The contemporary management of splenic artery aneurysms

Journal of Vascular Surgery, 2019

Background: True giant splenic artery aneurysms (GSAAs) >5 cm are rare and present unique therapeutic challenges. The aim of this study was to evaluate the anatomic and clinical characteristics of these lesions and the current surgical and endovascular techniques available for their treatment. Methods: A systematic review of the literature from 2004 to 2018 and the personal experience of the authors with management of GSAAs are presented. A total of 92 GSAA cases were reviewed. Analyses were performed on anatomic and clinical features and management modalities and outcomes of GSAA, including reintervention, morbidity, and mortality. Results: GSAA presented at a mean age of 56.1 6 17.3 years, with no sex predilection; 73% were symptomatic at presentation. Abdominal pain was the presenting symptom in >50% of cases; 34% percent were ruptured, with an overall mortality rate of 12.5%. This group often presented with gastrointestinal bleeding or hemodynamic collapse. The aneurysms were almost evenly distributed across the splenic artery and were not uncommonly associated with arteriovenous fistula formation (8.7%). There were 88 patients who had surgical (53.4%), endovascular (44.3%), or combination (2.3%) therapy. The most commonly performed procedure was aneurysmectomy and splenectomy with or without additional resection. Overall, surgical treatment had a lower morbidity (P ¼ .041) than endovascular therapy and comparable reintervention and mortality rates. Conclusions: GSAAs are uncommon vascular lesions, with distinct clinical features and aneurysm characteristics. Considering their high risk of rupture, timely diagnosis and management are essential to attain a satisfactory outcome. Surgery remains the standard treatment of these lesions. Endovascular intervention is a viable alternative in high-risk patients, particularly those with lesions <10 cm or with anomalous origin.

Case Reports in Surgery, 2012

Introduction. Visceral artery aneurysms are uncommon. Among them, splenic artery is the most common (46–60%). Most splenic artery aneurysms are asymptomatic and diagnosed incidentally, but its rupture, potentially fatal, occurs in up to 8% of cases.Presentation of Case. A female patient, 64 years old, diagnosed with a giant aneurysm of the splenic artery (approximately 6.5 cm in diameter) was successfully submitted to endovascular treatment by stent graft implantation.Discussion. Symptomatic aneurysms and those larger than 2 cm represent some of the main indications for intervention. The treatment may be by laparotomy, laparoscopy, or endovascular techniques. Among the various endovascular methods discussed in this paper, there is stent graft implantation, a method still few reported in the literature.Conclusion. Although some authors still consider the endovascular approach as an exception to the treatment of SAA, in major specialized centers these techniques have been consolidated...

Cureus, 2024

This case report aims to elucidate the current practices and efficacy of endovascular repair in managing splenic artery aneurysms (SAAs), particularly focusing on a case of a large, partially ruptured SAA. A 66year-old female presented with severe abdominal pain and was later diagnosed with a 53mm saccular, degenerative SAA showing signs of partial rupture. The patient underwent successful endovascular repair using a combination of interlocking detachable coils and fibered coils. Despite the initial success, a followup CT angiogram revealed residual issues, necessitating additional embolization. The patient recovered well, with subsequent follow-ups indicating complete aneurysm closure and no complications. The successful management of this case aligns with current trends in SAA treatment, emphasizing the shift towards endovascular repair methods. This approach, highlighted in the literature, offers a minimally invasive alternative to open surgery, with lower morbidity and mortality rates. This case underscores the importance of individualized treatment planning and vigilant follow-up, particularly in light of the potential need for secondary interventions. This report contributes to the growing body of evidence supporting endovascular repair as a safe and effective treatment for SAAs, advocating for continued research into long-term outcomes and the development of advanced endovascular technologies.

