Hepatic Artery Pseudoaneurysm Research Articles

Late-onset hemobilia due to pseudoaneurysm rupture after endoscopic ultrasound-guided hepaticogastrostomy.

We report the case of a 65-year-old man who experienced hemobilia due to rupture of a pseudoaneurysm of the left hepatic artery after endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS). The patient was diagnosed with pancreatic cancer and underwent endoscopic retrograde cholangiopancreatography for obstructive jaundice. Biliary drainage was converted to EUS-HGS due to tumor invasion in the superior duodenal angle. A partially covered metal stent was placed in the B3 intrahepatic bile duct. The procedure was completed without early complications, but 50days later, the patient developed fever, elevated hepatobiliary enzymes, and shock. Contrast-enhanced computed tomography (CT) showed that the hepatic end of the HGS stent had moved slightly toward the stomach compared to the previous CT. A 6-mm pseudoaneurysm was also observed near the A3 and A4 branches of the left hepatic artery, coinciding with the hepatic end of the EUS-HGS stent. Hemostasis was achieved with coil embolization. Biliary hemorrhage due to rupture of a pseudoaneurysm should be considered in the differential diagnosis of biliary obstruction accompanied by bleeding after EUS-HGS.

Experience of vascular injuries at a military hospital in Korea.

Vascular injuries require immediate surgical treatment with standard vascular techniques. We aimed to identify pitfalls in vascular surgery for trauma team optimization and to suggest recommendations for trauma and vascular surgeons. We reviewed 28 victims and analyzed the patterns of injuries, methods of repair, and outcomes. Ten patients had torso injuries, among whom three thoracic aorta injuries were repaired with thoracic endovascular aortic repair, one left hepatic artery pseudoaneurysm with embolization, and two inferior vena cava with venorrhaphy, three iliac arteries with patch angioplasty or embolization, and three common femoral arteries with bypass surgery or arterioplasty. Four patients had upper extremity injuries, among whom one brachial artery and vein was repaired with bypass surgery after temporary intravascular shunt perfusion, two radial arteries were repaired with anastomoses, and one ulnar artery was repaired with ligation. One radial artery under tension was occluded. Fourteen patients had lower extremity injuries, among whom one superficial femoral artery and vein was repaired with bypass and concomitant ligation of the deep femoral artery and vein, three superficial femoral arteries were repaired with bypass (two concomitant femoral veins with bypass or anastomosis), one deep femoral artery with embolization, two popliteal arteries with bypass or anastomosis, four infrapopliteal transected arteries, one arteriovenous fistula with ligation, and one pseudoaneurysm with bypass. However, one superficial femoral artery and all femoral veins were occluded. One leg replantation failed. There are potential complications of vascular access during resuscitative endovascular balloon occlusion of the aorta procedures. Vascular repair should be performed without tension or spasm. Preservation of the harvested vein in papaverine solution and blood while using a temporary intravascular shunt is a method of eliminating spasms.

A Rare Case of Hepatic Artery Pseudoaneurysm by Penetrating Duodenal Ulcer in an Early Living Donor Liver Recipient

A Rare Case of Hepatic Artery Pseudoaneurysm by Penetrating Duodenal Ulcer in an Early Living Donor Liver Recipient

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.

Multiple Hepatic Artery Pseudoaneurysms With Eosinophilia

Multiple Hepatic Artery Pseudoaneurysms With Eosinophilia

Removal of an impacted migrated biliary stent with cholangioscopy: lights, camera, action.

A 50-year-old woman was referred for removal of an internally migrated biliary stent. Fluoroscopy showed the migrated biliary stent and cholecystectomy clips ([Fig. 1]). She underwent endoscopic retrograde cholangiopancreatography (ERCP) and a biliary balloon was passed over the guidewire. Balloon sweeping was done; however, on sweeping, fresh blood was noticed emerging through the papilla. The procedure was therefore abandoned and a 7-Fr, 10-cm double-pigtail plastic stent (DPPS) was placed alongside the migrated stent. On day 3, the patient presented with severe anemia and hypotension. Contrast-enhanced computed tomography angiography (CTA) showed a right hepatic artery pseudoaneurysm, with an adjacent hematoma. She underwent conventional angiography and angioembolization with cyanoacrylate ([Fig. 2]).

