From the Guidelines
Prophylactic intervention is recommended for a patient with a splenic artery aneurysm who desires pregnancy, especially if the aneurysm is large (>2-3 cm) or has previously ruptured.
Management Strategies
- The management approach for a patient with a splenic artery aneurysm who desires pregnancy should be multidisciplinary, involving a team of specialists to discuss the optimal approach to delivery and potential complications 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, as the risk of rupture is highest in these cases 1.
- However, since up to 50% of SAA may rupture at sizes of less than 2 cm, it is difficult to make definitive recommendations on these smaller dilatations, and attention to the presence of SAA in women with severe splenomegaly is appropriate 1.
- The natural history of splenic artery aneurysms followed up through pregnancy is unknown, but the literature contains many case reports of pregnant women who were known to have splenic artery aneurysms that were at least 2.0 cm in diameter and that eventually ruptured during their pregnancies 1.
From the Research
Recommended Management for Splenic Artery Aneurysm in Pregnancy
The recommended management for a patient with a splenic artery aneurysm who desires pregnancy, as shown on computed tomography (CT) imaging, includes:
- Treatment for aneurysms >2 cm, symptomatic cases, and pregnant women 2, 3
- Various surgical/interventional procedures can be performed, selected based on the patient's sex, age, location of the aneurysm, size of the aneurysm, and presenting complaints/complications 2
- Endovascular techniques with or without stent-graft placement are being used more, given the minimally invasive nature of these procedures 2, 4
- Laparoscopic resection of the aneurysm with vascular reconstruction is a viable option for pregnant women, reducing the risk of spleen infarction and potentially avoiding splenectomy 5
Risk Factors and Treatment Approach
Key factors to consider in the management of splenic artery aneurysms in pregnancy include:
- Risk of rupture, which is increased in pregnancy, especially for aneurysms >2 cm in diameter 3, 6
- Symptomatic aneurysms, which require prompt treatment to prevent rupture 2, 3
- The use of endovascular therapy, such as embolization or stent grafting, as a primary therapeutic approach 3, 4
- The importance of prompt diagnosis and management to reduce maternal and fetal mortality 6
Treatment Options
Treatment options for splenic artery aneurysms in pregnancy include:
- Endovascular surgery using coil embolization or stent graft coverage 5, 4
- Laparoscopic or open surgical resection with arterial reconstruction and ligation, followed by splenectomy when necessary 5, 6
- Conservative management with regular imaging to monitor aneurysm size and progression, for aneurysms with a low risk of rupture 3