Medicinski pregled, 2009

Sazetak -Aneurizma je po definiciji trajno lokalno prosirenje dijametra arterije za 50% od uobicajenog dijametra posmatrane arterije. Aneurizma slezinske. tj, splenicne arterije (a. splenica) naicesca je visceralna arterijska aneurizma. Klinicki je najcesce asimptornatska, ali istovrerneno potencijalno zivotno ugrozavajuca, sa incidencijorn ruptuiranja 2-10%; u tom slucaju stopa mortaliteta krece se 20-36%. Pacijentkinja stara 51 godinu primljcna je na Kliniku za vaskularnu i transplantaeionu hirurgiju u Novorri Sadu nakon detekeije vel ike aneurizrne a. splenicae prilikom ultrasonografskog pregleda abdomena nakon holecistektomije. Dodatnom dijagnostikom -kompjuterizovanorn tomografijom abdomena sa i. v kontrastom digitalnom suptrakcionom angiografijorn potvrdena je aneurizma a. splenicae precnika 5 em, te je nakon preoperativne pripreme i procene rizika. indikovano elektivno operativno hirursko lecenje. Primenjen je hirurski pristup prosirenom levom supkostalnom incizijom po Chevronu, a detaljna hirurska eksploracija sledi otvaranjem omentalne burze. Nakon verifikacije istanjenog zida aneurizme sledi aneurizmektomija i rekonstrukcija a. splenicae termino-terminalnom anastomozom. Intraoperativno uzete su biopsije jetre i aneurizmatske vrece. Patohistoloski nalaz potvrduje aterosklerotsku etiologiju aneurizme, a kako postoperativni tok protice uredno, bolesniea se otpusta na dalje kucno lecenje osmi postoperativni dan. Kljucne reei: Aneurizma: Slezinska arterija; Dijagnoza: Elektivne hirurske procedure: Zen ski pol: Srednjc god inc Summary -An aneurysm has been defined as a permanent local dilatation ofthe diameter ofan artery by at least 5()% of its normal value. A splenic artery aneurysm is most frequently a visceral artery aneurysm and clinically it is usually asymptomatic but potentially life-threatening at the same time. with the incidence of its rupturing being 2-1()% and then the mortality rate rangesfrom 2() to 36%. A 5 J-year-old female patient was admitted to the Department of Vascular and Transplantation Surgery in Novi Sad having been found to have a big splenic artery aneurysm during the ultrasound examination of her abdomen after cholecystectomy. The additional diagnostic procedure -computerized tomography of the abdomen with i. v contrast subtraction angiography -confirmed the splenic artery aneurysm to have the diameter of5 em and therefore the elective surgical treatment was indicated after the preoperative preparation and risk assessment. The aneurysm was exposed through Chevron incision, and the detailed surgical exploration was done after the omental bursa had been opened. The aneurysmectomy and the reconstruction of the splenic artery by the termino-terminal anastomosis were performed after the weakening of the wall had been verified. The biopsies of the liver and the aneurysmal sac were done during the surgery. The pathohistologicalfinding confirmed the atherosclerotic etiology ofthe aneurysm. Since the postoperative course was normal, the patient 1vaS discharged on the eighth postoperative day.

E xcellent success rates have been achieved with differ-ent endovascular techniques in the treatment of splanchnic aneu-rysms. This pictorial essay describes the endovascular management of dif-ferent splanchnic aneurysms. METHOD This was a retrospective study that included all aneurysms involving the splanchnic arteries that were referred to our department for endovascular treatment over a period of more than 10 years (from June 2002 to December 2012). RESULTS 63 patients were included in this study. Males were more common than females (4.7:1) and more than half of the patients were in the 30 to 60 year age group. The most common symp-toms were abdominal pain, melena, and hematemesis (Figure 1A). Pancreatitis (29%), surgery (22%), infection (14%), and trauma (12%) were the most com-mon causes (Figure 1B). The most com-mon locations were the hepatic artery (39%) and the splenic artery (31%; Fig-ure 1C). The most common endovascu-lar techniques used were proximal coil embolization (51...

