A 38 year old woman was admitted to the hospital due to abdominal pain in the upper left quadrant. Emergent AngioCT scan showed a 30 x 25 mm splenic artery aneurysm with no hematoma and no bleeding. She didn’t have history suggestive of vasculitis, connective tissue disorders, or previous attacks of pancreatitis. Because of the high risk of rupture, an endovascular intervention was proposed as the treatment option.

AngioTC scan showed an 30x25 mm splenic artery aneurysm located in the middle third portion of the artery. The aneurysm was classified by morphology as a true sacular aneurysm. No associated underlying diseases. Ultrasound examination of the visceral vessels showed a sacular dilatation in the splenic artery with turbulent flow. Blood test analysis were normal.

Normal celiac artery anatomy: hepatic, left gastric and splenic artery. Splenic artery with proximal third tortuosity and a sacular aneurysm in the middle third with adequate proximal and distal stent landing zones. The direction of the splenic artery was from caudal to craneal in the proximal third, perfect for a femoral approach to avoid kinks in the sheath.

The endovascular procedure was performed via 6 Fr sheath placed in the right common femoral artery. With the use of hydrophilic guide wire and different tip catheter’s a super selective celiac arteriography was performed. A splenic artery sacular aneurysm was located in the middle third. The wire was exchanged for a 0.035 hydrophilic stiff (Advantage Glidewire, Terumo) and a long 6 Fr sheath was advanced into the celiac artery to provide support. Then the hydrophilic wire and a 5 Fr MP catheter were advanced into the aneurysm sac. An 8 x 20 mm coil (MicroVention, Terumo) was liberated inside the aneurysm sac to provide adequate sac closure. Finally a 5 x 22 mm covered stent (BeGraft, Bentley) was deployed in the splenic artery to provide aneurysm closure ensuring correct position in the distal and proximal ends. Postprocedural angiography confirmed the successful exclusion of the aneurysm and flow to the spleen. Right common femoral artery was closed using a vascular closure device (AngioSeal, St Jude Medical).

Endovascular approaches to managing visceral artery aneurysms offer the benefit of low procedural morbidity and mortality and are considered the preferred initial approach to most anatomically suitable aneurysms. The choice of treatment option depends on the size of the aneurysm, its location in relation to the splenic artery, tortuosity of the splenic artery, and comorbidities of the patient.