Splenic artery infectious aneurysms in infective endocarditis - An observational study and comprehensive literature review.

PURPOSE: To determine the prevalence, the clinical and radiological features, associated factors, treatment and outcome of splenic artery aneurysms (SAAs) in infective endocarditis (IE).

METHODS: We retrospectively reviewed 474 consecutive patients admitted to our institution with definite IE (2005-2020) RESULTS: Six patients had SAAs (1.3%; 3 women; mean age: 50). In all cases the diagnosis was obtained by abdominal CT-angiography (CTA). SAAs-IE were solitary, saccular with a mean diameter of 30mm (range: 10-90mm). SAAs-IE were intrasplenic (n=4) or hilar (n=2). Streptococcus spp were the predominant organisms (n=4). In all cases a left-sided native valve was involved (aortic, n=3; mitral, n=2, mitral-aortic, n=1). SAAs were silent in half-patients, and were revealed by abdominal pain (n=2) and by the resurgence of fever after cardiac surgery (n=1). All patients underwent emergent valve replacement. One patient died within 24h from multiorgan failure. For the others, uneventful coil embolization was performed in 4 patients after valve replacement (3 diagnosed early, one at 8 weeks). In the remaining patients, SAA-IE diagnosed at abdominal-CTA at day 16, with complete resolution under appropriate antibiotherapy alone.

CONCLUSION: SAAs-IE are a rare occurrence that may be clinically silent. SAAs-IE can be intrasplenic or hilar in location. Endovascular treatment in this context was safe. According to current guidelines, radiologic screening by abdominal-CTA allowed the detection of silent SAAs which could be managed by endovascular treatment to prevent rupture. The delayed formation of these SAAs could justify a CTA control at the end of antibiotherapy.