Journal of Vascular Surgery, 2004

Objectives: This study was undertaken to determine the effect of the preoperative diameter of abdominal aortic aneurysms on the midterm outcome after endovascular abdominal aneurysm repair (EVAR). Method: The data for 4392 patients who had undergone EVAR were analyzed. Patients were enrolled over 6 years to June 2002 in the EUROSTAR database. Outcomes were compared between three groups defined by the preoperative diameter of the aneurysm: group A (n ‫؍‬ 1962), 4.0 to 5.4 cm; group B (n ‫؍‬ 1528), 5.5 to 6.4 cm; and group C (n ‫؍‬ 902), 6.5 cm or larger. Patient characteristics, details of aortoiliac anatomy, operative procedures, old or current device generation, and postoperative complications in the three patient groups were compared. Outcome events included aneurysm-related death, unrelated death, conversion, and post-EVAR rupture of the aneurysm. Life table analysis and log-rank tests were used to compare outcome in the three study groups. Multivariate Cox models were used to determine whether baseline and follow-up variables were independently associated with adverse outcome events. Results: Patients in group C were significantly older than patients in groups A and B (73 years vs 70 and 72 years, respectively; P ‫؍‬ .003-P < .0001 for different group comparisons), and more frequently were at higher operative risk (American Society of Anesthesiologists classification >3; 63% vs 48% and 54%; P ‫؍‬ .0002-P <.0001). Device-related (type I) endoleaks were more frequently observed at early postoperative arteriography in group C compared with groups A and B (9.9% vs 3.7% and 6.8%; P ‫؍‬ .01-P < .0001). Postoperatively systemic complications were more frequently present in group C (17.4% vs 12.0% in group A and 12.6% in group B; P < .0001 and .001). The first-month mortality was approximately twice as high in group C compared with the other groups combined (4.1% vs 2.1%; P < .0001). Late rupture was most frequent in group C. Follow-up results at midterm were less favorable in groups C and B compared with group A (freedom from rupture, 90%, 98%, and 98% at 4 years in groups C, B, and A, respectively; P < .0001 for group C vs groups A and B). Aneurysm-related death was highest in group C (88% freedom at 4 years, compared with 95% in group B and 97% in A; P ‫؍‬ .001 and P < .0001, respectively; group B vs A, P ‫؍‬ .004). The annual rate of aneurysm-related death in group C was 1% in the first 3 years, but accelerated to 8.0% in the fourth year. Incidence of unrelated death also was higher in groups C and B than in group A (76% and 82% freedom at 4 years vs 87%; P < .0001 for both comparisons). Ratio of aneurysm-related to unrelated death was 23%, 21%, and 50% in groups A, B, and C, respectively. Cox models demonstrated that the correlation between large aneurysms (group C) and all assessed outcome events was independent and highly significant. Older generation devices had an independent association with aneurysmrelated and unrelated deaths (P ‫؍‬ .02 and P ‫؍‬ .04, respectively). However, this correlation was less strong than large aneurysm diameter (P ‫؍‬ .0001 and P ‫؍‬ .0009, respectively). Conclusions: The midterm outcome of large aneurysms after EVAR was associated with increased rates of aneurysmrelated death, unrelated death, and rupture. Reports of EVAR should stratify their outcomes according to the diameter of the aneurysm. Large aneurysms need a more rigorous post-EVAR surveillance schedule than do smaller aneurysms. In small aneurysms EVAR was associated with excellent outcome. This finding may justify reappraisal of currently accepted management strategies.

Journal of Vascular Surgery, 2009

OBJECTIVE-With the expansion of elective abdominal aortic aneurysm (AAA) repair after the introduction of endovascular aneurysm repair (EVAR), there is a concern that even with a lower operative mortality there could be increasing number of aneurysm related deaths. To evaluate this, we looked at national trends in AAA repair volume as well as mortality after intact and ruptured AAA repair encompassing the introduction of EVAR. METHODS-Patients with intact or ruptured AAA undergoing open repair or EVAR and all those with a diagnosis of ruptured AAA were identified within the 1993-2005 Nationwide Inpatient Sample database using ICD-9 diagnosis and procedure codes. The number of repairs, number of rupture diagnoses without repair, number of deaths, and associated mortality rates were measured for each year of the database. Outcomes (mean annual volumes) were compared from the pre-EVAR era (1993-1998) to the post-EVAR era (2001-2005). RESULTS-Since introduction, EVAR increased steadily and accounted for 56% of repairs, yet only 27% of the deaths for intact repairs in 2005. The mean annual number of intact repairs increased from 36,122 in the pre-EVAR era to 38,901 in the post-EVAR era while the mean annual number of deaths related to intact AAA repair decreased from 1,693 pre-EVAR to 1,207 post-EVAR (P <. 0001). Mortality for all intact AAA repair decreased from 4.0% to 3.1% (P < .0001) pre and post-EVAR but open repair mortality was unchanged (open repair 4.7% to 4.5%, P= .31; EVAR 1.3%). During the same time periods, mean annual number of ruptured repairs decreased from 2,804 to 1,846 and deaths from ruptured AAA repairs decreased from 2,804 to 1,846 (P < .0001). Mortality for ruptured AAA repair decreased from 44.3% to 39.9% (P < .0001) pre and post-EVAR (open repair 44.3% to 39.9%, P< .001; EVAR 32.4%). The overall mean annual number of ruptured AAA diagnoses (9,979 to 7,773, P < .0001) and overall mean annual deaths from a ruptured AAA decreased post-EVAR (5,338 to 3,901, P < .0001). CONCLUSIONS-Since the introduction of EVAR, there has been a significant decrease in the annual number of deaths from both intact and ruptured AAA. This coincided with an increase in intact AAA repair after the introduction of EVAR and a decrease in ruptured AAA diagnosis and repair volume.

