Intrahepatic Aneurysm Research Articles

Intrahepatic aneurysm in a branch of the right hepatic artery in a patient with vasculitis due to systemic lupus erythematosus

Intrahepatic aneurysm in a branch of the right hepatic artery in a patient with vasculitis due to systemic lupus erythematosus

Hepatic Artery Pseudo Aneurysm as Complication of Cholecystectomy: A Case Report

This manuscript discusses a rare complication of cholecystectomy, hepatic artery pseudoaneurysm (HAPA), which occurs as a result of thermal injury or direct trauma to the arterial wall. The case report of a 72-year-old woman who presented with melena and abdominal pain after a laparoscopic cholecystectomy is described. The patient was diagnosed with a false intrahepatic aneurysm via abdominal ultrasound and confirmed by CT angiography. The signs and symptoms, diagnostic techniques, and management options of HAPA are also discussed. The case was treated by trans femoral coil embolization artery embolization with superselection of the right hepatic artery by microcatheter and complete occlusion. The manuscript highlights the importance of identifying HAPA as a potential complication of cholecystectomy, and the efficacy of endovascular treatment for HAPA.

Contained rupture of a large right hepatic artery aneurysm: the ticking bomb within!

Hepatic artery aneurysms (HAAs) are rare and represents one fifth of visceral aneurysms. We report a case of a 75 year old female who presented to the outpatient department with complaints of abdominal pain and anorexia for 2 weeks. On examination the patient was stable, she had mild tenderness in the right hypochondrial region. Ultrasound abdomen showed an intrahepatic cystic area with both arterial and venous flow, suggesting the possibility of an intrahepatic arteriovenous malformation. Contrast-enhanced computed tomography abdomen showed a large right HAA with contained rupture and intra hepatic extension. She was posted for emergency laparotomy and was found to have a contained rupture a contained rupture of the right HAA of size 10×8 cm with intra hepatic extension. Right hepatectomy was done and the resected margin of liver showed a dilated cystic space with blood clot. Histopathological examination showed intrahepatic aneurysm with atherosclerosis and laminated luminal thrombus. Contained rupture of HAAs with intrahepatic extension are rare. Even though the prevalence of HAAs is low, the risk of rupture is reported to be as high as 20-80% and the mortality following spontaneous rupture is 40%. Hence an aggressive approach to the management of HAA is required whenever detected.

Idiopathic Intrahepatic Artery Aneurysm Presenting as Acute Hemorrhagic Cholecystitis

Intrahepatic artery aneurysm or pseudoaneurysm is an unusual condition encountered clinically that accounts for a very small part of all visceral artery aneurysm cases. True incidence of primary or spontaneous intrahepatic artery aneurysm is difficult to be verified and has been rarely reported. For intrahepatic artery aneurysm/pseudoaneurysm, the diagnosis and management are challenging owing to the lower incidence and occult or various presentations. Due to the insidious course, patients with such aneurysms often have a higher risk of rupture, sometimes causing a catastrophic bleeding situation. Herein, we present a case of a 20-year-old woman with idiopathic left intrahepatic artery aneurysm with initial presentation mimicking acute hemorrhagic cholecystitis. Following laparoscopic cholecystectomy, intermittent upper gastrointestinal bleeding occurred. At the second radiologic study, left lateral-superior subsegmental hepatic artery aneurysm was detected. After endovascular treatment, the patient recovered without complications. To avoid delayed diagnosis, we suggest that hepatic artery aneurysm/pseudoaneurysm should always be considered when there is no usual cause of upper gastrointestinal tract bleeding.

Management strategies for true and dissecting visceral artery aneurysms.

