Palliation can be an option for giant splenic artery aneurysm: a case report and review of literature

Giant splenic artery aneurysm (SAA) is a rare vascular pathology, though it remains the third most common intra-abdominal visceral artery aneurysm which is rarely goes above >3 cm in size. Only a few cases larger than 10 cm have been reported, with a rupture risk of 28% and 40% mortality when rupture occurs. A 78-year-old male with a history of vascular dementia, ischemic heart disease, diabetes, and a previously embolized 4 cm SAA (2008) is reported, who presented in March 2025 with COVID-19 infection and non-specific upper abdominal pain. Imaging revealed a 17.3 cm thrombosed splenic artery aneurysm—the largest reported to date. An attempt at endovascular embolization was unsuccessful due to distorted anatomy and multiple non-cannulable collaterals. Given his comorbidities, poor functional status, and the complexity of open surgery, the multidisciplinary team opted for conservative management with palliative intent. At 8-month follow-up, he remained stable and asymptomatic with no aneurysm growth. While endovascular or open surgical repair remains the treatment of choice for splenic artery aneurysms, palliation may be an appropriate option in selected patients where intervention poses disproportionate risk. Multidisciplinary discussion and individualized decision-making are essential in such rare and high-risk cases.