Journal of Vascular Surgery, 2001

The United Kingdom Small Aneurysm study has demonstrated the low risk of rupture in aneurysms less than 5.5 cm in diameter. With the advent of endoluminal techniques, patients considered unfit to undergo laparotomy are now considered for endovascular repair. However, the natural history of aneurysms larger than 5.5 cm remains uncertain, especially when severe comorbidity is present. In our center, we prospectively maintain records of all patients for whom elective aneurysm surgery was refused. This study documented the outcome of all patients referred with abdominal aortic aneurysms (AAAs) larger than 5.5 cm in diameter who were turned down for elective open repair and determined the cause of death and risk of rupture in all patients. Methods: Details of all patients with AAAs from January 5, 1989, to January 5, 1999, were recorded, and demographic details on all patients with AAAs larger than 5.5 cm were collected. Copies of death certificates were obtained from the Office of National Statistics, local in-hospital patient records, and general practitioner records. Results of postmortem examinations were also obtained. Aneurysms were stratified according to their size at presentation (5.5-5.9 cm, 6.0-7.0 cm, and > 7.0 cm), and the reasons no intervention was made were documented. Results: A total of 106 patients were turned down for elective aneurysm surgery in the 10-year period (10.6 per year). The mean age of the patients was 78.4 years (SD, 7.4), and 70 were men and 36 were women. At the end of the study, 76 patients (71.7%) had died. Overall, the 3-year survival rate was 17%. Patients with AAAs larger than 7.0 cm lived a median of 9 months. A ruptured aneurysm was certified as a cause of death in 36% of the patients with an AAA of 5.5 to 5.9 cm, in 50% of the patients with an AAA of 6 to 7.0 cm, and 55% of the patients with an AAA larger than 7.0 cm. Reasons given for not intervening were patient refusal (31 cases), the patient being "unfit for surgery" (18 cases), the "advanced age" of the patient (18 cases), cardiac disease (9 cases), cancer (9 cases), respiratory disease (6 cases), and other (15 cases). Conclusion: Although we recognize the problems with death certification, we found that rupture was a significant cause of death in patients with an untreated AAA that was larger than 5.5 cm. Although little difference in outcome was observed in aneurysms in the 5.5 to 7.0 cm size range, patients with an AAA that was larger than 7.0 cm seemed to have a much poorer prognosis.

Diagnostic and interventional radiology (Ankara, Turkey)

T he splenic artery is the third most common location of intraabdominal aneurysms, following the abdominal aorta and iliac arteries. Visceral arterial aneurysms are rare pathologies, the splenic artery constitutes 60%, hepatic artery 25%, and superior mesenteric artery 5%. Generally they are incidentally diagnosed on autopsies or abdominal radiographic examinations. Rupture is the most critical complication that occurs in 3%-10% of cases (1).

