Splenic artery aneurysm is a visceral arterial aneurysm involving focal dilatation of the splenic artery. Most intact true aneurysms are discovered incidentally, but risk stratification changes substantially with portal hypertension, pregnancy or childbearing potential, aneurysm growth or large size, symptoms, pseudoaneurysm biology, and rupture.
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name: Splenic artery aneurysm
creation_date: "2026-05-06T18:59:54Z"
updated_date: "2026-05-06T19:28:47Z"
category: Complex
description: >-
Splenic artery aneurysm is a visceral arterial aneurysm involving focal
dilatation of the splenic artery. Most intact true aneurysms are discovered
incidentally, but risk stratification changes substantially with portal
hypertension, pregnancy or childbearing potential, aneurysm growth or large
size, symptoms, pseudoaneurysm biology, and rupture.
disease_term:
preferred_term: splenic artery aneurysm
term:
id: MONDO:0001856
label: splenic artery aneurysm
synonyms:
- SAA
- Splenic aneurysm
- True splenic artery aneurysm
parents:
- Arterial disorder
- Vascular disorder
definitions:
- name: Visceral splenic arterial aneurysm
definition_type: CASE_DEFINITION
description: >-
A true splenic artery aneurysm is an aneurysmal dilatation of the splenic
artery and is distinct from splenic artery pseudoaneurysm, which is usually
caused by local wall disruption and carries a higher rupture-risk management
threshold.
scope: Clinical and imaging definition of splenic artery aneurysm
evidence:
- reference: PMID:31839799
reference_title: "Splenic aneurysms: natural history and treatment techniques."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
True splenic artery aneurysms (SAA) are a rare, but potentially fatal,
pathology.
explanation: >-
The review defines true SAA as a rare but clinically important splenic
arterial aneurysm entity.
- reference: PMID:39407852
reference_title: "The Definition, Diagnosis, and Management of Giant Splenic Artery Aneurysms and Pseudoaneurysms: A Systematic Review."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Giant splenic artery aneurysms (SAAs) and pseudoaneurysms (SAPs)
represent rare conditions, characterized by a diameter greater than or
equal to 5 cm.
explanation: >-
The systematic review supports the aneurysm/pseudoaneurysm distinction and
the clinically important giant-lesion size category.
progression:
- phase: Incidental intact aneurysm
age_range: Mostly adult detection in available cohorts
notes: >-
Many intact SAAs are detected incidentally and can grow slowly, so
observation may be appropriate for selected small, stable, asymptomatic true
aneurysms outside high-risk contexts.
evidence:
- reference: PMID:12089631
reference_title: "Splenic artery aneurysms: two decades experience at Mayo clinic."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Growth rates of SAA are slow and growth is infrequent.
explanation: >-
This Mayo Clinic series supports slow growth as a common natural-history
pattern for intact SAA.
- phase: Rupture and hemorrhagic emergency
age_range: Any age with SAA, with especially high concern in pregnancy and portal hypertension
notes: >-
Rupture converts a usually silent vascular lesion into an abdominal or
gastrointestinal hemorrhage emergency with shock and high mortality risk.
evidence:
- reference: PMID:38249169
reference_title: Spontaneous Rupture of Splenic Artery Aneurysm.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Splenic artery aneurysms are rare and usually asymptomatic, with a high
risk of mortality once they get ruptured.
explanation: >-
This case-report abstract summarizes the high-risk transition from
asymptomatic SAA to rupture-associated mortality.
pathophysiology:
- name: Splenic arterial wall remodeling
description: >-
Multifactorial splenic arterial wall remodeling weakens the vessel wall and
permits focal aneurysmal dilatation. The structured evidence base for
isolated true SAA is mostly clinical, so this node represents the shared
vessel-wall failure endpoint rather than a single molecular cause.
cell_types:
- preferred_term: vascular smooth muscle cell
term:
id: CL:0000359
label: vascular associated smooth muscle cell
- preferred_term: endothelial cell
term:
id: CL:0000115
label: endothelial cell
- preferred_term: fibroblast
term:
id: CL:0000057
label: fibroblast
locations:
- preferred_term: splenic artery
term:
id: UBERON:0001194
label: splenic artery
- preferred_term: tunica media
term:
id: UBERON:0002522
label: tunica media
biological_processes:
- preferred_term: blood vessel remodeling
modifier: ABNORMAL
term:
id: GO:0001974
label: blood vessel remodeling
- preferred_term: extracellular matrix organization
modifier: ABNORMAL
term:
id: GO:0030198
label: extracellular matrix organization
evidence:
- reference: PMID:31839799
reference_title: "Splenic aneurysms: natural history and treatment techniques."
supports: PARTIAL
evidence_source: HUMAN_CLINICAL
snippet: >-
There are multiple etiologies and it is believed that hormonal influences
and changes in portal flow during gestation play an important role in
development of SAA.
explanation: >-
The review supports a multifactorial vessel-wall and hemodynamic model,
while the abstract does not define a single cellular mechanism.
downstream:
- target: Aneurysm rupture and hemorrhage
description: Loss of wall integrity can progress from dilatation to rupture with hematoma, gastrointestinal bleeding, or shock.
causal_link_type: DIRECT
- name: Portal-hypertensive splenic hyperkinetic flow
description: >-
Portal hypertension can increase splenic arterial diameter and flow,
creating a hyperkinetic splenic circulation that increases mechanical stress
on the splenic artery and favors aneurysm formation or intervention.
cell_types:
- preferred_term: endothelial cell
term:
id: CL:0000115
label: endothelial cell
- preferred_term: vascular smooth muscle cell
term:
id: CL:0000359
label: vascular associated smooth muscle cell
locations:
- preferred_term: splenic artery
term:
id: UBERON:0001194
label: splenic artery
biological_processes:
- preferred_term: response to mechanical stimulus
modifier: INCREASED
term:
id: GO:0009612
label: response to mechanical stimulus
- preferred_term: blood vessel remodeling
modifier: ABNORMAL
term:
id: GO:0001974
label: blood vessel remodeling
evidence:
- reference: PMID:1483666
reference_title: Splenic hyperkinetic state and splenic artery aneurysm in portal hypertension.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
In the portal hypertensive patients with splenic artery aneurysms, the
splenic artery was larger (p < 0.05) and the splenic arterial flow greater
(p < 0.05), and these patients were in a more hyperkinetic state, than
were those with no splenic artery aneurysm.
