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What is the recommended treatment of a patient who has anasymptomatic splenic aneurysm that is 4 cm in diameter?
What is the recommended treatment of a patient who has anasymptomatic splenic aneurysm that is 4 cm in diameter?---- MDSplenic artery aneurysms are the most commonvisceral artery aneurysms; they account for up to60% of such lesions. Most are small (less than2 cm), saccular aneurysms, and more than 80%are located in the mid or distal splenic artery.These aneurysms are 4 times more common in womenthan in men. The risk of rupture of a splenic artery aneurysmis between 3% and 9.6%. The mortality rate afterrupture has remained high at 36%.Most splenic artery aneurysms are asymptomatic.The aneurysms are usually identified as incidental findingson diagnostic studies undertaken for other purposes. Theclassic radiographic appearance is that of a curvilinearsignet ring-shaped calcification in the left upper quadrant.The treatment of splenic artery aneurysms is basedon the natural history of these lesions. Treatment is recommendedfor the following groups:
However, most patients have asymptomatic splenicartery aneurysms and are not pregnant or likely to becomepregnant. For these patients, consider both therelatively low risk of rupture (3% to 9.6%) and the mortalityrate for patients who do have a rupture (approximately36%) in the decision to treat. Thus, treatment is recommendedfor all patients at low risk for surgical complicationswho have relatively large asymptomatic splenicartery aneurysms (greater than 2 cm). The majority ofthese aneurysms can now be treated by catheter-basedtechniques.
---- Louis M. Messina, MD
Professor of Surgery
Chief, Division of Vascular Surgery
University of California, San Francisco
School of Medicine
FOR MORE INFORMATION:
Messina LM, Stanley CJ. Visceral artery aneurysms.
Surgical Clinics of NorthAmerica.