Purpose: To assess the efficacy of endovascular management for ruptured hepatic artery pseudoaneurysm (HAP). Methods: Six cases of HAP in five patients (four men and one women; mean age, 50; range, 28 - 62) were treated with transcatheter arterial coil embolization using microcoil (Boston Scientific, Watertown, MA, USA) and Tornado Coil (Cook, Bloomington, IN, USA) with or without stent graft between January 2007 and September 2008. They were analyzed with regard to the clinical presentation, radiological findings with procedure, and clinical and radiologic outcomes. Results: All patients presented with epigastric pain or gastrointestinal bleeding. The pseudoaneurysms were ranged from 0.6 to 4.4 cm in size and located in the common hepatic artery (n = 1), junction between proper and right hepatic artery (n = 1), proper hepatic artery (n = 2), the left hepatic artery (n = 1), right hepatic artery (n = 1). Embolization was performed with microcoils in all pseudoaneurysmal sac with or without both afferent and efferent segment. A self-expandable stent (n = 1) was also used. Overall technical success was 100% (6 of 6) and complete occlusions of HAPs were achieved in 5 out of 6 cases, 83.3% of clinical success rate. Re-bleeding occurred in one case of stent graft at proper hepatic artery following coil packing for pseudoaneurysmal sac. Clinical success rate of embolization for both afferent and efferent segment was 100% (3 of 3). Procedure-related minor complications happened in 2 of 5 patients, and they were treated conservatively. Conclusion: Transcatheter coil embolization for ruptured HAP is sufficiently effective and additional embolization in both afferent segment and efferent segment can improve clinical success rate.
References
[1]
Abbas, M.A., Fowl, R.J., Stone, W.M., Panneton, J.M., Oldenburg, W.A., Bower, T.C., Cherry, K.J. and Gloviczki, P. (2003) Hepatic Artery Aneurysm: Factors that predict Complications. Journal of Vascular Surgery, 38, 41-45.
https://doi.org/10.1016/S0741-5214(03)00090-9
[2]
Mohan, I.V. and Stephen, M.S. (2013) Peripheral Arterial Aneurysms: Open or Endovascular Surgery? Progress in Cardiovascular Diseases, 56, 36-56.
https://doi.org/10.1016/j.pcad.2013.06.001
[3]
Dawson, J. and Fitridge, R. (2013) Update on Aneurysm Disease: Current Insights and Controversies: Peripheral Aneurysms: When to Intervene—Is Rupture Really a Danger? Progress in Cardiovascular Diseases, 56, 26-35.
https://doi.org/10.1016/j.pcad.2013.05.002
[4]
Yu, Y.H., Sohn, J.H., Kim, T.Y., Jeong, J.Y., Han, D.S., Jeon, Y.C. and Kim, M.Y. (2012) Hepatic Artery Pseudoaneurysm Caused by Acute Idiopathic Pancreatitis. World Journal of Gastroenterology, 18, 2291-2294.
https://doi.org/10.3748/wjg.v18.i18.2291
[5]
Lu, P.H., Zhang, X.C., Wang, L.F., Chen, Z.L. and Shi, H.B. (2013) Stent Graft in the Treatment of Pseudoaneurysms of the Hepatic Arteries. Vascular and Endovascular Surgery, 47, 551-554. https://doi.org/10.1177/1538574413488460
[6]
Nagaraja, R., Govindasamy, M., Varma, V., Yadav, A., Mehta, N., Kumaran, V., Gupta, A. and Nundy, S. (2013) Hepatic Artery Pseudoaneurysms: A Single-Center Experience. Annals of Vascular Surgery, 27, 743-749.
https://doi.org/10.1016/j.avsg.2012.08.018
[7]
Fankhauser, G.T., Stone, W.M., Naidu, S.G., Oderich, G.S., Ricotta, J.J., Bjarnason, H., Money, S.R. and Mayo Vascular Research Center, C. (2011) The Minimally Invasive Management of Visceral Artery Aneurysms and Pseudoaneurysms. Journal of Vascular Surgery, 53, 966-970. https://doi.org/10.1016/j.jvs.2010.10.071
[8]
Kim, S.K., Lee, J., Duncan, J.R., Picus, D.D., Darcy, M.D. and Sauk, S. (2014) Endovascular Treatment of Superior Mesenteric Artery Pseudoaneurysms Using Covered Stents in Six Patients. American Journal of Roentgenology, 203, 432-438.
https://doi.org/10.2214/AJR.13.11644
[9]
Polat, E., Ozogul, Y.B., Ercan, M., Karaman, K., Aksoy, E., Kucukay, F., Surmelioglu, A., Dalgic, T., Ulas, M., Bostanci, E.B. and Akoglu, M. (2012) Management of Hepatic Artery Aneurysms. Bratislava Medical Journal, 113, 676-679.
https://doi.org/10.4149/BLL_2012_154
[10]
Pedersoli, F., Isfort, P., Keil, S., Goerg, F., Zimmermann, M., Liebl, M., Schulze-Hagen, M., Schmeding, M., Kuhl, C.K. and Bruners, P. (2016) Stentgraft Implantation for the Treatment of Postoperative Hepatic Artery Pseudoaneurysm. Cardiovascular and Interventional Radiology, 39, 575-581.
https://doi.org/10.1007/s00270-015-1274-1
[11]
Peter, G., Shaheer, R., Narayanan, P. and Vinayakumar, K.R. (2014) Hepatic Artery Aneurysm: A Rare Case of Obstructive Jaundice with Severe Hemobilia. Annals of Gastroenterology, 27, 288-289.
[12]
Verzini, F., Biello, A., Marucchini, A., Parente, B., Parlani, G. and Cao, P. (2013) Total Endovascular Solution for Complex Visceral Aneurysms. Journal of Vascular Surgery, 58, 1412-1416. https://doi.org/10.1016/j.jvs.2013.05.045
