From the Guidelines
The primary treatment for a splenic artery saccular aneurysm, especially in high-risk cases such as pregnancy or aneurysms larger than 2-3 cm, is interventional radiology with trans-catheter embolization, as it is the mainstay of treatment in cases of rupture. This approach is supported by the most recent guidelines, including those from the Journal of Hepatology 1, which emphasize the importance of prompt intervention to prevent rupture, especially in the context of cirrhosis and pregnancy.
When considering treatment options, several factors come into play, including the size of the aneurysm, the patient's overall health, and whether the patient is pregnant or of childbearing age. For instance:
- Aneurysms larger than 2-3 cm are at a higher risk of rupture and may require prophylactic intervention.
- Pregnant women, especially those with cirrhosis, are at increased risk due to the hyperdynamic circulation in the third trimester.
- The presence of severe splenomegaly also warrants attention to the possibility of a splenic artery aneurysm.
The treatment approaches can be summarized as follows:
- Interventional radiology with trans-catheter embolization is the preferred method for treating ruptured aneurysms or those at high risk of rupture.
- Surgical options, including arterial ligation and splenectomy, are typically reserved for cases where interventional radiology is not feasible or has failed.
- For smaller, asymptomatic aneurysms in low-risk patients, conservative management with regular imaging surveillance may be considered, although this approach requires careful monitoring and control of blood pressure.
It's crucial to note that the mortality rates associated with ruptured splenic artery aneurysms can be as high as 70-95% in advanced cases, underscoring the importance of prompt and effective treatment 1. Therefore, a proactive approach, guided by the latest clinical guidelines and individual patient factors, is essential in managing splenic artery saccular aneurysms.
From the Research
Treatment Options for Splenic Artery Aneurysms
- Endovascular treatment is considered a first-line treatment for splenic artery aneurysms, as it is less invasive with less morbidity and mortality than surgery 2.
- Embolization is a common endovascular treatment approach, which can be performed using different materials, including coils 2.
- Stent grafting is another endovascular treatment option, which may offer a potential advantage over coil embolization by preserving blood flow and avoiding splenic infarction 3, 4, 5.
Outcomes of Endovascular Treatment
- A systematic literature review found that endovascular treatment of ruptured splenic artery aneurysms achieved a mortality rate of 7.8%, compared to 12.9% for open surgical repair 6.
- Another study reported a technical success rate of 90.2% for stent grafting in the treatment of splenic artery aneurysms, with no procedure-related deaths and a low rate of splenic infarction 3.
- A review of 18 cases of stent graft repair for splenic artery aneurysms found a 100% technical success rate, 11% splenic infarction rate, and 0% reintervention rate 4.
Comparison of Treatment Options
- A study comparing endovascular and open surgical repair of ruptured splenic artery aneurysms found no significant differences in overall complications or mortality between the two groups 6.
- However, endovascular repair was associated with a higher rate of reinterventions, mostly due to conversions to open surgery 6.
- Stent grafting may offer a viable alternative to coil embolization in selected patients with splenic artery aneurysms, particularly those with distal aneurysms and excessive vessel tortuosity 5.