Predictive factors for post-embolization infarction and long-term splenic remodeling in patients undergoing splenic...

To identify predictive factors for post-embolization splenic infarction and to assess long-term remodeling patterns of the spleen, including regeneration and atrophy, in patients undergoing embolization for splenic artery aneurysm (SAA).

This retrospective study included 64 patients (66 cases) with splenic artery aneurysms who underwent transcatheter arterial embolization between February 2007 and November 2023 at a single tertiary center. Embolization techniques included sac packing, trapping, combined approaches, and stent-graft placement.

Technical success was achieved in all 66 cases. Clinical success was obtained in 94.1% of evaluable patients, with two cases of recanalization and one new aneurysm detected during follow-up. Splenic infarction occurred in 24 patients (37.5%) and was associated with distal or hilar/intrasplenic location (p = 0.007), larger pre-embolization splenic volume (p = 0.018), and reduced splenic staining on angiography after embolization (p < 0.001). In multivariate analysis, only reduced splenic staining on angiography remained an independent predictor of infarction (HR = 0.939; p = 0.001). Among infarcted patients, 12 (50%) demonstrated regeneration and 12 (50%) progressed to atrophy, with regeneration associated with higher post-embolization splenic staining on angiography (p = 0.036), smaller infarcted volume (p = 0.003), and greater final splenic volume (p = 0.018). Overall complication rate was 39.1%, all of which resolved with conservative management. No major complications occurred.

Endovascular embolization for splenic artery aneurysms was safe and effective. Post-embolization splenic staining on angiography was the key predictor of infarction and was also associated with long-term splenic regeneration.