From the Guidelines
The recommended management for a patient with a splenic artery saccular aneurysm is intervention for aneurysms larger than 2 cm, those in pregnant women or women of childbearing age, symptomatic aneurysms, or those showing evidence of growth, with endovascular techniques as the preferred first-line treatment due to lower morbidity compared to open surgery.
Management Considerations
When considering management options for a patient with a splenic artery saccular aneurysm, several factors must be taken into account, including aneurysm size, patient symptoms, and risk factors for rupture.
- Aneurysm size is a critical factor, with intervention generally recommended for aneurysms larger than 2 cm, as the risk of rupture increases with size 1.
- Patient symptoms, such as abdominal pain, are also an important consideration, as symptomatic aneurysms are at higher risk of rupture.
- Risk factors for rupture, including pregnancy and childbearing age, must also be taken into account, as these factors increase the risk of rupture and associated morbidity and mortality 1.
Treatment Options
Treatment options for splenic artery saccular aneurysms include endovascular techniques, such as coil embolization or stent placement, and open surgical options, such as aneurysmectomy with or without splenectomy, or splenic artery ligation.
- Endovascular techniques are generally preferred as first-line treatment due to lower morbidity compared to open surgery 1.
- Open surgical options may be considered in cases where endovascular techniques are not feasible or have failed.
Surveillance and Prevention
For asymptomatic aneurysms smaller than 2 cm, regular surveillance with imaging (typically ultrasound or CT angiography) every 6-12 months is appropriate.
- Patients undergoing splenectomy should receive appropriate vaccinations against encapsulated organisms (pneumococcal, meningococcal, and Haemophilus influenzae type B) at least two weeks before elective procedures or as soon as possible after emergency splenectomy 1.
Morbidity and Mortality
The risk of rupture for splenic artery aneurysms is approximately 2-10%, with higher risk in pregnant women, and rupture carries a mortality rate of 25-70%, which justifies aggressive management in high-risk groups 1.
- The choice between treatment approaches depends on aneurysm location, patient anatomy, and surgical risk factors.
- Interventional radiology with trans-catheter embolisation is the mainstay of treatment in cases of rupture, with surgical arterial ligation and splenectomy reserved for failed therapy 1.
From the Research
Management of Splenic Artery Saccular Aneurysm
The management of splenic artery saccular aneurysm is variable, and the optimal approach remains elusive 2. However, several studies suggest the following:
- Indications for intervention: Intervention is recommended for symptomatic aneurysms, aneurysms larger than 2 cm in size, or any aneurysm in women of childbearing years 2, 3, 4.
- Treatment options: Treatment options include open ligation, transcatheter embolization, and endovascular coil/glue ablation 2, 3, 4, 5.
- Endovascular treatment: Endovascular treatment is considered the first-line treatment due to its less invasive nature and lower morbidity and mortality compared to surgery 3, 5.
- Embolization: Embolization using coils or other embolic agents is a safe and effective treatment option, with a low risk of complications such as splenic infarction 3, 5, 6.
- Observation: Observation is recommended for small aneurysms (<2 cm) that are asymptomatic and have a low risk of rupture 2, 4.
Key Considerations
- Rupture risk: The risk of rupture is higher for false aneurysms and those larger than 2 cm in size 3, 4.
- Growth rate: The growth rate of splenic artery aneurysms is slow, and growth is infrequent 2, 4.
- Calcification: Calcification does not appear to protect against rupture, although beta-blockade may be protective 2.
- Patient characteristics: Patients requiring intervention are more likely to be male, younger, and current smokers 4.