Abstract.Hepatic artery aneurysms account for up to 20% of all reported visceral aneurysms and might remain asymptomatic for a long period of time (1, 2). In cases presenting large lesions, compression on the elements of the hepatic pedicle might be encountered, inducing portal hypertension. It is estimated that the risk of aneurysmal rupture ranges between 20% and 80%, and the mortality rate reaches up to 21% (3, 4). Due to this reason, and the fact that there is no strong evidence to demonstrate any correlation between aneurysm size and rupture risk, all hepatic aneurysms should be treated (5). The main therapeutic procedures in uncomplicated aneurysms include endovascular techniques, such as percutaneous embolization or classical surgical approach, consisting of aneurysmal resection with or without vascular reconstruction. On the other hand, reconstructive procedures are mainly indicated when a patent collateral vascularization is not present (6). Case ReportA 68-year-old patient, who was investigated for recurrent upper digestive tract bleeding, was diagnosed during a computed tomography examination with a large aneurysm affecting the common and the proper hepatic artery as well as the gastroduodenal artery, and compressing the portal vein. The imagistic examinations revealed the presence of an accessory left hepatic artery entering the left liver lobe, originating from the left gastric artery. Due to the presence of the large, partially thrombosed aneurysm involving the common and the proper hepatic artery, as well as the gastroduodenal artery, the patient was initially submitted to a percutaneous right portal branch embolization in order to induce a left hemiliver hypertrophy. Two months later the patient was submitted to surgery; intraoperatively the findings of the imagistic examinations were confirmed. The 979

Abstract. Right Hepatic artery aneurysms represent uncommon lesions, accounting for up to 20% of all splanchnic artery aneurysms and are usually asymptomatic lesions, being discovered during various investigations for other pathologies (1). When it comes to the apparition of hepatic artery aneurysms, the main incriminated mechanism is the atherosclerotic one, followed by endocarditis, necrotizing vasculitis, Ehlers Danlos syndrome, Takayasu's arteritis and post-traumatic procedures such as liver transplantation, percutaneous transhepatic cholangiography (2-4). In the study conducted by Stanley et al. on 162 patients diagnosed with various splanchnic aneurysms, the authors demonstrated that 63% of cases reported common and proper hepatic artery aneurysms, 28% of cases were diagnosed with right hepatic artery aneurysms, 5% of cases presented left hepatic artery aneurysms while 4% of cases presented left and right hepatic artery aneurysms (5). Increasing incidence of reported hepatic artery aneurysms which has been reported in the last decade is mainly explained through the improvement of the imagistic techniques, offering a higher rate of aneurysms' detection especially among asymptomatic patients (6). Once hepatic aneurysms are diagnosed, performing an arteriography is 983

Ex-situ liver surgery refers to complex liver resections involving hepatic vascular exclusion and a warm ischemia time (WIT) of more than 90 minutes that allows liver resection and vascular reconstruction in patients with giant liver tumours with a difficult approach . Ante-situm liver resections, otherwise called "œex-situ in-vivo" resections is achieved through externalization of the liver outside of the abdominal cavity by clamping and sectioning of the efferent pedicles (suprahepatic veins) ("ex situ") without cutting the afferent vascular pedicle ("in vivo"), thus leaving the hepatic pedicle intact. We present a case report of a 36 yo male patient diagnosed by MRI scan with giant liver tumor in the left hemiliver. A left "ex-situ in-vivo" hepatectomy was performed by dissecting and ligating the left and middle hepatic veins, clamping and sectioning the right hepatic vein, Pringle maneuver, externalization of the liver followed by the tumor resection and right hepatic vein reimplantation. The short warm ischemia time (hepatic resection + liver reimplantation - 30 minutes) allowed us to perform the procedure without installing a veno-venous or porto-caval shunt otherwise used in all of ex-situ procedures described in the literature reviewed in this presentation. Ex-situ liver resection is a viable procedure for giant liver tumours in highly selected cases. It facilitates resection of large liver tumours that would be otherwise unresectable, extending the indications of surgical treatment.