CardioVascular and Interventional Radiology, 2003

Purpose: To assess the endovascular treatment of splenic artery aneurysms and false aneurysms. Methods: Twelve patients (mean age 59 years, range 47-75 years) with splenic artery aneurysm (n ϭ 10) or false aneurysm (n ϭ 2) were treated. The lesion was asymptomatic in 11 patients; hemobilia was observed in one patient. The lesion was juxta-ostial in one case, located on the intermediate segment of the splenic artery in four, near the splenic hilus in six, and affected the whole length of the artery in one patient. In 10 cases, the maximum lesion diameter was greater than 2 cm; in one case 30% growth of an aneurysm 18 mm in diameter had occurred in 6 months; in the last case, two distal aneurysms were associated (17 and 18 mm in diameter). In one case, stent-grafting was attempted; one detachable balloon occlusion was performed; the 10 other patients were treated with coils. Results: Endovascular treatment was possible in 11 patients (92%) (one failure: stenting attempt). In four cases among 11, the initial treatment was not successful (residual perfusion of aneurysm); surgical treatment was carried out in one case, and a second embolization in two. Thus in nine cases (75%) endovascular treatment was successful: complete and persistent exclusion of the aneurysm but with spleen perfusion persisting at the end of follow-up on CT scans (mean 13 months). An early and transient elevation of pancreatic enzymes was observed in four cases. Conclusion: Ultrasound and CT have made the diagnosis of splenic artery aneurysm or false aneurysm more frequent. Endovascular treatment, the morbidity of which is low, is effective and spares the spleen.

The American Journal of Surgery, 2001

Background: This retrospective study was conducted to describe the presentation, surgical treatment, and follow-up of patients with splenic artery aneurysms. Methods: From 1982 to 2000, 1,952 patients with abdominal aneurysms were referred to our department; 15 had splenic artery aneurysms. None had ruptured. All were operated on. Results: Fourteen complete and 1 partial aneurysmectomies were carried out. Arterial continuity was restored in 10, by end-to-end anastomosis, and 4 had splenectomies. In 1 patient the spleen was preserved without arterial reconstruction. There were no deaths. Morbidity was restricted to 1 patient with a limited, asymptomatic splenic infarction. Eleven patients were followed up for a mean 19.7 months. No deaths or major complications were recorded. Reconstructed splenic arteries were patent in all cases without atrophy or new cases of splenic infarction. Conclusions: Elective surgery for splenic artery aneurysms is safe. Arterial reconstruction allows good early and long-term results. In some cases splenectomy may be unavoidable.

Journal of Vascular Surgery, 2003

Objective: The purpose of this study was to establish the risk of rupture as related to size of abdominal aortic aneurysm (AAA), gender, and expansion of the aneurysm. Methods: Between 1976 and 2001, 476 patients with conditions considered unfit for surgery with AAA 5.0 cm or more were followed with computed tomographic scans every 6 months until rupture, surgery, death, or deletion from follow-up. Surgery was performed for rupture (n ‫؍‬ 22), improved medical condition (n ‫؍‬ 37), increase in size (n ‫؍‬ 95), symptoms (n ‫؍‬ 17), and other reasons (n ‫؍‬ 24). Results: Fifty ruptures occurred during the follow-up period. The average risk of rupture (and standard error) in male patients with 5.0-cm to 5.9-cm AAA was 1.0% (0.01%) per year, in female patients with 5.0-cm to 5.9-cm AAA was 3.9% (0.15%) per year, in male patients with 6.0-cm or greater AAA was 14.1% (0.18%) per year, and in female patients with 6.0-cm or greater AAA was 22.3% (0.95%) per year. Conclusion: The risk of rupture in male patients with AAA 5.0 to 5.9 cm is low. The four-time higher risk of rupture in female patients with AAA 5.0 to 5.9 cm suggests a lower threshold for surgery be considered in fit women. The data regarding risk of rupture in patients with AAA 6.0 cm or more may allow more appropriate decision analysis for surgery in patients with unfit conditions with large AAA. (J Vasc Surg 2003;37:280-4.)

International journal of biomedical science : IJBS, 2009

Splenic Artery Aneurysms are commonly detected incidentally and can present acutely as a source of intra-abdominal catastrophe. Management options include both surgical and endovascular repair. The role of endovascular repair in an haemodynamically stable acute rupture is undefined and the use of Amplatzer(®) Vascular Plug has not to our knowledge been reported.

Annals of Vascular Surgery, 2008

Acta chirurgica Belgica

Splenic artery aneurysms are extremely rare lesions. Elective repair of these aneurysms is justified only if the aneurysm&#39;s size is greater than 2 cm and the predicted peri-operative mortality is below 0.5%. Percutaneous techniques minimise the peri-operative morbidity and mortality rates and offer a safe and effective treatment option. We report a coil-embolisation of a 5.1 cm splenic artery aneurysm and a short review of the literature concerning the endovascular treatment options.