Management of Giant Splenic Artery Aneurysm

Abstract

To provide an overview of the medical literature on giant splenic artery aneurysm (SAA).The PubMed, Medline, Google Scholar, and Google databases were searched using keywords to identify articles related to SAA. Keywords used were splenic artery aneurysm, giant splenic artery aneuryms, huge splenic artery aneurysm, splenic artery aneurysm rupture, and visceral artery aneurysm. SAAs with a diameter ≥5 cm are considered as giant and included in this study. The language of the publication was not a limitation criterion, and publications dated before January 15, 2015 were considered.The literature review included 69 papers (62 fulltext, 6 abstract, 1 nonavailable) on giant SAA. A sum of 78 patients (50 males, 28 females) involved in the study with an age range of 27–87 years (mean ± SD: 55.8 ± 14.0 years). Age range for male was 30–87 (mean ± SD: 57.5 ± 12.0 years) and for female was 27–84 (mean ± SD: 52.7 ± 16.6 years). Most frequent predisposing factors were acute or chronic pancreatitis, atherosclerosis, hypertension, and cirrhosis. Aneurysm dimensions were obtained for 77 patients with a range of 50–300 mm (mean ± SD: 97.1 ± 46.0 mm). Aneurysm dimension range for females was 50–210 mm (mean ± SD: 97.5 ± 40.2 mm) and for males was 50–300 mm (mean ± SD: 96.9 ± 48.9 mm). Intraperitoneal/retroperitoneal rupture was present in 15, among which with a lesion dimension range of 50–180 mm (mean ± SD; 100 ± 49.3 mm) which was range of 50–300 mm (mean ± SD: 96.3 ± 45.2 mm) in cases without rupture. Mortality for rupture patients was 33.3%. Other frequent complications were gastrosplenic fistula (n = 3), colosplenic fistula (n = 1), pancreatic fistula (n = 1), splenic arteriovenous fistula (n = 3), and portosplenic fistula (n = 1). Eight of the patients died in early postoperative period while 67 survived. Survival status of the remaining 3 patients is unclear. Range of follow-up period for the surviving patients varies from 3 weeks to 42 months.Either rupture or fistulization into hollow organs risk increase in compliance with aneurysm diameter. Mortality is significantly high in rupture cases. Patients with an evident risk should undergo either surgical or interventional radiological treatment without delay.

Endovascular Therapy for Splenic Artery Aneurysm: A Case Report

“…Generally, visceral aneurysms have a high risk of breaking and mortality in the case of rupture being projected to range from 35% to 100%. In pregnant women, if the size is the more than 2 cm and if the size increases; pregnancy should be considered to be a risk factor for rupture and, hence, indications for the treatment of splenic artery aneurysm (9,15). Despite the merit mentioned, the results of this study may be affected by its limitations including surgeon experience, small numbers of patients, and the lack of a control group.…”

Splenic artery aneurysm with the double-rupture phenomenon

“…In symptomatic patients, vague abdominal pain is the most common clinical manifestation, especially in the epigastric or left upper quadrant area, and other symptoms such as nausea or vomiting can be seen [1,6]. …”

“…Spontaneous rupture is the most dangerous complication, with mortality rates of 25% to 75%, because of intraperitoneal hemorrhage and hypovolemic shock [1,6]. The high mortality is due to its asymptomatic nature before rupture, rapid aggravation after rupture, and frequent misdiagnosis.…”

Aneurismas de artéria esplênica: história natural e técnicas de tratamento

“…7 Splanchnic aneurysms account for 5% of intra-abdominal aneurysms. 1 Splenic artery aneurysms are the most common type of visceral aneurysms (60%), [8][9][10][11][12] followed by aneurysms of the hepatic arteries (20%), the superior mesenteric artery (5.9%), and the celiac artery (4%). 8 In large autopsy series, the incidence of SAA varied from 0.01% to 0.2% of patients.…”

“…Arterial aneurysms occur when an artery expands locally to a diameter exceeding 50% of its expected size and they constitute an important clinical condition, causing mortality and morbidity. 1 They are classified as fusiform or saccular, on the basis of morphology and dimensions, 1 and as true aneurysms (when all layers of the artery wall expand) or pseudoaneurysms (when the artery expands and there is focal rupture of the wall). 2 True splenic artery aneurysms (SAA) are a rare, but potentially fatal, pathology.…”