Splenic Artery Aneurysm

What is a splenic artery aneurysm?

A splenic artery aneurysm is a bulge in the artery that supplies blood to your spleen.

An aneurysm can happen in any of your arteries and is a result of weakening within the wall of the artery. Over time, aneurysms may grow. The larger the aneurysm, the more dangerous it can be.

A splenic artery aneurysm is by definition a splenic artery that is 1.0 cm or greater. A splenic artery aneurysm may cause no symptoms and go undetected for a long time. Or, it may cause symptoms that signal a medical emergency. It’s important to be aware of the symptoms and risk factors so you can seek medical care when needed.

How common are splenic artery aneurysms?

Splenic artery aneurysms affect between 1 in 1,000 and 1 in 2,500 people. They’re the most common type of visceral artery aneurysm or aneurysm of the arteries within your abdomen.

Who do splenic artery aneurysms affect?

Splenic artery aneurysms affect adults at various ages. But you face an increased risk if you’re:

• Female or assigned female at birth (AFAB).
• Over age 60.

Nearly 80% of splenic artery aneurysms occur in women and people AFAB.

How do splenic artery aneurysms affect my body?

Normally, your arteries are flexible enough to contract and expand as your blood flows through them. But they still keep their normal shape. An aneurysm causes one part of your artery to lose its normal shape and bulge outward. Your artery wall is weaker in that spot because it’s stretched out too far. Over time and without treatment, this can lead to serious complications.

How serious is a splenic artery aneurysm?

A splenic artery aneurysm is a serious medical condition. It can be life-threatening, especially for people who are pregnant. Like other aneurysms, a splenic artery aneurysm is dangerous because it can rupture (break open) or dissect (tear). Ruptures and dissections are medical emergencies that require immediate care and can be life-threatening.

Pseudoaneurysms can also affect your splenic artery. These are sometimes called “false aneurysms.” A true aneurysm affects all the layers of your artery wall. A pseudoaneurysm affects just one or two layers. A splenic artery pseudoaneurysm is also serious and is even more likely to rupture than a true aneurysm.

What does a splenic artery aneurysm feel like?

Symptoms of a splenic artery aneurysm include:

• Pain in the upper left part of your belly. This pain may radiate (spread) toward your left shoulder.
• Pulsating in your upper left belly.

If the aneurysm ruptures, you may experience sudden:

• Nausea and vomiting.
• Pain in your upper belly, just below your ribs.
• Pain in your left shoulder.
• Symptoms of hypovolemic shock.

A rupture may occur all at once, or in two stages. About 1 in 4 people experience two stages, in which the symptoms come on suddenly but then temporarily ease. This stable period is short-lived, and their body soon goes into shock.

Call 911 or your local emergency number if you have any symptoms of a splenic artery aneurysm or rupture.

Many people have no symptoms until the aneurysm is close to rupturing or ruptures. So, it’s important to learn the risk factors and talk with your provider about your level of risk.

What causes a splenic artery aneurysm to form?

Weakness in the wall of your splenic artery leads to an aneurysm. It’s not always clear exactly what causes this weakness. But researchers know there are many risk factors that make people more likely to have a splenic artery aneurysm.

One of the most important risk factors for splenic artery aneurysms is pregnancy. Plus, pregnant people face an even higher risk if they’ve had previous pregnancies. During pregnancy, hormonal changes affect your blood flow and lead to increased pressure in your splenic artery. This weakens the walls of your splenic artery and causes an aneurysm to form.

Many different medical conditions can raise your risk of a splenic artery aneurysm. These include:

• Arterial hypertension (high blood pressure).
• Atherosclerosis.
• Brain aneurysm.
• Cirrhosis of the liver.
• Connective tissue diseases including Marfan syndrome.
• Diabetes.
• Endocarditis.
• Fibromuscular dysplasia (FMD).
• Granulomatosis with polyangiitis (GPA, formerly called Wegener’s).
• Liver transplantation.
• Polyarteritis nodosa (PAN).
• Portal hypertension.
• Vasculitis.

Risk factors for splenic artery pseudoaneurysms include:

• Chronic pancreatitis.
• Surgical complications.
• Trauma such as a car accident or stab wound.

What causes a splenic artery aneurysm to rupture?

Risk factors for splenic artery aneurysm rupture include:

• Portal hypertension: Increased blood flow in the area near the aneurysm raises your risk of a rupture.
• Pregnancy: About 50% of aneurysms in pregnant people rupture sometime during the pregnancy. Usually, rupture happens in the last trimester.
• Presence of symptoms: People with symptoms face an 80% chance of a rupture (compared to a 10% risk among people with no symptoms).

How are splenic artery aneurysms diagnosed?

Splenic artery aneurysms can be hard to diagnose. They have vague symptoms that could point to many different problems. Sometimes, providers diagnose splenic artery aneurysms when running tests for other reasons.

Imaging tests are the best way for providers to diagnose splenic artery aneurysms, especially when you don’t have symptoms.

Tests that diagnose a splenic artery aneurysm

Tests that your provider may use to diagnose a splenic artery aneurysm include:

• Computed tomography angiography (CTA).
• Digital subtraction angiography (DSA).
• Ultrasonography, including an endoscopic ultrasound.
• Magnetic resonance angiography (MRA).

