Dawn M. Coleman, Huiting Chen, Anna Eliassen, Shipra Arya, Enrique Criado, Jonathan L. Eliason, John Rectenwald, James C. Stanley
Vascular Surgery, Univ. of Michigan, Ann Arbor, MI.
OBJECTIVES: This study aims to examine the shifting trend in the management of true splenic artery aneurysms (SAA) in an endovascular (EV) era.
METHODS: A retrospective review of a single institution experience with SAA was performed. Medical records and imaging of 74 patients diagnosed with SAA between 1997-2012 were reviewed. This data was compared to a historical cohort of 60 patients managed before 1974.
RESULTS: A female predominance of 80% was noted, of which 65% of women were multiparous and 13% reported grand-multiparity (≥6 pregnancies). Mean age at diagnosis was 56 years (range 32-80). Mean aneurysm size at diagnosis was 2cm (range 0.8-3.5). Thirty-one patients (41%) were followed conservatively and demonstrated no growth by surveillance imaging. Forty-three patients underwent surgical intervention for rupture (n=2), symptoms (n=13) or size. Mean size at intervention was 2.2cm (range 0.8-3.7). Fifteen patients underwent open repair while 28 (including all ruptures) underwent EV embolization (n=26) or covered stent exclusion (n=2). In the open surgical cohort, 7 patients underwent aneurysmectomy, while 8 underwent aneurysmectomy with splenectomy. In the elective EV cohort, technical success was noted in all patients; both patients managed for rupture required either intra-operative or delayed conversion to splenectomy for hemodynamic instability and splenic infarction respectively. No major operative morbidity or mortality was identified following elective open or EV repair. No recurrence, aneurysm-related mortality or major morbidity was identified during a mean follow-up of 42 months (range 0-89).
CONCLUSIONS: This contemporary experience is comparable to our historical experience in female predominance, aneurysm size at intervention, and post-operative morbidity and mortality justifying the current EV approach. There has been a reduction in grand multiparity by half (25% to 13%). Rupture remains a recognized risk which carries notable morbidity and mortality.
AUTHOR DISCLOSURES: S. Arya: Nothing to disclose; H. Chen: Nothing to disclose; D. M. Coleman: Nothing to disclose; E. Criado: Nothing to disclose; J. L. Eliason: Nothing to disclose; A. Eliassen: Nothing to disclose; J. Rectenwald: Nothing to disclose; J. C. Stanley: Nothing to disclose.
Posted April 2013