Abstract
IntroductionHepatic artery aneurysms are rare, and their treatment represents a challenge for the surgeons.Materials and methodsA new technique is presented for common hepatic artery (CHA) aneurysm: it requires minimal vascular surgical dissection and only one linear vascular stapler is applied at the bottom of aneurysm. Aneurysm exclusion is easily obtained, which allowed retrograde thrombosis. Liver blood supply is ensured to the right and left hepatic artery, through the gastroduodenal artery, and can be previously monitored, with temporary clamping of the section area, by visual control, enzyme evaluation and intraoperative ultrasound examination. We reported an open surgical treatment, with simultaneous removal of hepatic and adrenal metastases, secondary to colon cancer.ResultsThe duration of vascular surgery was 30 min and did not involve complications. Postoperative controls confirmed the efficacy of the procedure.DiscussionThis original technique can be added to the various open and endovascular techniques so far described for the treatment of a CHA aneurysm. It is advisable as open surgery, mostly in case of associated pathologies.ConclusionsThe authors believe that this “one shot” technique by vascular staple of the distal part of CHA is minimally invasive and effective to obtain the exclusion of the aneurysm.
Highlights
The hepatic artery aneurysm has a significant incidence (20–25%) in the area of visceral artery aneurysms, but a low incidence compared with abdominal aortic aneurysms (0.2–1.0%) [1,2]
The patient was admitted for 3 days in the postoperative intensive care unit, where she underwent blood tests, which confirmed the stable liver function and the stability of other serological parameters (Table 2)
Decision to carry out the associated treatment of liver and adrenal metastases with Common hepatic artery (CHA) aneurysm in a single surgical procedure came from a common evaluation and agreement among the oncology, abdominal surgery and vascular surgery teams
Summary
The hepatic artery aneurysm has a significant incidence (20–25%) in the area of visceral artery aneurysms, but a low incidence compared with abdominal aortic aneurysms (0.2–1.0%) [1,2]. Their etiology may be atherosclerotic (about 30% of cases, especially in elderly patients), but other causes have been described, such as for other visceral aneurysms, related to vasculitis, fibromuscular dysplasia, trauma, iatrogenic causes or infectious [3,4,5,6,7]. Common hepatic artery (CHA) is affected in 67% of cases of hepatic district aneurysm, mainly without any symptoms, but sometimes show jaundice or clinical signs similar to biliary colic [12]; in 32% of cases, the localization or extension of the aneurysm to gastroduodenal artery (GDA) was observed [1].
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