Each test offers advantages in diagnosing aneurysms and planning treatment. Your provider will tell you which tests you need and why.

How do I know if I need treatment for a splenic artery aneurysm?

Splenic artery aneurysms at risk of rupture or dissection need prompt treatment. Your provider may recommend treatment if you meet any of these criteria:

• The aneurysm is larger than 3 centimeters (30 millimeters) in diameter.
• The aneurysm has grown.
• You have symptoms.
• You need a liver transplant.
• You’re pregnant or could become pregnant.

If your aneurysm isn’t at risk of rupturing, your provider will recommend continued surveillance or follow-up imaging. Your provider will recommend treatment if your risk for a rupture goes up at any point.

What is the treatment for a splenic artery aneurysm?

There are several treatment options for splenic artery aneurysms. These include:

• Endovascular procedure. This is usually the best option to manage an aneurysm before it ruptures (elective treatment). Your provider excludes (blocks off) the aneurysm to prevent blood from flowing through it. There are many different methods. For example, a technique called “coiling” uses metal coils to fill the aneurysm space. Another technique injects a special liquid that hardens and blocks blood flow through the aneurysm. Your provider will choose the most suitable technique depending on the aneurysm’s shape and exact location.
• Open surgery. Providers recommend this for people in whom endovascular treatment is not an option or endovascular procedures have been unsuccessful in treating. You provider removes the damaged part of your artery. They may also need to remove your spleen (splenectomy).
• Laparoscopic procedure. This is a less invasive option than open surgery, with an easier recovery. It’s often the best option for treatment during pregnancy.

Talk with your provider about the most appropriate treatment plan for you.

Complications of treatment

Your provider will discuss the risks and complications of treatment with you. The most common complication is post-embolization syndrome (PES). Symptoms of PES include:

• Fever.
• Nausea and vomiting.
• Pain in your belly.

If you have any of these symptoms following your treatment, call your provider. Your provider may recommend pain medications or IV fluids to ease symptoms as you recover.

How can I reduce my risk of a splenic artery aneurysm?

It’s important to manage your medical conditions, including those that raise your risk for a splenic artery aneurysm. Talk with your provider about specific strategies based on the conditions you have. Some general tips include:

• Take all your medications as prescribed.
• Tell your provider any time you have new or changing symptoms.
• Visit your provider for yearly checkups, and keep all your follow-ups.

Also, lifestyle changes can help improve the health of all your blood vessels, including your splenic artery. Tips include:

• Avoid smoking and tobacco use.
• Eat a heart-healthy diet.
• Exercise regularly, as recommended by your provider.
• Limit alcohol consumption.

What can I expect if I have a splenic artery aneurysm?

If you have a splenic artery aneurysm, closely follow your provider’s guidance. You may not need treatment right away. Instead, your provider may use “watchful waiting” to keep an eye on the situation. This means you need imaging tests on a regular basis (likely every year) so your provider can see if the aneurysm is growing. Timely treatment is essential to prevent an aneurysm rupture or dissection.

What is the outlook for people with splenic artery aneurysms?

Your outlook depends on many factors, including:

• Aneurysm size and location.
• How quickly the aneurysm grows.
• Whether or not the aneurysm ruptures.
• Your associated conditions and risk factors.

Splenic artery aneurysm ruptures are often fatal. Research shows a rupture is deadly for:

• About 25% to 40% of non-pregnant people.
• About 65% to 75% of pregnant people (with a fetal mortality rate of 90% to 95%).
• Over 50% of people with portal hypertension.

Splenic artery pseudoaneurysm ruptures are nearly always fatal.

Talk with your provider about your individual prognosis.

How do I take care of myself?

Living with a splenic artery aneurysm may feel stressful. You might wonder what’s happening behind the scenes inside your body, or you might worry the aneurysm will rupture.

It’s normal to feel concerned. Share your concerns with your provider. Your provider will recommend elective, proactive treatment for an aneurysm that’s at risk of rupturing. Ask your provider to show you the imaging test results and explain what they mean. The more involved you become in your care, the more you’ll feel in control of the situation.

When should I see my healthcare provider?

Your provider will tell you how often you need to come in for follow-ups and imaging tests. Call your provider any time you have questions or concerns, or if you experience new or changing symptoms.

What questions should I ask my healthcare provider?

Ask your provider to explain your diagnosis and your treatment plan going forward. Some questions you may want to ask include:

• How big is the aneurysm?
• Where exactly is it located?
• What are the chances it could rupture?
• What symptoms should I look out for?
• When should I call 911?
• How often do I need to come back for follow-ups or testing?
• What tests do I need? How should I prepare for them?

Also, ask your provider for additional resources that can help you understand your diagnosis and treatment plan.

A note from Cleveland Clinic

Like other aneurysms, splenic artery aneurysms are most dangerous when they go unnoticed. If your provider diagnosed you with a splenic artery aneurysm, you’re already one step ahead of the game. Your provider will monitor the situation and tell you when you need treatment.

If you’ve received treatment for an aneurysm or a rupture, long-term vigilance is key. Don’t miss any follow-ups, and talk with your provider about new or changing symptoms. Be an active partner in your medical care, and learn as much as you can about your condition. With knowledge and resources, you can work with your care team to help lower your risk of future problems.