Imaging modalities used in follow-up after coil embolization of splenic artery aneurysm - a systematic review.

Purpose: Endovascular procedures have become the method of choice for treating splenic artery aneurysms (SSAs). However, there is no consensus regarding the intervals and imaging methods for follow-up examinations in patients with true SAAs treated with coil embolisation. We aimed to evaluate the utility of digital subtraction angiography (DSA), computed tomography angiography (CTA), magnetic resonance angiography (MRA), contrast-enhanced ultrasound, and duplex ultrasound (DUS) for follow-up screening of patients with SAAs treated with coil embolisation.

Material and methods: We conducted a systematic review according to the PRISMA 2020 Statement. We searched 5 databases: Embase, Medline Ultimate, PubMed, Scopus, and Web of Science, each up to 10 April 2024. Eventually, 20 relevant original studies were included.

Results: DSA is an invasive procedure that requires ionising radiation and should not be performed as a routine check-up. CTA is an appropriate examination method in patients immediately after coil embolisation in whom severe complications, primarily bleeding, are suspected. Still, it is unsuitable for assessing persistent aneurysmal sac perfusion. MRA is a promising noninvasive technique that does not require ionising radiation. Several studies have demonstrated the superiority of MRA over DSA in detecting small aneurysmal sac reperfusion. DUS, while not a standalone method, may supplement MRA in patients at low risk of reintervention.

Conclusions: The evidence regarding follow-up imaging methods after SAAs coil embolisation is limited and of low quality. MRA should be preferred over DSA for detecting aneurysmal sac reperfusion. Due to artifacts, CTA is suitable for emergency cases but not for routine follow-up.