Samed Sayar, Haci Vural Soyer, Sinan Aslan, Guvenc Diner, Mehmet Hatip Adiguzel, Sarhun Zirek
In this intervention-only cohort, urgent and emergency presentations accounted for 13/20 procedures (65%) and were managed according to presentation and anatomy, with endovascular therapy predominating in urgent stable patients and splenectomy used in all ruptured emergency cases. The findings describe institutional treatment patterns rather than the appropriateness of intervention thresholds, and longer, standardized follow-up is needed before drawing conclusions about durability.
BACKGROUND: Splenic artery aneurysm (SAA) management is influenced by clinical presentation, aneurysm type, anatomy, and size. Evidence describing treated urgent and emergency presentations remains limited, particularly in small tertiary-center series.
METHODS: We retrospectively reviewed 20 consecutive adults with SAA who underwent intervention at a tertiary center between January 2023 and December 2025. Patients managed by surveillance were not included. Procedures were classified as elective, urgent (symptomatic but hemodynamically stable), or emergency (rupture, active bleeding, or hemodynamic instability). Treatment modality, technical and clinical success, 30-day complications, reintervention, and follow-up were summarized descriptively. Because only five patients received a non-endovascular treatment, multivariable modeling of treatment selection was not considered statistically reliable.
RESULTS: The cohort included 18/20 women (90%) and had a median age of 69.5 years (IQR 62.8-74.2; range 34-79). Fourteen/20 aneurysms (70%) were <30 mm, including 13 in the 20-30 mm range and one <20 mm. Seven/20 procedures (35%) were elective, 9/20 (45%) urgent, and 4/20 (20%) emergency. All four emergency cases were treated by splenectomy; 8/9 urgent cases underwent endovascular treatment and one received fibrin sealant/Tisseel, whereas all seven elective cases were treated endovascularly. Technical success was 20/20 (100%) and clinical success 18/20 (90%). Early complications occurred in 5/20 patients (25%): 2/7 elective, 3/9 urgent, and 0/4 emergency. Two patients required reintervention. Follow-up was heterogeneous (mean 21.8 +/- 9.6 months; range 2-32); 16/20 patients had at least 12 months of follow-up.
CONCLUSION: In this intervention-only cohort, urgent and emergency presentations accounted for 13/20 procedures (65%) and were managed according to presentation and anatomy, with endovascular therapy predominating in urgent stable patients and splenectomy used in all ruptured emergency cases. The findings describe institutional treatment patterns rather than the appropriateness of intervention thresholds, and longer, standardized follow-up is needed before drawing conclusions about durability.