Comparison of the Long Term Safety and Effectiveness of Endovascular Sac Embolisation and the Isolation Technique for Treatment of True Saccular Splenic Artery Aneurysms

Zhiquan Zhuang; Jingqin Ma; Shuai Ju; Guoqing Gu; Tao Wei; Yongjie Zhou; Wen Zhang; Zhiping Yan; Jianjun Luo

doi:10.1016/j.ejvs.2024.11.018

Comparison of the Long Term Safety and Effectiveness of Endovascular Sac Embolisation and the Isolation Technique for Treatment of True Saccular Splenic Artery Aneurysms

Eur J Vasc Endovasc Surg. 2024 Nov 20:S1078-5884(24)00974-2. doi: 10.1016/j.ejvs.2024.11.018. Online ahead of print.

Authors

Zhiquan Zhuang¹, Jingqin Ma², Shuai Ju³, Guoqing Gu⁴, Tao Wei⁵, Yongjie Zhou², Wen Zhang², Zhiping Yan⁶, Jianjun Luo⁷

Affiliations

¹ Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Interventional Radiology, Zhongshan Hospital, Fudan University (Xiamen Branch), Xiamen, China; National Clinical Research Centre for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
² Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Centre for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China.
³ Department of Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai, China.
⁴ Department of Radiology, Minhang Hospital, Fudan University, Shanghai, China.
⁵ Department of Radiology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.
⁶ Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Centre for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China; Centre for Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai, China.
⁷ Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Centre for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China; Centre for Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai, China. Electronic address: luojianjun@fudan.edu.cn.

PMID: 39577486
DOI: 10.1016/j.ejvs.2024.11.018

Abstract

Objective: To compare the safety, effectiveness, hospital stay (HS), and total hospital cost (THC) of sac embolisation (SE) and the isolation technique (IT) for treating isolated saccular true unruptured splenic artery aneurysms (SAAs).

Methods: A total of 208 patients with isolated saccular true unruptured SAAs receiving endovascular SE or IT treatment at four medical centres in China between January 2016 and December 2022 were retrospectively included. Technical success rates, splenic infarction (SI) rates, aneurysm revascularisation (AR) rates, HS, and THC were compared between groups. Each group was divided into three subgroups, based on the size of SAAs: 2.0 - 2.9 cm (S1), 3.0 - 3.9 cm (S2), and ≥ 4.0 cm (S3).

Results: The technical success was 100%. During the median follow up time of 48.8 (IQR 33.0, 70.4) months, no patients had SAA rupture or died. The two year and five year cumulative incidences of aneurysm revascularisation were 1.8% and 8.7% for the SE group and 2.2% and 2.2% for the IT group, respectively (p = .12). Compared with the SE group, the IT group had a higher SI rate (p < .001), a comparable AR rate (p = .12), a higher median HS (p < .001), and a lower median THC (p < .001). The median THC was comparable between the SE and IT groups in S1. The median THC of the SE group was approximately 1.36 times and 2.2 times of that in the IT group in S2 and S3 (both p < .001), respectively.

Conclusion: Sac embolisation and IT are safe and effective methods for treating isolated saccular true unruptured SAAs. The isolation technique seems to be superior in reducing THC, whereas SE may be superior in reducing SI rates and HS. Sac embolisation may be more suitable for smaller SAAs, whereas IT could be a better choice for larger SAAs.

Keywords: Endovascular treatment; Isolation technique; Sac embolisation; Splenic artery aneurysms.