Management of a common and proper hepatic artery aneurysm

Quincke Triad and Hepatic Artery Pseudoaneurysm Presenting to the Emergency Department: A Case Report

INTRODUCTION

Hepatic artery aneurysms are exceedingly rare, often asymptomatic, and usually diagnosed when patients present with complications such as rupture or bile duct obstruction.

CASE REPORT

This report describes a 70-year-old female who presented to the emergency department with Quincke triad (epigastric pain, obstructive jaundice, and gastrointestinal bleeding) and was diagnosed with multiple hepatic artery pseudoaneurysms with a thrombosed fistulous connection to the biliary system. She was treated effectively with extensive embolization and biliary stenting.

CONCLUSION

This case underscores the importance of early diagnosis and highlights the role of multidisciplinary intervention in preventing life-threatening complications from hepatic artery aneurysms.

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.

Hepatic artery aneurysm with no proximal neck and proper hepatic artery bifurcation involvement

We report the case of a patient with a saccular aneurysm of the hepatic artery with maximum diameter of 2.8 cm, no proximal neck, and involving the bifurcation of the proper hepatic artery, constituting a hostile anatomy for endovascular treatment, which would usually be the first choice for such cases. We performed open surgical treatment with resection and reconstruction using an autologous graft (internal saphenous vein). We illustrate the surgical technique used for adequate vascular exposure of the celiac trunk and hepatic hilum (which is often an area little explored by vascular surgeons) and of structures anatomically close to the hepatic artery. We also illustrate the anastomosis with telescoping technique. We demonstrate the need for vascular surgeons to master the anatomy and classical surgical technique for visceral branches, even in the era of minimally invasive procedures.

Right Gastroepiploic Artery Transposition for a Common Hepatic Artery and Proper Hepatic Artery Aneurysm Repair

Although hepatic artery aneurysms (HAAs) are uncommon, they are associated with risk of rupture. HAAs >2 cm in diameter require endovascular or open surgical repairs. For HAAs involving the proper hepatic artery or gastroduodenal artery, which is a collateral artery from the superior mesenteric artery, hepatic arterial reconstruction is especially important to avoid ischemic liver injury. In this study, right gastroepiploic artery transposition was performed in a 53-year-old man after a 4 cm common hepatic artery and proper hepatic artery aneurysm was identified. The patient was discharged without any complications on postoperative day 8.

Splenic artery transposition for reconstruction of a large hepatic artery aneurysm: A case report and literature review

INTRODUCTION AND IMPORTANCE

Hepatic artery aneurysms (HAAs) are rare. Typical treatment options for HAAs are surgical resection and endovascular treatment but treatment choices remain controversial.

CASE PRESENTATION

A 65-year-old woman was rushed to our hospital suspected to have hemorrhage. Contrast-enhanced CT showed a large 12 cm aneurysm of the common hepatic artery (CHA). We diagnosed duodenal hemorrhage due to imminent rupture of the HAA. Angiography was first performed. The inferior pancreaticoduodenal artery was embolized with a coil under interventional radiology technique for arterial bleeding control. Next, we performed resection of the aneurysm and total pancreatectomy with splenic artery reservation. We reconstructed via splenic artery transposition because of the reconstruction distance, vascular system, and stability of the anastomosis. The patient was discharged from the hospital on postoperative day 21 without any complications.

CLINICAL DISCUSSION

There are two key points in this report. Firstly, the choice of splenic artery transposition is optimal for caliber difference and reconstruction distance. The choice of splenic artery should be considered a reliable option. Secondly, total pancreatectomy avoids exposure to pancreatic juice at the anastomosis site due to pancreatic fistula.

CONCLUSION

Splenic artery transposition for HAA is advantageous in adjustability of the caliber difference and securing of sufficient distance. In addition, total pancreatectomy may be acceptable in patients with a normal pancreas to avoid fatal complications such as disruption of the anastomosis and reconstructed artery due to pancreatic juice exposure.