explanation: >-
This case-control angiographic study directly links portal hypertension
with increased splenic artery size and flow in SAA patients.
downstream:
- target: Splenic arterial wall remodeling
description: Increased flow and wall stress can drive remodeling of the splenic arterial wall.
causal_link_type: DIRECT
- name: Tortuous splenic artery hemodynamic stress
description: >-
Tortuous splenic artery geometry may concentrate hemodynamic forces and
correlate with aneurysm formation and dilatation, especially in female
patients.
cell_types:
- preferred_term: endothelial cell
term:
id: CL:0000115
label: endothelial cell
- preferred_term: vascular smooth muscle cell
term:
id: CL:0000359
label: vascular associated smooth muscle cell
locations:
- preferred_term: splenic artery
term:
id: UBERON:0001194
label: splenic artery
biological_processes:
- preferred_term: response to mechanical stimulus
modifier: INCREASED
term:
id: GO:0009612
label: response to mechanical stimulus
evidence:
- reference: PMID:29363319
reference_title: Morphological analysis using geometric parameters for splenic aneurysms.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Background Considering the unique characteristics of splenic artery
aneurysms, we hypothesized that hemodynamic forces could play an important
role in splenic artery aneurysm formation and that splenic artery geometry
should be correlated with aneurysm development.
explanation: >-
This study frames tortuous splenic artery geometry as a hemodynamic
contributor to SAA formation.
- reference: PMID:29363319
reference_title: Morphological analysis using geometric parameters for splenic aneurysms.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Conclusion Females with a tortuous splenic artery may have an increased
risk of aneurysm formation.
explanation: >-
The abstract conclusion supports tortuosity as a sex-linked geometric
risk context for SAA.
downstream:
- target: Splenic arterial wall remodeling
description: Local geometry-driven stress can promote focal dilatation.
causal_link_type: DIRECT
- name: Pregnancy-associated portal-flow and hormonal stress
description: >-
Pregnancy is a high-risk physiologic context for SAA because gestational
hormonal influences and portal-flow changes can interact with pre-existing
wall vulnerability, and rupture has very high maternal and fetal mortality.
cell_types:
- preferred_term: vascular smooth muscle cell
term:
id: CL:0000359
label: vascular associated smooth muscle cell
locations:
- preferred_term: splenic artery
term:
id: UBERON:0001194
label: splenic artery
biological_processes:
- preferred_term: blood vessel remodeling
modifier: ABNORMAL
term:
id: GO:0001974
label: blood vessel remodeling
evidence:
- reference: PMID:31839799
reference_title: "Splenic aneurysms: natural history and treatment techniques."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Among pregnant patients, mortality after rupture is 65-75%, with fetal
mortality exceeding 90%.
explanation: >-
The review quantifies the exceptionally severe pregnancy-associated
rupture prognosis.
- reference: PMID:31839799
reference_title: "Splenic aneurysms: natural history and treatment techniques."
supports: PARTIAL
evidence_source: HUMAN_CLINICAL
snippet: >-
There are multiple etiologies and it is believed that hormonal influences
and changes in portal flow during gestation play an important role in
development of SAA.
explanation: >-
This supports pregnancy-related hormonal and portal-flow mechanisms while
preserving the review's wording that the mechanism is believed rather than
experimentally proven.
downstream:
- target: Aneurysm rupture and hemorrhage
description: Pregnancy-related hemodynamic and hormonal stress increases concern for rupture.
causal_link_type: DIRECT
- name: Aneurysm rupture and hemorrhage
description: >-
Rupture of a splenic artery aneurysm causes internal bleeding that may
present with abdominal pain, hematoma, gastrointestinal bleeding,
hypotension, syncope, or hypovolemic shock.
locations:
- preferred_term: splenic artery
term:
id: UBERON:0001194
label: splenic artery
evidence:
- reference: PMID:38249169
reference_title: Spontaneous Rupture of Splenic Artery Aneurysm.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
The patient presented in the emergency department with abdominal pain,
nausea, and vomiting, followed by syncope.
explanation: >-
The case report supports the symptomatic rupture presentation.
- reference: PMID:35915344
reference_title: Giant splenic artery aneurysm rupture into the stomach that was successfully managed with emergency distal pancreatectomy.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
He developed upper gastrointestinal (UGI) bleeding and hypovolemic shock.
explanation: >-
This case report directly supports bleeding and shock as rupture
consequences.
phenotypes:
- category: Cardiovascular
name: Splenic artery aneurysm
diagnostic: true
description: >-
The defining finding is aneurysmal dilatation of the splenic artery,
detected by vascular imaging, angiography, operation, or pathology.
phenotype_term:
preferred_term: splenic artery aneurysm
term:
id: HP:0002617
label: Vascular dilatation
evidence:
- reference: PMID:31839799
reference_title: "Splenic aneurysms: natural history and treatment techniques."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
True splenic artery aneurysms (SAA) are a rare, but potentially fatal,
pathology.
explanation: >-
The review directly defines true SAA as a rare and potentially fatal
aneurysm pathology.
- category: Constitutional
name: Asymptomatic incidental presentation
description: >-
Many intact true SAAs are found incidentally before rupture or other
complication.
evidence:
- reference: PMID:30496903
reference_title: Endovascular and Surgical Management of Intact Splenic Artery Aneurysm.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Thirty-nine (92.9%) patients were asymptomatic, and 3 (7.1%) patients were
symptomatic.
explanation: >-
This intact-SAA intervention cohort supports frequent asymptomatic
presentation among intact aneurysms.
- category: Gastrointestinal
name: Abdominal pain
description: >-
Symptomatic SAA, especially giant or ruptured lesions, can present with
abdominal, epigastric, or left upper quadrant pain.
phenotype_term:
preferred_term: Abdominal pain
term:
id: HP:0002027
label: Abdominal pain
evidence:
- reference: PMID:39407852
reference_title: "The Definition, Diagnosis, and Management of Giant Splenic Artery Aneurysms and Pseudoaneurysms: A Systematic Review."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
The most frequently described symptom was pain (59.76%).
explanation: >-
The systematic review identifies pain as the most common symptom among
giant SAA/SAP cases.
