From the Guidelines
Splenic artery aneurysms greater than 2 cm in diameter require immediate attention and intervention due to the high risk of rupture, which can be life-threatening with mortality rates of 25-70%. This size threshold is critical because aneurysms of this size or larger are at a significantly increased risk of rupture, particularly in pregnant women or those of childbearing age, where the risk of maternal and fetal mortality can be as high as 70% to 95% 1. Additional factors that warrant intervention regardless of size include aneurysms in pregnant women or women of childbearing age, symptomatic aneurysms, rapidly growing aneurysms, and those in patients with portal hypertension or liver transplantation.
Key Considerations for Intervention
- Aneurysm size: greater than 2 cm in diameter
- Pregnancy or childbearing age
- Symptomatic aneurysms
- Rapidly growing aneurysms (growth of >0.5 cm/year)
- Presence of portal hypertension or liver transplantation
Treatment Options
- Endovascular techniques such as coil embolization or stent placement
- Surgical approaches including aneurysmectomy or splenectomy in certain cases
Monitoring for Smaller Aneurysms
Smaller aneurysms (<2 cm) without high-risk features can typically be monitored with serial imaging every 6-12 months to assess for growth, as up to 50% of splenic artery aneurysms may rupture at sizes of less than 2 cm 1. The decision for intervention should be individualized based on patient factors, aneurysm characteristics, and available expertise, considering the latest guidelines and evidence from studies such as those published in the Journal of Hepatology 1 and Circulation 1.
From the Research
Size of Splenic Artery Aneurysm Requiring Attention
- Aneurysms with a diameter of more than 2 cm are considered to be at high risk of rupture and should undergo active treatment 2, 3, 4, 5
- Symptomatic aneurysms, enlarging aneurysms, and those detected in pregnancy, childbearing age, or following liver transplantation are also at high risk of rupture and should be treated 2, 4
- False aneurysms should also be treated 2
- Aneurysms smaller than 2 cm in diameter may be treated conservatively with regular imaging to monitor progress 2, 4, 5
Treatment Options
- Endovascular therapy, including embolization or stent grafting, is a primary therapeutic approach for splenic artery aneurysms 2, 3, 6, 5
- Open surgical treatment, including aneurysmectomy and splenectomy, may be considered for patients with ruptured or complicated aneurysms 4, 5
- Conservative management may be appropriate for patients with small, asymptomatic aneurysms and no risk factors for rupture 2, 4, 5