Visceral artery aneurysms (VAA) are rare and the literature regarding management strategies is limited. The study aim was to evaluate our 13-year experience with VAA treatment including conservative, open surgical and endovascular therapy. This retrospective single-center study included 37 patients (31 male, median age 70 years [46-79 years]) with true and dissecting VAA treated between January 2006 and December 2018. Indications for invasive therapy were ruptured (N.=1) and symptomatic (N.=8) VAA or asymptomatic VAA>20 mm (N.=15). The decision on the treatment type was made after interdisciplinary (vascular surgeons/radiologists) discussion. The aneurysms affected the celiac trunk (N.=18, 49%), the splenic artery (N.=11, 30%), the superior mesenteric artery (SMA, N.=6, 16%), the hepatic artery (N.=5, 14%) and proximal SMA side branches (N.=2, 5%). Six patients had multiple VAA, one had an intrahepatic artery aneurysm and one had peripheral mesocolic artery aneurysms plus a VAA. 46% of the patients (N.=17) had coexisting aneurysms in other vascular territories. Thirteen patients were managed conservatively (median VAA diameter 15 [14-25] mm), 18 underwent open surgery with venous or prosthetic bypass or interposition graft implantation and 6 were treated by endovascular means (coiling [N.=3] or endograft [N.=3]). Median follow-up (FU) was 21 months (4-123 months). In-hospital mortality was 0%. Median length of hospital stay was 11 days (5-28 days) after surgical and 3 days (2-71 days) after endovascular treatment. Complications included an early type I endoleak, 3 secondary open abdominal surgeries for bleeding/peritonitis after endovascular treatment of a ruptured intrahepatic aneurysm, an asymptomatic aorto-truncal bypass occlusion and aneurysm recurrence after a venous SMA interposition graft. None of the conservatively treated VAA required invasive treatment during FU. Small (<20 mm) asymptomatic VAA can be managed conservatively. Whenever invasive treatment is indicated, both open and endovascular treatments can be performed with low complication rates. In order to choose the optimal therapeutic approach, anatomical features and patient comorbidities should be considered and, ideally, discussed interdisciplinarily.

Management of hemodynamically unstable, ruptured multiple hepatic artery pseudoaneurysms by open surgery combined with endovascular embolization

Hepatic artery pseudoaneurysm is a type of visceral artery aneurysm, which may cause life-threatening situation if the diagnosis and treatment are delayed after rupture. Increased clinical awareness and aggressive, definitive management are necessary in obtaining optimal outcomes. In general, surgery is the preferred treatment for extrahepatic lesions, whereas embolization is appropriate for intrahepatic aneurysms. However, exploratory laparotomy for vascular ligation or anastomosis is the only way in emergency if the hemodynamic status is unstable. Since the cases of ruptured pseudoaneurysm in both intra- and extra-hepatic artery is rare, we present a case of ruptured hepatic artery pseudoaneurysms with hemorrhagic shock rescued by surgery to stabilize the patient, followed by angioembolization to manage the multiple hepatic aneurysms and provide a review of the current literature on this topic, focusing on appropriate decision-making under multidisciplinary management.

Segmental arterial mediolysisに伴う未破裂多発肝内動脈瘤の自然軽快例

Segmental arterial mediolysisに伴う未破裂多発肝内動脈瘤の自然軽快例

A Case Study of Refractory Liver Abscesses Following Transcatheter Hepatic Arterial Embolization for an Intrahepatic Aneurysm Rupture that Occurred After Choledochojejunostomy

A Case Study of Refractory Liver Abscesses Following Transcatheter Hepatic Arterial Embolization for an Intrahepatic Aneurysm Rupture that Occurred After Choledochojejunostomy

A rare case of huge intrahepatic portal vein aneurysm

Introduction: Our case was incidentally diagnosed large aneurysm of the main portal vein. The incidence of intrahepatic and extrahepatic portal vein aneurysms (PVAs) is not clear. Portal vein aneurysm usually occurs at the junction of the superior mesenteric vein and splenic veins or at the hepatic hilus at the bifurcation of the right and left portal veins [1]. Case Report: Color Doppler and contrast-enhanced dynamic computed tomography scan and computed tomography angiography clearly showed a well-circumscribed, 44x34 mm intrahepatic portal vein aneurysm. Conclusion: The aim of this study is to evaluate the imaging features of portal vein aneurysm.

Spontaneous Rupture of a Saccular Intrahepatic Artery Aneurysm

Hepatic artery aneurysms are the second most common visceral aneurysm but are still relatively uncommon. Over the last century, methods for treating these lesions have evolved substantially. The presented case covers the presentation, diagnosis, and treatment of a 65-year-old woman with an aneurysm of the intrahepatic portion of the hepatic artery. This case demonstrates the variety of techniques available for managing these lesions and the importance of both a thorough knowledge of the available treatments and the flexibility to switch among them when necessary.

