Böbrek nakli alıcısında splenik arter anevrizması

Öz

Bu yazıda, böbrek nakli alıcısında, nakil hazırlığı sırasında tesadüfen tespit edilen ve başarıyla tedavi edilen ilk SAA (Splenik Arter Anevrizması) vakasını sunuyoruz. Karın ultrasonografi ile yapılan hazırlık incelemesinde böbrek nakli alıcılarında 25 mm SAA saptandı. Nakil öncesi splenik arter ligasyonu ve anevrizmektomi yapıldı. İntraoperatif Doppler ultrasonografi ile dalak kan akışında herhangi bir anormallik olmadığı gösterildi. Takibin ilk ayında hasta asemptomatik kaldı ve laboratuvar incelemelerinde herhangi bir anormallik görülmedi. Dalak korunarak SAA'ların seçici ligasyonu ve rezeksiyonu, splenik fonksiyonu korurken SAA'nın kalıcı tedavisine izin veren, olumlu kısa ve uzun vadeli sonuçları olan seçilmiş vakalar için güvenli bir tedavi yöntemidir

Anahtar Kelimeler

• Splenik arter anevrizması
• böbrek nakli
• anevrizmektomi

Splenic artery aneurysm in kidney transplant recipient

Öz

In this article, we present the first case of SAA (Splenic Artery Aneurysm) in a kidney transplantation recipient, which was incidentally detected during the preparation of the transplantation and successfully treated. A 25-mm SAA was detected at kidney transplant recipient during the preparation examination by abdominal ultrasonography. Splenic artery ligation and aneurysmectomy was performed before the transplantation. Intraoperative Doppler ultrasonography revealed that there were no abnormalities of the spleen blood supply. During the first month of follow-up, the patient remained asymptomatic and laboratory investigations revealed no abnormalities. Selective ligation and resection of SAAs combined with spleen preservation is a safe treatment modality for selected cases with favorable short and long-term results, allowing the permanent treatment of the SAA, while preserving the splenic function

Anahtar Kelimeler

• Splenic artery aneurysm
• kidney transplantation
• aneurysmectomy

Kaynakça

1. 1. Jiang J, Ding X, Su Q, Zhang G, Wang Q, Jian W, et al.Therapeutic management of superior mesenteric artery aneurysms. J Vasc Surg. 2011 Jun;53(6):1619-24. doi: 10.1016/j.jvs.2011.02.004. Epub 2011 Apr 30.
2. 2. Spanos CP, Ktenidis K, Saratzis N, Lazaridis I, Kiskinis D.Laparoscopic ligation of splenic artery aneurysms: report of two cases and literature overview. Updates Surg. 2014 Mar;66(1):73-6. doi: 10.1007/s13304-012-0180-1. Epub 2012 Sep 19.
3. 3. Erben Y, Brownstein AJ, Rajaee S, Li Y, Rizzo JA, Mojibian H, et al. Natural history and management of splanchnic artery aneurysms in a single tertiary referral center. J Vasc Surg. 2018 Oct;68(4):1079-1087. doi: 10.1016/j.jvs.2017.12.057. Epub 2018 Mar 21. PMID: 29573962
4. 4. Iida A, Katayama K, Yamaguchi A. Laparoscopic resection for splenic artery aneurysm using the lateral approach: report of two cases. Asian J Endosc Surg. 2013 May;6(2):147-50. doi: 10.1111/ases.12000.PMID: 23602003
5. 5. He MX, Zheng JM, Zhang SH, Wang JJ, Liu WQ, Zhu MH. Rupture of splenic artery aneurysm in pregnancy: a review of the literature and report of two cases. Am J Forensic Med Pathol. 2010 Mar;31(1):92-4. doi: 10.1097/PAF.0b013e3181c65da2. PMID: 20032776
6. 6. Xu WL, Li SL, Wang Y, Shi BJ, Li M, Li YC, et al. Laparoscopic splenectomy: color Doppler flow imaging for preoperative evaluation. Chin Med J (Engl). 2009 May 20;122(10):1203-8. PMID: 19493472
7. 7. İnan B, Teker ME, Ay Y, Aydın C, Zeybek R. Our experience on splenic artery aneurysms. Vasc Sur J. 2013;22(3):257-62
8. 8. Małczak P, Wysocki M, Major P, Pędziwiatr M, Lasek A, Stefura T, et al. Laparoscopic approach to splenic aneurysms. Vascular. 2017 Aug;25(4):346-350. doi: 10.1177/1708538116682164. Epub 2016 Dec 5. PMID: 27903932

9. 9. Müller-Eschner M, Kortes N, Rehnitz C, Sumkauskaite M, Rengier F, Böckler D, et al. Endovascular repair of a complex splenic artery aneurysm using a multilayer stent. Cardiovasc InterventRadiol. 2015 Apr;38(2):494-7. PMID: 25918769
10. 10. Lee SY, Florica O. Laparoscopic resection of splenic artery aneurysm with preservation of splenic function. Singapore Med J. 2008 Nov;49(11):e303-4. PMID: 19037534
11. 11. LaBella GD, Muck P, Kasper G, Welling R, Schlueter F, Vaughan A. Operative management of an aberrant splenic artery aneurysm: Utility of the medial visceral rotation approach: a case report and review of the literature. Vasc Endovascular Surg. 2006 Aug-Sep;40(4):331-3. doi: 10.1177/1538574406292005. PMID: 16959727
12. 12. Moriyama H, Ishikawa N, Kawaguchi M, Inaki N, Watanabe G. Laparoscopic approaches for splenic artery aneurysms. Minim Invasive Ther Allied Technol. 2012 Sep;21(5):362-5. doi: 10.3109/13645706.2011.636051. Epub 2011 Nov 18. PMID: 22098441
13. 13. Toyoda Y, Igami T, Ochiai Y, Ebata T, Yokoyama Y, Sugawara G, et al. Single-Incision Laparoscopic Splenectomy for an Unruptured Aneurysm of the Splenic Artery. Med PrincPract. 2018;27(1):95-98. doi: 10.1159/000485836. Epub 2017 Nov 29. PMID: 29186719