Splenic Artery Infectious Aneurysms in Infective Endocarditis – An Observational Study and Comprehensive Literature Review

Abstract

PurposeTo determine the prevalence, the clinical and radiological features, associated factors, treatment and outcome of splenic artery aneurysms (SAAs) in infective endocarditis (IE). MethodsWe retrospectively reviewed 474 consecutive patients admitted to our institution with definite IE (2005-2020) ResultsSix patients had SAAs (1.3%; 3 women; mean age: 50). In all cases the diagnosis was obtained by abdominal CT-angiography (CTA). SAAs-IE were solitary, saccular with a mean diameter of 30mm (range: 10-90mm). SAAs-IE were intrasplenic (n=4) or hilar (n=2). Streptococcus spp were the predominant organisms (n=4).In all cases a left-sided native valve was involved (aortic, n=3; mitral, n=2, mitral-aortic, n=1). SAAs were silent in half-patients, and were revealed by abdominal pain (n=2) and by the resurgence of fever after cardiac surgery (n=1).All patients underwent emergent valve replacement. One patient died within 24h from multiorgan failure. For the others, uneventful coil embolization was performed in 4 patients after valve replacement (3 diagnosed early, one at 8 weeks). In the remaining patients, SAA-IE diagnosed at abdominal-CTA at day 16, with complete resolution under appropriate antibiotherapy alone. ConclusionSAAs-IE are a rare occurrence that may be clinically silent. SAAs-IE can be intrasplenic or hilar in location. Endovascular treatment in this context was safe. According to current guidelines, radiologic screening by abdominal-CTA allowed the detection of silent SAAs which could be managed by endovascular treatment to prevent rupture. The delayed formation of these SAAs could justify a CTA control at the end of antibiotherapy.