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Splenic artery aneurysm

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The following summarized guidelines for the evaluation and management of splenic artery aneurysm are prepared by our editorial team based on guidelines from the Society for Vascular Surgery (SVS 2020).
1

Guidelines

1.Diagnostic investigations

Diagnostic imaging: obtain CTA as the initial diagnostic tool of choice for splenic artery aneurysm.
B
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  • Screening for other aneurysms

2.Therapeutic procedures

Indications for repair: perform emergent intervention for Ruptured splenic artery aneurysms.
A
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3.Surgical interventions

Surgical repair
Consider performing open surgery, including possible splenectomy, as opposed to endovascular methods for the treatment of distal splenic artery aneurysm adjacent to the hilum of the spleen, given concern for the possibility of end-organ ischemia, including splenic infarction and pancreatitis.
C
Perform ligation with or without splenectomy depending on the aneurysm location in patients with ruptured splenic artery aneurysm discovered at laparotomy.
B

4.Specific circumstances

Pregnant patients: individualize treatment decisions in pregnant patients with splenic artery aneurysm regardless of size taking into account the potential morbidity to both the mother and fetus.
E

5.Follow-up and surveillance

Surveillance imaging
Consider obtaining annual surveillance with CT or ultrasound to assess for growth in size in patients with splenic artery aneurysm observed with a nonoperative or noninterventional approach.
C
Consider obtaining periodic surveillance with CTA, ultrasound or MRA after endovascular intervention for splenic artery aneurysms to assess for the possibility of endoleak or other continued aneurysm perfusion likely to lead to a continued risk of aneurysm growth or rupture.
C