PLoS ONE (Jan 2020)

Higher prevalence of splenic artery aneurysms in hereditary hemorrhagic telangiectasia: Vascular implications and risk factors.

  • Jacques Sellier,
  • Carma Karam,
  • Alain Beauchet,
  • Axel Dallongeville,
  • Stephen Binsse,
  • Sandra Blivet,
  • Isabelle Bourgault-Villada,
  • Philippe Charron,
  • Thierry Chinet,
  • Mélanie Eyries,
  • Carole Fagnou,
  • Jérome Lesniak,
  • Gilles Lesur,
  • Jérome Lucas,
  • Agnès Nicod-Tran,
  • Augustin Ozanne,
  • Aurélien Palmyre,
  • Florent Soubrier,
  • Mostafa El Hajjam,
  • Pascal Lacombe

DOI
https://doi.org/10.1371/journal.pone.0226681
Journal volume & issue
Vol. 15, no. 1
p. e0226681

Abstract

Read online

BACKGROUND:Splenic artery aneurysm (SAA) is a rare but potentially fatal condition. Rupture results in 25% mortality up to 75% in pregnant women with 95% fetal mortality. Brief reports suggest an increased risk of developing SAA in patients with HHT. METHODS:We analyzed enhanced multidetector CT data in 186 HHT patients matched (gender and ± 5 year old) with 186 controls. We screened for SAA and recorded diameter of splenic and hepatic arteries and hepatic, pancreatic and splenic parenchymal involvements. We determined by univariate and multivariate analysis, the relationship with age, sex, genetic status, cardiovascular risk factors (CVRF) and visceral involvement. RESULTS:SAA concerned 24.7% of HHT patients and 5.4% of controls, p<0.001. Factors associated with increased risk of SAA in HHT were female gender (p = 0.04, OR = 2.12, IC 95% = 1.03-4.50), age (p = 0.0003, OR = 1.04, 95% CI = 1.02-1.06) and pancreatic parenchymal involvement (p = 0.04, OR = 2.13, 95% CI = 1.01-4.49), but not type of mutation, hepatic or splenic parenchymal involvements, splenic size or splenic artery diameter or CVRF. CONCLUSIONS:We found a 4.57 higher rate of SAA in HHT patients without evidence of splenic high output related disease or increased CVRF. These results suggest the presence of a vascular intrinsic involvement. It should lead to screening all HHT patients for SAA. The vasculopathy hypothesis could require a change in management as screening of all systemic arteries and even the aorta and to further research in the field.