5
Splenic Artery Aneurysm (SAA)
Recommendation
Grade/
LOE
1. Diagnosis and evaluation
1.1 We recommend CTA as the initial diagnostic tool of choice for SAAs,
with 1-mm thick sections if available.
1-C
1.2 In patients with suspected SAAs and pre-existing renal insufficiency
limiting the use of iodinated contrast material, we recommend MRA to
establish diagnosis.
1-C
1.3 We recommend using arteriography when noninvasive studies have not
sufficiently demonstrated the status of relevant collateral blood flow
and when endovascular intervention is planned.
1-B
2. Treatment indications, size criteria, and true vs. false aneurysms
2.1 We recommend emergent intervention for ruptured SAAs. 1-A
2.2 We recommend treatment of nonruptured splenic artery
pseudoaneurysms of any size in patients of acceptable risk because of
the possibility of rupture.
1-B
2.3 We recommend treating nonruptured splenic artery true aneurysms of
any size in women of childbearing age because of the risk of rupture.
1-B
2.4 We recommend treating nonruptured splenic artery true aneurysms
>3 cm with a demonstrable increase in size or with associated
symptoms in patients of acceptable risk because of the risk of rupture.
1-C
2.5 We suggest observation over repair for small (<3 cm), stable
asymptomatic splenic artery true aneurysms or those in patients with
significant medical comorbidities or limited life expectancies.
2-C
3. Treatment options
3.1 In patients with ruptured SAA discovered at laparotomy, we suggest
treatment with ligation with or without splenectomy, depending on the
aneurysm location.
2-B
3.2 In patients with ruptured SAA diagnosed on preoperative imaging
studies, we suggest treatment with open surgical or appropriate
endovascular techniques based on the patient's anatomy and underlying
clinical condition.
2-B
3.3 We suggest elective treatment of SAA using an endovascular approach
if it is anatomically feasible. However, elective treatment may
appropriately involve open surgical, endovascular, or laparoscopic
methods of intervention, depending on the patient's anatomy and
underlying clinical condition.
2-B
