Abstract
Purpose: To assess the efficacy of endovascular management for ruptured hepatic artery pseudoaneurysm (HAP). Methods: Six cases of HAP in five patients (four men and one women; mean age, 50; range, 28 - 62) were treated with transcatheter arterial coil embolization using microcoil (Boston Scientific, Watertown, MA, USA) and Tornado Coil (Cook, Bloomington, IN, USA) with or without stent graft between January 2007 and September 2008. They were analyzed with regard to the clinical presentation, radiological findings with procedure, and clinical and radiologic outcomes. Results: All patients presented with epigastric pain or gastrointestinal bleeding. The pseudoaneurysms were ranged from 0.6 to 4.4 cm in size and located in the common hepatic artery (n = 1), junction between proper and right hepatic artery (n = 1), proper hepatic artery (n = 2), the left hepatic artery (n = 1), right hepatic artery (n = 1). Embolization was performed with microcoils in all pseudoaneurysmal sac with or without both afferent and efferent segment. A self-expandable stent (n = 1) was also used. Overall technical success was 100% (6 of 6) and complete occlusions of HAPs were achieved in 5 out of 6 cases, 83.3% of clinical success rate. Re-bleeding occurred in one case of stent graft at proper hepatic artery following coil packing for pseudoaneurysmal sac. Clinical success rate of embolization for both afferent and efferent segment was 100% (3 of 3). Procedure-related minor complications happened in 2 of 5 patients, and they were treated conservatively. Conclusion: Transcatheter coil embolization for ruptured HAP is sufficiently effective and additional embolization in both afferent segment and efferent segment can improve clinical success rate.
Highlights
Hepatic artery aneurysms are rare but represent approximately 20% of all visceral artery aneurysms [1] [2] [3]
Embolization was performed with microcoils in all pseudoaneurysmal sac with or without both afferent and efferent segment
We reviewed our experience of assessment of efficacy in endovascular managements for hepatic artery pseudoaneurysm
Summary
Hepatic artery aneurysms are rare but represent approximately 20% of all visceral artery aneurysms [1] [2] [3]. Hepatic artery pseudoaneurysm (HAP) is caused by inflammation and injurious causes such as surgery, trauma and percutaneous procedures [3]. Incidence of HAP is growing due to increase in laparoscopic or percutaneous hepatobiliary procedures and frequent use of computed tomography (CT) scanning [3] [4] [5]. Treatment of HAP includes open surgery and minimally invasive interventional treatment, surgical procedures are gradually replaced by diverse kinds of endovascular or percutaneous transabdominal techniques in many published literature [5] [6] [7]. Percutaneous transabdominal techniques include direct injection of thrombin or glue and endovascular management include transcatheter arterial embolization or stent graft placement [5] [6]. We reviewed our experience of assessment of efficacy in endovascular managements for hepatic artery pseudoaneurysm
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