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 RR13. A Review of the Contemporary and Historical Management of 134 Patients with Splenic Artery Aneurysms

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

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