Common Hepatic Artery Aneurysm Research Articles

Ruptured Common Hepatic Artery Aneurysm Masquerading as an Intestinal Obstruction

Ruptured Common Hepatic Artery Aneurysm Masquerading as an Intestinal Obstruction

Coil Embolization of True, Common and Proper, Hepatic Artery Aneurysms: Technique, Safety and Outcome.

To retrospectively assess the safety and efficacy of coil embolization for catheter-directed true common and proper hepatic artery aneurysm exclusion. Nine consecutive patients (2005-2021) in two university centers presenting with true common and proper hepatic artery aneurysms (> 2cm in diameter) were treated with 'frontdoor-backdoor' coil embolization. Patients presenting with a hepatic artery pseudoaneurysm, mycotic aneurysm or patients with small (< 2cm diameter) aneurysms and followed up by imaging were excluded. Technical and clinical success was defined as complete coil-exclusion of the aneurysm on completion angiography and absence of post-embolization adverse events, in particular mass effect or hemorrhage, respectively. Patient characteristics, technical and clinical success, liver function tests and follow-up results were assessed based on the patients' electronic medical records. Technical and 30-day clinical success was achieved in all procedures (100%). No major procedural complications were reported. Liver function test values were available in 6/9 patients, showing transient elevation of bilirubin in one patient. No end organ ischemia was reported. The mean clinical follow-up period of the study patients was 72months (12-168months). Long-term stable occlusion of the hepatic aneurysms was achieved in 9/9 patients (100%). One patient showed late complication (3years) with coil migration into a bulbar ulcer, without aneurysm recanalization, however with fatal outcome. Coil embolization for the endovascular exclusion of true common and proper hepatic artery aneurysms is safe and effective.

Complicated visceral artery aneurysms in chronic pancreatitis

Visceral artery aneurysms are rare and occur only in 0.01-0.2% of people. According to various authors, incidence of aneurysm rupture is 10-20% with mortality rate of 20-70% depending on localization and dimensions. One of the causes of visceral artery aneurysms, in particular common hepatic artery aneurysm, is chronic pancreatitis. Incidence of this complication is 2-10%. The first clinical manifestation is often hemorrhagic shock following false aneurysm rupture and bleeding into abdominal cavity, gastrointestinal tract or retroperitoneal space. Common hepatic artery aneurysm is complicated by bleeding in 35% of cases, and mortality may be up to 75%. Treatment of visceral artery aneurysm following chronic pancreatitis and post-necrotic parapancreatic cyst includes several stages. Endovascular methods are the first stage of treatment. The second stage is elimination of the cause of visceral artery false aneurysm (surgery for chronic pancreatitis). We present 3 patients with visceral artery aneurysms and chronic pancreatitis.

