Endovascular Management of Anastomotic Blowout of Proper Hepatic to Common Hepatic Artery Saphenous Vein Bypass With Coil Embolization and Hepatic Artery Stent Placement

Abstract

Mesenteric and visceral artery pseudoaneurysms in the abdomen are a relatively rare complication after abdominal surgery. It is a complication primarily associated with pancreatic and hepatobiliary surgery, trauma, iatrogenic causes and inflammatory diseases. Regardless of etiology, visceral artery pseudoaneurysms of the abdomen reportedly occur only in 0.01% to 2% of the population. Although rare, these are associated with life-threatening bleeding complications and need to be appropriately managed. We present the case of a patient who presented with bleeding after developing a pseudoaneurysm at the distal anastomotic site of a common hepatic to proper hepatic artery interposition saphenous vein bypass that was subsequently excluded by coil embolization and stent graft placement.

Repair of superior mesenteric artery bypass pseudoaneurysm with physician-modified fenestrated aortic endograft

“…There is a single case report describing pseudoaneurysmal degeneration of a hepatic vein bypass graft requiring repair for hemorrhage as well as only two reports of delayed rupture complicating aortorenal vein bypass grafts 14, 15. In general, more common saphenous vein bypass complications include arterialization and subsequent stenosis as well as thrombosis as often cited in both the coronary and the peripheral vascular bed literature 15 .…”