Treatment Of Hepatic Artery Aneurysm Research Articles

Robot-assisted endovascular treatment of hepatic artery aneurysm: A case report.

Robot-assisted endovascular surgery has emerged as a new alternative to interventional procedures, with its application expanding to peripheral and visceral approaches. The objective of this paper is to describe a robot-assisted endovascular treatment in splanchnic arteries. A case report of an asymptomatic male patient with an incidental finding of a saccular aneurysm of the proper hepatic artery measuring 3.7 × 2.7cm and distant 0.6cm from the origin of the gastroduodenal artery. Using a robot-assisted endovascular technique (CorPath GRX platform - Siemens), 2 guidewires were advanced in parallel: the first one was placed inside the aneurysm sac, while the second one was placed in the proper hepatic artery distal to the aneurysm; through the first guidewire, a balloon was advanced, positioned distally to the aneurysm, and through the second one, a microcatheter was advanced. Embolization of the aneurysm was performed with the use of coils and Onyx. Control exam performed 120days after embolization revealed treated aneurysm and preserved distal arterial flow. Using a robotic platform for navigation in splanchnic territory is safe and effective.

Hepatic artery aneurysms: open and endovascular repair

During the last decade endovascular treatment has emerged as an important alternative to open surgical repair because of its reduced invasiveness. Results of both modalities are evaluated in this study. A retrospective review of 26 patients (18 males and 8 females; mean age: 62±9 years) who underwent surgical open repair of hepatic artery aneurysm (HAA) between 1998 and 2015 was performed. Indications to open or endovascular procedure was based on aneurysm size, anatomical features and operative risk. Aneurysm size ranged between 2 and 17 cm (mean value: 3.3 cm). Endovascular treatment was performed in 9 patients (34.6%) while open repair in 17 (65.4%). Endovascular procedures included 5 (55.5%) coils embolization and 4 (44.5%) endograft exclusion. Open repair included 9 (53%) aneurysmectomies with end-to-end anastomosis, 7 (41.1%) aneurysmectomies and bypass grafting and 1 (5.9%) simple ligation. In the surgical group, one case of respiratory insufficiency and one myocardial infarction were observed. A 7 cm pseudoaneurysm was found during follow-up for a hepatic artery aneurysm treated 8 years before: the patient underwent re-laparotomy and artery ligation. In the endovascular group, a stent-graft thrombosis occurred and one case of aneurysm reperfusion after coils embolization was found at 48 months follow-up: both patients were treated by means of surgical conversion with aorto-hepatic bypass. Endovascular and open repair are both effective in the treatment of HAA. Type of treatment selection is individualized based on patients' clinical status, aneurysm location and the presence of hepatic collateral circulation.

Hepatic artery aneurysm in a patient with hepatitis C liver cirrhosis: report of a case.

Visceral artery aneurysms are rare, with an incidence rate of only 0.01-0.2% in routine autopsies, and hepatic artery aneurysms account for approximately 20% of these aneurysms. Despite recent advances in therapeutic techniques and diagnostic tools, the management of visceral artery aneurysms remains clinically challenging. We report a case of hepatic artery aneurysm with liver cirrhosis due to hepatitis C in an 81-year-old woman. A computed tomography scan demonstrated a hepatic artery aneurysm 4.4cm in diameter. She underwent successful aneurysmectomy with vascular anastomosis. A computed tomography scan on postoperative day 7 demonstrated patent hepatic artery. The patient was followed-up for 1year after surgery and died owing to progressive liver failure. However, she did not show any hepatic artery problem such as hepatic arterial thrombosis or occlusion. We discuss the risk factors of atherosclerosis in patients with liver cirrhosis, and present an overview of the treatment of hepatic artery aneurysms.

Endovascular treatment of hepatic artery aneurysm by multilayer stents: two cases and one-year follow-up

We wished to analyze our initial experience with the Cardiatis Multilayer Stent for visceral artery aneurysms. Two males with a hepatic artery aneurysm (34 mm and 48 mm in diameter, respectively) were treated, via a percutaneous femoral approach, with multilayer stents. We deployed the stent in front of the aneurysm neck, covering the hepatic artery branches. At 12 months, a computed tomography scan showed thrombosis of the aneurysmal sac and patency of all the branches of the hepatic artery. The Multilayer Stent appears to be a viable alternative for the treatment of visceral artery aneurysms in patients at high surgical risk, but long-term follow-up is needed.

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.

Common hepatic artery aneurysm successfully treated with a celiac axis stent graft. Two years of follow up

Purpose To present a case of partially thrombosed 5 cm wide aneurysm of the origin of common hepatic artery with occlusion of common hepatic artery distal to the aneurysm and proper hepatic artery revascularized by gastroduodenal and superior mesenteric arteries. Case report After a preliminary 3D rotational angiography evaluation a stent graft was deployed in the celiac axis to exclude the common hepatic artery and the aneurysm taking the advantage of developed complete collateral liver blood supply. Two year CT follow up showed stent patency without clinical and radiological evidence of visceral ischemic damage. Clinical and technical considerations are discussed. Conclusions The positive mid-term outcome confirms the efficacy of endovascular exclusion with stent graft, in the treatment of hepatic artery aneurysm in selected cases.

The radiological treatment of hepatic artery aneurysms

Improvements in the quality and availability of cross-sectional imaging should result in more frequent detection of hepatic artery aneurysms before rupture. Interventional radiological treatment for extra-hepatic lesions has not previously been discussed in the literature. We present two cases of extra-hepatic hepatic artery aneurysms treated using different endovascular techniques and discuss the relative merits of these approaches.

Current Trends in the Diagnosis and Treatment of Hepatic Artery Aneurysms

Aneurysms of the hepatic artery are rare lesions that constitute 20% of all splanchnic artery aneurysms. Their well-documented natural history includes progressive enlargement and eventual rupture. Computerized tomography, abdominal ultrasonography, or MRI may be used for initial evaluation, but angiography is required to make the definitive diagnosis and for delineation of the vascular anatomy. The lesion should be corrected surgically after the diagnosis is confirmed. Lesions proximal to the gastroduodenal artery may be ligated if there is sufficient collateral flow to the liver. For lesions distal to this artery, surgical resection and reconstruction is required. Selective embolization of intrahepatic or subhepatic aneurysms may be an effective alternative in high-risk patients. We had two cases of aneurysm of the hepatic artery diagnosed at our institution over the course of 18 months. Excellent results were obtained from surgical revascularization of the liver in both cases.