Predictive factors for post-embolization infarction and long-term splenic remodeling in patients undergoing splenic artery aneurysm embolization

초록

Objective: To identify predictive factors for post-embolization splenic infarction and to assess long-term remodeling patterns of the spleen, including regeneration and atrophy, in patients undergoing embolization for splenic artery aneurysm (SAA). Methods: This retrospective study included 64 patients (66 cases) with splenic artery aneurysms who underwent transcatheter arterial embolization between February 2007 and November 2023 at a single tertiary center. Embolization techniques included sac packing, trapping, combined approaches, and stent-graft placement. Results: Technical success was achieved in all 66 cases. Clinical success was obtained in 94.1% of evaluable patients, with two cases of recanalization and one new aneurysm detected during follow-up. Splenic infarction occurred in 24 patients (37.5%) and was associated with distal or hilar/intrasplenic location (p = 0.007), larger pre-embolization splenic volume (p = 0.018), and reduced splenic staining on angiography after embolization (p < 0.001). In multivariate analysis, only reduced splenic staining on angiography remained an independent predictor of infarction (HR = 0.939; p = 0.001). Among infarcted patients, 12 (50%) demonstrated regeneration and 12 (50%) progressed to atrophy, with regeneration associated with higher post-embolization splenic staining on angiography (p = 0.036), smaller infarcted volume (p = 0.003), and greater final splenic volume (p = 0.018). Overall complication rate was 39.1%, all of which resolved with conservative management. No major complications occurred. Conclusion: Endovascular embolization for splenic artery aneurysms was safe and effective. Post-embolization splenic staining on angiography was the key predictor of infarction and was also associated with long-term splenic regeneration.

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