What is a characteristic of splenic artery aneurysm?

Characteristics of Splenic Artery Aneurysm

Splenic artery aneurysms are usually asymptomatic at the time they are recognized as an incidental finding during some type of abdominal imaging. 1

Epidemiology and Demographics

• Splenic artery aneurysms (SAAs) are the most common visceral artery aneurysms, accounting for approximately 60% of all visceral aneurysms 1
• They are more common in women, particularly multiparous women 2
• They are NOT more common in young males (option C is incorrect)
• Portal hypertension is a significant risk factor for development of SAAs 3

Clinical Presentation

• Most SAAs (approximately 80%) are asymptomatic and discovered incidentally during imaging for other conditions 1
• Only about 20% of patients present with symptoms, which may include:
  • Chronic upper abdominal pain
  • Acute rupture with hemorrhage 1

True Aneurysms vs. Pseudoaneurysms

• SAAs are typically true aneurysms, involving all three layers of the arterial wall (intima, media, and adventitia) 4
• Pseudoaneurysms involve only one or two layers and are often secondary to pancreatitis, trauma, or iatrogenic causes 4, 5
• SAAs are NOT usually pseudoaneurysms (option B is incorrect)

Rupture Risk and Mortality

• Rupture of SAAs is often fatal, with mortality rates ranging from 10-25% in non-pregnant patients 1
• In pregnant women, the risk of maternal death from rupture is significantly higher, estimated at 70%, with fetal mortality exceeding 90% 1
• Rupture IS potentially fatal, making option D (rupture is seldom fatal) incorrect

Management Considerations

• Treatment is indicated for:
  • Symptomatic SAAs
  • SAAs ≥2 cm in diameter
  • SAAs in women of childbearing age
  • Pregnant women with SAAs
  • Patients with portal hypertension 3, 4
• Treatment options include:
  • Surgical excision/ligation
  • Endovascular embolization
  • Observation for small (<2 cm), asymptomatic aneurysms in low-risk patients 3, 6

Common Pitfalls

• Mistaking SAAs for other splenic lesions on imaging
• Underestimating the risk of rupture, particularly in pregnant women
• Failing to recognize that even small SAAs (<2 cm) can rupture during pregnancy 7
• Assuming rupture has low mortality (in fact, rupture carries significant mortality risk)

The correct answer is (a) - splenic artery aneurysm is usually asymptomatic.