This protocol addresses patients with an unruptured giant splenic artery aneurysm (diameter >5 cm) in whom prior open surgical intervention did not achieve its intended endpoint, and a structured next-line approach is required.
A giant splenic artery aneurysm (GSAA) is defined by an aneurysm diameter of >5 cm — a size threshold that places it in a distinct category with specific management considerations.
The previous intervention was open surgery: splenic artery aneurysm resection or ligation, with or without splenectomy. The goal of that line — complete occlusion or resection of the aneurysm confirmed under direct visualization — was not achieved. This protocol defines the next step after that failure.
An endovascular approach forms the basis of next-line management, with the specific technique guided by anatomical factors and available anchoring conditions. The defined treatment goal is complete exclusion of the splenic artery aneurysm, confirmed on immediate postoperative angiography.
DOI: 10.1016/j.jvs.2024.05.030
Type IVa is located at the opening of the splenic artery or an aberrant splenic artery originating from the superior mesenteric artery (SMA), type IVb is a giant SAA (GSAA) defined by an aneurysm diameter of >5 cm, and type IVc is characterized by severe tortuosity or tandem aneurysms of the main splenic artery.
Nevertheless, endovascular therapy is considered valuable for high-risk elderly patients and GSAAs with anomalous origins.
Technical success was defined as complete exclusion of the aneurysm via immediate postoperative angiography and complete occlusion or resection of the aneurysm under endoscopy or direct visualization.
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