A Novel Approach to Complex Splenic Hilar Aneurysms: ICG-Guided Partial Spleen Preservation Combined With Distal Pancreatectomy

Abstract

Background

Splenic hilar aneurysms exceeding 2 cm in diameter typically warrant surgical intervention given their elevated risk of fatal rupture. While complete splenectomy has historically been the conventional approach to mitigate operative complexity, this procedure carries significant postoperative concerns including compromised immune function and increased thrombotic risks associated with splenic absence.

Case presentation

In two cases of splenic artery aneurysms (SAAs) deeply embedded within the pancreatic tail at the splenic hilar region, we performed laparoscopic resection of the splenic artery aneurysm and distal pancreas. Intraoperative indocyanine green (ICG) fluorescence imaging was employed to map perfusion patterns of the spleen, demonstrating sequential greening and subsequent fading of the splenic upper pole. This confirmed preserved arterial inflow and venous drainage, thus confirming maintained vascularization following splenic artery ligation. The patients achieved an uneventful recovery and were discharged without complications.

Conclusions

We described the first use of a technique that integrates distal pancreatectomy with ICG-guided partial splenic preservation for complex splenic hilar aneurysms. This strategy facilitates precise resection of the aneurysm and non-viable spleen, thereby maximizing functional preservation and establishing itself as a promising option for managing these challenging lesions.