- reference: PMID:38249169
reference_title: Spontaneous Rupture of Splenic Artery Aneurysm.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
The patient presented in the emergency department with abdominal pain,
nausea, and vomiting, followed by syncope.
explanation: >-
This rupture case demonstrates abdominal pain at acute presentation.
- category: Gastrointestinal
name: Gastrointestinal hemorrhage
description: >-
Rare rupture into the stomach or gastrointestinal tract can cause upper
gastrointestinal bleeding.
phenotype_term:
preferred_term: Gastrointestinal hemorrhage
term:
id: HP:0002239
label: Gastrointestinal hemorrhage
evidence:
- reference: PMID:35915344
reference_title: Giant splenic artery aneurysm rupture into the stomach that was successfully managed with emergency distal pancreatectomy.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
This report shows that splenic artery aneurysm can cause UGI bleeding.
explanation: >-
The case-report conclusion directly supports upper gastrointestinal
bleeding as a possible complication.
- category: Cardiovascular
name: Hypovolemic shock
severity: SEVERE
description: >-
Rupture-related blood loss can produce hypovolemic shock.
phenotype_term:
preferred_term: Hypovolemic shock
term:
id: HP:0031274
label: Hypovolemic shock
evidence:
- reference: PMID:35915344
reference_title: Giant splenic artery aneurysm rupture into the stomach that was successfully managed with emergency distal pancreatectomy.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
He developed upper gastrointestinal (UGI) bleeding and hypovolemic shock.
explanation: >-
The case report directly documents hypovolemic shock from ruptured SAA.
- category: Cardiovascular
name: Hematoma after rupture
description: >-
Rupture may be visible on contrast CT as peri-aneurysmal hematoma or active
contrast extravasation.
phenotype_term:
preferred_term: Internal hemorrhage
term:
id: HP:0011029
label: Internal hemorrhage
evidence:
- reference: PMID:38249169
reference_title: Spontaneous Rupture of Splenic Artery Aneurysm.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
A contrast-enhanced CT scan was performed and showed a splenic artery
aneurysm measuring 40 × 35 mm surrounded by a hematoma.
explanation: >-
The CT finding of a hematoma surrounding the ruptured aneurysm supports
internal hemorrhage.
environmental:
- name: Portal hypertension
presence: Associated
description: >-
Portal hypertension is a high-risk clinical context for SAA, associated
with hyperkinetic splenic flow, larger aneurysm diameter at diagnosis, and
greater intervention rates.
effect: Increased SAA formation risk and higher-risk management context
evidence:
- reference: PMID:1483666
reference_title: Splenic hyperkinetic state and splenic artery aneurysm in portal hypertension.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
The study suggests that splenic artery aneurysms in cases of portal
hypertension may be the consequence of a hyperkinetic state in the spleen.
explanation: >-
This provides a mechanistic association between portal hypertension and
SAA through splenic hyperkinesis.
- reference: PMID:39009114
reference_title: Comparison of Splenic Artery Aneurysms in Patients with and without Portal Hypertension.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Splenic artery aneurysms (SAAs) are rare but seem to have higher incidence
in patients with portal hypertension (PH).
explanation: >-
The 2024 cohort paper identifies portal hypertension as an incidence-risk
context.
- name: Liver transplantation and parenchymal liver disease context
presence: Associated
description: >-
SAA is enriched in liver-transplant populations with portal hypertension and
parenchymal liver disease, making pre- or peri-transplant detection and
management clinically important.
effect: Higher prevalence and rupture concern in transplant populations
evidence:
- reference: PMID:9382977
reference_title: Splenic artery aneurysms in liver transplant patients. Liver Transplant Group.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
In patients without portal hypertension no aneurysms were identified,
whereas in 16% of the patients with portal hypertension aneurysms were
found (p<0.001).
explanation: >-
The liver-transplant angiography series supports the portal-hypertension
association in a transplant-relevant cohort.
- name: Pregnancy and childbearing potential
presence: Associated
description: >-
Pregnancy and childbearing potential are high-risk contexts because rupture
during pregnancy carries very high maternal and fetal mortality.
effect: Lower threshold for repair and heightened rupture-risk concern
evidence:
- reference: PMID:31839799
reference_title: "Splenic aneurysms: natural history and treatment techniques."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
True aneurysms account for 60% of SAA and affect four times as many women
as men, generally related to increased incidental or symptomatic findings
that coincide with use of ultrasonography in pregnancy.
explanation: >-
The review supports female and pregnancy-linked detection/risk context.
- reference: PMID:31839799
reference_title: "Splenic aneurysms: natural history and treatment techniques."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Among pregnant patients, mortality after rupture is 65-75%, with fetal
mortality exceeding 90%.
explanation: >-
This quantifies the high-consequence pregnancy rupture risk.
- name: Essential hypertension
presence: Associated
description: >-
Essential hypertension has been reported as a significant risk factor in
non-portal-hypertension SAA patients.
effect: Increased SAA development risk in non-portal-hypertension patients
evidence:
- reference: PMID:10549737
reference_title: "Management of splenic artery aneurysms: the significance of portal and essential hypertension."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
In patients without a history of PHTN (n = 12), essential hypertension was
a significant risk factor (p < 0.001) for development of SAA.
explanation: >-
This treated-SAA cohort identifies essential hypertension as a risk factor
outside portal hypertension.
diagnosis:
- name: Contrast-enhanced CT angiography
description: >-
Contrast CT/CTA is central for identifying SAA size, location, hematoma,
active extravasation, and treatment anatomy.
results: Splenic artery aneurysm size, location, hematoma, and active extravasation
evidence:
- reference: PMID:39407852
reference_title: "The Definition, Diagnosis, and Management of Giant Splenic Artery Aneurysms and Pseudoaneurysms: A Systematic Review."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
The CT scan was the most utilized imaging study (80.49%).
explanation: >-
The 2024 systematic review supports CT as the dominant diagnostic imaging
modality in giant SAA/SAP cases.
- reference: PMID:38249169
reference_title: Spontaneous Rupture of Splenic Artery Aneurysm.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
A contrast-enhanced CT scan was performed and showed a splenic artery
aneurysm measuring 40 × 35 mm surrounded by a hematoma.
explanation: >-
This rupture case shows contrast-enhanced CT detecting the aneurysm and
adjacent hemorrhage.
