Management of hepatic artery aneurysms

Abstract

Abstract:Background: Hepatic artery aneurysm (HAA) is a rare clinical entity that can lead to potentially life threatening complications. We reported our personal experience of 4 cases, in which we used different procedures. Methods: The fi rst case had a pseudo-aneurysm involving the right hepatic artery. The second case had a pseudoaneurysm, which was localized distal to the accidentally ligated right hepatic artery from the previous cholecystectomy operation. The third case had multiple aneurysms with accompanying dissecting abdominal aortic aneurysm. The fourth case had a pseudo-aneurysm originating from the proper hepatic artery. A covered stent was successfully placed in the case 1. In the second case, the right hepatic artery was ligated distal to the aneurysm. In the third case, vascular structures were not appropriate for vascular reconstruction, and a covered stent placement and embolization were unsuccessful. In the fourth case, ligation of the proper hepatic artery and cholecystectomy was performed.Results: The third case with multiple aneurysms died from multi-organ failure due to sepsis. The remaining cases (case 1, 2, and 4) are disease free and alive. Conclusion: HAAs are more commonly observed clinical entities, and their treatment should be handled for each patient separately. Computerized tomography-Angiography and intraoperative Doppler ultrasound are useful radio-diagnostics for determination of aneurysm and planning the operative procedure (Fig. 5, Ref. 15). Full Text in PDF www.elis.sk.

Splenectomy Caused by Transcatheter Arterial Embolization Treated Hepatic Arterypseudoaneurysm: A CaseReport

“…In clinic the interventional treatment of hepatic aneurysm mainly includes arterial embolization and stent implantation [6]. Endovascular stent can completely cover the diseased blood vessels, effectively seal the tumor body and keep the diseased artery obstructed, which is the most satisfactory treatment in theory.…”

Effectiveness of Endovascular Coil Embolization of Ruptured Hepatic Artery Pseudoaneurysm

“…The risk of rupture increases in the size greater than 2 cm, which is indicated for treatment CT angiography is the first step for optimal treatment planning [9]. Because there are numerous variations in hepatic arterial anatomy, determination of the type, number and localization of the pseudoaneurysm and its associated collaterals are evaluated by CT angiography [2] [9]. Direct percutaneous injection with thrombin or glue for aneurysmal sac is considered when neither transcatheter embolization nor surgical approach is difficult [5].…”

“…In recent five years, endovascular treatment has become the first choice of HAPs except ruptured HAPs [2] [5] [6] [9] [11]. The location and number are more important factors than the size and the gastroduodenal artery is pivotal in treatment algorithm [2] [6] [9]. Ligation or transarterial embolization of the hepatic artery distal to gastroduodenal artery can result in hepatic ischemia, abscesses, and cholecystitis if collaterals are insufficient [6] [9].…”

“…Although rupture-related mortality rate in HAP is not negligible, the strong consensus regarding treatment indication and method is not yet established [2] [3]. The risk of rupture increases in the size greater than 2 cm, which is indicated for treatment CT angiography is the first step for optimal treatment planning [9]. Because there are numerous variations in hepatic arterial anatomy, determination of the type, number and localization of the pseudoaneurysm and its associated collaterals are evaluated by CT angiography [2] [9].…”

“…The location and number are more important factors than the size and the gastroduodenal artery is pivotal in treatment algorithm [2] [6] [9]. Ligation or transarterial embolization of the hepatic artery distal to gastroduodenal artery can result in hepatic ischemia, abscesses, and cholecystitis if collaterals are insufficient [6] [9]. Therefore, CT angiography has a great role in evaluation of pancreaticoduodenal arcade, pericholedochal arteries, perigastric arteries, hypertrophic inferior phrenic arteries and arteries from the falciform or round ligaments [6] [9].…”