Giant Splenic Artery Pseudoaneurysm: A Case Report and Literature Review

Abstract

Splenic artery aneurysms (SAAs) are the third most frequent intra-abdominal aneurysm, following abdominal aorta and iliac artery aneurysms. SAAs are classified according to their involvement of arterial wall layers: true aneurysms involve all 3 layers (intima, media, and adventitia), and pseudoaneurysms involve only one or two. Herein we present a new case of giant pseudo SAA. A 65-year-old female patient with a pancreatic mass and iron deficiency was referred to our clinic for further investigation. Abdominal ultrasonography, contrast-enhanced CT and magnetic resonance imaging showed a lesion resembling a subcapsular hemangioma in the spleen, and aneurysmatic dilation of the splenic artery with a diameter of >5 cm. The large size of the aneurysm and the clinical findings were indications for surgical treatment. The patient underwent en bloc resection of the spleen, distal pancreas, and aneurysmatic segment of the splenic artery. The patient remains complication-free 2 months after the operation. Spontaneous rupture is the most important life-threatening complications of giant SAAs. Therefore, all symptomatic patients with SAA should be treated, as well as asymptomatic patients with lesions ≥2 cm, who are pregnant or fertile, have portal hypertension, or are candidates for liver transplantation. Despite advances in endovascular techniques, conventional abdominal surgery remains the gold standard for treatment.

Multiple splenic artery aneurysms causing sinistral portal hypertension

“…Usually, at presentation SAA measures about 2.1cm and rarely presents with the diameter above 3.1cm. Giant aneurysms are generally defined as the diameter >5cm [1].…”

Long-term outcomes of elective transcatheter dense coil embolization for splenic artery aneurysms: a two-center experience

“…16,17 Akbulut and Otan 18 reviewed 69 papers and reported that giant SAA with a diameter of >5 cm was associated with a mortality of 33.3% in ruptured cases. Another literature review by Yagmur et al 19 revealed that spontaneous rupture could be considered the most critical complication of splenic artery pseudoaneurysm. Therefore, the general consensus is that all splenic artery pseudoaneurysms and SAAs meeting the criteria should be treated to reduce the potentially lifethreating risk associated with rupture.…”

Endovascular treatment of pseudoaneurysms secondary to chronic pancreatitis: reports of two cases

“…However, pseudoaneurysms more commonly manifest through silent anemia, melena, pain in the upper left quadrant, or copious bleeding followed by hemodynamic instability. 4 , 5 Therefore, a pseudoaneurysm should be considered a disease requiring emergency care that must be diagnosed and treated promptly and precisely. 9 , 10 …”

“…In contrast, true aneurysms of the splenic artery account for more than half of all visceral artery aneurysms. 5 Risk factors for true splenic artery aneurysm are hypertension, atherosclerosis, cirrhosis, portal hypertension, liver transplantation, female sex, pregnancy, and multiparity, 6 but can also include splenomegaly, medial fibrodysplasia, arteritis, collagen vascular disease, polyarteritis nodosa, systemic lupus erythematosus, anomalous splenic artery origin, a 1-antitrypsin deficiency, and inflammatory and infectious diseases. 5 - 7 …”