The Seoul experience of splenic artery aneurysms

Background and Aims: Aneurysms of the splenic artery (SAA) are the most com mon type of aneurysms found ire the splanchnic arterial bed (1) and are sec ond in frequency only to aortic and iliac artery aneurysms among intra-abdo minal aneurysms (2). Historically rupture occurs in 6-9.2 % of asymptomatic cases and in pregnant women rupture occurs in 95 % of afflicted women furt her emphasizing the importance of early diagnosis (3-5). Possible treatment s are surgical resection or trans-catheteral arterial embolization. Material and Methods: The relationship of SAA to pregnancy, pancreatitis an d the outcome after surgical resection or arterial embolization was studied . Fifteen patients were diagnosed with SAA between January, 1992 and Decemb er 1999. The patients were classified by their clinical characteristics, et iology, size, and location of the aneurysm, relationship to pregnancy in wo men, clinical outcome of ruptured aneurysms and treatment. Results: Fifteen patients, male to female ratio of 1.1:1 (eight men, seven women), with splenic artery aneurysm were treated. Patients were mostly in their sixty's and the mean age was 49.07. Chronic pancreatitis and pseudocy sts were found in four cases (26.7 %). Acute pancreatitis, portal hypertens ion, splenomegaly, and bronchitis were comorbidities found each in one case (6.7 %). Eight cases (53.3 %) were without associated disease Conclusions: SAA has historically shown predominance in women, but in this study, men showed predominance and no relation to pregnancy could be found. In cases were the aneurysms ruptured and treatment was initiated, one of f our patients died. One patient refused treatment and subsequently died. As most of the aneurysms measure over 2 cm at the time of detection, operative resection was recommended in all cases. In the high-risk patients, arteria l embolization using coiling can be effective early in treatment but arteri al embolization in SAA secondary to pancreatitis was shown only to be palli ative and needed to be complimented with surgical intervention. Arterial em bolization is the method of choice in high-risk patients.