Splenic Artery Aneurysms: When to Treat and Why

What is the recommended treatment of a patient who has anasymptomatic splenic aneurysm that is 4 cm in diameter?---- MDSplenic artery aneurysms are the most commonvisceral artery aneurysms; they account for up to60% of such lesions. Most are small (less than2 cm), saccular aneurysms, and more than 80%are located in the mid or distal splenic artery.These aneurysms are 4 times more common in womenthan in men. The risk of rupture of a splenic artery aneurysmis between 3% and 9.6%. The mortality rate afterrupture has remained high at 36%.Most splenic artery aneurysms are asymptomatic.The aneurysms are usually identified as incidental findingson diagnostic studies undertaken for other purposes. Theclassic radiographic appearance is that of a curvilinearsignet ring-shaped calcification in the left upper quadrant.The treatment of splenic artery aneurysms is basedon the natural history of these lesions. Treatment is recommendedfor the following groups:

• Patients who are symptomatic.
• Pregnant women.
• Women of child-bearing age who may subsequently becomepregnant.
• Patients with pseudoaneurysms associated with inflammatoryprocesses.

However, most patients have asymptomatic splenicartery aneurysms and are not pregnant or likely to becomepregnant. For these patients, consider both therelatively low risk of rupture (3% to 9.6%) and the mortalityrate for patients who do have a rupture (approximately36%) in the decision to treat. Thus, treatment is recommendedfor all patients at low risk for surgical complicationswho have relatively large asymptomatic splenicartery aneurysms (greater than 2 cm). The majority ofthese aneurysms can now be treated by catheter-basedtechniques.

---- Louis M. Messina, MD
Professor of Surgery
Chief, Division of Vascular Surgery
University of California, San Francisco
School of Medicine

References:

FOR MORE INFORMATION:

Messina LM, Stanley CJ. Visceral artery aneurysms.

Surgical Clinics of NorthAmerica.

1997;77:425-441.