Ann Hepatobiliary Pancreat Surg.  2020 Aug;24(3):333-338. 10.14701/ahbps.2020.24.3.333.

Management of hepatic artery aneurysm: A case series

• Rosenberg A
• Trebska-McGowan K
• Reichman T
• Sharma A
• Cotterell A
• Strife B
• Khan AA
• Kumaran V
• Bruno DA
• Levy MF
• Bhati CS

• KMID: 2505347
• DOI: http://doi.org/10.14701/ahbps.2020.24.3.333

Abstract

Hepatic artery aneurysms are rare, but their diagnosis is important because of high mortality and complications.Common risk factors for developing these aneurysms include hypertension, vascular disease, pancreatitis, diabetes, tobacco use, autoimmune diseases, and previous transplantation. Frequent imaging for trauma and tumor surveillance has increased the incidence of naive hepatic aneurysms. These aneurysms can be difficult to manage, and it can be challenging to decide the correct treatment modality for the patient. Hereby, we present four cases of hepatic artery aneurysm and discuss various treatment options. Patient 1 suffered from a proper and right hepatic artery aneurysm discovered incidentally; repaired with an endovascular intervention later complicated by an endoleak which was further managed by another stenting. Patient 2 had a common hepatic artery aneurysm followed with serial imaging without any intervention. Patient 3 had a hepatic artery aneurysm and liver mass diagnosed concurrently. The patient underwent an open surgical repair of his aneurysm with graft and liver resection which was complicated later with rupture of aneurysm followed by surgical bypass repair. Patient 4 suffered from a large hepatic artery aneurysm causing bile duct compression. Her aneurysm was repaired open with splenic artery grafting. Patients were managed from careful observation to surgery with different outcomes.

Keyword

Hepatic artery aneurysm; Liver transplantation; Vascular diseases; Angiogram

Figure

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  Fig. 1 Patient 1: (A) Pretreatment imaging with fusiform dilatation of hepatic artery; (B, C) angiography procedure with clear fusiform dilation and intraluminal guidewire; (D, E) post-procedure imaging showing resolution of the aneurysm.

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  Fig. 2 Patient 2: (A-C) Stable hepatic artery aneurysm on imaging obtained 3 months apart.

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  Fig. 3 Patient 3: (A) Hepatic artery aneurysm prior to surgery; (B) pedunculated mass arising from the right lobe of the liver; (C) post-surgical angiogram, demonstrating resolution of the aneurysm; (D) post second surgery CT angiogram, demonstrating iliac conduit.

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  Fig. 4 Patient 4: Pre-operative imaging. (A) Coronal imaging with a thick arrow indicating the aneurysm, and a thin arrow showing intrahepatic biliary dilatation; (B) hepatic artery.

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