Intraoperative Decisions in Patients with Hepatic or Splenic Artery Aneurysms

Introduction Visceral artery aneurysms might remain asymptomtic for a long period of time due to the development of a well-functioning collateral circulation. However, in certain cases, they can become symptomatic once complications occur. Material and method We present a case series of three patients diagnosed with hepatic aneurysms (two cases) and splenic artery aneurysms (one case) that were diagnosed due to the apparition of aneurysm related complications. Results Cases with hepatic artery aneurysms were investigated for upper digestive bleeding and were diagnosed with a common hepatic artery aneurysm and respectively a right hepatic artery aneurysm. However, due to the long evolution of the disease, a proper collateral circulation was developed in both cases, so the aneurysms were successfully resected without performing any hepatic resection. The vascularization of the liver was provided by accessory hepatic artery in the first case and by the left hepatic artery in the second case. The third case was diagnosed with a large splenic artery aneurysm; due to the large dimension of the aneurysm the patient was submitted to surgery, the lesion being resected en bloc with splenectomy and distal pancreatectomy. Conclusions Visceral arterial aneurysms are usually diagnosed at the time of developing complications. Due to the long evolution of such cases, a good collateral circulation is present at the time of diagnostic, providing the surgeon the possibility of preserving the corresponding viscera; however, the final decision in regard with the extent of the surgical procedure should be taken intraoperatively, after a close inspection of the vascular resources of the collateral pathways.