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.

Digestive Haemorrhage Revealing a Pseudoaneurysm of the Right Hepatic Artery: A Case Report

Introduction: Hepatic artery aneurysms (HAA) are rare and account for 20% of all visceral artery aneurysms. Hepatic artery aneurysms are often discovered at autopsy, but their rupture and bleeding cause significant morbidity and may manifest as haemobilia. Here we report a case of idiopathic right hepatic artery pseudoaneurysm revealed by upper GI bleeding. Presentation: A 72 year old Moroccan woman presented to the emergency department with an upper GI bleed with haematemesis and melaena without any evidence of jaundice. She was admitted with pre-shock haemorrhage and the initial management required early resuscitation measures he turned out to have a pseudoaneurysm of one of the branches of the right subhepatic artery. The aetiology of the pseudoaneurysm was atherosclerosis. The patient underwent radioembolization, the aftermath of which was uncomplicated. Clinical Discussion: Hepatic artery aneurysms (HAA) is a rare cause of gastrointestinal haemorrhage, the management of which requires resuscitative measures Atherosclerosis is the main cause of formation, but it may be associated with connective tissue disorders and arteritis. Most Hepatic artery aneurysms (AAA) are asymptomatic. Aneurysms can be managed by surgical or endovascular interventions. Conclusion: Digestive haemorrhage may reveal a pseudoaneurysm of the right hepatic artery by rupture or fissure in the biliary system. Knowledge on this subject is important for emergency doctors, resuscitators, gastroenterologists, vascular surgeons and hepatobiliary surgeons for the diagnosis and early intervention of this rare entity.

Post-traumatic Pseudoaneurysm of Hepatic Artery (Case Report and Literature Review)

Pseudoaneurysm (PA) of the hepatic artery is a rare complication of abdominal trauma, iatrogenic injuries (biopsy, endoscopic cholecystectomy, liver transplantation), infections, tumors, vasculitis, acute and chronic pancreatitis. This case report presents a life-threatening complications in a patient who underwent surgery for liver lesion. Due to the use of CT angiography, it was possible to determine the cause of bleeding from the upper gastrointestinal tract, evaluation the localization of pseudoaneurysm and treated with elective management.

Arterioportal fistula with hepatic artery pseudoaneurysm: A rare complication of percutaneous transhepatic biliary drainage

We describe a rare complication of percutaneous transhepatic biliary drainage in a 51-year-old female with recurrent hilar cholangiocarcinoma. The patient presented with blood-mixed pericatheter leak of bile, 1 month after placement of a 10F ring biliary internal-external drainage catheter through the left-sided biliary radical. Color Doppler and triphasic computed tomography angiography revealed a pseudoaneurysm arising from segment 3 branch of the left hepatic artery and an arterioportal fistula immediately distal to the pseudoaneurysm. Endovascular coil embolization of the hepatic artery proximal to the pseudoaneurysm was done which resulted in occlusion of the pseudoaneurysm and fistula as well as clinical improvement in the symptoms.

Kist hidatiğin nadir prezantasyonu: hepatik arter psödoanevrizma kanaması ve senkron duodenal fistül

