Abstract:Background and Aims: Splenic artery aneurysms (SAA) are a type of visceral aneurysmal disease, which are uncommon but potentially fatal if rupture occurs. The traditional treatment for SAA is open aneurysmectomy with splenectomy. In recent years, endovascular operation for SAA become increasingly popular with the development of interventional techniques and materials. Endovascular treatment has the advantages of minimal invasion, simple operation and fast postoperative recovery. Therefore, this study was conducted to assess the efficacy and safety of endovascular treatment of SAA.
Methods: The clinical data of 30 patients with SAA treated in the Department of Vascular Surgery, Xiangya Hospital, Central South University during Janurary 2012 to December 2019 were reviewed, and three interventional methods used for the treatment of SAA in our department were also introduced.
Results: Definitive diagnosis of SAA was made by abdominal CTA in all the 30 patients. The lesions were located in the proximal splenic artery in17 cases, in the middle segment of the splenic artery in 9 cases, and in the distal splenic artery in 4 cases; 19 lesions were fusiform and 11 lesions were saccular. All patients received endovascular repair, of whom, 21 cases underwent SAA embolization, 6 cases underwent splenic artery stenting, and 3 cases received splenic artery bare stent placement plus embolization. The average length of hospital stay was 4 d, and average medical expense was 50 000 yuan. The symptoms such as abdominal pain, vomit and fever occurred in 10 patients after operation, and were alleviated within 3 d without any sequelae. One patient had puncture site bleeding and was recovered and discharged after conservative treatment. No acute splenic infarction and complications requiring re-operation occurred during hospitalization. Postoperative follow-up was conducted in 22 patients, and the CTA showed that the aneurysms were occluded completely by thrombosis without endoleak of contrast agent, and asymptomatic focal splenic infarction was found in 5 patients.
Conclusion: Interventional endovascular treatment can cure the SAA with preservation of the spleen. It has demonstrable efficacy with minimal invasiveness and quick recovery, low incidence of complications, and short length of hospitalization, and without increase in cost compared to open surgery. Endovascular therapy can be considered as the first choice for majority of SAA, and the specific procedure selection should be based on the morphology and position of the SAA shown by CTA.