Splenic Artery Aneurysm: A Retrospective Study of Management in Alexandria University

Background: Splenic artery aneurysms (SAAs) are rare but are increasingly being diagnosed as incidental findings. They account for around 60% of visceral artery aneurysms and are the third most common intra-abdominal aneurysms after aortic and iliac aneurysms.The true incidence of SAA is difficult to determine as the majority of cases are asymptomatic. It is clear, however, that SAAs are being found more frequently and identified earlier due to the availability of advanced imaging techniques.The appropriate treatment for SAAs depends on the location and size of the aneurysm, operative risks, and clinical status. The treatment of symptomatic SAAs should be performed. However, no consensus has been reached regarding intervention in asymptomatic patients. Aim of work: Was to study the appropriate and different ways of management of splenic artery aneurysms. Patients and methods: 13 patients in ten years attended the main hospital of Alexandria University with a diagnosis of splenic artery aneurysm. Assessed risk factors included age, gender, hypertension, diabetes, hyperlipidaemia, gallbladder diseases, coronary artery diseases, and tobacco use. Patients were also assessed for whether SAA was an incidental finding, symptomatic, or ruptured at presentation. The role of duplex scanning and/or computed tomography (CT) was successful in distinguishing pseudoaneurysm from true one. Calcification, thrombosis, and postoperative splenic infarction were assessed with the assistance of reconstruction of axial imaging. Surgical treatment depended on the site of the aneurysm. Aneurysms located in the proximal or middle third of the splenic artery were treated with simple excision, with proximal and distal ligation of the artery and with splenic preservation. The spleen was preserved only after observation of good back-flow in the distal portion of the splenic artery, and the colour of the spleen was not changed. For aneurysms located in the distal third, resection with splenectomy was performed. Results: The mean age at diagnosis was 66 years, and 8 of 13 patients (62%) were females. Co-morbidities were gallbladder diseases (69%) and systemic hypertension (54%), however to a less extent were cigarette smoking (54%), portal hypertension (46%) and hyperlipidaemia (46%). 77% of the patients were complaining of abdominal symptoms, varying from dyspepsia, abdominal discomfort and attacks of upper abdominal pain. One patient was haemodynamically unstable. Two patients were diagnosed incidentally. The size of the splenic artery aneurysms were between 8mm and 120mm with mean of 26mm in diameter. Most of the aneurysms (85%) were located in the middle and the distal third of the splenic artery; however the proximal third was affected in only 2 (15%) patients. Calcification of the wall of the aneurysm was present in 10 (83%) patients. Open surgery was done for all patients, and the lesser sac was opened to approach the splenic artery. Double ligation of the splenic artery and splenectomy was the strategy except in two patients where the aneurysm was in the proximal 1/3 of the splenic artery. In these two patients only double ligation-excision of the aneurysm was done with preservation of the spleen. The spleen colour was not changed and fair backflow from distal part of the splenic artery before ligation was present. Post-operative course was smooth for all patients. Pain was present in all patients and was controllable by analgesia. Patients were discharged after 4-7 days from surgery
Conclusion: SAAs are usually silent, but their diagnosis nowadays is increasing due to the presence of good imaging techniques. Risk factors for growth and rupture of SAAs should be identified for prophylactic early intervention. Many forms of management have been reported, however open surgery is still favoured