title: Open repair, endovascular repair, and conservative management of true splenic artery aneurysms.
abstract: OBJECTIVE
  True splenic artery aneurysms (SAAs) are a rare but potentially fatal pathology. For many years, open repair (OPEN) and conservative management (CONS) were the treatments of choice, but throughout the last decade endovascular repair (EV) has become increasingly used. The purpose of the present study was to perform a systematic review and meta-analysis evaluating the outcomes of the three major treatment modalities (OPEN, EV, and CONS) for the management of SAAs.
  
  
  METHODS
  A systematic review of all studies describing the outcomes of SAAs treated with OPEN, EV, or CONS was performed using seven large medical databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to ensure a high-quality review. All articles were subject to critical appraisal for relevance, validity, and availability of data regarding characteristics and outcomes. All data were systematically pooled, and meta-analyses were performed on several outcomes, including early and late mortality, complications, and number of reinterventions.
  
  
  RESULTS
  Original data of 1321 patients with true SAAs were identified in 47 articles. OPEN contained 511 patients (38.7%) in 31 articles, followed by 425 patients (32.2%) in CONS in 16 articles and 385 patients (29.1%) in EV in 33 articles. The CONS group had fewer symptomatic patients (9.5% vs 28.7% in OPEN and 28.8% in EV; P < .001) and fewer ruptured aneurysms (0.2% vs 18.4% in OPEN and 8.8% in EV; P < .001), but no significant differences were found in existing comorbidities. CONS patients were usually older and had smaller-sized aneurysms than patients in the OPEN and EV groups. The only identified difference in baseline characteristics between OPEN and EV was the number of ruptured aneurysms (18.4% vs 8.8%; P < .001). OPEN had a higher 30-day mortality than EV (5.1% vs 0.6%; P < .001), whereas minor complications occurred in a larger number of the EV patients. EV required more reinterventions per year (3.2%) compared with OPEN (0.5%) and CONS (1.2%; P < .001). The late mortality rate was higher in patients treated with CONS (4.9% vs 2.1% in OPEN and 1.4% in EV; P = .04).
  
  
  CONCLUSIONS
  EV of SAA has better short-term results compared with OPEN, including significantly lower perioperative mortality. OPEN is associated with fewer late complications and fewer reinterventions during follow-up. Patients treated with CONS showed a higher late mortality rate. Ruptured SAAs are predictors of a significantly higher perioperative mortality compared with nonruptured SAAs in the OPEN and EV groups.
authors.affiliation: Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn; Section of Vascular Surgery, University Medical Center, Utrecht, The Netherlands.
authors.forename: Wouter
authors.initials: W
authors.lastname: Hogendoorn
authors.affiliation: Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn; Department of Vascular Surgery, Imperial College of Science, Technology and Medicine, London, United Kingdom.
authors.forename: Anthi
authors.initials: A
authors.lastname: Lavida
authors.affiliation: Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Health Policy & Management, Harvard School of Public Health, Boston, Mass.
authors.forename: M G Myriam
authors.initials: MG
authors.lastname: Hunink
authors.affiliation: Section of Vascular Surgery, University Medical Center, Utrecht, The Netherlands.
authors.forename: Frans L
authors.initials: FL
authors.lastname: Moll
authors.affiliation: Department of Vascular Surgery, Imperial College of Science, Technology and Medicine, London, United Kingdom.
authors.forename: George
authors.initials: G
authors.lastname: Geroulakos
authors.affiliation: Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn.
authors.forename: Bart E
authors.initials: BE
authors.lastname: Muhs
authors.affiliation: Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn. Electronic address: bauer.sumpio@yale.edu.
authors.forename: Bauer E
authors.initials: BE
authors.lastname: Sumpio
mesh_terms: D000783:Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000401:mortality / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013157:Splenic Artery / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome