A review of management options for splenic artery aneurysms and pseudoaneurysms

Abstract

Background A review of the management of splenic artery aneurysms (SAA). There is no general consensus as to when and what type of intervention should be chosen to treat SAAs. The aim of this study is to investigate the types of intervention for SAAs including complication, reintervention, rupture, mortality after intervention of SAA in a review. Method A literature search was performed using “keywords” in Medline and Embase limited to publications from 2008 to 2018. 289 articles were identified during the initial literature search. 143 articles met the eligibility criteria. 83 articles were included in the quantitative synthesis. Descriptive analysis was performed. Results 576 patients were identified with 588 reported SAAs. The mean ± SD age was 52.6 ± 5.8 years (range 17–85). The mean ± SD size of SAA was 49.9 ± 13.2 mm (range 6–180). Types of intervention reported were endovascular treatment, open surgery, laparoscopic surgery and conservative management. Mortality rate in patients with endovascular treatment was 0.5% compared to 4.9% with open surgery. 3.4% of patients with conservative management were reported to have aneurysms that grew over time and 2.8% patients had further intervention. ANOVA test to compare mortality between open surgery, endovascular treatment and laparoscopic surgery showed there is no difference between mortality between the 3 different interventions as F (2.71) < F crit (3.02) (P = 0.07). Conclusion Endovascular treatment is now the first choice of treatment for SAA, but future studies are required to determine its long-term durability. By introducing a management pathway for SAA, we hope to see an improvement in managing patients. The management algorithm will require further validation through application with careful and complete follow-up of all cases to improve the pathway depending on patient outcome.

Endovascular Treatment of Aberrant Splenic Artery Aneurysm Presenting With Painless Progressive Jaundice: A Case Report and Literature Review

“…Moreover, the onset of splenic infarction after SA occlusion may be well tolerated by the patient, which are usually asymptomatic, and their conditions can be managed non-surgically. 1,9 Therefore, this combination technique is a safe and effective approach for aberrant SAA.…”

“…3,5 SAAs are often asymptomatic and incidentally identified. 1,9 However, the aberrant SAAs usually originate from the proximal SMA behind the pancreas, and the retroperitoneal plexus may be compressed by the aberrant aneurysm. Authors have reported that 41.5% patients with aberrant SAAs complained of epigastric pain or discomfort.…”

“…4,5,7 Coil embolization has been successfully performed in most orthotopic SAAs, especially for aneurysm in middle and distal SA. 9 Some authors reported that performing coil embolization alone with detachable coils was possible on the aberrant SAAs. 6,13,14 Nevertheless, dislodgment or misplacement of coils into SMA with consequent bowel ischemia is a potential complication.…”

Surgical management of splenic artery aneurysm

“…Although the rupture could cause hemorrhagic shock leading to death. When splenic artery aneurysms are suspected, angiography is the gold standard for diagnosis [ 8 ]. Generally, SAA is diagnosed with CT angiography which enables arterial reconstruction and appreciates its features and location [ 5 ].…”

“…Management of splenic artery aneurysms depends on their size, location, and presenting symptoms [ 8 ]. Splenic artery aneurysms are indicated for treatment in the following situations: Symptomatic patients, asymptomatic with lesions >2 cm [ 7 ], pregnant women, or women of childbearing age with SAA > 1 cm.…”