Stent Graft Placement by Pseudoaneurysm of the Hepatic Arteries: Efficacy and Patency Rate in Follow-up

F Pedersoli,S Keil,V Van Den Bosch,C K Kuhl,P Sieben,G Wiltberger,M Schulze-Hagen,E Barzakova,P Bruners,P Isfort

doi:10.1007/s00270-021-02993-0

F Pedersoli, S Keil + Show 8 more

Open Access

https://doi.org/10.1007/s00270-021-02993-0

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Abstract

PurposeTo investigate efficacy and patency status of stent graft implantation in the treatment of hepatic artery pseudoaneurysm.Materials and MethodsA retrospective analysis of patients who had undergone endovascular treatment of hepatic artery pseudoaneurysms between 2011 and 2020 was performed. Medical records were examined to obtain patients’ surgical histories and to screen for active bleeding. Angiographic data on vascular access, target vessel, material used and technical success, defined as the exclusion of the pseudoaneurysm by means of a stent graft with sufficient control of bleeding, were collected. Vessel patency at follow-up CT was analyzed and classified as short-term (< 6 weeks), mid-term (between 6 weeks and 1 year), and long-term patency (> 1 year). In case of stent occlusion, collateralization and signs of hepatic hypoperfusion were examined.ResultsIn total, 30 patients were included and of these, 25 and 5 had undergone stent graft implantation and coiling, respectively. In patients with implanted stent grafts, technical success was achieved in 23/25 patients (92%). Follow-up CT scans were available in 16 patients, showing stent graft patency in 9/16 patients (56%). Short-term, mid-term, and long-term short-term stent patency was found in 81% (13/16), 40% (4/10), and 50% (2/4). In patients with stent graft occlusion, 86% (6/7) exhibited maintenance of arterial liver perfusion via collaterals and 14% (1/7) exhibited liver abscess during follow-up.ConclusionStent graft provides an effective treatment for hepatic artery pseudoaneurysms. Even though patency rates decreased as a function of time, stent occlusion was mainly asymptomatic due to sufficient collateralization.

Highlights

Pseudoaneurysms of the hepatic arteries represent a rare but potentially fatal complication after major pancreatic or hepatic surgery
Among the interventional and endovascular options, treatment of pseudoaneurysms by stent graft implantation has the advantage of preserving arterial hepatic perfusion, which decreases the onset of major postoperative complications in these patients [5]
Endovascular treatment of hepatic artery pseudoaneurysms was performed in 30 patients (24 males, 6 females) with a median age of 64 years (IQR: 53; 73 years)

Summary

Introduction

Pseudoaneurysms of the hepatic arteries represent a rare but potentially fatal complication after major pancreatic or hepatic surgery. Their incidence is increased in complicated postoperative courses with anastomotic fistulae [1]. Because of the high risk of rupture and consequent massive hemorrhage [2], with an associated mortality rate of up to 60% [3], pseudoaneurysms should be treated promptly. Among the interventional and endovascular options, treatment of pseudoaneurysms by stent graft implantation has the advantage of preserving arterial hepatic perfusion, which decreases the onset of major postoperative complications in these patients [5]. Despite preliminary evidence on the efficacy of stent grafting in the treatment of hepatic pseudoaneurysms, clinical studies with substantial patient

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