Comparison of splenic artery aneurysms in patients with and without portal hypertension

Introduction Splenic artery aneurysms (SAA) are rare but seem to have higher incidence in patients with portal hypertension (PH). The present article aims to analyze the interference of portal hypertension (PH) in the natural history of these aneurysms. Methods This was a retrospective study of data recorded prospectively. Between January 2000 and December 2019, all SAAs patients in follow-up at a tertiary institution were selected for analysis. Primary endpoint was to analyze the presentation and evolution of SAAs in patients with PH, and secondary was to identify cumulative rates of freedom from rupture, interventions and survival in this group, during a 10-year follow up. Results In total, 96 patients were identified with SAAs, 79 (82.29%) did not have PH and 17 (17.7%) had this comorbidity. Among the demographic characteristics, the patients with SAAs and PH were significantly younger [52 years (SD 13.3) versus 61.9 years (SD 12.2) (p=0.05)] and had lower number of pregnancies [(1.1 pregnancies (SD 1.2) versus 3.37 pregnancies (SD 2.3) (p=0.03)]. Patients with PH had a higher cumulative rate of surgical intervention throughout follow-up (up to 75.6% in 10 years) when compared to patients without PH, with 36.9% intervention rate in 10 years of follow-up. Patients with PH had larger diameter at diagnosis (35mm, SD 27.3) compared to patients without PH (22.6 mm, SD 16.1), p = 0.008. However, there was no statistical differences in the relative growth rate, in aneurysmal rupture rate throughout follow-up, as well as in survival over the years, between the groups. Conclusions The patients with SAAs and PH are significantly younger, have larger SAA diameters at diagnosis and have a higher cumulative rate of surgical intervention throughout follow-up in 10 years, despite the relative growth rate being similar to that of patients without PH.