Immediate and long-term results of 64 visceral aneurysms treated in open or video-assisted surgery

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 Riolanís 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.