Visceral vessels aneurysmectomy
When is this procedure indicated?
This procedure is indicated in cases of aneurysm of the splenic artery, superior mesenteric artery, and celiac tripod, in patients with acceptable surgical and anesthesiological risk and deemed ineligible for endovascular exclusion treatment.
How is it performed?
The intervention consists in aneurysmectomy followed by reconstruction of the artery that can be performed in different ways: through direct reconstruction of the artery, through the interposition of prosthesis or segment of vein. If it is impossible to reconstruct the artery, it is possible to proceed with ligation of the vessel in question.
With regard to the splenic artery, especially if the aneurysmal pathology involves a very distal segment, it is possible to perform a ligation in the absence of subsequent revascularization, which is mandatorily associated with splenectomy. After splenectomy it is possible to perform an autologous reimplantation of splenic fragments in the omental fat.
Often aneurysmectomy of the superior mesenteric artery is associated with cholecystectomy.
After discharge, a 1-week home convalescence period is still required before fully resuming previous activities. In this period, it is normal to feel rather weak, have no appetite. It is important to eat small and frequent meals, following the dietary instructions received at discharge. It is important to gradually resume physical activity, try to take short walks, with the goal of doing more each day than the previous day.
Complications related to a surgery of this magnitude do exist, occurring at a general frequency of about 20%. Complications can be trivial, such as infection or dehiscence of the surgical wound, urinary or respiratory infections, but they can also be very serious such as those listed below:
- Cardiovascular failure; respiratory failure; renal failure with risk of even permanent dialysis.
- Hepatic ischemia with secondary liver failure; splenectomy necessitatis with secondary immunocompetence deficiency and plateletosis; nephrectomy necessitatis; continuous injuries to the digestive tract with the need for resections.
- Embolic complications involving splanchnic organs: intestinal ischemia requiring extensive ileal and colic resection, acute pancreatitis on an ischemic basis requiring reintervention.
- Acute pancreatitis with outcome in chronic pancreatic insufficiency and secondary diabetes mellitus, need for surgery following these events, possible formation of pseudo cysts secondary to this with possible need for reintervention.
- Postoperative bleeding, even massive, with the need for surgical revision, capable of conditioning hemorrhagic shock and exitus.
- Multi-organ failure with exitus.
- Local and generalized sepsis; septic shock, favored by possible splenectomy.
- Postoperative intestinal occlusion with need for surgical revision. Wound infection and/or dehiscence.
- Infection of the vascular prosthesis, with septic complications, including generalized, pseudoaneurysms and failure of anastomoses.
- Laparocele with need for reintervention and cosmetic damage.
- Increased susceptibility to infection and platelet disease secondary to splenectomy.