Objective: Splenic artery aneurysms (SAA) are an uncommon pathology, which have potential for serious complications including rupture. Serial imaging and follow up are essential to monitor growth and determine if definitive repair is needed. The purpose of this study was to understand the referral patterns to vascular surgery for SAA along with follow up rates after diagnosis and treatment modalities.
Methods: After institutional IRB approval, patient electronic medical records with diagnosis of SAA (ICD 10 I72.8) at a single institution were reviewed retrospectively from 2010-2020. Demographics, past medical history, and initial patient presentation data were collected. Endpoints included department of presentation, referral patterns after diagnosis, follow up time, and treatment data.
Results: Analysis yielded 50 patients (mean age 70.3 ± 13.1, 24% male) of 130 charts screened. Initial diagnosis of SAA was made using CT (82%), US (4%), MRI (2%), X-ray (2%) and angiography (4%). Average initial SAA size was 1.5 cm ± 0.66. 32% of patients were current smokers and 14% of patients were former smokers with a mean pack year of 35.6 ± 23.02. 68% of patients were asymptomatic at time of diagnosis with other presenting symptoms including abdominal pain (12%), flank pain (4%), and nausea and vomiting (4%). 34% of patients received a referral to vascular surgery, and 50% of patients received no referral for their diagnosis. The remaining 16% of patients were referred to various other services including internal medicine, cardiology, interventional radiology, pulmonology, and cardiothoracic surgery. The average follow up time was 4.18 years ± 3.79 with 36% of patients lost to follow up. Average imaging studies during the follow up period were 3.1 ± 2.7. 18% of patients were treated with endovascular embolization (n=8) or open repair (n=1). The mean treated aneurysm size was 2.38 cm ± 0.84 and the mean untreated aneurysm size was 1.39 ± 0.50.
Conclusion: Our results show that among our patients, 50% received a referral for follow up after SAA diagnosis and 34% were referred to vascular surgery representing a significant gap in care. 36% of patients that were referred were lost to follow up. To improve SAA recognition and management, further changes are needed, including determining reasons for lack of follow up along with refinement of referral guidelines and referring physician education.
