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

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). Two hundred and eight 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 included retrospectively. 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 the SAAs: 2.0 – 2.9 cm (S1), 3.0 – 3.9 cm (S2), and ≥ 4.0 cm (S3). Technical success was 100%. During a median follow up of 48.8 (IQR 33.0, 70.4) months, no patients had SAA rupture or died. The two 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. 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 might be a better choice for larger SAAs.