Gastrointestinal hemorrhage caused by rupture of a pseudoaneurysm of the hepatic artery

Gastrointestinal bleeding secondary to rupture of a hepatic artery pseudoaneurysm is rare. We report the case of a 61-year-old woman, who was admitted to our institution with hematemesis and melena. Upper gastrointestinal endoscopy and flexible sigmoidoscopy failed to reveal any significant abnormality. Computed tomography scan showed an aneurysm arising from the hepatic artery. A selective angiography showed a ruptured pseudoaneurysm originating from the right hepatic artery with extravasation. It was decided to embolize the pseudoaneurysm, and the neck of the pseudoaneurysm was occluded successfully with two microcoils. While these investigations and interventions were being performed, disseminated intravascular coagulation and acute hepatic failure occurred due to the massive blood transfusion and gross intrahepatic hematoma. Consequently, the patient died 10 days after admission. In this case, we observed that delayed diagnosis of hepatic artery aneurysm rupture may lead to a life-threatening situation. Thus, computed tomography and selective angiography should be obtained immediately. The percutaneous super-selective angiographic embolization of intrahepatic aneurysms is a promising form of treatment, with low risk.

Computed tomography findings in portal vein aneurysm of dogs

In this retrospective study, the appearances of extrahepatic and intrahepatic portal vein aneurysms (PVAs) in dogs were evaluated using multidetector computed tomography (CT). Data from 3060 dogs that underwent abdominal CT were reviewed for focal portal vein dilatation. PVAs were detected in 15/3060 (0.49%) dogs. The bodyweights of dogs with PVAs were significantly higher than the bodyweights of dogs without aneurysms (P=0.0001). Male sex was also significantly associated with PVAs (OR=6.23). Boxers were predisposed to the development of PVA (OR=11.88). Extrahepatic PVAs were always located in the portal vein at the level of the gastroduodenal vein insertion and were saccular in 10/15 dogs and fusiform in 5/15 dogs. One dog had an additional intrahepatic aneurysm of the umbilical part of the left intrahepatic portal branch. No dogs had clinical signs related to the PVA(s), although one dog developed a portal vein thrombosis in the site of the aneurysm.

Hepatic Artery Aneurysms: Evolution from Open to Endovascular Repair Techniques

With the development of endovascular therapy, treatment for hepatic artery aneurysm (HAA) has evolved from open excision and repair to include endovascular approaches. We reviewed our recent experience with HAA to help define the treatment of HAA. From 2002 to 2010, five patients underwent treatment of HAA, all men with a median age of 63.2 years (range, 41-75). The median diameter of HAA was 5.8 cm (range, 2.4 cm-11 cm). Four lesions involved the extrahepatic portion of the hepatic artery, and one was an intrahepatic HAA that involved the right hepatic artery. Three were true aneurysms and two were pseudoaneurysms associated with trauma. Four of the five HAA patients were symptomatic, three with nonspecific abdominal pain, and one with free hemorrhage from a ruptured intrahepatic pseudoaneurysm. All five underwent computed tomography and selective arteriography. Two patients underwent open surgical aneurysmectomy and revascularization because of aneurysm location and concerns of the potential lack of collateral flow. Three patients underwent an endovascular coil embolization because obliteration of a saccular aneurysm could be achieved without compromising arterial flow of the native hepatic vessel. Re-embolization was necessary in the intrahepatic aneurysm because of recanalization of a feeding vessel. Endovascular embolization is an important minimally invasive approach in the treatment of HAA. Depending on HAA location and the adequacy of collateral arterial flow around the lesion, open aneurysmectomy and revascularization may be required.