Painful pulsatile epigastric mass

A 40-year-old woman with obesity and hypertension presented to the emergency department with abdominal pain. Physical examination revealed a tender, pulsatile, epigastric abdominal mass. A 6.5 × 6.5-cm fusiform common hepatic artery aneurysm, extending from the celiac bifurcation to the origin of the gastroduodenal artery, was seen on a computed tomography scan (A, B, C/Cover, D). Pulse examination was normal. She denied a smoking history or a family history of aneurysm. The patient was admitted for blood pressure control, and the following day was taken for urgent aneurysm repair. Proximal control of the celiac artery was obtained. The left gastric and splenic arteries were ligated to mobilize celiac artery for adequate exposure and control. Distally, the proper hepatic artery and gastroduodenal artery were controlled. The aneurysm sac was opened and reconstructed using a saphenous vein interposition extending from the celiac artery to the common origin of the proper hepatic and gastroduodenal arteries. The aneurysm sac was closed over the graft. Postoperatively, the patient developed elevations of the hepatic transaminases, which soon normalized. Aspirin was administered for antiplatelet therapy and the patient was discharged home on postoperative day 6 and was advised to return to normal activity. At 6 months, she had no pain and fully resumed her daily activities. Hepatic artery aneurysm has an incidence of 0.002% in the population.1Abbas M.A. Fowl R.J. Stone W.M. Panneton J.M. Oldenburg W.A. Bower T.C. et al.Hepatic artery aneurysm: factors that predict complications.J Vasc Surg. 2003; 38: 41-45Abstract Full Text Full Text PDF PubMed Scopus (229) Google Scholar The causes of hepatic artery aneurysms are unclear, but they are most frequently associated with fibromuscular dysplasia, Takayasu arteritis, vasculitis, Wegner granulomatosis, and connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome.2Chaer R.A. Abularrage C.J. Coleman D.M. Eslami M.H. Kashyap V.S. Rockman C. et al.The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms.J Vasc Surg. 2020; 72S: 3S-39SAbstract Full Text Full Text PDF Scopus (94) Google Scholar Repair is recommended for aneurysms larger than 2 cm in size or if they are symptomatic or ruptured.1Abbas M.A. Fowl R.J. Stone W.M. Panneton J.M. Oldenburg W.A. Bower T.C. et al.Hepatic artery aneurysm: factors that predict complications.J Vasc Surg. 2003; 38: 41-45Abstract Full Text Full Text PDF PubMed Scopus (229) Google Scholar, 2Chaer R.A. Abularrage C.J. Coleman D.M. Eslami M.H. Kashyap V.S. Rockman C. et al.The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms.J Vasc Surg. 2020; 72S: 3S-39SAbstract Full Text Full Text PDF Scopus (94) Google Scholar, 3Berceli S.A. Hepatic and splenic artery aneurysms.Semin Vasc Surg. 2005; 18: 196-201Crossref PubMed Scopus (159) Google Scholar, 4Lumsden A.B. Mattar S.G. Allen R.C. Bacha E.A. Hepatic artery aneurysms: the management of 22 patients.J Surg Res. 1996; 60: 345-350Abstract Full Text PDF PubMed Scopus (82) Google Scholar Endovascular and open repair are viable options. The hepatic circulation should be maintained and ligation is recommended only if adequate collateral circulation is present.2Chaer R.A. Abularrage C.J. Coleman D.M. Eslami M.H. Kashyap V.S. Rockman C. et al.The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms.J Vasc Surg. 2020; 72S: 3S-39SAbstract Full Text Full Text PDF Scopus (94) Google Scholar,3Berceli S.A. Hepatic and splenic artery aneurysms.Semin Vasc Surg. 2005; 18: 196-201Crossref PubMed Scopus (159) Google Scholar Although combined left gastric and splenic ligations can lead to proximal gastric ischemia, if the gastroepiploic artery is preserved, ischemic complications are rare. Open repair was chosen in this case owing to an inadequate distal landing zone for stent placement. Publication was discussed with the patient and consent obtained.

Complex Aortic Aneurysm Associated with Multiple Splanchnic Arterial Aneurysms and A Giant Coronary Artery Aneurysm

A 50-year-old male diabetic, hypertensive and chronic smoker presented with complex aortic, splanchnic aneurysms with impending rupture of iliac artery aneurysm, underwent coiling of celiac artery, internal iliac artery, and fenestrated/chimney endovascular aortic repair. One month later, the patient landed in an emergency due to bleeding complications of common hepatic artery and gastroduodenal artery aneurysms, which were managed successfully using endovascular techniques. The mayhem of progressive nature of the disease in the patient continued as he had left lower limb ischemia due to occlusion of the iliac artery and iliac limb of the aortic graft device as he continued to smoke. All of the above sequences of events occurred over a period of 5 years. He also developed a giant aneurysm of left anterior descending of 6.8 cm diameter, which had to be repaired by open surgical technique. The patient has been followed up for 6 years since his first presentation, and he was managed successfully from all the catastrophe of events using endovascular techniques. Giant coronary artery aneurysm with previous aneurysms at multiple sites is quite unusual and rare. Currently, there is no consensus regarding the clinical characteristics, diagnostic method, and the treatment of these cases.

