PC084 Natural History and Management of Splanchnic Artery Aneurysms in a Single Tertiary Referral Center

Abstract

Splanchnic artery aneurysms (SAA) are rare, and little is known about their natural history and management. We reviewed our single-center experience managing this patient population. A retrospective review of the Yale radiology database from January 1999 to December 2016 was performed. Only patients with a SAA and a computed tomography (CT) scan of the abdomen were selected for review. Patient demographics, aneurysm characteristics, management, post-operative complications and follow-up data were collected. A total of 125 patients (77 men [62%]) with 138 SAA were identified. The mean age was 66 years (range, 25-94 years). On CT, 56 (45%) had previously diagnosed/concomitant aneurysms elsewhere. There were 30 patients (22%) who underwent operative repair (OR). The rest were monitored with serial scans without operative intervention (NOR). All patients who presented with severe abdominal pain (n = 11 [44%]) underwent OR. Five patients presented with a ruptured SAA (3.6%; range, 2.3-5.0 cm), for which all underwent OR except one. Other indications for repair included large size in 7, rapid growth in 2, other open abdominal surgical procedures in 2, multiple aneurysms in 1, and desire to pursue fertility treatment in 1. The mean overall vessel diameter was 1.76 ± 0.83 cm. The diameter of OR and NOR was 2.41 ± 1.23 cm and 1.58 ± 0.56 cm, respectively (P = .00001). Operative repair included 14 (56%) endovascular embolizations and 11 (44%) open abdominal operations. Two patients after embolization underwent abdominal operation for hematoma and splenectomy. Open repairs included bypasses in 6, splenectomy in 2, resection in 2, and plication in 1. Two patients had postoperative acute kidney injury that resolved and one died of multisystem organ failure. One bypass occluded without sequelae. The overall complication rate was 20% (6 of 30). Mean follow-up was 50 ± 42 months for NOR, without any adverse events related to SAA, including 10 patients with SAA >2.0 cm. On multivariate regression analysis, a history of smoking (P = .04) and male gender (P = .02) were inversely related to growth rates. The mean growth rate for SAA was 0.064 ± 0.18 cm/y (Fig). It seems reasonable to follow asymptomatic patients with a SAA <2.0 cm because of their slow growth rate (0.064 ± 0.18 cm/y) and because in our series, the smallest ruptured SAA was 2.3 cm in diameter. However, when intervention is needed, open and endovascular options should both be considered. The complication rate is not insignificant; therefore, careful patient selection is necessary.