Management of a common and proper hepatic artery aneurysm

Abstract

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Right Gastroepiploic Artery Transposition for a Common Hepatic Artery and Proper Hepatic Artery Aneurysm Repair

“…Owing to the collateral circulations from the GDA and right gastric artery, most HAAs localized within the CHA can be treated with ligation without arterial reconstruction [5]. For HAAs involving the PHA or the GDA, additional procedures, such as patch angioplasty [6] and bypass with autologous or prosthetic graft [1,7], are required to avoid hepatic ischemia after aneurysm removal, as well as transposition of the splenic artery or the RGEA [8,9].…”

Hepatic artery aneurysm: A rare but significant differential diagnosis

“…8 A ruptured intrahepatic aneurysm however is more likely to rupture into the biliary tract, with one third of symptomatic patients presenting with Quincke's triad of haemobilia; obstructive jaundice, abdominal pain, and upper gastro-intestinal bleeding. 3,5,11 Haemobilia is caused when a connection exists between the splanchnic vessels and the intra-or extra-hepatic biliary system. In the case of a HAA, over time, the presence of the aneurysm can cause erosion or potentially rupture into the biliary tree.…”

“…2 Current treatment options for HAA repair include ligation, arterial grafting and reconstruction, excision and repair, hepatic resections, and endovascular approaches. 11 The appropriate surgical approach depends on factors such as the intra-or extra-hepatic location of the aneurysm, whether collateral flow is present, as well as the patient's clinical status. 10,13 Regarding our case study, vascular specialists were consulted, but to date no surgical intervention was undertaken due to patient comorbidities and other risk factors.…”

“…Symptomatic patients secondary to extrahepatic aneurysms rupture will haemorrhage into the peritoneum and suffer from the subsequent haemodynamic instability 8 . A ruptured intrahepatic aneurysm however is more likely to rupture into the biliary tract, with one third of symptomatic patients presenting with Quincke's triad of haemobilia; obstructive jaundice, abdominal pain, and upper gastro‐intestinal bleeding 3,5,11 . Haemobilia is caused when a connection exists between the splanchnic vessels and the intra‐ or extra‐hepatic biliary system.…”

Splenic artery transposition for reconstruction of a large hepatic artery aneurysm: A case report and literature review

“…Of these, we believe that the most important advantages of the splenic artery are the adjustable caliber difference and ability to secure sufficient distance. A PubMed search using the keywords “open surgery” and “hepatic artery aneurysm” revealed 15 cases of hepatic artery resection and reconstruction among 10 years from 2011 to 2021, including our own cases ( Table 1 ) [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] . Five cases had autologous arterial reconstruction and four of these five cases had splenic artery transposition.…”