Technical and clinical outcomes of endovascular treatment for splenic artery aneurysms

This study aimed to evaluate the outcomes of endovascular treatment for splenic artery aneurysms (SAAs). A retrospective review was conducted of patients with SAAs who underwent endovascular treatment between January 2019 and June 2024. Patient demographics, aneurysm characteristics, treatment strategies, and perioperative and long-term outcomes were analyzed. A total of 19 patients with SAAs, with a median age of 53 years (IQR 47–57 years), were treated endovascularly. Of these, 15 patients were treated with embolization alone, and 4 with covered stent placement. Technical success, defined as successful deployment of devices and complete exclusion of the aneurysm on final angiography, was achieved in 18 out of 19 patients (94.74%). The mean contrast medium volume used was 88.5 ± 9.5 mL, and the median operative time was 84 min (IQR 65–105 min). Post-embolization syndrome (PES) occurred in 15.79% (3/19) of patients. One patient developed splenic artery dissection, and 47.37% (9/19) had splenic infarction. During a median clinical follow-up of 35.5 months (IQR 11.25–45.5 months), there was no mortality, no hepatic or intestinal ischemia, or need for reintervention in either the perioperative period or during follow-up. The median duration of CT imaging follow-up was 28 months (IQR 10.5–35.5 months). The median aneurysm diameter was 25 mm (IQR 19.5–30.6 mm) before treatment and decreased to 19.9 mm (IQR 16.9–24.8 mm) on the last follow-up CT scan (P = 0.130). Among the nine patients with splenic infarction, follow-up imaging revealed complete resolution of the infarcted area in four cases and a marked reduction in infarct size in the remaining five. One patient with a minor endoleak and a stable aneurysm was managed conservatively. The vast majority of aneurysms (94.74%, 18/19) were completely excluded and had achieved complete thrombosis. Univariate regression analyses found no significant association between spleen diameter and complete aneurysm thrombosis (P = 0.999) or the degree of aneurysm sac shrinkage (P = 0.297). Based on our single-center experience, endovascular techniques appear to be feasible, safe, and effective for treating SAAs, with appropriate intervention tailored to anatomical location and aneurysm characteristics.