Management of a common and proper hepatic artery aneurysm

First-line management of hepatic artery aneurysms is via an endovascular approach. However, unfavorable anatomy may preclude this. We present a patient with an aneurysm involving most of the common hepatic artery and the entire proper hepatic artery including the emergence of the right and left hepatic artery and the gastroduodenal artery. The endovascular approach was not feasible due to unfavorable anatomy. The patient was successfully treated with an open bifurcated Dacron graft.

Open Surgical Repair for a Giant Common Hepatic Artery Aneurysm with Difficulty in Proximal Arterial Clamping: A Case Report.

Hepatic artery aneurysm has been considered as a rare, life-threatening disease. In this study, we report on a patient requiring surgical treatment for a giant hepatic artery aneurysm by aneurysmectomy without revascularization. A 70-year-old woman who complained of epigastric pain was referred to our hospital. Enhanced computed tomography scan has revealed a giant (11×9 cm) common hepatic artery aneurysm. She then underwent emergency surgery; the intra-aortic balloon occlusion technique was applied in order to control the blood inflow into the aneurysm. The aneurysm was then incised, and direct closure of the inflow and outflow orifices was performed safely without evidence of ischemic change in the liver.

A Case of Common Hepatic Artery Aneurysm Treated by Abdominal Aorta—Proper Hepatic Artery Bypass and Coil Embolization—

A Case of Common Hepatic Artery Aneurysm Treated by Abdominal Aorta—Proper Hepatic Artery Bypass and Coil Embolization—

Surgical treatment for common hepatic aneurysm. Original one-step technique.

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.

Impending Rupture of a Common Hepatic Artery Aneurysm Successfully Treated by Emergency Coil Embolization: A Case Report

Impending Rupture of a Common Hepatic Artery Aneurysm Successfully Treated by Emergency Coil Embolization: A Case Report

Surgical treatment of common hepatic artery aneurysm: a case report

患者女性，70岁，因腰背部胀痛不适2个月余入院。320排CT血管造影示：腹腔干右分支动脉瘤，来源肝动脉可能。入院后诊断：腹腔干动脉瘤：肝动脉瘤？高血压病。在全麻下行肝总动脉瘤切除术＋肝动脉自体大隐静脉移植术＋门静脉人工血管移植术。术后病理结果显示(动脉瘤壁)动脉壁部分区域变薄伴黏液变性，病变符合动脉瘤改变。

A Case of Surgery Combined with Endovascular Treatment for a Giant Common Hepatic Artery Aneurysm

A Case of Surgery Combined with Endovascular Treatment for a Giant Common Hepatic Artery Aneurysm

Hepatic artery aneurysm: an unusual cause of upper gastrointestinal bleed

An 86-year-old woman presented to hospital with melaena. This was her third presentation with the same symptom. There was no obvious source of bleeding on her oesophagogastroduodenoscopy; however, it did...

НОВЕЙШИЕ ТЕХНОЛОГИИ В ЛЕЧЕНИИ АНЕВРИЗМ БАССЕЙНА ЧРЕВНОГО СТВОЛА

Artery aneurysms of pool celiac trunk and superior mesenteric artery are not often in clinical practice. Often, the first clinical manifestation of the aneurysm is a hemorrhagic shock which proceed from its rupture. The risk of aneurysm rupture doesn’t depend on their size, ranging from 3% to 10%. But the mortality from aneurysm rupture can be reaches 36%. As we know well that the aneurysm ruptures has a high rate of mortality, treatment as symptomatic as asymptomatic aneurysms are essential. The authors of the article represent the demonstration of successful endovascular treatment of aneurysms splenic artery and posttraumatic aneurysm of common hepatic artery using modern embolization materials. In the first case performed embolization of lumen aneurysm by embolization coil with next installation in the lumen of the artery stent graft, in the second case – the feeding artery was embolized by microemboles. Nowadays, the medical instruments for X – ray surgical interventions allow you to perform a complete embolization of pathological structures such as aneurysms of the main arteries of the celiac trunk. Thanks to low level of interventions endovascular therapies can be related to the method of choice in the treatment of many surgical diseases in compulsory with the open methods of operation.

