Interventional Radiologist SAMEER's Description of a New Method: Intricate Splenic Artery Pseudoaneurysm Embolization through Sequential Gelatin-based Hemostatic Agent and Autologous Blood Clot Injection, Followed by Suture Coiling
In a recent case, a 49-year-old man presented with severe acute pancreatitis, leading to a large splenic artery pseudoaneurysm. The patient experienced profuse sweating, giddiness, pallor, cold and clammy extremities, a rapid heart rate, and a significant drop in blood pressure and hemoglobin level.
The pseudoaneurysm, measuring approximately 7.3 × 5.8 × 5.2 cm, was located in the lesser sac and was partially thrombosed. The neck of the pseudoaneurysm was noted in relation to one of the distal hilar branches of the splenic artery.
In this critical situation, the SAMEER technique was employed for percutaneous direct embolization of the pseudoaneurysm. This novel approach, which is particularly useful in resource-poor settings, involves the use of a gelatin-based hemostatic agent and autologous blood clot mixture, followed by coiling the aneurysm sac with nylon sutures.
The procedure, which took approximately 20 minutes, resulted in complete hemostasis within the aneurysm sac. The patient improved clinically with resuscitation measures and did not require any further blood transfusions. At a 3-week follow-up, the patient's hemoglobin level was recorded at 9.4 g/dL, and vitals were stable. Moreover, the aneurysm showed complete occlusion and no signs of recanalization at a follow-up doppler ultrasound.
Splenic artery pseudoaneurysms often arise as a complication of pancreatitis. In cases where endovascular embolization is not feasible, percutaneous image-guided direct puncture and embolization of the pseudoaneurysms is a valuable option.
While the SAMEER technique is a recent, emerging, or specialized procedural approach, it has been demonstrated to be safe and effective in a series of 2 cases. However, detailed technical, clinical, or economic information on this technique may not be widely documented in publicly indexed literature. Consulting specific surgical or interventional radiology training providers or the original developers of the SAMEER technique might be necessary for more detailed information.
Treatment of splenic artery pseudoaneurysms is considered a priority in the management of pancreatitis due to the risk of rupture. Previous publications have reported on the use of n-butyl cyanoacrylate, coils, and thrombin for percutaneous embolization of splenic artery pseudoaneurysms, but these agents may not be easily accessible in emergency situations or may be cost-prohibitive. The SAMEER technique, with its use of readily available materials, could provide a cost-effective alternative in such situations.
In conclusion, the SAMEER technique offers a promising approach for the treatment of splenic artery pseudoaneurysms, especially in resource-limited settings where endovascular embolization may not be feasible or cost-prohibitive. Further research and documentation of this technique are necessary to fully understand its potential benefits and limitations.
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