Coil embolization of ruptured intrahepatic pseudoaneurysm through percutaneous transhepatic biliary drainage

Multiple intrahepatic artery aneurysms during the treatment for IgG4-related sclerosing cholangitis: A case report

BACKGROUND

The purpose of this case report is to describe a case of multiple intrahepatic artery aneurysms during treatment for IgG4-related sclerosing cholangitis (IgG4-SC) and to provide information for daily practice.

CASE SUMMARY

A 64-year-old Japanese woman was diagnosed with IgG4-SC five years prior and was receiving maintenance treatment with prednisolone 7.5-10 mg/day. She developed abdominal pain and a sudden onset of black stool and was admitted to our hospital. Abdominal contrast-enhanced computed tomography (CT) and ultrasonography (US) revealed multiple intrahepatic artery aneurysms that developed during the treatment for IgG4-SC. Emergency transarterial embolization for multiple hepatic artery aneurysms was performed. Hepatic artery aneurysms disappeared on contrast-enhanced CT and US, the progression of anemia ceased, and the melena resolved. Thus, hemostasis was achieved.

CONCLUSION

Hepatic artery aneurysms should be considered poor prognostic complications of IgG4-SC.

Percutaneous Trans-Hepatic Embolization of an Iatrogenic Extra-Hepatic Pseudoaneurysm of the Right Hepatic Artery in a Patient With Previous Occlusion of the Proper Hepatic Artery: An Endovascular Procedure to Avoid a Difficult Surgical Repair

We report a case of successful percutaneous transhepatic, embolization of an iatrogenic extra-hepatic pseudoaneurysm (PsA) of the right hepatic artery (RHA) under combined fluoroscopic and ultrasonographic guidance. A 73-year-old man underwent percutaneous transhepatic biliary drainage placement in another hospital, complicated by haemobilia and development of a RHA PsA. Endovascular embolization was attempted, resulting in coil embolization of the proper hepatic artery, and persistence of the PsA. At this point, the patient was referred to our hospital. Computed tomography and direct angiography confirmed the iatrogenic extra-hepatic PsA of the RHA, refilled by small collaterals from the accessory left hepatic artery (LHA) and coil occlusion of the proper hepatic artery. Attempted selective catheterization of these vessels was unsuccessful due to the tortuosity and very small caliber of the intra-hepatic collaterals, the latter precluding endovascular treatment of the PsA. Percutaneous trans-hepatic combined fluoroscopic and ultrasound-guided embolization of the PsA was performed with Lipiodol® and cyanoacrylate-based glue (Glubran®2). Real time fluoroscopic images and computed tomography confirmed complete occlusion of the pseudoaneurysm. Surgical repair, although feasible, was considered at high risk. In our patient, we decided to perform a percutaneous trans-hepatic combined fluoroscopic and ultrasound-guided embolization of the PsA using a mix of Lipiodol® and Glubran®2 because of the fast polymerization time of the glue allowing the complete occlusion of the PsA in few seconds, thus eliminating the risk of coil migration, reducing the risk of PsA rupture and avoid a difficult surgical repair.