Idiopathic Giant Hepatic Artery Pseudoaneurysm

Combined Endovascular Repair of a Giant Symptomatic Hepatic Aneurysm: A Case Report and Comprehensive Literature Review

Hepatic artery aneurysms (HAAs) are an uncommon vascular disease, which account for 20% of visceral artery aneurysms. The majority are usually asymptomatic and discovered accidentally during imaging control, but occasionally, they can present as acute abdominal pain, haemobilia, obstructive jaundice, or gastrointestinal bleeding due to aneurysm sac expansion or rupture with catastrophic consequences. We present the case of a 51-year-old male patient with a giant common HAA of 11.1 cm who was managed endovascularly. A combined endovascular approach was decided due to the anatomy of the aneurysm. Endovascular embolization with coils in the distal part of the aneurysm and deployment of a stent graft proximally to exclude inflow were used. At six months, the aneurysm size was regressed at 5 cm; however, seven months after the operation, the patient presented with pylorus perforation due to coil migration which was managed by coil removal, peripheral gastrectomy, and Roux-en-Y gastric bypass. We provide a narrative literature review regarding the endovascular repair of giant HAAs. The PubMed, Scopus, and Google Scholar databases were searched for articles up to January 2024. Thirty-eight studies (case reports, case series) were retrieved. The conclusion is that giant HAAs are a rare and severe condition in which their treatment can be challenging with unexpected adverse events. The literature review suggests that the endovascular approach whenever feasible is a safe and effective treatment option with low morbidity and mortality.

Late development of giant hepatic artery pseudoaneurysm following abdominal trauma due to tire blast: case report and literature review

Giant hepatic artery pseudoaneurysm is rare but could have a significant implication. A 35-year-old male was severely injured by a truck tire explosion and presented with hypotension and positive focused assessment with sonography in trauma scan. After resuscitation, abdomen computed tomography (CT) scan showed a Grade 4 liver injury. The patient was admitted to the intensive care unit, and the liver injury was treated conservatively. Seventeen days later, he developed abdominal pain with deep epigastric tenderness. Repeated abdomen CT scan detected a giant hepatic artery pseudoaneurysm. Embolization was achieved using gel foam with the placement of six microcoils. The patient had an uneventful recovery. Late development of giant hepatic artery pseudoaneurysm is a rare complication of hepatic trauma and could be life-threatening. Timely identification and treatment with endovascular intervention are crucial. We recommend, especially when dealing with trauma related to blast injury, follow-up images for patients who develop symptoms suggestive of hepatic injury.

An infrequently encountered case of spontaneous subcapsular liver hematoma with hepatic artery pseudoaneurysm

Hepatic artery pseudoaneurysm (HAP) is a rare complication of liver trauma and liver transplant, and spontaneous subcapsular liver hematoma is not frequently encountered outside the setting of preeclampsia and hemolysis, elevated liver enzyme and low platelet (HELLP) syndrome. We report a rare case of spontaneous subcapsular liver hematoma with hepatic artery pseudoaneurysm without any apparent liver trauma or recent interventional procedures of the hepatobiliary system. Although subcapsular hepatic hematoma and HAP are uncommon diagnoses, clinicians should be aware of these diagnoses to promptly diagnose and effectively treat them. Clinicians should also not forget these diseases could be masked by other common etiologies, such as gastritis.

Endovascular Intervention of a Mycotic Pseudoaneurysm of Accessory Left Hepatic Artery Arising from the Left Gastric Artery Presenting Secondary to Clostridium difficile Colitis: A Case Report

Hepatic artery aneurysms have an estimated incidence of approximately 0.002%, of which one half are pseudoaneurysms (PsAs). These typically occur following trauma or liver transplant and are often asymptomatic. An uncommon pathology, mycotic aneurysms or PsAs are those that result as a consequence of infections. The danger in mycotic processes stems from their complications of systemic seeding of infection, rupture, and possible exsanguination. This case reports a mycotic PsA that was found in an accessory left hepatic artery (aLHA) branching from the left gastric artery (LGA). The patient presented with recurrent Clostridium difficile colitis with perforation and was later found to have a left upper quadrant vascular lesion during repeat imaging after failing to progress in their clinical course. After multidisciplinary meetings with vascular surgery and interventional radiology, the patient eventually underwent endovascular coil embolization. This is the first documented case of a mycotic PsA secondary to recurrent C. difficile colitis located in an aLHA branching from the LGA.