Endovascular and Surgical Management of Intact Splenic Artery Aneurysm

Objective: This study aims to reveal the experience with endovascular and surgical management of intact splenic artery aneurysms in our single center.

Method: Between January 2011 and June 2017, 42 patients with intact splenic artery aneurysm were enrolled in this study. Twenty patients undergoing surgical intervention were classified as the surgical group, and 22 patients who received endovascular repair were categorized as the endovascular group. Demographic data, preoperative comorbidities, and anatomical characteristics of aneurysms were collected and analyzed. Details of interventions, perioperative outcomes, and follow-up results were evaluated and compared between the 2 groups.

Results: Forty-two patients with a mean age of 53.4 ± 11.6 years were enrolled in this study, and 44 aneurysms were repaired. Thirty-nine (92.9%) patients were asymptomatic, and 3 (7.1%) patients were symptomatic. The diameter of splenic artery aneurysms was 3.3 ± 1.6 cm, and the shape was mostly saccular. In the surgical group, the common methods used were splenic artery aneurysm resection (9 patients), followed by splenic artery aneurysms resection and splenectomy (6 patients), splenic artery aneurysm resection and arterial reconstruction with end-to-end anastomosis (3 patients), and laparoscopic splenic artery aneurysm resection coexisting with splenectomy (2 patients). In the endovascular group, the exclusive means was embolization with coils. The technical success rates in both open repair and endovascular repair were 100%. The 30-day mortality was nil, and no severe complication was found in the early time except that 1 patient suffered multiple splenic abscess in the endovascular group after embolization. Endovascular repair had significantly shorter surgery time (82.5 ± 27.6 vs 191.9 ± 62.7 min, P < 0.001) and hospital stay (5.6 ± 3.1 vs 10.8 ± 5.2 days, P < 0.001) compared with open repair. The median follow-up period in this study was 34.5 (interquartile range 16.8-60.8) months. Two sac reperfusions were detected during the follow-up in the endovascular group, and patients needed new embolization. No late deaths were found in the follow-up period, and the freedom from reintervention in the endovascular group at 1 and 3 years postoperatively was 95.5% and 82.4%, respectively. In addition, the freedom from reintervention in the surgical group at both 1 year and 3 years postoperatively were 100%. No significant differences were observed in late survival and reintervention between open repair and endovascular repair.

Conclusions: Open repair and endovascular repair were equally feasible, safe, and effective for intact splenic artery aneurysm. Endovascular repair is less invasive accompanied with an obvious decrease in surgery time and rapid recovery with a short hospital time.