- name: Angiographic and ultrasound assessment
description: >-
Angiography can define splenic artery anatomy and enable endovascular
therapy, while ultrasound may detect SAA incidentally or in pregnancy but is
less comprehensive than CTA/MRA for treatment planning.
results: Aneurysm morphology, splenic arterial flow, and treatment-access anatomy
evidence:
- reference: PMID:1483666
reference_title: Splenic hyperkinetic state and splenic artery aneurysm in portal hypertension.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
The splenic arterial flow was assessed by measuring the radii of the
splenic arteries on celiac arteriograms.
explanation: >-
This supports angiography-based measurement of splenic arterial flow in
portal-hypertension-associated SAA.
- reference: PMID:31839799
reference_title: "Splenic aneurysms: natural history and treatment techniques."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
True aneurysms account for 60% of SAA and affect four times as many women
as men, generally related to increased incidental or symptomatic findings
that coincide with use of ultrasonography in pregnancy.
explanation: >-
This supports ultrasound as a frequent route to detection in pregnancy.
- name: Post-embolization surveillance imaging
description: >-
After coil embolization, follow-up imaging is used to detect sac
reperfusion, bleeding, or other complications.
results: Persistent sac perfusion, reperfusion, or post-procedural bleeding
evidence:
- reference: PMID:40626033
reference_title: Imaging modalities used in follow-up after coil embolization of splenic artery aneurysm - a systematic review.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
MRA should be preferred over DSA for detecting aneurysmal sac reperfusion.
explanation: >-
This systematic review conclusion supports MRA-based surveillance for sac
reperfusion after coil embolization.
treatments:
- name: Endovascular coil embolization
description: >-
Coil embolization excludes the aneurysm or parent artery from flow and is a
common first-line approach for intact anatomically suitable SAA.
treatment_term:
preferred_term: embolization therapy
term:
id: NCIT:C15230
label: Embolization Therapy
target_phenotypes:
- preferred_term: splenic artery aneurysm
term:
id: HP:0002617
label: Vascular dilatation
target_mechanisms:
- target: Splenic arterial wall remodeling
treatment_effect: INHIBITS
description: Endovascular exclusion reduces flow into the aneurysm sac and mitigates rupture risk.
evidence:
- reference: PMID:30496903
reference_title: Endovascular and Surgical Management of Intact Splenic Artery Aneurysm.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
In the endovascular group, the exclusive means was embolization with coils.
explanation: >-
The intact-SAA cohort directly describes coil embolization as the
endovascular approach used.
- reference: PMID:30496903
reference_title: Endovascular and Surgical Management of Intact Splenic Artery Aneurysm.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Endovascular repair is less invasive accompanied with an obvious decrease
in surgery time and rapid recovery with a short hospital time.
explanation: >-
The cohort conclusion supports the perioperative recovery advantage of
endovascular repair.
- name: Open surgical repair, ligation, resection, or splenectomy
description: >-
Open repair includes aneurysm ligation or resection, sometimes with
splenectomy, arterial reconstruction, or distal pancreatic resection,
especially for rupture, giant lesions, unfavorable anatomy, or instability.
treatment_term:
preferred_term: surgical procedure
term:
id: MAXO:0000004
label: surgical procedure
target_phenotypes:
- preferred_term: splenic artery aneurysm
term:
id: HP:0002617
label: Vascular dilatation
target_mechanisms:
- target: Aneurysm rupture and hemorrhage
treatment_effect: INHIBITS
description: Open ligation, resection, and splenectomy control bleeding and remove the aneurysm when rupture or anatomy requires surgery.
evidence:
- reference: PMID:30496903
reference_title: Endovascular and Surgical Management of Intact Splenic Artery Aneurysm.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
In the surgical group, the common methods used were splenic artery
aneurysm resection (9 patients), followed by splenic artery aneurysms
resection and splenectomy (6 patients), splenic artery aneurysm resection
and arterial reconstruction with end-to-end anastomosis (3 patients), and
laparoscopic splenic artery aneurysm resection coexisting with splenectomy
(2 patients).
explanation: >-
The cohort enumerates open/laparoscopic surgical approaches for intact
SAA.
- reference: PMID:38249169
reference_title: Spontaneous Rupture of Splenic Artery Aneurysm.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
The patient was submitted to emergency laparotomy with ligation of the
splenic artery, aneurysm resection, and splenectomy.
explanation: >-
This rupture case supports emergency open surgical control with ligation,
aneurysm resection, and splenectomy.
- name: Selective surveillance of small stable intact true aneurysms
description: >-
Selected intact asymptomatic true SAAs can be monitored rather than repaired
immediately when high-risk features such as childbearing potential,
symptoms, growth, large size, or pseudoaneurysm are absent.
treatment_term:
preferred_term: clinical surveillance
target_phenotypes:
- preferred_term: splenic artery aneurysm
term:
id: HP:0002617
label: Vascular dilatation
evidence:
- reference: PMID:12089631
reference_title: "Splenic artery aneurysms: two decades experience at Mayo clinic."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
From analysis of the patient data we concluded that although SAAs may
rupture, not all intact aneurysms need intervention.
explanation: >-
This supports selective nonintervention for carefully selected intact
aneurysms.
- reference: PMID:32201007
reference_title: The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
They include evidence-based size thresholds for repair of aneurysms of the
renal arteries, splenic artery, celiac artery, and hepatic artery, among
others.
explanation: >-
The SVS guideline abstract supports threshold-based rather than universal
repair of visceral aneurysms including SAA.
clinical_trials:
- name: NCT07053605
status: RECRUITING
description: >-
Single-group interventional study evaluating laparoscopic resection of SAA
with spleen preservation and post-treatment immune and portal/splenic
hemodynamic markers.
target_phenotypes:
- preferred_term: splenic artery aneurysm
term:
id: HP:0002617
label: Vascular dilatation
evidence:
- reference: clinicaltrials:NCT07053605
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
In this study, researchers examined the changes in related indicators such
as immune function, splenic vein,proper hepatic artery, and portal venous
hemodynamics following laparoscopic resection of a splenic artery
aneurysm.
explanation: >-
The trial summary directly describes laparoscopic SAA resection with
spleen preservation and hemodynamic/immune follow-up.
