Surgical treatment of visceral artery aneurysms: A 25-year experience.
OBJECTIVE
The aim of this study was to analyze our 25-year experience with surgical treatment of visceral artery aneurysms (VAAs), with particular attention paid to early and long-term results.


METHODS
From January 1982 to September 2007, 55 patients (32 males, 58%, and 23 females, 42%) underwent surgical treatment of 59 VAAs. Only one patient was treated with an endovascular procedure. Mean patient age was 59.3 years (range, 36-78 years). The site of aneurysmal disease was splenic artery in 30 (50.8%) cases, renal artery in nine (15.2%) cases, common hepatic artery in seven (11.9%) cases, pancreaticoduodenal artery in four (6.8%) cases, celiac trunk in three (5.1%) cases, superior mesenteric artery in two (3.4%) cases, and gastroduodenal, inferior mesenteric, middle colic and right gastroepiploic in one (1.7%) case for each artery. Two (3.6%) patients had multiple VAAs. In five (9.1%) patients, an abdominal aortic aneurysm coexisted. Early results in terms of mortality and major complications were assessed. Follow-up consisted of clinical and ultrasound examinations at 1 and 12 months, and yearly thereafter. Long-term results in terms of survival and aneurysm-related complications were analyzed.


RESULTS
In all but two cases, elective intervention in asymptomatic patients was performed. Two (3.6%) patients had a ruptured aneurysm (one pancreaticoduodenal artery and one middle colic artery). The one perioperative death was due to an acute pancreatitis in a patient operated on for a giant inflammatory splenic artery aneurysm, yielding a perioperative mortality rate of 1.8%. Two major complications (retroperitoneal hematoma and acute pancreatitis) were recorded. Mean duration of follow-up was 82.1 months (range, 0-324 months). Estimated 10-year survival rate was 79.5%. During follow-up two aneurysm-related complications occurred, with an estimated 10-year, aneurysm-related, complication-free survival rate of 75.2%.


CONCLUSIONS
In the era of minimally invasive therapeutic approaches, elective open surgical treatment of visceral artery aneurysms is safe and effective, and offers satisfactory early and long-term results.
Pulli
Raffaele
R
Department of Vascular Surgery, University of Florence, Florence, Italy. rpulli@unifi.it
Dorigo
Walter
W
Troisi
Nicola
N
Pratesi
Giovanni
G
Innocenti
Alessandro Alessi
AA
Pratesi
Carlo
C
D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D000792:Angiography / Q000379:methods; D017130:Angioplasty / Q000009:adverse effects / Q000379:methods*; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000601:surgery; D008643:Mesentery / Q000098:blood supply* / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011336:Probability; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013152:Splanchnic Circulation; D013157:Splenic Artery / Q000000981:diagnostic imaging / Q000601:surgery; D016019:Survival Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*