Hybrid Repair of a Hepatic Artery Aneurysm

doi:10.1016/j.avsg.2011.08.024

Annals of Vascular Surgery

Volume 26, Issue 4, May 2012, Pages 575.e1-575.e3

https://doi.org/10.1016/j.avsg.2011.08.024 Get rights and content

Visceral arterial aneurysm is a rare pathology. Currently, there are no sufficient data to support the superiority of surgical or endovascular treatment. The choice depends mainly on patient characteristics and the anatomy of the aneurysm. We present a case of a 12-cm fusiform aneurysm of the common hepatic artery. A combined approach including endovascular exclusion of the celiac trunk and surgical closure of the aneurysm was chosen. The postoperative course was uneventful. To our knowledge, this is the first case in the literature describing this combined approach.

Section snippets

Case Report

An 88-year-old patient treated with endovascular aneurysm repair in 2007 for abdominal aortic aneurysm was diagnosed at the time with a 65-mm aneurysm of the common hepatic artery. He remained asymptomatic until 2009 when he presented with abdominal pain, weight loss, nausea, and dysphagia. A computed tomography scan demonstrated a significant enlargement of the aneurysm (12 cm), with no signs of rupture (Fig. 1).

The patient was admitted, with indication for surgery. During a multidisciplinary

Discussion

Many techniques are available for the treatment of visceral arterial aneurysms; endovascular procedures are considered as the first-line treatment by most of the authors.1, 11, 14, 16 In the light of recent publications, even classical indications for conventional surgery, such as rupture, seem to be managed with endovascular treatment.¹⁷ Conventional surgery is usually performed in patients with unstable ruptured aneurysms or if the anatomy does not allow for endovascular techniques.¹²

Open

Conclusion

Hybrid approach with aortic endoclamping is a safe and feasible alternative for proximal control and should be considered when anatomic features do not permit for a conventional clamp placement. To our knowledge, this is the first report describing this combined approach for the treatment of a hepatic artery aneurysm.

References (22)

A.B. Lumsden et al.
Hepatic artery aneurysms: the management of 22 patients
J Surg Res
(1996)
L.M. Messina et al.
Visceral artery aneurysms
Surg Clin North Am
(1997)
M.A. Arneson et al.
Ruptured hepatic artery aneurysm: case report and review of literature
Ann Vasc Surg
(2005)
T. Luebke et al.
Combined endovascular-open surgical procedure in a great hepatic artery aneurysm
Ann Vasc Surg
(2007)
S.C. Carr et al.
Visceral artery aneurysm rupture
J Vasc Surg
(2001)
R. Pulli et al.
Surgical treatment of visceral artery aneurysms: a 25-year experience
J Vasc Surg
(2008)
R. Chiesa et al.
Visceral Artery Aneurysms
Ann Vac Surg
(2005)
S.S. Saltzberg et al.
Is endovascular therapy the preferred treatment for all visceral artery aneurysms?
Ann Vasc Surg
(2005)
R.A. Larson et al.
Stent graft repair of visceral artery aneurysms
J Vasc Surg
(2002)
G.L. de Ruiter-Derksen et al.
Endovascular treatment of a hepatic artery aneurysm causing chronic abdominal pain; a case report
Ann Hepatol
(2010)

D. Grotemeyer et al.

Visceral artery aneurysms–follow-up of 23 patients with 31 aneurysms aftersurgical or interventional therapy

Langenbecks Arch Surg

(2009)

Cited by (6)

Splenic artery transposition for reconstruction of a large hepatic artery aneurysm: A case report and literature review
2022, International Journal of Surgery Case Reports
Citation Excerpt :
Of these, we believe that the most important advantages of the splenic artery are the adjustable caliber difference and ability to secure sufficient distance. A PubMed search using the keywords “open surgery” and “hepatic artery aneurysm” revealed 15 cases of hepatic artery resection and reconstruction among 10 years from 2011 to 2021, including our own cases (Table 1) [10–22]. Five cases had autologous arterial reconstruction and four of these five cases had splenic artery transposition.
Hepatic artery aneurysms (HAAs) are rare. Typical treatment options for HAAs are surgical resection and endovascular treatment but treatment choices remain controversial.
A 65-year-old woman was rushed to our hospital suspected to have hemorrhage. Contrast-enhanced CT showed a large 12 cm aneurysm of the common hepatic artery (CHA). We diagnosed duodenal hemorrhage due to imminent rupture of the HAA. Angiography was first performed. The inferior pancreaticoduodenal artery was embolized with a coil under interventional radiology technique for arterial bleeding control. Next, we performed resection of the aneurysm and total pancreatectomy with splenic artery reservation. We reconstructed via splenic artery transposition because of the reconstruction distance, vascular system, and stability of the anastomosis. The patient was discharged from the hospital on postoperative day 21 without any complications.
There are two key points in this report. Firstly, the choice of splenic artery transposition is optimal for caliber difference and reconstruction distance. The choice of splenic artery should be considered a reliable option. Secondly, total pancreatectomy avoids exposure to pancreatic juice at the anastomosis site due to pancreatic fistula.
Splenic artery transposition for HAA is advantageous in adjustability of the caliber difference and securing of sufficient distance. In addition, total pancreatectomy may be acceptable in patients with a normal pancreas to avoid fatal complications such as disruption of the anastomosis and reconstructed artery due to pancreatic juice exposure.
Endovascular treatment of a giant hepatic artery aneurysm with Amplatzer vascular plug
2014, Journal of Vascular Surgery
Citation Excerpt :
These findings were confirmed by CT scan performed at 5 months. There are various treatment options for hepatic artery aneurysms, including endovascular, surgical, and laparoscopic techniques.2-4,7,8 The choice of the best treatment modality for each case depends on clinical presentation, location of the aneurysm, associated risk factors, and general status of the patient.3
Hepatic artery aneurysms are uncommon and account for 20% of visceral aneurysms. Some authors consider endovascular procedures as the first line treatment for most hepatic artery aneurysms, being the conventional surgery reserved for unstable ruptured aneurysms or if the anatomy is unsuitable for endovascular repair. In this report, we describe the endovascular treatment of a giant common hepatic artery aneurysm with an Amplatzer vascular plug.
Giant hepatic artery aneurysm: Management of an infrequent entity
2014, Gastroenterologia y Hepatologia
Vascular surgical aspects in abdominal surgery: Results from a tertiary care center over a 10-year time period
2019, Chirurg
Visceral Artery Aneurysms: Decision Making and Treatment Options in the New Era of Minimally Invasive and Endovascular Surgery
2019, International Journal of Angiology
Differential vascular medical management of visceral artery aneurysms in a single-centre consecutive patient cohort as part of an ongoing disease-specific systematic clinical prospective observational study
2014, Zentralblatt fur Chirurgie - Zeitschrift fur Allgemeine, Viszeral- und Gefasschirurgie

View full text

Case ReportHybrid Repair of a Hepatic Artery Aneurysm

Section snippets

Case Report

Discussion

Conclusion

J Surg Res

Surg Clin North Am

Ann Vasc Surg

Ann Vasc Surg

J Vasc Surg

J Vasc Surg

Ann Vac Surg

Ann Vasc Surg

J Vasc Surg

Ann Hepatol

Visceral artery aneurysms–follow-up of 23 patients with 31 aneurysms aftersurgical or interventional therapy

Langenbecks Arch Surg

Case Report
Hybrid Repair of a Hepatic Artery Aneurysm