Splenic artery aneurysms

Area of Science:

• Vascular Surgery
• Gastroenterology
• Obstetrics & Gynecology

Background:

• Splenic artery aneurysms (SAAs) are rare but can lead to life-threatening rupture.
• Etiological factors include female sex, pregnancy, portal hypertension, and arteriosclerosis.
• Histological changes in affected women include subendothelial thickening and medial fibrodysplasia.

Purpose of the Study:

• To report on nine cases of splenic artery aneurysms.
• To analyze the etiopathogenic factors and histological findings.
• To evaluate the surgical outcomes and management strategies.

Main Methods:

• Retrospective review of nine patients with splenic artery aneurysms.
• Clinical data, including patient history, symptoms, and management, were analyzed.
• Histopathological examination of surgical specimens was performed.

Main Results:

• Female predominance was noted, with pregnancy identified as a significant factor.
• Histological findings in women included subendothelial thickening, internal elastic lamina fragmentation, medial fibrodysplasia, and acid glycosaminoglycan accumulation.
• Two cases of rupture during pregnancy showed microcystic degeneration.
• Five out of six operated patients underwent aneurysmectomy with splenectomy, with successful outcomes in most.
• One case of gestational rupture required reoperation due to splenic bleeding and fetal demise.

Conclusions:

• Splenic artery aneurysms have distinct etiopathogenic factors in women, including pregnancy and portal hypertension.
• Histological analysis reveals specific vascular wall changes.
• Surgical management, often involving splenectomy, is generally effective, but careful consideration is needed for pregnant patients.
• Arteriography is crucial for diagnosing SAAs in patients with portal hypertension.
• SAAs should be considered in the differential diagnosis of shock during pregnancy.