- name: NCT01387828
status: COMPLETED
description: >-
Randomized comparison of open versus laparoscopic surgical management of
splenic artery aneurysms.
target_phenotypes:
- preferred_term: splenic artery aneurysm
term:
id: HP:0002617
label: Vascular dilatation
evidence:
- reference: clinicaltrials:NCT01387828
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
The purpose of this study is compare two different surgical treatments of
splenic artery aneurysms: open and laparoscopic approach.
explanation: >-
The trial summary supports the existence of a completed open-vs-laparoscopic
SAA surgical comparison.
notes: >-
Falcon deep research and PubMed follow-up did not identify a causal gene,
multi-omics signature, model organism system, or validated quality-of-life
instrument for isolated splenic artery aneurysm. Portal hypertension,
pregnancy/childbearing potential, size, symptoms, and growth are the dominant
actionable risk stratifiers for true SAA. Pseudoaneurysm-specific pancreatitis
and pseudocyst mechanisms were treated as out of scope for this MONDO true-SAA
entry.
Splenic artery aneurysm (SAA) is the most common visceral artery aneurysm and is often incidentally detected; despite a generally low rupture rate for true SAAs, rupture can be catastrophic, with particularly high maternal and fetal mortality in pregnancy. Contemporary expert guidance (SVS 2020; CIRSE 2024) recommends CTA-based diagnosis, aggressive management for pseudoaneurysms (treat regardless of size), and size-/risk-stratified treatment for true SAAs (treat ≥3 cm, symptomatic, enlarging, or in women of childbearing age). Endovascular therapy is generally preferred when anatomically feasible and is associated with lower perioperative morbidity and shorter length of stay, while open surgery remains crucial for rupture, hemodynamic instability, pregnancy-associated rupture, and distal/hilar anatomy. (chaer2020thesocietyfor pages 12-13, chaer2020thesocietyfor pages 13-15, rossi2024cirsestandardsof pages 1-3, hogendoorn2014openrepairendovascular pages 4-5, rinaldi2023endovascularandopen pages 1-3)
| Topic | Key points | Quantitative data | Key sources |
|---|---|---|---|
| Disease definition / identifiers / synonyms | Splenic artery aneurysm (SAA) is a dilation of the splenic artery; one review defines SAA as arterial dilation >50% of the normal splenic artery diameter. Distinguish true SAA from splenic artery pseudoaneurysm (SAP/SAPA), which has a much higher rupture risk. Common synonyms: splenic artery aneurysm, SAA, true splenic artery aneurysm; pseudoaneurysm terms: splenic artery pseudoaneurysm, SAP. “Giant” SAA is variably defined, most often ≥5 cm, sometimes >10 cm. | Giant SAA definition used in literature: ≥5 cm in 62.5% of articles that specified a cutoff; >10 cm in 37.5%. | Rinaldi et al., J Clin Med 2024, DOI: 10.3390/jcm13195793, https://doi.org/10.3390/jcm13195793 (2024) (rinaldi2024thedefinitiondiagnosis pages 1-2, rinaldi2024thedefinitiondiagnosis pages 4-6, rinaldi2024thedefinitiondiagnosis pages 7-9) |
| Epidemiology / frequency | SAA is the most common visceral artery aneurysm. Population estimates vary by detection method; frequency has risen with modern imaging. | SAAs account for ~60% of visceral/splanchnic aneurysms; reported incidence 0.09% at autopsy and 0.78% on angiography; one older clinical paper cites incidence <0.8%. | Rinaldi et al., J Clin Med 2024, DOI: 10.3390/jcm13195793, https://doi.org/10.3390/jcm13195793 (2024); Sticco et al., Vascular 2016, DOI: 10.1177/1708538115613703, https://doi.org/10.1177/1708538115613703 (2016) (rinaldi2024thedefinitiondiagnosis pages 7-9, sticco2016acomparisonof pages 1-2) |
| Sex / age distribution | Classic SAA is more common in women, especially multiparous women; giant SAA series show more balanced sex distribution. Diagnosis is usually in adulthood/midlife. | Female predominance reported as ~4:1 for common SAA; giant SAA pooled review: 43 males / 39 females, median age 55.79 years. | Obara et al., Surgery Today 2020, DOI: 10.1007/s00595-019-01898-3, https://doi.org/10.1007/s00595-019-01898-3 (2020); Rinaldi et al., J Clin Med 2024, DOI: 10.3390/jcm13195793, https://doi.org/10.3390/jcm13195793 (2024) (obara2020currentmanagementstrategies pages 5-7, rinaldi2024thedefinitiondiagnosis pages 1-2) |
| Rupture risk and mortality | True SAA rupture risk is generally low but clinically important because rupture can be catastrophic. Pseudoaneurysms rupture much more often and are treated regardless of size. | Common true SAA rupture risk ~2–3%; older review cites ~3% in more recent series (historically ~10%). Pseudoaneurysm rupture risk reported 37–47%; SVS excerpt cites rupture 76.3% for pseudoaneurysm vs 3.1% for true aneurysm. Ruptured SAA mortality up to ~25% overall; older reports cite rupture mortality up to 30% or 36%. | Rinaldi et al., J Clin Med 2024, DOI: 10.3390/jcm13195793, https://doi.org/10.3390/jcm13195793 (2024); Chaer et al., J Vasc Surg 2020, DOI: 10.1016/j.jvs.2020.01.039, https://doi.org/10.1016/j.jvs.2020.01.039 (2020); Obara et al., Surgery Today 2020, DOI: 10.1007/s00595-019-01898-3, https://doi.org/10.1007/s00595-019-01898-3 (2020); Dave et al., Ann Vasc Surg 2000, DOI: 10.1007/s100169910039, https://doi.org/10.1007/s100169910039 (2000) (rinaldi2024thedefinitiondiagnosis pages 7-9, chaer2020thesocietyfor pages 12-13, chaer2020thesocietyfor pages 13-15, obara2020currentmanagementstrategies pages 5-7, dave2000splenicarteryaneurysm pages 4-5, sticco2016acomparisonof pages 1-2) |
