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Kedwai BJ, Byrne M, Geiger JT, Lehane DJ, Mix DS, Stoner MC. Stenting of a hepatic artery pseudoaneurysm rupture secondary to a celiac artery dissection. J Vasc Surg Cases Innov Tech 2024; 10:101471. [PMID: 38591020 PMCID: PMC10999480 DOI: 10.1016/j.jvscit.2024.101471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
Hepatic artery (HA) pseudoaneurysm rupture is a rare and potentially lethal pathology. We present the case of a celiac artery dissection complicated by an HA pseudoaneurysm rupture that was treated successfully with endovascular stenting. The patient's postoperative course was uncomplicated, and he was further evaluated for an underlying connective tissue disorder. There is no standard treatment for a ruptured HA pseudoaneurysm, although transarterial embolization is most frequently reported. This report demonstrates that self-expanding stent grafts are effective in the emergent repair of HA pseudoaneurysm rupture.
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Affiliation(s)
- Baqir J. Kedwai
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Matthew Byrne
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Joshua T. Geiger
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Daniel J. Lehane
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Doran S. Mix
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Michael C. Stoner
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY
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Percutaneous thrombin injection in an infant to treat hepatic artery pseudoaneurysm after failed embolization. Pediatr Radiol 2013; 43:1532-5. [PMID: 23660876 DOI: 10.1007/s00247-013-2705-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 03/29/2013] [Accepted: 04/05/2013] [Indexed: 10/26/2022]
Abstract
Percutaneous thrombin injection has been described in case reports as an alternative to surgical intervention for the treatment of hepatic artery pseudoaneurysms associated with high-grade liver lacerations in adults. However, there is limited description in the literature of this technique being applied in children, particularly in preadolescents, and no published literature describes its use in infants. The procedure can be performed by pediatric radiologists and pediatric interventional radiologists skilled in ultrasound-guided aspiration techniques. We report successful application of percutaneous thrombin injection in an infant to treat a pseudoaneurysm of a left hepatic arterial branch in an 11-month-old girl with a grade IV liver laceration after superselective transcatheter arterial embolization failed to achieve thrombosis.
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Endovascular Management of Severe Bleeding After Major Abdominal Surgery. Ann Vasc Surg 2013; 27:1098-104. [DOI: 10.1016/j.avsg.2012.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 10/12/2012] [Accepted: 10/17/2012] [Indexed: 12/19/2022]
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Adkisson CD, Sibulesky L, Collis GN, McLaughlin DW, Oldenburg WA, Nguyen JH. Aneurysmectomy and revascularization of a large hepatic artery aneurysm. Ann Vasc Surg 2011; 25:556.e11-5. [PMID: 21549927 DOI: 10.1016/j.avsg.2010.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Accepted: 09/28/2010] [Indexed: 10/18/2022]
Abstract
Aneurysms of the hepatic artery are rare, but are associated with significant mortality because of their lack of symptoms at presentation and risk of rupture. We report a case of an enlarging 4-cm hepatic artery aneurysm involving the proximal common hepatic artery to the bifurcation of the right and left hepatic arteries which was found incidentally on ultrasound examination. Endovascular treatment with a stent was considered, but because of the location of the aneurysm as well as the presence of significant thrombosis involving the right and left hepatic arteries, aneurysmectomy and revascularization using saphenous vein was performed. Doppler ultrasound measurements demonstrated good flow through the graft postoperatively and at 1-month follow-up. Although a variety of endovascular techniques exist to treat hepatic artery aneurysms, our results indicate that open excision and revascularization may be required and can have a good outcome.
