Pulli Raffaele, Dorigo Walter, Troisi Nicola, Pratesi Giovanni, Innocenti Alessandro Alessi, Pratesi Carlo
Department of Vascular Surgery, University of Florence, Florence, Italy.
J Vasc Surg. 2008 Aug;48(2):334-42. doi: 10.1016/j.jvs.2008.03.043.
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.
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.
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%.
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.
本研究旨在分析我们25年来内脏动脉瘤（VAA）手术治疗的经验，特别关注早期和长期结果。
1982年1月至2007年9月，55例患者（32例男性，占58%；23例女性，占42%）接受了59例VAA的手术治疗。仅1例患者接受了血管内介入治疗。患者平均年龄为59.3岁（范围36 - 78岁）。动脉瘤疾病的部位：脾动脉30例（50.8%），肾动脉9例（15.2%），肝总动脉7例（11.9%），胰十二指肠动脉4例（6.8%），腹腔干3例（5.1%），肠系膜上动脉2例（3.4%），胃十二指肠动脉、肠系膜下动脉、结肠中动脉和胃网膜右动脉各1例（各占1.7%）。2例（3.6%）患者有多个VAA。5例（9.1%）患者合并腹主动脉瘤。评估了死亡率和主要并发症方面的早期结果。随访包括术后1个月和12个月以及此后每年的临床和超声检查。分析了生存率和动脉瘤相关并发症方面的长期结果。
除2例患者外，其余均对无症状患者进行了择期干预。2例（3.6%）患者动脉瘤破裂（1例胰十二指肠动脉，1例结肠中动脉）。1例围手术期死亡是由于1例巨大炎性脾动脉瘤手术患者发生急性胰腺炎，围手术期死亡率为1.8%。记录到2例主要并发症（腹膜后血肿和急性胰腺炎）。平均随访时间为82.1个月（范围0 - 324个月）。估计10年生存率为79.5%。随访期间发生2例动脉瘤相关并发症，估计10年无动脉瘤相关并发症生存率为75.2%。
在微创治疗方法的时代，内脏动脉瘤的择期开放手术治疗是安全有效的，并且能提供令人满意的早期和长期结果。
