucometry, platelets), biochemical dosages (protein electrophoresis) and anatomopathological studies. Results: regeneration of autogenous splenic implants occurred in the animals of the groups with preservation of the spleen at 4ºC. The uptake of colloidal tin was higher in groups 1, 3, 6 and 7 compared with the others. There was no difference in hematimetric values in the seven groups. Protein electrophoresis showed a decrease in the gamma fraction in the group of splenectomized animals in relation to the operated groups. Conclusion: the splenic tissue preserved in Ringer-lactate solution at 4º C maintains its morphological structure and allows functional recovery after being implanted on the greater omentum.
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Revascularização do miocárdio com a artéria radial.

Revascularização do miocárdio com a artéria radial.

- Vasoreactivity of the radial artery: comparison with the internal mammary artery and the gastroepiploic arteries: implications for coronary artery bypass. - Critique of[r]

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Unusual looping of the internal carotid artery in relation to an enlarged lymph node

Unusual looping of the internal carotid artery in relation to an enlarged lymph node

The internal carotid artery is the larger terminal branch of common carotid artery. It originates at the level of upper border of the lamina of thyroid cartilage and ascends vertically in the carotid sheath and enters the carotid canal at the base of the skull. In the cranial cavity it passes through the cavernous sinus. After coming out of the cavernous sinus, it divides into anterior and middle cerebral arteries at the base of the brain. It is the major artery of the brain, eye and the internal ear. It has a straight course in the neck. Kink in its course in the neck may result in hindrance in the blood flow to the above regions and can cause serious problems.
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Superior mesenteric artery syndrome.

Superior mesenteric artery syndrome.

The Superior Mesenteric Syndrome is a rare and controversial disease. The compression of the duodenum by the mesenteric artery and aorta causes an intermitent obstruction. Preoperative diagnosis is very difficult.We present one case of this syndrome in a pacient with severe weight loss and signs of high intestinal obstruction. The diagnosis was based on clinical and radiologic findings. A duodenojejunostomy was performed after medi- cal treatment failure.This patient died on the 20 th posoperative day due to cardiac complications. This syndro-

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Symptomatic Renal Artery Aneurysm

Symptomatic Renal Artery Aneurysm

A 33 year old patient with no relevant medical history was admitted after the incidental finding of a right renal artery aneurysm on ultrasound performed for persistent flank pain. Computed tomography angiography confirmed a distal 21 mm saccular aneurysm, involving the artery’s trifurcation and proximal inferior segmental artery (A). To preserve renal perfusion, a self expandable open-cell nitinol stent (Xpert, Abbott Vascular, Abbott Park, IL, USA) was deployed from the renal to the anterior segmental artery, after which microcatheter coil embolisation (AZUR, Terumo, Shibuya, Tokyo, Japan) of the sac was performed through the stent mesh. Completion angiography revealed total aneurysm exclusion (B) with full preservation of renal perfusion.
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Posttransplant renal artery pseudoaneurysm.

Posttransplant renal artery pseudoaneurysm.

Vascular complications after kidney transplantation have been described and pseudoaneurysms represent a well-recognized vascular complication. Although the incidence of pseudoaneurysm is low, it may potentially cause graft loss or may even be fatal for the patients if it is not diagnosed and treated quickly. The authors report a case of renal artery pseudoaneurysm diagnosed two months posttransplantation with cadaveric graft, the treatment and literature data (Rev. Col. Bras. Cir. 2006; 33(6): 413-415).

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J. vasc. bras.  vol.6 número3

J. vasc. bras. vol.6 número3

Although descriptions of the right inferior phrenic artery (RIPA) and left inferior phrenic artery (LIPA) are typically very brief and lacking in detail in anatomy text- books, they have received increased attention in recent years in the clinical literature. This stems largely from the discovery of the involvement of the right (most fre- quently) or left inferior phrenic arteries in the arterial

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Macrophages support splenic erythropoiesis in 4T1 tumor-bearing mice.

Macrophages support splenic erythropoiesis in 4T1 tumor-bearing mice.

indeed tumor-associated macrophages (TAMs) have been observed in a variety of human tu- mors [34–37], and spleen-derived TAMs contribute to tumor growth [38]. In this study, sple- nectomy or depletion of macrophages with clodronate suppresses the tumor growth. Our findings suggest that macrophages promote tumor growth at least partly through simulating splenic erythropoiesis that leads to increased oxygen perfusion and improved tumor-associated anemia. BMP4, a member of the transforming growth factor beta (TGF-β) superfamily of growth factors, has been suggested to regulate HSCs development [39] and promote stress erythropoiesis [40]. Of interest, our results indicate that splenic macrophages synthesize bone morphogenetic protein 4(BMP4) in response to tumor stress. Liposomal clodronate treatment impairs BMP4 induction, delays development of stress BFU-E of spleen and severely reduces peripheral erythroid in tumor-bearing mice, consistent with the requirement of macrophages to mount BMP4-mediated stress erythropoiesis. Our results also suggest the importance of Epo in the promotion of tumor-driven erythropoiesis in the spleen, as the serum Epo kept high lev- els in tumor-bearing mice.
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