Endovascular treatment of patients with splenic artery aneurysm

• Papoyan S.A.
• Gromov D.G.
• Shchegolev A.A.
• Markarov A.E.
• Mutaev M.M.
• Mishkina P.A.

Abstract

Background. Splenic artery aneurysm is a disease with a low incidence (0.1–2%), which is rarely diagnosed due to the paucity of clinical manifestations. At the same time, this pathology poses a great danger as a hidden source of internal bleeding in case of spontaneous or traumatic rupture. Giant true aneurysms larger than 5 cm (28%) and pseudoaneurysms of the splenic artery (37%) are more likely to rupture, the cause of which in most patients is pancreatic necrosis. Currently, there are no uniform clinical recommendations illustrating a clear-cut examination plan, indications and all the variety of surgical interventions for such patients, with endovascular technologies being at the research stage.

Objective. The aim of our study was to evaluate the efficacy of endovascular methods of treatment of patients with true and false splenic artery aneurysms.

Patients and methods. The study included a total of 18 patients diagnosed with a splenic artery aneurysm. Of these, true splenic artery aneurysms were diagnosed in 12 (66.7%) patients, and false ones in 6 (33.3%). The average age of the patients was 53±1.7 years, with 8 (44.4%) men and 10 (55.6%) women thereamong. The femoral access was used in nine patients. The following procedures were performed: 10 (55.6%) embolizations of splenic artery aneurysms, 1 (5.6%) stenting of the splenic artery aneurysm, 2 (11.1%) embolizations of the proximal portion of the splenic artery, 1 (5.6%) embolization of the anterior branch of the splenic artery and 4 (22.2%) diagnostic angiographies.

Results. 17 (94.4%) of the 18 patients had no complications in the early postoperative period. A fragmentary spleen infarction was detected in 1 patient after embolization of the proximal portion of the splenic artery according to the findings of computed tomography. The in-hospital mortality rate was 5.6%. The average number of bed-days for true and false splenic artery aneurysms amounted to 3±1 and 10±2, respectively.

Conclusion. Timely endovascular treatment of patients with splenic artery aneurysms is characterized by minimal postoperative complications and length of hospital stay.

Funding. The study had no financial support.

Conflict of interest. The authors declare no conflicts of interest.

Authors’ contribution. Study conception and design – Papoyan S.A., Gromov D.G., Mutaev M.M.; data collection and handling – Papoyan S.A., Mutaev M.M., Mishkina P.A.; statistical processing – Gromov D.G., Papoyan S.A., Mishkina P.A.; draft manuscript preparation – Mishkina P.A.; manuscript revision – Papoyan S.A.

For citation: Papoyan S.A., Gromov D.G., Shchegolev A.A., Markarov A.E., Mutaev M.M., Mishkina P.A. Endovascular treatment of patients with splenic artery aneurysm. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (1): 53–61. DOI: https://doi.org/10.33029/1027-6661-2024-30-1-53-61

Keywords:splenic artery aneurysm; splenic artery; true aneurysm; splenic artery pseudoaneurysm; false aneurysm; embolization