Spontaneous Rupture of Hepatic Artery Aneurysm Associated with Polyarteritis Nodosa

Polyarteritis nodosa (PAN) is a vasculitis, which often involves small and medium sized visceral arteries. This condition may result in multifocal aneurismal formation and end-organ damage. Uncommonly, PAN may present with rupture of hepatic artery aneurysms. Here, we report a rare case of a ruptured intrahepatic aneurysm associated with PAN. A 79-year-old woman presenting with abdominal pain had CT scan of the abdomen, which revealed hematoma in the right hepatic lobe. Visceral angiogram confirmed pseudo-aneurysm of a right hepatic arterial branch, and this was managed with endovascular coil embolization. The diagnosis of PAN was made and corticosteroid therapy was initiated. We also performed a literature review to define this condition's demographics, clinical presentations, and appropriate management. The review revealed 17 published cases of ruptured PAN-related intrahepatic aneurysms. We conclude that unexplained findings of visceral arterial aneurysms should prompt investigations for vasculitis as the etiology.

Portal Venous Aneurysms—Report of 4 Cases

Portal venous aneurysms are rare and are usually discovered as incidental findings on abdominal imaging studies. Although most are asymptomatic, they may occasionally cause symptoms of compression of an adjacent structure, thrombosis, or bleeding. Treatment is usually not necessary and conservative follow-up is suggested. We present four patients with portal system aneurysms. One patient had a 10.5 cm thrombosed aneurysm, one had a right 3.5 cm intrahepatic portal aneurysm, one patient had a symptomatic 4 cm splenic artery aneurysm, which was repaired, and one patient had a 4 cm aneurysm at the confluence of the splenic and portal veins.

Two-stage treatment of an unusual haemobilia caused by intrahepatic pseudoaneurysm

A 84-year-old man with a surgical history of subtotal gastrectomy for gastric cancer was transferred to our department because of a disorder of consciousness. Septic shock due to obstructive suppurative cholangitis secondary to choledocholithiasis was diagnosed. Anemia was also present, and upper gastrointestinal tract endoscopy revealed blood emerging from the Papilla of Vater. The cause of the anemia was identified as haemobilia. Angiography showed a small aneurysm over the artery on segment 3 (A3). The cause of the haemobilia was suspected to be the bleeding into the biliary tree from this aneurysm. Because the patient's general condition was poor, minimally invasive therapy was needed. Transcatheter arterial embolization (TAE) was selected initally. Later, lateral sectionectomy was performed in order to remove the aneurysm on A3. No surgical complication occurred and, after surgery, no haemobilia was identified. In conclusion, a two-stage treatment, namely, surgery following TAE, is recommended for patients in a physically poor condition who have haemobilia due to intrahepatic aneurysm.

Multiple Intrahepatic Artery Aneurysms in a Patient with Behçet’s Disease: Use of Transcatheter Embolization for Rupture

Intrahepatic artery aneuryms are a rare and potentially life-threatening condition. We present the first case in the English literature of multiple intrahepatic artery aneuryms in a patient with Behçet's disease who presented acutely with rupture. The ruptured aneurysm was treated successfully with transcatheter arterial coil embolization-CT and clinical follow-up confirming a good result. We discuss the management dilemma with regard to prophylactic embolization of the numerous other small asymptomatic intrahepatic aneurysms in this same patient.

Spontaneous Rupture of Intrahepatic Aneurysm

Spontaneous Rupture of Intrahepatic Aneurysm

Computed-tomography-guided direct percutaneous transhepatic embolization of a bleeding hepatic artery branch aneurysm

A case of successful direct percutaneous transhepatic coil embolization of a ruptured intrahepatic aneurysm under computed tomography (CT) guidance is presented. The patient had a history of multiple operations for liver echinococcosis and was transferred to the emergency department in a deteriorating clinical condition due to active hemorrhage. The aneurysm was treated with percutaneous transhepatic embolization under CT guidance. The procedure is not time-consuming and keeps the time interval between diagnosis and treatment to a minimum, thereby limiting subsequent blood loss.

Hepatic artery aneurysm: A pitfall in biliary surgery

This paper describes a patient operated upon for gall-bladder and bile duct stones, who presented with an extrahepatic aneurysm of the main hepatic arterial trunk and with a central intrahepatic haematoma assumed to be caused by the rupture of an intrahepatic aneurysm or by secondary intrahepatic necrosis. Exploration of the bile ducts resulted in haemobilia. The presence of extrahepatic arterial collaterals precluded individualization of the left and right hepatic arteries and subsequent distal arterial ligation or partial hepatectomy. Ligation of the common hepatic artery, although initially successful, was insufficient to avoid a recurrent and fatal haemobilia.