Aims: Hydatid cyst disease is a rare cause of upper gastrointestinal bleeding. Peculiarly if it's resulted from a ruptured hepatic artery aneurysm in the hydatid cyst cavity which is fistulated into the duodenum. We here present a case of hepatic artery pseudoaneurysm due to a complicated hydatid cyst with synchronous duodenal fistula. &#x0D; &#x0D; Case: A 45-year-old male was admitted to the emergency department with hematemesis and hematochezia. The patient had a history of a hydatid cyst of liver and a surgical procedure of lung ecinoccosis. Endoscopy revealed an unusual ulcerated lesion in the duodenum. Yellow membranes were observed in the midst and blood oozing. After unsuccessful endoscopic sclerotherapy, a Computerized Tomography (CT) was performed. CT revealed a ruptured hydatid cyst into the duodenum and bleeding from the formed hepatic artery pseudoaneurysm. Hepatic artery coil embolization was performed urgently and a percutaneous transhepatic drainage catheter was applied to maintain the bile flow. Subsequently, a 10 Fr , 10 cm plastic stent was inserted via Endoscopic Retrograde Cholangiopancreatography (ERCP). The rare complication which was observed after embolization was the hepatic abscess. Although a percutaneous catheter was inserted initially, drainage wasn’t successful. As a last option, surgical debridement was considered.&#x0D; &#x0D; Conclusion: If a patient who presented with upper gastrointestinal bleeding with a previous history of liver hydatid cyst, cyst complications must be listed as a differential diagnosis. Besides endoscopy, contrast-enhanced CT and ЕRCP are the essential diagnostic and therapeutic approaches.

Hepatic Artery Pseudoaneurysm after Hepatic Transplant - Endovascular Treatment with Graft Stenting

Hepatic Artery Pseudoaneurysms (HAP) after liver transplantation are rare and associated with high mortality. Different treatment options exist for HAP, which include surgical intervention, radiological coil embolization or stenting and retransplantation. We describe a case of a patient presenting with HAP after a liver transplantion, that was successfully treated with stent grafting, allowing preservation of the arterial flow and minimal risk of organ failure. Endovascular intervention of HAP should be regarded as the treatment of choice, either in symptomatic or in asymptomatic patients.

Massive duodenal ulcer bleeding due to the ruptured hepatic artery pseudoaneurysm after living donor liver transplantation

BackgroundThe rupture of a hepatic artery pseudoaneurysm (HAP) is a rare but lethal complication after living donor liver transplantation (LDLT) and often manifests as acute gastrointestinal bleeding.Case presentationThis report describes three patients who experienced HAP after LDLT. These patients initially presented with active bleeding of a duodenal ulcer (DU) in the duodenal bulb, followed by diagnosis of the ruptured HAP by angiography. None of the patients had evidence of an active intra-abdominal infection or bile leakage preceding the rupture of HAP. All patients were initially treated by transcatheter arterial coil embolization (TAE). In all cases, TAE was successful for hemostasis but resulted in complete obstruction of the arterial inflow to the graft. Arterial revascularization by surgical reconstruction using the autologous arterial graft in one case and re-LDLT in another one was successfully performed. The other one succumbed to sepsis caused by later liver abscesses.ConclusionThis is the first detailed case series of massive DU bleeding as a warning signal of ruptured HAP after LDLT. HAP should be included in the differential diagnosis when an LDLT recipient presents with gastrointestinal bleeding.

Interventional Radiology Management of Adult Liver Transplant Complications.

Liver transplant remains the definitive therapy for patients with end-stage liver disease. Outcomes have continued to improve, in part owing to interventions used to treat posttransplant complications involving the hepatic arteries, portal vein, hepatic veins or inferior vena cava (IVC), and biliary system. Significant hepatic artery stenosis can be treated with angioplasty or stent placement to prevent thrombosis and biliary ischemic complications. Hepatic arterioportal fistula and hepatic artery pseudoaneurysm are rare complications that can often be treated with endovascular means. Treatment of hepatic artery thrombosis can have mixed results. Portal vein stenosis can be treated with venoplasty or more commonly stent placement. The rarer portal vein thrombosis can also be treated with endovascular techniques. Hepatic venous outflow stenosis of the hepatic veins or IVC is amenable to venoplasty or stent placement. Complications of the bile ducts are the most encountered complication after liver transplant. When not amenable to endoscopic intervention, biliary stricture, bile leak, and ischemic cholangiopathy can be treated with percutaneous transhepatic cholangiography with biliary drainage and other interventions. New techniques have further improved care for these patients. Transsplenic portal vein recanalization has improved transplant candidacy for patients with chronic portal vein thrombosis. Spontaneous splenorenal shunt and splenic artery steal syndrome (nonocclusive hepatic artery hypoperfusion syndrome) remain complicated topics, and the role of endovascular embolization is developing. When patients have recurrence of cirrhosis after transplant, most commonly due to viral hepatitis, transjugular intrahepatic portosystemic shunt (TIPS) may be required to treat symptoms of portal hypertension. Online supplemental material is available for this article. ©RSNA, 2022.

