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OBJECTIVES: Splenic artery aneurysms (SAA) are rare with an overall estimated incidence of less than 0.01%. Open surgical techniques have traditionally been used to treat or exclude SAAs. More recently endovascular procedures have emerged as a preferred treatment. However, evidence to support an endovascular management strategy for SAA is limited to few case series and mostly individual case reports.
METHODS: We used the Nationwide Inpatient Sample (NIS) and gathered data from 2008 to 2011 to compare open to endovascular SAA repair by assessing postoperative outcomes, length of hospital stay, and mortality. Multivariate logistic regression analysis was done to determine predictors of postoperative complications.
RESULTS: There were 2316 admissions during the study period with a diagnosis code for SAA. Among these admissions, 347 (14.9%) patients underwent endovascular repair and 112 (4.8%) patients underwent open surgery. There was a statistically significantly lower rate of cardiac (2.3% vs 6.9%, P=0.05) and pulmonary (8.9% vs 16.1%, P=0.05) complications in patients undergoing endovascular repair compared with those undergoing open surgery. In addition, the risk of surgical site infection in endovascularly treated SAA was lower (0.6% vs 5.1%, P=0.01). Median in-hospital LOS was significantly greater for open repairs than endovascular repairs (6 vs. 4 days respectively, P=0.01). There were no statistically significant differences across procedures for renal complications (8.9% in both groups, P=0.88) or in-hospital mortality (3% in both groups, P=0.99). Regression analysis established age, CHF, renal failure, and procedure type to be independent predictors of postoperative complications.
CONCLUSION: In this observational study, endovascular repair of SAA is associated with a lower complication rate and less resource utilization but no difference in mortality peri-operatively when compared to open surgery. This may justify an endovascular first treatment strategy in the management of SAA.