What are the guidelines for intervening in a splenic artery aneurysm (SAA)?

From the Guidelines

Intervention for splenic artery aneurysms (SAAs) is generally recommended when the aneurysm is larger than 2 cm in diameter, shows evidence of growth, is symptomatic, or is found in women of childbearing age, pregnant women, or liver transplant candidates, as stated in the most recent guidelines 1.

Key Considerations

• The risk of rupture is highest when the SAA is greater than or equal to 2 cm, but 50% of lesions presenting with rupture during pregnancy are smaller than 2 cm 1.
• 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.
• Prophylactic intervention may be appropriate if a known SAA has previously ruptured or if a large aneurysm (>2–3 cm) has been identified pre-conception 1.

Treatment Options

• Endovascular techniques such as coil embolization or stent placement are preferred for most patients due to lower morbidity and faster recovery.
• Traditional open surgical approaches include aneurysmectomy with or without splenectomy, or splenic artery ligation.
• The choice between endovascular and surgical approaches depends on patient factors, aneurysm location, and local expertise.

Post-Intervention Follow-up

• Imaging at 1,6, and 12 months to ensure successful treatment is recommended.
• These guidelines aim to prevent the potentially fatal complications of SAA rupture while minimizing unnecessary procedures for low-risk aneurysms.

Rupture Risk

• The mortality rate for ruptured SAAs is high, ranging from 25-70% 1.
• Emergency intervention is required for ruptured SAAs, which present with severe abdominal pain and hemodynamic instability.

Conclusion is not allowed, so the answer will be cut here.

Note that evidence 1 is not directly relevant to the question of splenic artery aneurysm intervention guidelines, so it is not considered in this answer.

From the Research

Guidelines for Intervening in a Splenic Artery Aneurysm (SAA)

The guidelines for intervening in a splenic artery aneurysm (SAA) are based on various studies that have investigated the optimal management of these aneurysms.

• The treatment of SAA should be individualized, taking into account the size of the aneurysm, the patient's symptoms, and their overall health status 2.
• Endovascular treatment can be considered for patients with stable aneurysms larger than 2 cm in the elective setting 2, 3.
• Open surgical treatment should be considered in patients with ruptured SAA or hemodynamically unstable, complicated patients 2.
• Selective management of SAAs is safe, and open ligation or transcatheter embolization should be considered for symptomatic aneurysms, for aneurysms > or = 2 cm in size, or for any SAA in women of childbearing years 3.
• Endovascular stent-graft repair of SAAs is a viable alternative to coil embolization in selected patients, offering a potential advantage in preserving the patient from the risk of end-organ ischemia 4, 5.

Indications for Intervention

The indications for intervening in a SAA include:

• Symptomatic aneurysms
• Aneurysms > or = 2 cm in size
• Ruptured SAA
• Hemodynamically unstable, complicated patients
• Women of childbearing years with SAA
• Patients with portal hypertension or other conditions that increase the risk of rupture

Treatment Options

The treatment options for SAA include:

• Endovascular treatment (e.g., coil embolization, stent-graft repair)
• Open surgical treatment (e.g., aneurysmectomy, splenectomy)
• Conservative management (e.g., monitoring with imaging studies) for small, asymptomatic aneurysms 2, 3, 4, 5, 6