| Pregnancy-associated risk | Pregnancy markedly increases rupture risk and is a major reason for aggressive treatment in women of childbearing age. Rupture often occurs in late pregnancy. | Pregnancy accounts for ~20–50% of ruptures in older literature/SVS excerpt; maternal mortality ~70–80%; fetal mortality ~90–95%. | Chaer et al., J Vasc Surg 2020, DOI: 10.1016/j.jvs.2020.01.039, https://doi.org/10.1016/j.jvs.2020.01.039 (2020); Rinaldi et al., J Clin Med 2024, DOI: 10.3390/jcm13195793, https://doi.org/10.3390/jcm13195793 (2024); Dave et al., Ann Vasc Surg 2000, DOI: 10.1007/s100169910039, https://doi.org/10.1007/s100169910039 (2000) (chaer2020thesocietyfor pages 12-13, rinaldi2024thedefinitiondiagnosis pages 7-9, dave2000splenicarteryaneurysm pages 4-5) |
| Portal hypertension / liver transplant association | Portal hypertension, cirrhosis, and liver transplantation are recurring associations and influence management because of higher rupture/growth concern. | Older review: portal hypertension present in up to 24% of SAA patients; incidence in cirrhosis/portal hypertension 7–20%; 8–13% of liver-transplant candidates have SAA. Another review cites 20.5% in liver-transplant recipients. | Dave et al., Ann Vasc Surg 2000, DOI: 10.1007/s100169910039, https://doi.org/10.1007/s100169910039 (2000); Obara et al., Surgery Today 2020, DOI: 10.1007/s00595-019-01898-3, https://doi.org/10.1007/s00595-019-01898-3 (2020) (dave2000splenicarteryaneurysm pages 4-5, obara2020currentmanagementstrategies pages 5-7, pratesi2024guidelinesonthe pages 51-53) |
| Other risk factors / associations | Reported associations include multiparity, pancreatitis/pseudocysts, prior surgery, trauma, infection, and nonatherosclerotic arteriopathies such as segmental arterial mediolysis. Pseudoaneurysms are particularly linked to pancreatitis and local inflammatory/surgical injury. | Giant SAA/SAP review: pancreatitis/pseudocysts present in 15.85% of pooled giant cases; giant pooled symptoms included pain in 59.76% and asymptomatic presentation in 17.07%. | Rinaldi et al., J Clin Med 2024, DOI: 10.3390/jcm13195793, https://doi.org/10.3390/jcm13195793 (2024); Rinaldi et al., J Clin Med 2023, DOI: 10.3390/jcm12186085, https://doi.org/10.3390/jcm12186085 (2023) (rinaldi2024thedefinitiondiagnosis pages 4-6, rinaldi2024thedefinitiondiagnosis pages 9-10, rinaldi2023endovascularandopen pages 1-3) |
| Clinical presentation | Most SAAs are asymptomatic and incidentally discovered, but symptomatic lesions usually present with abdominal or left upper quadrant/epigastric pain. Rupture can cause shock and hemoperitoneum. | Older review: 80–95% asymptomatic. Giant pooled series: pain 59.76%, palpable mass 28.05%, asymptomatic 17.07%. | Dave et al., Ann Vasc Surg 2000, DOI: 10.1007/s100169910039, https://doi.org/10.1007/s100169910039 (2000); Rinaldi et al., J Clin Med 2024, DOI: 10.3390/jcm13195793, https://doi.org/10.3390/jcm13195793 (2024) (dave2000splenicarteryaneurysm pages 4-5, rinaldi2024thedefinitiondiagnosis pages 4-6, rinaldi2024thedefinitiondiagnosis pages 9-10) |
| Diagnostic imaging | CTA is the preferred initial diagnostic test in most guidelines; MRA is preferred when iodinated contrast is contraindicated and is favored in pregnancy. Angiography is used when planning intervention or when noninvasive imaging is insufficient. Ultrasound/EcoColorDoppler can be first-line screening, but sensitivity for small SAA is limited. | CT used in 80.49% of giant pooled cases; selective angiography 54.88%; EcoColorDoppler 45.12%; MRI 3.66%. SVS excerpt notes ultrasound has poor sensitivity for SAA <3 cm. | Chaer et al., J Vasc Surg 2020, DOI: 10.1016/j.jvs.2020.01.039, https://doi.org/10.1016/j.jvs.2020.01.039 (2020); Rinaldi et al., J Clin Med 2024, DOI: 10.3390/jcm13195793, https://doi.org/10.3390/jcm13195793 (2024) (chaer2020thesocietyfor pages 12-13, rinaldi2024thedefinitiondiagnosis pages 9-10, rinaldi2024thedefinitiondiagnosis pages 4-6) |
| SVS 2020 treatment thresholds | Treat ruptured SAAs emergently; treat all splenic artery pseudoaneurysms regardless of size; treat all true SAAs in women of childbearing age regardless of size; treat true SAAs that are symptomatic, enlarging, or ≥3 cm. Observation is reasonable for small, stable, asymptomatic true SAAs in non-childbearing patients or those with limited life expectancy. Endovascular therapy is preferred initially when anatomically feasible; open surgery is favored for rupture, pregnancy-related rupture, or distal/hilar lesions. | Thresholds: pseudoaneurysm any size; true SAA in women of childbearing age any size; true SAA ≥3 cm; interval growth >0.5 cm/year is an indication. Nonoperative series cited by SVS: mean observed size 2.1 cm, mean follow-up 75 months. | Chaer et al., J Vasc Surg 2020, DOI: 10.1016/j.jvs.2020.01.039, https://doi.org/10.1016/j.jvs.2020.01.039 (2020) (chaer2020thesocietyfor pages 13-15, chaer2020thesocietyfor pages 12-13) |
| CIRSE 2024 thresholds / surveillance | Intervene for any symptomatic VAA/VAPA; for SAA specifically, treat asymptomatic lesions ≥2 cm, especially if saccular/distal/favorable anatomy; treat any VAA growing ≥0.5 cm/year; treat VAPAs regardless of symptoms; treat any asymptomatic VAA in women of childbearing age. After endovascular therapy, CTA or MRA surveillance is recommended. | Thresholds: SAA ≥2 cm; growth ≥0.5 cm/year. Surveillance after EVT: 3 months, 12 months, then yearly. | Rossi et al., Cardiovasc Intervent Radiol 2024, DOI: 10.1007/s00270-023-03620-w, https://doi.org/10.1007/s00270-023-03620-w (2024) (rossi2024cirsestandardsof pages 1-3) |
