Splenic Artery Aneurysms: Two Decades Experience at Mayo Clinic

Abbas, Maher A.; Stone, William M.; Fowl, Richard J.; Gloviczki, Péter; Oldenburg, W. Andrew; Pairolero, Peter C.; Hallett, John W.; Bower, Thomas C.; Panneton, Jean M.; Cherry, Kenneth J.

doi:10.1007/s10016-001-0207-4

Cited by 366 publications

(331 citation statements)

References 22 publications

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“…18 The presence of an AAA is associated with aneurysms of the iliac, femoral, and popliteal arteries, but, compared with AAA, all of these have a higher incidence ratio in men versus women. 19 However, some aneurysms are found predominantly or equally in women, with splenic 20 and cerebral artery 21 aneurysms being respective examples.…”

Section: Prevalence and Incidencementioning

confidence: 99%

Abdominal Aortic Aneurysm

2007

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M ost manifestations of cardiovascular disease are more common in men than in women. However, cardiovascular disease is the most common cause of death in women worldwide. 1 Coronary heart disease in women has a worse outcome than in men, and this has attracted considerable attention in recent years, with calls for more gender-specific research. 1,2 Abdominal aortic aneurysms (AAAs) also are less common in women than in men, and, as with coronary heart disease, there is evidence that women with AAA also have a worse prognosis. The present review addresses the epidemiology, development, natural history, management, and outcomes of AAA in women. Prevalence and IncidenceWhen the definition of a maximum external diameter Ն3 cm is used, the prevalence of AAA is up to 6 times greater in men than in women. 3,4 In a community-based screening study of the older population, the prevalence of AAA was 1.3% in women compared with 7.6% in men. 4 Similarly, the ratio of men to women in surgical series is Ϸ5:1. 5-7 Because of the relatively low prevalence, women were excluded from the large trials of screening for AAA. 8 -10 The prevalence in women from families with a strong history of AAA may be as high as 8.3%, and these women should be offered screening. 11 Modeling studies have indicated that screening for AAA in women could be cost-effective because the rupture rate appears to be much higher in women than in men. 12 The incidence of AAA has continued to rise over the last 4 decades. [13][14][15][16] Initially, a similar pattern was seen in both genders, although the increase in mortality and admission rate has been become more marked in women. 15,16 Inspection of data derived from national (England and Wales) statistics shows that the annual number of hospital admissions for aneurysm rupture between 1997 and 2005 has declined by 2% to 3% per annum in men. 17 In women, although the total number of admissions for ruptured AAA is Ϸ40% of male admissions, there has been an increase of Ϸ0.5% per annum since 2005. The reasons for this are unknown. Population screening for AAA in men is not yet widespread in England and Wales and is unlikely to have made a major contribution to these trends. However, AAA appears to be a late event after smoking exposure, and these trends may reflect temporal changes in smoking prevalence. The rise of smoking in women occurred over the period 1950 to 1970, several decades after the widespread uptake of smoking by men. Since then, rates of cessation have been greater in men than in women. 18 The presence of an AAA is associated with aneurysms of the iliac, femoral, and popliteal arteries, but, compared with AAA, all of these have a higher incidence ratio in men versus women. 19 However, some aneurysms are found predominantly or equally in women, with splenic 20 and cerebral artery 21 aneurysms being respective examples. Natural History: Expansion and RuptureThere is no good evidence to suggest that aneurysm growth rate is different in men and women. 22 Although a single small study suggested that ...

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Section: Prevalence and Incidencementioning

confidence: 99%

Abdominal Aortic Aneurysm

2007

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“…Thus, laparoscopy may represent an interesting alternative to open surgery and provided that the same range of technical solutions offered by open surgery can be achieved with similar results [1,[14][15][16][17][18] and the general advantages of laparoscopy are confirmed in this specific application, the laparoscopic option may represent a challenging alternative not only to laparotomic surgery but also to endovascular procedures. Endovascular management, albeit minimally invasive, requires accurate patient selection and presents some Registration Number: NCT01387828.…”

Section: Introductionmentioning

confidence: 99%

Prospective randomized comparison of open versus laparoscopic management of splenic artery aneurysms: a 10-year study

et al. 2012

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Background The literature does not support the choice between open and laparoscopic management of splenic artery aneurysms (SAA). Methods We designed a prospective, randomized comparison between open and laparoscopic surgery for SAA. Primary end points were types of surgical procedures performed and clinical outcomes. Analysis was developed on an intention-to-treat basis. Results Fourteen patients were allocated to laparotomy (group A) and 15 to laparoscopy (group B). Groups displayed similar patient-and aneurysm-related characteristics. The conversion rate to open surgery was 13.3 %. The type of surgical procedure performed on the splenic artery was similar in the two groups: aneurysmectomy with splenic artery ligature or direct anastomosis was performed in 51 % and 21 % of patients in group A and in 60 % and 20 % in group B, respectively. The splenectomy rate was similar (14 % vs. 20 %). Postoperative splenic infarction was observed in one case in each group. Laparoscopy was associated with shorter procedures (p = 0.0003) and lower morbidity (25 % vs. 64 %, p = 0.045). Major morbidity requiring interventional procedures and blood transfusion was observed only in group A. Laparoscopy was associated with quicker resumption of oral diet (p \ 0.001), earlier drain removal (p = 0.046), and shorter hospital stay (p \ 0.01). During a mean follow-up of 50 months, two patients in group A required hospital readmission. In group B, two patients developed a late thrombosis of arterial anastomoses. Conclusions Our study demonstrates that laparoscopy permits multiple technical options, does not increase the splenectomy rate, and reduces postoperative complications. It confirms the supposed clinical benefits of laparoscopy when ablative procedures are required but laparoscopic anastomoses show poor long-term results.Keywords Clinical paper Á Trials Á Splenic artery aneurysms Recent literature reports on the feasibility, safety, and effectiveness of laparoscopic management of splenic artery aneurysms (SAA) as well as its appreciation by patientsoften young females-who harbour the disease [1][2][3][4][5][6][7][8][9][10][11][12][13]. Thus, laparoscopy may represent an interesting alternative to open surgery and provided that the same range of technical solutions offered by open surgery can be achieved with similar results [1,[14][15][16][17][18] and the general advantages of laparoscopy are confirmed in this specific application, the laparoscopic option may represent a challenging alternative not only to laparotomic surgery but also to endovascular procedures. Endovascular management, albeit minimally invasive, requires accurate patient selection and presents some Registration Number: NCT01387828.

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“…However, there is little follow-up information for this method and recurrence is a possible long-term hazard. When embolization is difficult or contraindicated by the proximity of the aneurysm to the spleen (with risk of splenic infarction) the options are open or laparoscopic surgery with ligation of the splenic artery, excision of the aneurysm with anastomosis of the artery or splenectomy with removal of the aneurysm (5,7,8). In conclusion; giant SAA are a rare clinical entity.…”

Section: öZetmentioning

confidence: 99%

“…Among the giant SAA reviewed, 25% of aneurysms ruptured (5). Ultrasonography (US) and Doppler US show anechoic mass with or without mural thrombus, turbulent and pulsatile flow.…”

Section: öZetmentioning

confidence: 99%