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Boufi M, Belmir H, Hartung O, Ramis O, Beyer L, Alimi YS. Emergency stent graft implantation for ruptured visceral artery pseudoaneurysm. J Vasc Surg 2011; 53:1625-31. [PMID: 21530142 DOI: 10.1016/j.jvs.2011.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Revised: 02/09/2011] [Accepted: 02/09/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND Literature series that include visceral artery pseudoaneurysms rarely separate them from true aneurysms, although they address different issues. Guidelines for optimal management of these lesions are lacking. We report our experience of stent graft treatment of these lesions with midterm results. METHODS We retrospectively reviewed all patients with a visceral pseudoaneurysm who were treated with a stent graft in our institution. Patient history, clinical characteristics, procedure details, and outcome were recorded and analyzed. RESULTS From March 2004 to June 2009, 10 consecutive patients (9 men), who were a mean age of 59 years, were treated for symptomatic visceral artery pseudoaneurysm, with hemorrhagic shock in 8 patients (80%), after pancreaticoduodenectomy in 8, gastrectomy in 1, and abdominal trauma in 1. A mean of 24 days (range, 7-60 days) passed between the initial surgery or trauma and pseudoaneurysm diagnosis. Septic complications were associated in six patients (60%). The pseudoaneurysm was in the hepatic artery in 8 patients, the splenic artery in 1, and the superior mesenteric artery in 1. Technical and clinical success was achieved in 80% of patients. Two failures of catheterization were followed by redo surgery and death (20%). No patients died postoperatively, and no complications among the patients who were treated successfully. Mean follow-up was 37 months (range, 10-63 months). All stent grafts were patent, with no signs of infection. Two patients died secondary to neoplasm. No rebleeding or recurrent aneurysms were noted. CONCLUSION Stent graft exclusion of visceral artery pseudoaneurysm seems to be a valid therapeutic approach regardless of the patient's septic or hemodynamic status.
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Affiliation(s)
- Mourad Boufi
- Department of Vascular Surgery, University Hospital Nord, Marseille, France.
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Luebke T, Heckenkamp J, Gawenda M, Beckurts KTE, Lackner K, Brunkwall J. Combined Endovascular–Open Surgical Procedure in a Great Hepatic Artery Aneurysm. Ann Vasc Surg 2007; 21:807-12. [PMID: 17703916 DOI: 10.1016/j.avsg.2007.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 04/21/2007] [Accepted: 06/28/2007] [Indexed: 10/21/2022]
Abstract
Visceral artery aneurysms are rare lesions. They involve the hepatic artery in approximately 20% of cases. Various therapeutic options are available for patients with hepatic artery aneurysms (HAAs). Dictated predominately by the need to maintain distal end-organ perfusion, potential therapies include traditional surgical techniques and laparoscopic surgery, endovascular methods of embolization, and stenting of the lesions. There is still a lack of studies demonstrating the comparative efficacy or inefficacy of any particular treatment, so there are currently no precise indications for determining which type of treatment should be used. In this paper, we present a case of great HAA in a 59-year-old man. He was preoperatively diagnosed and treated with a combined surgical and endovascular approach. The clinical presentation, management, and therapy of patients with HAAs are discussed. In addition to that, we reviewed the literature dealing with HAAs. This case report lays emphasis on the aspect that the treatment strategy in HAAs has to be determined individually in each case due to the high anatomic variability of the arterial supply of the liver. Treatment with a combined surgical and endovascular approach may reduce the risk of liver ischemia and morbidity.
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Affiliation(s)
- T Luebke
- Division of Vascular Surgery, University of Cologne, Cologne, Germany.
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Goffette PP. Imaging and Intervention in Post-traumatic Complications (Delayed Intervention). Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kaw LL, Saeed M, Brunson M, Delaria GA, Dilley RB. Use of a stent graft for bleeding hepatic artery pseudoaneurysm following pancreaticoduodenectomy. Asian J Surg 2006; 29:283-6. [PMID: 17098663 DOI: 10.1016/s1015-9584(09)60103-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Although uncommon, bleeding following pancreaticoduodenectomy is associated with high mortality. Management generally includes surgical reexploration or, alternatively, transarterial embolization. We report the case of a 62-year-old man who presented with massive upper gastrointestinal bleeding 3 weeks after pancreaticoduodenectomy. Selective coeliac angiography revealed a large pseudoaneurysm involving the proper hepatic artery. This was treated successfully with a stent graft. There was no recurrence of bleeding at the 6-month follow-up. To our knowledge, this is the first report of stent graft repair of bleeding hepatic artery pseudoaneurysm following pancreaticoduodenectomy.