| Other 2024 guideline / review excerpts | 2024 guidance excerpts broadly support emergency treatment for rupture and symptomatic lesions; observation for stable asymptomatic SAAs <3 cm; intervention for SAAs >3 cm. Some sources advocate treatment at ≥2 cm in pregnant/fertile patients with portal hypertension or those awaiting liver transplant. | Usual cutoffs in 2024 excerpts: observe <3 cm if stable; treat >3 cm electively; lesions <2 cm often observed unless rapid growth. | Pratesi et al. guideline excerpt (2024) (pratesi2024guidelinesonthe pages 51-53); Rinaldi et al., J Clin Med 2024, DOI: 10.3390/jcm13195793, https://doi.org/10.3390/jcm13195793 (2024) (rinaldi2024thedefinitiondiagnosis pages 9-10) |
| Endovascular treatment | Endovascular therapy is now generally first-line for elective anatomically suitable SAAs. Techniques include coil embolization, sac/parent-artery embolization, plugs, covered stents/stent-grafts, glue/Lipidol, thrombin, stent-assisted coiling. Advantages include shorter length of stay and lower perioperative morbidity; drawbacks include splenic infarction, post-embolization syndrome, and higher reintervention risk in rupture. | Giant SAA pooled review: endovascular complication rate 23.08%, mean LOS 2.36 days, no recanalization during median follow-up 17.28 months. Stent-graft review: immediate technical/clinical success 90.2%, splenic infarction 4.9%, aneurysm exclusion 87.8%, no reinterventions. Wang 2024 cohort (63 pts): postembolization syndrome 10 pts; splenic infarction 7 pts; mean LOS 5.5 days; complete thrombosis in all at mean 17.2 months. | Rinaldi et al., J Clin Med 2024, DOI: 10.3390/jcm13195793, https://doi.org/10.3390/jcm13195793 (2024); Borghese et al., J Clin Med 2024, DOI: 10.3390/jcm13102802, https://doi.org/10.3390/jcm13102802 (2024); Wang et al., CVIR Endovasc 2024, DOI: 10.1186/s42155-024-00427-9, https://doi.org/10.1186/s42155-024-00427-9 (2024) (rinaldi2024thedefinitiondiagnosis pages 1-2, rinaldi2024thedefinitiondiagnosis pages 6-7) |
| Open surgery | Open repair remains important for ruptured SAAs, hemodynamic instability, pregnancy-associated rupture, and distal/hilar aneurysms where splenic preservation may not be feasible. Procedures include ligation, aneurysmectomy, splenectomy ± distal pancreatectomy, and selective reconstruction. | Giant pooled review: open complication rate 14.89%, mean LOS 12.29 days. In nationwide inpatient comparison, open repair had higher cardiac (6.9% vs 2.3%), pulmonary (16.1% vs 8.9%), and SSI (5.1% vs 0.6%) complication rates and longer LOS (6 vs 4 days), with similar in-hospital mortality (3% both) compared with endovascular repair. | Rinaldi et al., J Clin Med 2024, DOI: 10.3390/jcm13195793, https://doi.org/10.3390/jcm13195793 (2024); Sticco et al., Vascular 2016, DOI: 10.1177/1708538115613703, https://doi.org/10.1177/1708538115613703 (2016) (rinaldi2024thedefinitiondiagnosis pages 1-2, sticco2016acomparisonof pages 1-2) |
| Hybrid treatment | Hybrid approaches are used selectively for anatomically complex giant lesions. | Giant pooled review: hybrid used in 9/82 patients (10.98%), complication rate 22.22%, mean LOS 5 days. | Rinaldi et al., J Clin Med 2024, DOI: 10.3390/jcm13195793, https://doi.org/10.3390/jcm13195793 (2024) (rinaldi2024thedefinitiondiagnosis pages 1-2, rinaldi2024thedefinitiondiagnosis pages 6-7) |
| Comparative outcomes: intact/elective SAA | Comparative observational data generally favor endovascular repair for lower perioperative morbidity and shorter hospitalization, while open repair may offer fewer reinterventions/stronger primary technical success in some series. | Nationwide inpatient study: LOS 4 vs 6 days (EVT vs open), similar mortality 3% each; lower cardiac/pulmonary/SSI complications with EVT. Mixed VAA/RAA series: LOS 7.2±6.9 vs 11.8±6.7 days in elective cases; primary technical success 79.3% EVT vs 100% open. | Sticco et al., Vascular 2016, DOI: 10.1177/1708538115613703, https://doi.org/10.1177/1708538115613703 (2016); Wolk et al., Langenbecks Arch Surg 2021, DOI: 10.1007/s00423-021-02149-1, https://doi.org/10.1007/s00423-021-02149-1 (2021) (sticco2016acomparisonof pages 1-2) |
| Outcomes in ruptured SAA: open vs EVT | For ruptured SAA, available evidence shows similar mortality between open and EVT overall, but EVT has substantially more reinterventions/conversions; open repair remains preferred in hemodynamic instability and pregnancy-related rupture. | Systematic review of 350 ruptured SAA patients: overall mortality 10.6%; OSR 12.9% vs EVT 7.8% (p=0.84). Reinterventions after EVT 22.4% (37 total; many converted to laparotomy/splenectomy) vs 1.6% after OSR. | Rinaldi et al., J Clin Med 2023, DOI: 10.3390/jcm12186085, https://doi.org/10.3390/jcm12186085 (2023) (rinaldi2023endovascularandopen pages 1-3) |
Table: This table summarizes high-yield, evidence-supported facts on splenic artery aneurysm, including epidemiology, major risk factors, imaging, guideline thresholds, and treatment outcomes. It is designed as a compact reference for disease knowledge-base curation and clinical/research synthesis.
Most available evidence for SAA derives from aggregated disease-level sources such as guidelines, systematic reviews/meta-analyses, and retrospective series; the rarity and heterogeneity of SAA limit randomized evidence. (marone2023currentdebatesin pages 1-4, hogendoorn2014openrepairendovascular pages 4-5)
SAA is a multifactorial vascular disease driven by arterial wall vulnerability and hemodynamic stress.
A. Asymptomatic/incidental detection (common in non-giant SAAs) * Older review: 80–95% asymptomatic and incidentally found. (dave2000splenicarteryaneurysm pages 4-5) * Giant series differs: only 17.07% asymptomatic. (rinaldi2024thedefinitiondiagnosis pages 4-6) * Suggested HPO: Asymptomatic (HP:0000007).
