Peripheral Vascular Surgery Society

Abstract

#11 THE CHANGING FACE OF SPLENIC ARTERY ANEURYSMS (SAA): THE SIGNIFICANCE OF PORTAL AND ESSENTIAL HYPERTENSION

Paul C. Lee, MD, Robert Y. Rhee, MD, Ram Y. Gordon, BA, John J. Fung, MD, PhD, and Marshall W. Webster, MD The University of Pittsburgh Medical Center Pittsburgh, PA.

Purpose: SAA are rare. However, the incidence and importance of SAA in patients with portal hypertension (PHTN), especially in those who undergo orthotopic liver transplantation (OLTx), may be underestimated.

Methods: We performed an 11-year (2/87-6/98) retrospective review of our experience with treated SAA. Two distinct groups were identified: 1) SAA in patients with PHTN, and 2) SAA without PHTN. Patients in each of the above categories were further subdivided into ruptured-versus-elective presentations. Risk factors, essential hypertension (HTN) and female sex (FS) were evaluated for each group. Two types of pathology were observed: atherosclerosis (ASO) and fibromuscular dysplasia (FMD).

Results: Thirty-four patients (22 [65%] in the PHTN group) were treated for SAA during the study period. Sixty-two percent (21/34) were female; the average age was 50.6 years. Of the 22 patients who had PHTN, 20 had undergone OLTx. This group represented less than 1% of all patients (n=2487) who underwent OLTx during the study period. All patients underwent surgical treatment for their SAA: resection with splenectomy (23), ligation with splenectomy (5), ligation of SAA only (4), and vascular reconstruction (2). After a mean follow-up period of 46 months, the survival after rupture was 60%, but was 100% after elective repair (p+0.005). HTN was a significant risk factor for rupture in the SAA+PHTN group (p<.001) and was associated with 83% of the patients in the SAA group. In three patients, SAA were found during OLTx and were repaired concurrently. Six of the 7 patients with rupture of the SAA after OLTx presented within the acute postoperative period (median of 6 days).

Group: N=34 Risk Factors ,Size , Histology (%) Mortality

HTN FS (cm) ASO FMD (%)

1) SAA+PHTN

Rupture 9 3 6 5.2 33 67 56

Elective 13 0 10 4.3 100 0 0

2) SAA

Rupture 6 5 3 5.4 60 40 17

Elective 6 5 2 4.8 100 0 0

Conclusions: Elective repair of SAA remains a safe and effective method of treatment for both groups. Rupture of SAA is associated with a higher mortality in the PHTN group. Essential and portal hypertension are significant risk factors for development and rupture of SAA. A consideration should be made to screen for and treat SAA found in OLTx patients, especially during the immediate postoperative period when the risk of rupture is highest.

Return to Master Program

Return to Homepage 

Last updated January 10, 1999