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Affiliation(s)
- Leoncio L Kaw
- Division of Cardiothoracic and Vascular Surgery, Scripps Clinic and Scripps Green Hospital, La Jolla, California, USA.
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Dambrin C, Marcheix B, Birsan T, Cron C, Muscari F, Suc B, Cérène A, Rousseau H. Posttraumatic pseudoaneurysm of the hepatic artery: treatment with ultrasound-guided percutaneous transhepatic thrombin injection. ACTA ACUST UNITED AC 2005; 59:239-42. [PMID: 16096571 DOI: 10.1097/01.ta.0000171526.24911.b2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Camille Dambrin
- Department of Cardiovascular Surgery, Rangueil Hospital, Toulouse, France.
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Sessa C, Tinelli G, Porcu P, Aubert A, Thony F, Magne JL. Treatment of visceral artery aneurysms: description of a retrospective series of 42 aneurysms in 34 patients. Ann Vasc Surg 2005; 18:695-703. [PMID: 15599627 DOI: 10.1007/s10016-004-0112-8] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Visceral artery aneurysms (VAA) can be treated by revascularization, ligation, or, most often, endovascular techniques depending on clinical presentation, hemodynamic status, and location. From 1975 to 2002 a total of 42 VAA in 34 patients were treated. The lesion involved the splenic artery (SA; 19), pancreaticoduodenal artery (PDA; 6), celiac trunk (CT; 5), superior mesenteric artery (SNA; 4), common hepatic artery (CHA; 3), gastroduodenal artery (GDA; 2), left hepatic artery (LHA; 1), a branch of the inferior mesenteric artery (BIMA; 1), and a branch of the SMA (BSMA; 1). Twenty-seven VAA in 21 patients (64%) were uncomplicated (group I) and 15 VAA in 13 patients (36%) had ruptured (group II) (PDA; 6; CT, 3; SA, 1; CHA, 1; LHA, 1; BSMA, 1; BIMA, 1). In group I VAA were treated by embolization (n = 11), splenectomy (n = 6), bypass (n = 7), ligation (n = 2), and aneurysmorraphy (n = 1). No deaths were observed. The morbidity rate associated with surgical treatment was 12% including hepatic bypass thrombosis without ischemic complications in two cases. The morbidity rate associated with endovascular treatment was 18% including cholecystitis in one case and bile duct stenosis in one case. The VAA recanalization rate following embolization was 9%. In group II, 12 VAA (80%) were treated by ligation in association with splenectomy in two cases and left hepatectomy in one case. Only one bypass procedure was performed and embolization was used to treat two VAA (1 SMA and 1 PDA). The mortality rate was 20% (3/15). The morbidity rate associated with surgical treatment was 46% (6/13) including bile duct stenosis in one case, ischemic cholecystitis in one case, duodenal fistula in one case, pancreatic fistula in one case, bile tract fistula in one case, and colonic ischemia in one case. No patient died after endovascular treatment and the morbidity rate was 50% (1/2) with duodenal stenosis occurring in one case. In sum, VAA can rupture. Emergency cases can be treated by ligation in most cases or by embolization if the hemodynamic status of the patient allows. Regardless of treatment technique, the morbidity and mortality rate remains high after rupture, especially in cases involving PDA. Embolization can be proposed as a first-line treatment for most VAA. Because of the risk of rupture, endovascular or open repair is warranted for VAA and has a favorable prognosis.
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Affiliation(s)
- Carmine Sessa
- Department of Vascular Surgery, Grenoble University Hospital, Grenoble, France.
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Marcheix B, Dambrin C, Cron C, Sledzianowski JF, Aguirre J, Suc B, Cerene A, Rousseau H. Embolisation transhépatique percutanée d’un pseudoanévrisme post-traumatique de l’artère hépatique. ACTA ACUST UNITED AC 2004; 129:603-6. [PMID: 15581823 DOI: 10.1016/j.anchir.2004.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pseudoaneurysm of the hepatic artery is a rare complication of blunt abdominal trauma. We report a case of post-traumatic pseudoaneurysm diagnosed several months after the initial traumatism in a 18-year-old man who presented recurrent abdominal pain. This pseudoaneurysm was successfully treated by association of both classical endovascular treatment and transhepatic percutaneous embolization.
