A splenic artery aneurysm of 19mm or 22mm be fixed or just watched?

Depends. The two sizes stated may have different recommendations - size alone will affect which one may need surgery. Hormonal status (i.e. Pre vs post menopausal) can affect decision as well. Additional characteristics of the aneurysm such as calcifications also might impact determination. For the one less than 2 cm and if asymptomatic, an observational strategy is likely. .