A Common Hepatic Artery Aneurysm with Stenoses of the Celiac Artery and the Superior Mesenteric Artery Treated by Two-step Hybrid-procedure

A Common Hepatic Artery Aneurysm with Stenoses of the Celiac Artery and the Superior Mesenteric Artery Treated by Two-step Hybrid-procedure

総肝動脈瘤の総胆管穿破に対して瘤切除，右肝動脈血行再建術および胆道再建術を行った1 例

総肝動脈瘤の総胆管穿破に対して瘤切除，右肝動脈血行再建術および胆道再建術を行った1 例

Transcatheter Arterial Coil Embolization of Ruptured Common Hepatic Artery Aneurysm in a Patient with Behçet's Disease.

Hepatic artery aneurysm is a rare and potentially life-threatening entity. We report a case of ruptured common hepatic artery aneurysm in a patient with Behçet's disease. The ruptured aneurysm was treated successfully with transcatheter arterial coil embolization. Transcatheter arterial embolization is the preferred treatment modality in patients at high risk of surgical intervention.

Robotic resection of a common hepatic artery aneurysm.

The introduction of robotics into surgery represents progression in the field of minimally invasive surgery. Its use has been reported in coronary artery bypass graft along with repair of other major vascular structures. We report the first case of robot-assisted resection of a large hepatic artery aneurysm. Robotic surgery is safe and feasible and is a significant advance in the field of aneurismal repair. It offers significant advantages in the degrees of freedom of movement compared to laparoscopic surgery.

Successful Diagnosis of an Atypical Prosthetic Vascular Graft Infection Without Perivascular Abscess

A 62-year-old woman with a vascular prosthesis for a common hepatic artery aneurysm (3 years ago) was hospitalized because of a 2-week history of lumbago and fever. Six months previously, she was hospitalized at another medical facility for 1 month because of a fever of unknown pathogenesis. Laboratory examination revealed moderate inflammation with an elevated C-reactive protein level of 6.5 mg/dL and a white blood cell count of 7070/mm3. Initial 8-row multi-detector computed tomography (CT) with contrast agent in the emergency department did not show any focus for the origin of the fever. She was referred to the orthopedic surgery department, and MRI of the pelvis revealed inflammation of the left sacroiliac joint (Figure 1). Her first 2 sets of blood cultures were positive for Streptococcus anginosus . Intravenous administration of ampicillin/cloxacillin sodium was started. She was then transferred to the cardiology department for the evaluation of septicemia, which could have been caused by infectious endocarditis. A transthoracic echocardiogram showed severe aortic regurgitation, which was not seen at the time of previous surgery for the vascular prosthesis (Figure 2A). However, a transesophageal echocardiogram only detected a small degenerative change in the right coronary cusp of the aortic valve, which could be healed …

Treatment of Visceral Aneurysm Using Multilayer Stent: Two-Year Follow-Up Results in Five Consecutive Patients

The present study was performed to analyze the midterm results (five consecutive patients, 2-year follow-up) of the endovascular management of visceral artery aneurysms using the Cardiatis Multilayer Flow Modulator (CMFM) (Cardiatis, Isnes, Belgium), a self-expandable stent. From August 2009 to January 2011, we implanted five CMFMs in five patients (all men; mean age 73 years) to treat two common hepatic artery aneurysms, one celiac trunk aneurysm, one splenic artery aneurysm, and one superior mesenteric artery aneurysm (diameter 25-81 mm). The primary end point was technical success. The secondary end point was stent patency, absence of aneurysm rupture or reperfusion, and shrinking of the sac at 6-, 12-, and 24-month follow-up using computed tomography angiography. Follow-up ranged from 24 to 48 months (mean 31.2). Technical success was achieved in all patients. Complete exclusion of the aneurysm with sac shrinking was achieved in two patients. Two stents became occluded at 6- and 24-month follow-up, respectively; both patients were asymptomatic and were not retreated. One patient developed sac reperfusion due to incomplete aneurysm exclusion. Long-term results in a wider population are needed to validate the effectiveness of the CMFM.