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Affiliation(s)
- B Marcheix
- Service de chirurgie cardiovasculaire, CHU Rangueil, 1, avenue Jean-Poulhes, 31403 Toulouse, cedex, France
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Prokesch RW, Bankier AA, Ba-Ssalamah A, Schima W, Bader TR, Lammer J. Displacement of coils into the lung during embolotherapy: clinical importance and follow-up with helical CT. Acad Radiol 2001; 8:501-8. [PMID: 11394543 DOI: 10.1016/s1076-6332(03)80622-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
RATIONALE AND OBJECTIVES The authors performed this study to evaluate the clinical importance and computed tomographic (CT) appearance of coils displaced into the lung during embolotherapy. MATERIALS AND METHODS The authors retrospectively studied clinical charts and serial chest images from 25 consecutive patients after coil embolization. Chest radiography was performed in all patients, whereas helical chest CT was performed only in patients in whom dislocated coils were visible on chest radiographs. Coils were applied for the treatment of peripheral arteriovenous (AV) malformations and fistulas (n = 9), renal AV malformations or fistulas (n = 8), and primary or secondary tumors (n = 8). Clinical charts were analyzed for short- and long-term symptoms; chest radiographs and CT scans were reviewed for signs indicative of pulmonary infarction. RESULTS None of the patients had clinical symptoms suggestive of pulmonary infarction. In two of the 25 patients (8%), displaced coils were seen in the pulmonary vasculature at chest radiography; these patients had been treated for renal AV fistula and peripheral AV fistula, respectively. One patient had two coils in the left hemithorax (upper and lower lobe), and the other patient had two coils in the right hemithorax (middle lobe). Neither of the patients had abnormalities suggestive of pulmonary infarction at helical CT. CONCLUSION Chest radiography can help confirm the presence of coils displaced to the pulmonary vasculature during embolotherapy. Helical CT can also help rule out the presence of coil-associated pulmonary infarction.
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Affiliation(s)
- R W Prokesch
- Department of Radiology, University of Vienna, Austria
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Glehen O, Feugier P, Ducerf C, Chevalier JM, Baulieux J. [Hepatic artery aneurysms]. ANNALES DE CHIRURGIE 2001; 126:26-33. [PMID: 11255968 DOI: 10.1016/s0003-3944(00)00453-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIM OF THE STUDY The aim of this retrospective study was to report a series of nine aneurysms of the hepatic arteries, including real aneurysms (n = 4), pseudoaneurysms (n = 3) and false aneurysms (n = 2) observed from 1987 to 1999. PATIENTS There were 7 men and 2 women (mean age: 58 years). In 3 cases, the aneurysm was asymptomatic and detected by sonography; in 4 cases it was revealed by rupture with a severe hemorrhage and in 2 cases by cholestasis. The aneurysm was located on right (n = 3), proper and common (n = 3), proper (n = 2), and common (n = 1) hepatic arteries. The aneurysm was associated with hepatocellular carcinoma (n = 1), carcinoma of the head of the pancreas (n = 1) and liver metastases (n = 1). METHODS AND RESULTS Eight patients were operated and one of them was operated three times. Hepatic arterial blood supply was restored in 6 patients with simple suture (n = 1), Goretex graft (n = 2), allograft (n = 2) and autologous vein (n = 1), with one failure which required liver retransplantation. Only one of the three attempts of embolization was successful. One patient with surgical contraindications died from hemobilia after embolization failure. During follow-up, there was one thrombosis of the common hepatic artery which had been excluded and two late deaths: one from rupture of a false aneurysm after bypass with an allograft and one by terminal progression of the cancer. The other 6 patients were alive at the time of this study. CONCLUSION Clinical characteristics and therapeutic indications of hepatic arterial aneurysm are variable. Management is usually surgical, while embolization is reserved for special circumstances. Restoration of the hepatic arterial blood supply is necessary in aneurysms located on the proper hepatic artery.
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Affiliation(s)
- O Glehen
- Service de chirurgie générale et thoracique, centre hospitalier Lyon-Sud, 69495 Pierre Bénite, France.
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