Autologer Ersatz einer aneurysmatragenden Arteria hepatica mittels Veneninterponat

Abstract

BACKGROUND: Hepatic artery aneurysms are rare and are often diagnosed accidentally. These aneurysms can rupture into the peritoneal cavity resulting in life-threatening hemoperitoneum and shock, or perforate into the biliary tree, the portal vein or the GI tract. METHODS: A 66-year-old women with right upper quadrant pain was diagnosed with an aneurysm-bearing right hepatic artery originating from the superior mesenteric artery. After resection of the aneurysm-bearing segment, a venous graft was anastomosed from the left gastric artery to the right hepatic artery. Follow-up for eight years. Detailed description of the case-history, the operative technique and review of the literature. RESULTS: Total time of hepatic arterial occlusion was 50 minutes. No blood transfusion was required. The postoperative course was uneventful. No rise of liver function parameters (serum bilirubin, alkaline phosphatase and serum glutamic oxaloacetic transaminase) was noted postoperatively. In a follow-up examination six years and eight years postoperatively the patient had no abdominal complaints. Liver function tests were within normal limits and abdominal ultrasound revealed a patent graft with a diameter of 6 mm without aneurysmatic dilatation and a physiologic hepatic artery flow-spectrum. CONCLUSIONS: The current study demonstrates that elective venous grafting for replacement of an aneurysm-bearing right hepatic artery originating from the superior mesenteric artery can be performed safely, with a good long-term outcome.