B. Abdominal pain (most common symptom in giant lesions) * Giant pooled review: pain in 59.76% (left upper quadrant/epigastric common). (rinaldi2024thedefinitiondiagnosis pages 4-6) * Suggested HPO: Abdominal pain (HP:0002027); Left upper quadrant abdominal pain (HP:0025404, if used);
C. Palpable abdominal mass (giant lesions) * Giant pooled review: palpable mass 28.05%. (rinaldi2024thedefinitiondiagnosis pages 4-6) * Suggested HPO: Abdominal mass (HP:0003270).
D. Rupture phenotype: hemorrhage and shock * Ruptured SAA commonly presents with severe abdominal pain, hypotension/hemorrhagic shock, anemia/coagulopathy; emergent CTA used for diagnosis. (rinaldi2023endovascularandopen pages 1-3) * Suggested HPO: Hemorrhagic shock (HP:0001919); Hypotension (HP:0002615); Anemia (HP:0001903).
Kaya et al. list associated conditions including collagen vascular disease, arteritis, medial fibrodysplasia, and alpha-1 antitrypsin deficiency, but do not provide gene/variant-level data in the excerpt. (kaya2016prevalenceandpredictive pages 5-6)
A. Portal hypertension-associated true SAA 1. Chronic liver disease → portal hypertension → hyperdynamic splanchnic circulation and increased splenic venous flow (“splenic hyperkinetic state”). (dave2000splenicarteryaneurysm pages 4-5) 2. Hyperkinetic splenic arterial flow increases arterial diameter and wall tension (Laplace law) → progressive wall degeneration → aneurysm formation and increased rupture susceptibility. (kobori1997splenicarteryaneurysms pages 3-4, dave2000splenicarteryaneurysm pages 4-5) 3. Clinical manifestation: incidental aneurysm or rupture with hemoperitoneum/shock. (dave2000splenicarteryaneurysm pages 4-5, rinaldi2023endovascularandopen pages 1-3)
B. Pregnancy-associated SAA rupture risk 1. Pregnancy → elevated estrogen/progesterone/relaxin and other hormonal mediators → structural weakening (fragmented internal elastic lamina, subendothelial thickening) and altered elastin integrity. (rinaldi2024thedefinitiondiagnosis pages 7-9, dave2000splenicarteryaneurysm pages 4-5) 2. Concurrent late-pregnancy hemodynamic stress (increased blood volume/cardiac output, increased BP) → increased wall stress → rupture risk. (rinaldi2024thedefinitiondiagnosis pages 7-9)
C. Pancreatitis-associated splenic artery pseudoaneurysm (SAP) 1. Acute/chronic pancreatitis or pseudocyst → enzymatic/inflammatory injury to arterial wall or focal disruption → pseudoaneurysm formation. (rinaldi2024thedefinitiondiagnosis pages 7-9, uy2017vasculardiseasesof pages 4-5) 2. Clinical manifestation: hemorrhage, GI bleeding (e.g., hemosuccus pancreaticus), hemodynamic instability. (obara2020currentmanagementstrategies pages 5-7)
D. Segmental arterial mediolysis (SAM) leading to SAA 1. SAM: segmental medial lysis with smooth muscle loss → gaps/dissecting hematoma → aneurysmal dilation. (lohr2013rapidprogressionof pages 2-3) 2. Superimposed hemodynamic stress (BP surges; portal hypertension increasing inflow) → expansion/rupture. (lohr2013rapidprogressionof pages 2-3, imai2005berrysplenicartery pages 4-5)
SVS 2020 (key points from excerpt): * CTA recommended as initial diagnostic tool for SAA (thin sections if available). (chaer2020thesocietyfor pages 12-13) * MRA recommended when iodinated contrast is contraindicated; arteriography reserved for unclear noninvasive results or when planning endovascular therapy. (chaer2020thesocietyfor pages 12-13) * Ultrasound has poor sensitivity for SAA <3 cm in SVS excerpt. (chaer2020thesocietyfor pages 12-13)
Giant SAA/SAP imaging patterns (2024 systematic review): CT used in 80.49%, angiography in 54.88%, EcoColorDoppler in 45.12%, MRI rarely (3.66%). (rinaldi2024thedefinitiondiagnosis pages 4-6)
SVS 2020 (Journal of Vascular Surgery; published Jul 2020; DOI: 10.1016/j.jvs.2020.01.039): * Treat ruptured SAA emergently. (chaer2020thesocietyfor pages 12-13) * Treat splenic artery pseudoaneurysms of any size (high rupture risk). (chaer2020thesocietyfor pages 12-13) * Treat all true SAAs in women of childbearing age regardless of size. (chaer2020thesocietyfor pages 12-13) * Treat true SAAs ≥3 cm, those with growth, or those that are symptomatic. (chaer2020thesocietyfor pages 12-13) * Observation suggested for small (<3 cm), stable, asymptomatic true SAAs or patients with limited life expectancy. (chaer2020thesocietyfor pages 12-13)
CIRSE Standards of Practice (Cardiovascular and Interventional Radiology; Nov 2024; DOI: 10.1007/s00270-023-03620-w): * Treat any symptomatic VAA/VAPA; treat SAA ≥2 cm (particularly saccular/distal/favorable anatomy); treat lesions growing ≥0.5 cm/year; treat VAPAs regardless of symptoms; treat asymptomatic VAAs in women of child-bearing age. (rossi2024cirsestandardsof pages 1-3) * Post-endovascular surveillance suggested with CTA/MRA at 3 months, 12 months, then yearly. (rossi2024cirsestandardsof pages 1-3)
Guideline-collision commentary (May 2023; DOI: 10.3390/jcm12093267): * Notes discrepancies across ESVS vs SVS thresholds (e.g., SVS 3 cm threshold for SAA) and differences in surveillance intervals (SVS annual imaging vs ESVS every 2–3 years for small asymptomatic aneurysms). (marone2023currentdebatesin pages 1-4)
MAXO suggestions (non-exhaustive): * Endovascular embolization procedure; stent-graft placement; aneurysm repair (endovascular). (chaer2020thesocietyfor pages 13-15, rossi2024cirsestandardsof pages 1-3)
MAXO suggestions: * Aneurysmectomy; arterial ligation; splenectomy; distal pancreatectomy (for select hilar lesions). (rinaldi2024thedefinitiondiagnosis pages 6-7, chaer2020thesocietyfor pages 13-15)
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