Clinical radiology · 2026
Incidental splenic artery aneurysms: systematic literature review and single-centre study.
СтатьяСистематический обзорНазвание и аннотация: Перевод пока не подготовлен
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Lee R J, Tong E, Alderson J, Common M, Clark A, Sheehan K P, Lenihan J, Bruen R, Briody H, O'Sullivan N, Lee M J
Аннотация
AIM: The natural history and optimal management of splenic artery aneurysms (SAAs) remain uncertain. We combined a systematic literature review (2000-2025) with a local single-centre retrospective cohort to evaluate the natural history, predictors of growth, and rupture risk of incidental splenic artery aneurysms.
MATERIALS AND METHODS: A systematic review of 5 databases (2000-2025) identified longitudinal studies of true SAAs and were quality assessed. A parallel local retrospective cohort of untreated SAA diagnosed on computed tomography (CT) (2008-2023) was analysed. Demographic, imaging, and clinical factors were examined for associations with growth and rupture.
RESULTS: Eight studies plus our local cohort yielded 1774 SAA (1692 patients; mean age 64 years; 70% female). The mean follow-up was 49.5 months. 78% of aneurysms remained stable; the mean growth was 0.04 cm/year. The mean SAA size was 1.7 cm (1.2-2.4 cm). Rupture occurred in 4 aneurysms (0.2%), three <2 cm. Our local cohort of 275 SAA (241 patients; mean age 70; mean follow-up 46 months) grew minimally (0.05 cm/year) with no ruptures. Increasing circumferential calcification independently predicted reduced growth (P = 0.003) similar to 5 other studies. Mural thrombus showed no significant association with growth. Portal hypertension, female sex, size >1.4 cm, and smoking were associated with SAA growth.
CONCLUSION: Incidental SAAs are typically indolent, with minimal growth and very low rupture risk. Calcification appears protective, while mural thrombus is not predictive of rupture. On discovery of asymptomatic SAAs under 2 cm, yearly surveillance for 3 years seems advisable, with further surveillance at increasing intervals, but prospective multicentre studies are required to refine surveillance strategies.
MATERIALS AND METHODS: A systematic review of 5 databases (2000-2025) identified longitudinal studies of true SAAs and were quality assessed. A parallel local retrospective cohort of untreated SAA diagnosed on computed tomography (CT) (2008-2023) was analysed. Demographic, imaging, and clinical factors were examined for associations with growth and rupture.
RESULTS: Eight studies plus our local cohort yielded 1774 SAA (1692 patients; mean age 64 years; 70% female). The mean follow-up was 49.5 months. 78% of aneurysms remained stable; the mean growth was 0.04 cm/year. The mean SAA size was 1.7 cm (1.2-2.4 cm). Rupture occurred in 4 aneurysms (0.2%), three <2 cm. Our local cohort of 275 SAA (241 patients; mean age 70; mean follow-up 46 months) grew minimally (0.05 cm/year) with no ruptures. Increasing circumferential calcification independently predicted reduced growth (P = 0.003) similar to 5 other studies. Mural thrombus showed no significant association with growth. Portal hypertension, female sex, size >1.4 cm, and smoking were associated with SAA growth.
CONCLUSION: Incidental SAAs are typically indolent, with minimal growth and very low rupture risk. Calcification appears protective, while mural thrombus is not predictive of rupture. On discovery of asymptomatic SAAs under 2 cm, yearly surveillance for 3 years seems advisable, with further surveillance at increasing intervals, but prospective multicentre studies are required to refine surveillance strategies.