Abstract
Purpose
To determine the safety and efficacy of elective coil embolization for unruptured splenic artery aneurysms (SAA).Materials and methods
A retrospective review of unruptured SAA treated endovascularly from October 2002 to January 2026 was performed. When the inflow vessel was embolized, primary technical success required both cessation of antegrade flow in the inflow vessel and absence of opacification of the aneurysm sac. When the sac alone was embolized or excluded, primary technical success required absence of sac opacification alone. Risk factors for major splenic infarct were assessed.Results
A total of 156 unique aneurysms were treated in 130 patients. Mean aneurysm size was 2.4 ± 1.1 cm. Primary technical success was achieved in all but one (0.8%) patient over a mean follow-up of 4.1 ± 5.0 years. Secondary technical success was 100% and freedom from sac opacification was 95.1%. Reintervention was required in 4/122 (3.3%) patients with follow-up imaging, all of whom remained successfully treated. Major splenic infarct occurred in 17/122 (13.9%) patients, with portal hypertension as the only independent risk factor for major splenic infarct (adjusted OR 6.07; 95% CI 1.90-19.35; p = 0.002). Eight (6.2%) mortalities occurred, one (0.8%) within 30 days, all unrelated to SAA embolization.Conclusion
Elective coil embolization is a safe and effective treatment for SAA with robust rates of technical success, freedom from rupture, and freedom from sac enlargement.