Aneurysm resection and vascular reconstruction for true aneurysm at the initial segment of splenic artery

Abstract

The aneurysms at the initial segment of splenic artery are rare. This paper aimed to investigate the methods to treat the true aneurysm at the initial segment of splenic artery by aneurysmectomy plus vascular reconstruction. Retrospectively reviewed were 11 cases of true aneurysm at the initial segment of splenic artery who were treated in our hospital from January 2000 to June 2013. All cases were diagnosed by color ultrasonography, computer tomography (CT) and angiography. Upon resection of the aneurysm, the auto-vein transplantation was performed in situ between the hepatic artery and the distal part of the splenic artery in 1 case; the artificial vessel bypass was done between the infra-renal aorta and distal portion of the splenic artery in 7 cases; the splenectomy was done in 2 cases; the splenectomy in combination with ligation of multiple small aneurysms were performed in 1 case. All cases were cured and discharged from the hospital 10-14 days after operation. A 1-14 year follow-up showed that 9 cases survived, and 2 cases died, including 1 case who died of acute myocardial infarction 2 years after aorta-splenic artery bypass operation and 1 case who died of acute cerebral hemorrhage 5 years after aneurysm resection and the splenectomy. Among 6 cases receiving aorta-splenic artery bypass, 1 gradually developed stenosis at anatomosed site, which eventually progressed to complete occlusion 2 years to 6 years after operation, without suffering from splenic infarction because the spleen was supplied by the short gastric vessel and its collaterals. The other 5 cases receiving aorta-splenic artery bypass and 1 case undergoing autologous vascular transplantation did not develop stricture or pseudoaneurysm at the stoma. Our study showed that the aneurysmectomy plus vascular reconstruction is a better treatment for aneurysm at the initial segment of splenic artery.

Single-Incision Laparoscopic Splenectomy for an Unruptured Aneurysm of the Splenic Artery

“…In such situations, a surgical approach is a necessary and reliable procedure [3,4,5]. Laparoscopic surgery has become increasingly accepted as a surgical approach for unruptured visceral artery aneurysms in which transcatheter arterial embolization is impossible [4,5].…”

“…Laparoscopic surgery has become increasingly accepted as a surgical approach for unruptured visceral artery aneurysms in which transcatheter arterial embolization is impossible [4,5]. When the aneurysm of the splenic artery is close to the hilum of the spleen, laparoscopic splenectomy is a suitable and safe procedure [3,4,5,7]. In previous reports [3,4,5,7,8], laparoscopic splenectomies for aneurysms of the splenic artery were performed in 24 patients, including 3 patients with a distal pancreatectomy.…”

“…When the aneurysm of the splenic artery is close to the hilum of the spleen, laparoscopic splenectomy is a suitable and safe procedure [3,4,5,7]. In previous reports [3,4,5,7,8], laparoscopic splenectomies for aneurysms of the splenic artery were performed in 24 patients, including 3 patients with a distal pancreatectomy. SILS for aneurysms of the splenic artery were performed in 3 patients, including our patient; however, 2 other patients had an additional port and/or a cloth tape to hang the hilum of the spleen from an extra-abdominal cavity [8].…”

“…To prevent bleeding from the short gastric vein during laparoscopic splenectomy, the use of an energy device is recommended [3,4,5,9,10]. Because the manipulability of a straight energy device is inconvenient during SILS, we used articulated laparosonic coagulating shears and articulated laparoscopic forceps.…”

“…When transcatheter arterial embolization is impossible, a surgical approach is required to treat an unruptured visceral artery aneurysm [3]. Laparoscopic surgery for unruptured visceral artery aneurysm has been increasingly reported [4,5].…”