WE2.4 Optimal timing of Laparoscopic Cholecystectomy for symptomatic gallstone disease: the importance of symptom duration

Abstract Aims This study aims to assess outcomes of laparoscopic cholecystectomy (LC) performed in patients presenting with acute cholecystitis or symptomatic gallstone disease within 7 days of onset of symptoms compared to 7 days of diagnosis. Methods A prospective case note analysis was conducted for all patients undergoing laparoscopic cholecystectomy in a tertiary center between February and April, 2018. Outcome measures were compared between 2 patient cohorts: A- those undergoing laparoscopic cholecystectomy within 7 days of diagnosis and B-within 7 days of onset of symptoms. Results 86 patients met inclusion criteria. The mean duration between LC and diagnosis was 5 days, and 16 patients (18%) had surgery over a week after diagnosis. The mean duration between LC and symptom onset was 9 days, and 44 patients (51%) underwent LC over 7 days after symptom-onset. There was a statistically significant reduction in the number of pre-operative ERCPs(p-0.08) and MRCPs(p&amp;lt;0.01) in patients of group B compared to A. A similar decline was noted in surgery length(p&amp;lt;0.01) and incidence of complicated gallbladder disease (characterised by adhesions, empyema, retrograde dissection, perforation, necrosis, pancreatitis) (p&amp;lt;0.01) in the former group when measured against the latter. We further observed significantly better post-operative outcome in group A with reduced rates of complications(p&amp;lt;0.01) (urinary retention, bile leak and hepatic artery pseudoaneurysm) and readmission(p-0.03). Conclusions This is the first study to demonstrate the advantages of using symptom onset to guide practice, and whilst higher power studies are needed to confirm our findings, could represent the beginning of an important shift.

Role of interventional radiology in management of post-liver transplant anastomotic complications

BackgroundLiver transplantation is considered to be the treatment of choice in cases of end-stage liver disease; however, as a major procedure, the operation is fraught with complications. The etiology, symptoms, and diagnostic methods for arterial, portal, and biliary issues are thoroughly discussed. Interventional procedures such as balloon angioplasty and stent placement in the arterial and portal systems, as well as biliary interventional procedures, are described.ResultsIn our study, we reviewed 25 cases of post-living donor transplanted liver, with anastomotic complications including biliary stenosis 40%, hepatic vein stenosis 20%, portal vein stenosis 16%, biliary leakage 16%, and hepatic artery stenosis or pseudo-aneurysm 16%. We had 10 cases of biliary stenosis, 7 of which were successfully treated with the insertion of an internal/external drain, and one case failed. Two patients died. We had four cases of hepatic venous obstruction with successfully implanted stents and a perfect outcome, efficacy, and patency rate of 100%. We also had two cases of hepatic artery stenosis that were perfectly managed by stent placement, with a patency rate of 100%. We came across two cases of hepatic artery pseudo-aneurysm. One case failed due to large sac size, while the other was successful. Finally, in our study, we had a 100% success rate in 5 cases of portal vein stenosis in the early postoperative period.ConclusionsPercutaneous IR was effective treatment for hepatic vein occlusion, portal vein stenosis, hepatic artery stenosis, and anastomotic biliary stricture after living donor liver transplantation. The interventional radiology team is now an integral part of the multi-disciplinary care of transplant patients. As new interventional instruments are developed and experience is gained, the outcomes of interventional treatments will continue to improve.

