What does a CT result showing a patent splenic artery stent with occlusion of the adjacent splenic artery aneurysm and minimal decrease in aneurysm size, along with minimal improvement in small splenic lesions, indicate?

Understanding Your CT Results After Splenic Artery Aneurysm Treatment

Your CT scan shows that the endovascular treatment of your splenic artery aneurysm was technically successful—the stent is working properly and the aneurysm is excluded from blood flow—but the aneurysm sac itself has only minimally decreased in size, which is expected in the early follow-up period and does not indicate treatment failure. 1, 2

What Each Finding Means

Patent Splenic Artery Stent

• "Patent" means the stent is open and blood is flowing normally through it, maintaining blood supply to your spleen 1, 3
• This is the desired outcome, as stent-graft placement preserves splenic function while excluding the aneurysm from the circulation 1, 4
• Stent patency without endoleak indicates successful aneurysm exclusion 1

Occlusion of the Adjacent Aneurysm

• The aneurysm is "occluded" or sealed off from blood flow, which is the therapeutic goal 1, 2
• The stent-graft creates a new channel for blood flow that bypasses the aneurysm sac entirely 3, 4
• This prevents the aneurysm from rupturing, which carries significant mortality risk in splenic artery aneurysms 5, 6

Minimal Decrease in Aneurysm Size

• It is normal for the aneurysm sac to show only minimal size reduction in early follow-up imaging 1
• The aneurysm sac typically remains thrombosed (filled with clot) and stable rather than immediately shrinking 1, 2
• What matters most is that the sac is not enlarging, which would suggest endoleak or continued pressurization 1, 2
• Complete sac remodeling can take months to years, and stability without enlargement is considered successful treatment 1

Small Splenic Lesions with Minimal Improvement

• These lesions are likely benign findings such as small areas of splenic infarction or incidental benign lesions 7, 8
• For lesions <1 cm, serial ultrasound follow-up every 3-6 months is appropriate, as lack of growth over 1-2 years confirms benign etiology 7
• The key is that they show improvement rather than progression, which argues against abscess formation or other complications 8
• Wedge-shaped peripheral lesions would suggest splenic infarction, which can occur after endovascular procedures but typically resolves with conservative management 8

What This Means for Your Care

Immediate Interpretation

• Your treatment was technically successful with no evidence of complications 1, 2
• The stent is functioning as intended, maintaining splenic blood flow while excluding the aneurysm 1, 3
• No endoleak is present (blood leaking back into the aneurysm sac) 1

Expected Follow-Up

• Continue surveillance imaging at 4-6 months initially, then yearly thereafter 1
• Monitor for stent graft patency, absence of endoleak, and stability (not enlargement) of the aneurysm sac 1, 2
• The splenic lesions should be followed according to their size and characteristics, with serial imaging if <1 cm 7

Warning Signs to Watch For

• Persistent or recurrent fever, ongoing abdominal pain, or signs of infection would suggest progression to splenic abscess, though this is uncommon with stent-graft treatment 8
• New or worsening left upper quadrant pain could indicate delayed complications 8
• Hemodynamic instability would be concerning for delayed rupture, though this is prevented by successful aneurysm exclusion 8

Key Clinical Context

The advantage of stent-graft treatment over coil embolization is preservation of splenic blood flow, which eliminates the risk of splenic infarction and abscess that can occur with embolization techniques 1, 4. Studies show technical success rates of 80-95% with stent-grafts, with no ischemic complications, stent occlusions, or endoleaks in successfully treated patients at median 9-month follow-up 1. The minimal decrease in aneurysm size you're seeing is consistent with successful exclusion, as the sac remains thrombosed without enlargement 1, 2.