Anatomical Variations of the Splenic Artery: Clinical and Surgical Implications—A Systematic Review

Background: The splenic artery exhibits considerable anatomical variability in its origin, course, and branching pattern, with important implications for upper abdominal surgery. However, existing evidence remains fragmented across anatomical, radiological, and clinical studies. Objective: This systematic review aimed to synthesise current evidence on anatomical variations in the splenic artery and evaluate their surgical implications in upper abdominal procedures. Methods: A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and the Cochrane Library. Studies reporting anatomical variations in the splenic artery identified through cadaveric dissection, radiological imaging, or intraoperative findings were included. Data were extracted on origin, course, branching pattern, and accessory arteries, along with reported surgical implications. Methodological quality varied across study designs, with radiological and clinical studies generally demonstrating lower risk of bias than descriptive cadaveric investigations. Results: Seventeen studies involving 4301 subjects and specimens were included, encompassing cadaveric, radiological, and clinical investigations. The splenic artery most commonly originates from the celiac trunk, although less common origins from the abdominal aorta and the superior mesenteric artery have been reported. A suprapancreatic course was predominant, but retropancreatic and intrapancreatic variations were consistently documented. The artery frequently exhibited a tortuous configuration, and branching patterns were highly variable, with terminal bifurcation being most common. Segmental and polar arteries, as well as variations in gastric branches, were frequently observed. These vascular variations may influence operative complexity and increase the risk of intraoperative vascular injury, particularly during pancreatic, gastric, and splenic procedures. Conclusions: The splenic artery exhibits substantial anatomical variability with direct implications for surgical planning and outcomes. Preoperative vascular assessment using advanced imaging techniques may improve surgical safety in upper abdominal procedures.