Outcomes and management of delayed complication after severe blunt liver injury

BackgroundThe treatment of delayed complications after liver trauma such as bile leakage (BL) and hepatic artery pseudoaneurysms (HAPs) is difficult. The purpose of this study is to investigate the outcomes and management of post-traumatic BL and HAPs.MethodsWe retrospectively evaluated patients diagnosed with blunt liver injury, graded by the American Association for the Surgery of Trauma Liver Injury Scale, who were admitted to our hospital between April 2010 and December 2019. Patient characteristics and treatments were analyzed.ResultsA total of 176 patients with blunt liver injury were evaluated. Patients were diagnosed with grade I–II liver injury (n = 127) and with grade III-V injury (n = 49). BL was not observed in patients with grade I–II injury. Eight patients with grade III-V injury developed BL: surgical intervention was not needed for six patients with peripheral bile duct injury, but hepaticojejunostomy was needed for two patients with central bile duct injury. Out of 10 patients with HAPs, only three with grade I–II injury and one with grade III–V were treated conservatively; the rest six with grade III-V injury required transcatheter arterial embolization (TAE). All pseudoaneurysms disappeared.ConclusionsSevere blunt liver injury causing peripheral bile duct injury can be treated conservatively. In contrast, the central bile duct injury requires surgical treatment. HAPs with grade I–II injury might disappear spontaneously. HAPs with grade III–V injury should be considered TAE.

Pseudoaneurysm of the right hepatic artery after laparoscopic cholecystectomy: A case report

Pseudo aneurysms after laparoscopic cholecystectomy are rare and manifest as late hemobilia which is difficult to diagnose and manage. This condition mainly affects the right branch of the hepatic artery and the prognosis is poor. We report the case of an patient diagnosed with a pseudo aneurysm 10 days after laparoscopic cholecystectomy. Following radiological exploration, hemobilia was identified on the 10th postoperative day. In this case, selective embolization was not possible and therefore a ligation of the right hepatic artery was performed. The postoperative period was marked by the reappearance of hemobilia evoking the diagnosis of vascular shunts in the hepatic hilum, and double ligation of the right hepatic artery was required.

Successful hemostasis by percutaneous transhepatic cyanoacrylate injection for hepatic artery pseudoaneurysm causing hemobilia.

A 73‐year‐old man, post‐liver transplantation, was scheduled for ERCP to evaluate anastomotic biliary stricture. The patient developed massive bleeding from hepatic artery pseudoaneurysm. Angiography via femoral artery could not identified feeding artery of the pseudoaneurysm. Thus, trans‐abdominal ultrasonography was performed and percutaneous transhepatic glue embolization successfully.

Recurrent right hepatic artery pseudoaneurysm after robotic-assisted cholecystectomy in a patient with Mirizzi syndrome: a case report

BackgroundIatrogenic hepatic artery pseudoaneurysm is a rare complication following laparoscopic cholecystectomy. Trans-arterial embolization (TAE) is an effective way to control bleeding after a ruptured aneurysm. But uncommonly, rebleeding may occur which will require a second embolization or even laparotomy.Case presentationWe report a case of a 45-year-old woman who underwent robotic-assisted cholecystectomy after the diagnosis of type II Mirizzi syndrome. During the operation, the anterior branch of the right hepatic artery was damaged and Hem-o-lok clips were applied to control the bleeding. The postoperative course was smooth, and the patient was discharged 6 days after the procedure. However, one week after hospital discharge, she presented to the emergency department with right upper abdominal tenderness, melena, and jaundice. After examination, the computed tomography angiography (CTA) revealed a 3 cm pseudoaneurysm at the distal stump of the right hepatic artery anterior branch. TAE with gelfoam material was performed. Three days later, the patient had an acute onset of abdominal pain. A recurrent pseudoaneurysm was found at the same location. She underwent TAE again but this time with a steel coil. No further complication was noted, and she was discharged one week later.ConclusionsEven with the assistance of modern technologies such as the robotic surgery system, one should still take extra caution while handling the vessels. Also, embolization of the pseudoaneurysm with steel coils may be suitable for preventing recurrence.