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Tigkiropoulos K, Sidiropoulou K, Abatzis-Papadopoulos M, Karamanos D, Lazaridis I, Saratzis N. Combined Endovascular Repair of a Giant Symptomatic Hepatic Aneurysm: A Case Report and Comprehensive Literature Review. Cureus 2024; 16:e62228. [PMID: 39006572 PMCID: PMC11244715 DOI: 10.7759/cureus.62228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
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.
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Affiliation(s)
- Konstantinos Tigkiropoulos
- 1st Surgical Department, Division of Vascular Surgery, Papageorgiou General Hospital, Aristotle University, Thessaloniki, GRC
| | - Katerina Sidiropoulou
- 1st Surgical Department, Division of Vascular Surgery, Papageorgiou General Hospital, Aristotle University, Thessaloniki, GRC
| | - Manolis Abatzis-Papadopoulos
- 1st Surgical Department, Division of Vascular Surgery, Papageorgiou General Hospital, Aristotle University, Thessaloniki, GRC
| | - Dimitrios Karamanos
- 1st Surgical Department, Division of Vascular Surgery, Papageorgiou General Hospital, Aristotle University, Thessaloniki, GRC
| | - Ioannis Lazaridis
- 1st Surgical Department, Division of Vascular Surgery, Papageorgiou General Hospital, Aristotle University, Thessaloniki, GRC
| | - Nikolaos Saratzis
- 1st Surgical Department, Division of Vascular Surgery, Papageorgiou General Hospital, Aristotle University, Thessaloniki, GRC
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Fukamatsu F, Sugiura K, Takekoshi D, Fukuzawa T, Oyama K, Tsukahara Y, Kurozumi M, Shimizu A, Fujinaga Y. A ruptured splenic artery aneurysm treated by transcatheter arterial embolization using n-butyl cyanoacrylate-Lipiodol-Iopamidol. Radiol Case Rep 2023; 18:2385-2390. [PMID: 37179814 PMCID: PMC10172629 DOI: 10.1016/j.radcr.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/25/2023] [Accepted: 04/03/2023] [Indexed: 05/15/2023] Open
Abstract
N-butyl cyanoacrylate, one of embolic materials, is usually used as a mixture with Lipiodol (N-butyl cyanoacrylate-Lipiodol mixture). N-butyl cyanoacrylate-Lipiodol-Iopamidol was developed by adding a nonionic iodine contrast agent (Iopamiron) to N-butyl cyanoacrylate-Lipiodol mixture. N-butyl cyanoacrylate-Lipiodol-Iopamidol has lower adhesiveness than N-butyl cyanoacrylate-Lipiodol mixture and the ability to form a single large droplet. We report the case of a 63-year-old man with a ruptured splenic artery aneurysm treated by transcatheter arterial embolization using N-butyl cyanoacrylate-Lipiodol-Iopamidol. He was referred to the emergency room because of sudden onset of upper abdominal pain. A diagnosis was established using contrast-enhanced computed tomography and angiography. Emergency transcatheter arterial embolization was performed, and the ruptured splenic artery aneurysm was successfully embolized using a combination of coil framing and N-butyl cyanoacrylate-Lipiodol-Iopamidol packing. This case demonstrates the usefulness of a combination of coil framing and N-butyl cyanoacrylate-Lipiodol-Iopamdol packing for the embolization of aneurysms.
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Affiliation(s)
- Fumiaki Fukamatsu
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
- Corresponding author.
| | - Kazusa Sugiura
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Daiya Takekoshi
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Takuya Fukuzawa
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Kazuki Oyama
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Yoshinori Tsukahara
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Masahiro Kurozumi
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Akira Shimizu
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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Van Holsbeeck A, Dhondt E, Marrannes J, Claus E, Bonne L, Defreyne L, Maleux G. Coil Embolization of True, Common and Proper, Hepatic Artery Aneurysms: Technique, Safety and Outcome. Cardiovasc Intervent Radiol 2023; 46:480-487. [PMID: 36918422 DOI: 10.1007/s00270-023-03379-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/27/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE To retrospectively assess the safety and efficacy of coil embolization for catheter-directed true common and proper hepatic artery aneurysm exclusion. MATERIALS AND METHODS Nine consecutive patients (2005-2021) in two university centers presenting with true common and proper hepatic artery aneurysms (> 2 cm in diameter) were treated with 'frontdoor-backdoor' coil embolization. Patients presenting with a hepatic artery pseudoaneurysm, mycotic aneurysm or patients with small (< 2 cm diameter) aneurysms and followed up by imaging were excluded. Technical and clinical success was defined as complete coil-exclusion of the aneurysm on completion angiography and absence of post-embolization adverse events, in particular mass effect or hemorrhage, respectively. Patient characteristics, technical and clinical success, liver function tests and follow-up results were assessed based on the patients' electronic medical records. RESULTS Technical and 30-day clinical success was achieved in all procedures (100%). No major procedural complications were reported. Liver function test values were available in 6/9 patients, showing transient elevation of bilirubin in one patient. No end organ ischemia was reported. The mean clinical follow-up period of the study patients was 72 months (12-168 months). Long-term stable occlusion of the hepatic aneurysms was achieved in 9/9 patients (100%). One patient showed late complication (3 years) with coil migration into a bulbar ulcer, without aneurysm recanalization, however with fatal outcome. CONCLUSION Coil embolization for the endovascular exclusion of true common and proper hepatic artery aneurysms is safe and effective.
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Affiliation(s)
- A Van Holsbeeck
- Department of Radiology, AZ Sint-Jan Hospital Brugge, Brugge, Belgium.,Department of Radiology, AZ Sint-Lucas Hospital Brugge, Brugge, Belgium
| | - E Dhondt
- Department of Radiology, University Hospital Gent, Ghent, Belgium
| | - J Marrannes
- Department of Radiology, AZ Sint-Jan Hospital Brugge, Brugge, Belgium.,Department of Radiology, AZ Sint-Lucas Hospital Brugge, Brugge, Belgium
| | - E Claus
- Department of Radiology, University Hospital Leuven, Herestraat 49, 3000, Louven, Belgium
| | - L Bonne
- Department of Radiology, University Hospital Leuven, Herestraat 49, 3000, Louven, Belgium
| | - L Defreyne
- Department of Radiology, University Hospital Gent, Ghent, Belgium
| | - G Maleux
- Department of Radiology, University Hospital Leuven, Herestraat 49, 3000, Louven, Belgium.
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Chui JN, Ziaziaris WA, Mohtashami A, Lim CSH, Wong S, Mittal A, Samra JS. Open repair of an anatomically complex hepatic artery aneurysm with great saphenous vein graft. ANZ J Surg 2023; 93:704-706. [PMID: 35790066 DOI: 10.1111/ans.17899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 05/02/2022] [Accepted: 06/24/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Juanita N Chui
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - William A Ziaziaris
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ali Mohtashami
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Christopher S H Lim
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Shen Wong
- Department of Vascular Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Anubhav Mittal
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Surgery, University of Notre Dame Australia, Sydney, Australia
| | - Jaswinder S Samra
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Spüntrup E, Fares A, Stavrou GA, Steffen MS. Behandlung eines großen Aneurysmas der Arteria hepatica propria mit einem Flowdiverter. GEFÄSSCHIRURGIE 2022. [DOI: 10.1007/s00772-022-00958-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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