Surgical treatment of visceral and renal abdominal artery aneurysms of various etiology

Abstract

Visceral artery aneurysms are detected when complications occur or accidentally during examination for other diseases gastrointestinal tract, aimed at determining the functional significance. Over the past 10 years, we have observed 31 patients with abdominal visceral artery aneurysms, 10 patients had renal aneurysms, 15 had splenic arteries, hepatic artery and pancreatoduodenal artery aneurysms – in one case. The combination of aneurysms – in 2 cases: in one case – the renal artery with the splenic artery, in the other – the renal artery and the abdominal trunk. The patients ranged in age from 24 to 78 years, the average age is 43±6.5. Previously, infection was considered the most common cause of splenic artery aneurysms in 10 cases, with most patients complaining of fever, abdominal pain and a pulsating mass in the abdomen. And two patients with splenic artery aneurysm noted abdominal trauma. 3 had atherosclerotic changes. The causes of renal artery aneurysms are atherosclerosis in 6 cases, fibromuscular dysplasia in 2 cases, and Nonspecific aortoarteritis in 2 cases. Also, atherosclerotic etiology is present in aneurysms of the external iliac arteries aneurysms. Reconstructions on hepatobiliary aneurysms were performed in 6 (20%) cases, in 5 cases - resection with end-to-end anastomosis and in 2 cases - resection of splenic artery aneurysm, resection of splenic artery aneurysms with autovenous patch, clipping of splenic artery aneurysms – in 2 cases (6.5%), endovascular techniques were applied in 18 cases (58%). In 2 cases, nephroectomy was performed due to the spread of the aneurysm into the kidney gate and the lack of conditions for reconstruction. In the immediate and long-term (after 6 months and 3 years) postoperative period, the preservation of organ function in reconstructive and ligating methods of surgical treatment is the same. Signs of ischemia and impairment in the immediate postoperative period were not observed with reconstructive and ligating methods of surgical treatment. The choice of treatment method depends on the severity of the patient’s condition, clinical manifestations, as well as the localization of the aneurysm and its morphology. Preference is given to endovascular techniques, which are not traumatic enough and provide a good long-term result. However, in each case, the patient’s management tactics are individual, the choice of the optimal method of treatment of visceral artery aneurysms is based on data from the entire spectrum of possible diagnostic manipulations.