From the Guidelines
Splenic artery aneurysms larger than 2 cm, those that are symptomatic, or in women of childbearing age, should undergo intervention due to the high risk of rupture, as recommended by the most recent guidelines 1.
Management of Splenic Artery Aneurysm
The management of splenic artery aneurysms (SAAs) is crucial to prevent rupture, which can lead to high maternal and fetal mortality rates, ranging from 70% to 95% 1. The preferred treatment options for SAAs include:
- Endovascular techniques such as coil embolization or stent placement, which are minimally invasive and have shorter recovery times
- Traditional open surgical options, including aneurysmectomy with or without splenectomy For asymptomatic aneurysms smaller than 2 cm, conservative management with regular imaging surveillance every 6-12 months is appropriate, as the risk of rupture is lower, but still significant, with up to 50% of SAAs rupturing at sizes less than 2 cm 1.
Risk Factors for Rupture
The risk of rupture increases during pregnancy, with portal hypertension, and in patients with certain connective tissue disorders 1. Prompt intervention is crucial if symptoms develop, as rupture carries a high mortality rate. Patients undergoing splenectomy should receive appropriate vaccinations against encapsulated organisms.
Key Considerations
- The natural history of SAAs followed up through pregnancy is unknown, highlighting the need for careful management and monitoring 1
- The literature contains many case reports of pregnant women who were known to have SAAs that eventually ruptured during their pregnancies, emphasizing the importance of prompt intervention 1
From the Research
Definition and Prevalence
- Splenic artery aneurysm is the third most common intra-abdominal aneurysm, with a prevalence as high as 10% in some studies 2.
- The widespread use of abdominal imaging has resulted in the increasing detection of asymptomatic incidental aneurysms 2.
Risk Factors and Treatment
- Aneurysms with a low risk of rupture may be treated conservatively but require regular imaging to ascertain progress 2.
- Available evidence suggests that splenic artery aneurysms that are symptomatic, enlarging, more than 2 cm in diameter, or those detected in pregnancy, childbearing age, or following liver transplantation are at high risk of rupture and should undergo active treatment 2.
- Endovascular therapy by either embolization or stent grafting is the primary therapeutic approach 2, 3.
- Endovascular treatment can be considered for patients with stable aneurysms larger than 2 cm in the elective setting 4.
- Open surgical treatment should be considered in patients with ruptured SAA or hemodynamically unstable, complicated patients 4.
Diagnosis and Management
- Splenic artery aneurysms are now diagnosed more frequently thanks to the increase and improvement in different imaging techniques 3.
- The development of interventional endovascular radiology has provided new therapeutic options for the management of aneurysms, by excluding the sac from the arterial circulation with coil embolisation or with a covered stent 3.
- Embolization is rarely associated with an infarction of the spleen due to the good supply of short gastric vessels 5.
- Post-embolization syndrome can be seen with persistent pain, fever, and other systemic symptoms 5.
Outcomes and Prognosis
- The overall mortality of ruptured splenic aneurysms is 25% 5.
- Endovascular treatment compared to open surgery is associated with better quality of life and appears to be the most cost-effective strategy 5.
- Ten-year survival was 89.4% for all patients, with no late aneurysm-related mortality identified 6.