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Online ISSN 1827-1847
Bonardelli S. 1, Maffeis R. 3, Portolani N. 2, Compagnoni B. 3, Dellaglio E. 3, Martini M. 3, Guadrini C. 3, Cervi E. 3, Tiberio G.A.M. 3, Giulini S. M. 3
1 USD and Chair of Vascular Surgery, Department of Medical and Surgical Sciences, Brescia University Hospital, Brescia, Italy;
2 USD and Chair of Emergency Surgery, Department of Medical and Surgical Sciences, Brescia University Hospital, Brescia, Italy;
3 UO and Chair of Clinical Surgery, Department of Medical and Surgical Sciences, Brescia University Hospital, Brescia, Italy
AIM: Visceral artery aneurysms (VAAs) are rare lesions. The aim of this paper was to introduce surgical indication and treatment methods in terms of their immediate and, above all, long-term results.
METHODS: The study enrolled 64 patients affected with VAAs. Inclusion criteria for surgical indication were: VAAs with a diameter of over 2 cm; symptomatic VAAs; female patients of fertile age. Fifty-two patients were treated electively (47 in open surgery and 5 with the video-laparoscopic approach, with 1 conversion in open surgery) with average clinical and instrumental follow-up of 73.7 months (IQR 22-124). In 35 cases the VAAs were of the splenic artery, in 4 of the celiac trunk, in 2 of the hepatic artery, in 1 of the superior mesenteric artery, in 2 of the inferior mesenteric artery, in 3 of the pancreatic-duodenal arches, in 1 of Riolan’s arch and in 16 of the renal artery. The average diameter was 2.3 cm; in 7 cases, obstructive lesions of the visceral vessels were present. Twenty-seven single aneurysmectomies, 17 aneurysmectomies associated with vascular reconstructions (9 direct and 8 with the interposition of autologous or heterologous prosthesis), 3 kidney autotransplants, and 2 partial resections of the spleen (by intraparenchymal extension of the lesion), 6 spleenectomies (with removal of 10 total aneurysms) and 5 nephrectomies were performed.
RESULTS: Operating mortality was nil, and there was surgical morbidity in 3 cases (1 surgical hemostasis; 1 nephrectomy due to thrombosis of the arterial graft; 1 asymptomatic occlusion of the liver bypass performed due to associated occlusion of the celiac trunk). In the long term, correlated mortality and morbidity were 0%, and the patency of residual revascularizations, monitored with echo-colour Doppler in 18/19 patients, was 100%.
CONCLUSION: Although adopting execution techniques that are often not simple, open surgery performed on VAAs can achieve excellent results even in the long-term. Such figures seem to suggest that mini-invasive solutions are only feasible in cases that do not require associated vascular reconstruction. Video laparoscopy is viable in selected cases on the splenic artery; endovascular techniques, with results that are still uncertain in the long term, are reserved only for patients with prohibitive operating risk.