Surgical Treatment of a Giant Right Hepatic Artery Aneurysm with an Aberrant Left Hepatic Artery: Report of a Case

Abstract

Hepatic artery aneurysms are rare. We describe a case of a successful surgical treatment of a giant hepatic aneurysm without revascularization. A 63-year-old female was admitted to our department complaining of abdominal pain. Computed tomography showed a thrombosed hepatic artery aneurysm measuring 5.5 cm in diameter. A celiac angiography revealed an aberrant left hepatic artery and a right hepatic aneurysm. Liver blood flow and the right hepatic aneurysm were visualized via collateral pathway from the aberrant left hepatic artery. We performed an aneurysmorrhaphy without revascularization. Postoperative course was uneventful and the patient is doing well 3 months after surgery. Keywords: hepatic artery, aneurysm, surgical treatmentHere, we report the surgical treatment of a giant right HAA (RHAA) with an aberrant left hepatic artery, which grew up to 6.0 × 5.5 cm in diameter, in spite that the aneurysm was thrombosed. Case ReportIn July 2013, a 63-year-old female patient was admitted to our emergency department with sudden abdominal pain. The patient had undergone coronary artery bypass graft for angina pectoris and Dor procedure for left ventricular aneurysm. Because of those operations, she required warfarin. She had no history of cholecystitis, pancreatitis, previous abdominal operation and trauma. Abdominal examination revealed a large mass in right upper quadrant and moderate discomfort with deep palpation in the epigastric area. The laboratory data were within normal limit. CT showed an unruptured thrombosed HAA measuring 5.3 × 5.3 cm in diameter. Her symptom improved gradually with administration of antiulcer drugs in a few days, therefore the aneurysm was observed with CT twice a year. Until in July 2014, diameter of the aneurysm did not change. In Feb 2015, she was readmitted to our department with sudden abdominal pain. In this time, she had tender mass in right upper quadrant, and CT showed that the aneurysm grew up to 6.0 × 5.5 cm in diameter without enhancement of contrast medium (Fig. 1). A celiac angiography through the femoral artery was performed. The angiography revealed a giant RHAA. An origin of the right hepatic artery was calcified and occluded and the left hepatic artery arose from the celiac trunk. Moreover, blood flow in a RHAA was visualized via collateral blood flow from the left hepatic artery in the late phase angiogram (Fig. 2). The aneurysm was indicated for operation because of impending rupture.At operation, the aneurysm was exposed through a hokey-stick incision. The left hepatic artery, the common hepatic artery (CHA) and the gastroduodenal artery (GDA) were under control (Fig. 3A). We clamped CHA and GDA, and incised the aneurysm longitudinally. After removing the thrombus in the aneurysm, the collateral