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      Idiopathic Giant Hepatic Artery Pseudoaneurysm

      case-report

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          Abstract

          Hepatic artery pseudoaneurysm (HAP) incidence is rising due to more common use of endoscopic and percutaneous hepatic interventions. HAP is potentially fatal, as it could lead to sudden life-threatening hemorrhage. HAP can be intrahepatic or extrahepatic. On computed tomography angiogram (CTA) and magnetic resonance angiogram (MRA), HAP follows blood pool on multiphasic examination, with brisk arterial enhancement that washes out, similar to the abdominal aorta on later phases. We present a case of idiopathic giant HAP in an 82-year-old male. Currently, angioembolization is replacing surgery as the initial modality of choice for management of this condition.

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          Pseudoaneurysms and the role of minimally invasive techniques in their management.

          Nael Saad, Wael Saad, Mark Davies … (2005)
          Pseudoaneurysms are common vascular abnormalities that represent a disruption in arterial wall continuity. Some complications associated with pseudoaneurysms develop unpredictably and carry high morbidity and mortality rates. The advent of new radiologic techniques with a greater sensitivity for asymptomatic disease has allowed more frequent diagnosis of pseudoaneurysms. Conventional angiography remains the standard of reference for diagnosis but is an invasive procedure, and noninvasive diagnostic modalities (eg, ultrasonography [US], computed tomographic angiography, magnetic resonance angiography) should be included in the initial work-up if possible. A complete work-up will help in determining the cause, location, morphologic features, rupture risk, and clinical setting of the pseudoaneurysm; identifying any patient comorbidities; and evaluating surrounding structures and relevant vascular anatomy, information that is essential for treatment planning. Therapeutic options have evolved in recent years from the traditional surgical option toward a less invasive approach and include radiologic procedures such as US-guided compression, US-guided percutaneous thrombin injection, and endovascular management (embolization, stent-graft placement). The use of noninvasive treatment has led to a marked decrease in the morbidity and mortality rates for pseudoaneurysms. Copyright RSNA, 2005.
          Article 0 comments Cited 118 times – based on 0 reviews     Review now
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            Hepatic artery aneurysm: factors that predict complications.

            Peter Gloviczki, Whitney Panneton, Richard J Fowl … (2003)
            We reviewed the Mayo Clinic experience with management and outcome of hepatic artery aneurysms (HAA). Retrospective review of charts for 306 patients with true visceral aneurysm diagnosed from 1980 to 1998 enabled identification of 36 patients (12%) with HAA. Patients with HAA included 23 men and 13 women, with mean age of 62.2 years (range, 20-85 years). Most aneurysms were extrahepatic (78%) and single (92%). Mean aneurysm diameter at presentation was 3.6 cm (range, 1.5-14 cm). Five aneurysms had ruptured (14%), and four were symptomatic (11%). Mortality from rupture was 40%. Of the 9 patients with ruptured or symptomatic aneurysms, 2 patients had multiple HAA, 3 patients had fibromuscular dysplasia, and 2 patients had polyarteritis nodosa. All five HAAs that ruptured were of nonatherosclerotic origin (P =.001). Fourteen patients (39%) underwent elective procedures, including excision with vein graft (n = 7), excision with dacron graft (n = 3), excision alone (n = 2), and percutaneous embolization (n = 2). Two vein grafts and one dacron graft became occluded within 1 year. Nonoperative management was elected in 22 patients (61%) with mean aneurysm diameter 2.3 cm (range, 1.5-5 cm). No complications related to the aneurysm occurred during mean follow-up of 68.4 months (range, 1-372 months). Aneurysm growth was identified in 27%, the greatest being 0.8 cm over 34 months. HAA are at definite risk for rupture (14%). Risk factors for rupture include multiple HAA and nonatherosclerotic origin. Patients with symptomatic aneurysms or any of these risk factors should be considered for intervention.
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              Hepatic artery aneurysm.

              J F Olliff, S. Olliff, D O'Driscoll (1999)
              Hepatic artery aneurysms (HAAs) are rare. A review of the English language literature from 1985 to 1995 for reports of visceral artery aneurysms showed HAA to be the most frequently reported visceral aneurysm during that decade. This increase in incidence relates to the increasing use of percutaneous diagnostic and therapeutic procedures. A second factor is the increased use of diagnostic CT scanning after blunt liver trauma. The purpose of this pictorial review is to illustrate the imaging presentation and radiological management of HAAs.
              Article 0 comments Cited 23 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Ahmed Abdelbaki:
                ORCID: http://orcid.org/0000-0001-6280-415X
                Journal
                Journal ID (nlm-ta): Case Rep Vasc Med
                Journal ID (iso-abbrev): Case Rep Vasc Med
                Journal ID (publisher-id): CRIVAM
                Title: Case Reports in Vascular Medicine
                Publisher: Hindawi
                ISSN (Print): 2090-6986
                ISSN (Electronic): 2090-6994
                Publication date (Print): 2017
                Publication date (Electronic): 17 October 2017
                Volume: 2017
                Electronic Location Identifier: 4658065
                Affiliations
                1Department of Radiology, Yale New Haven Health, Bridgeport Hospital, 267 Grant St, Bridgeport, CT 06610, USA
                2Department of Radiology, St Vincent's Medical Center, 2800 Main St, Bridgeport, CT 06606, USA
                3Department of Medicine, Yale New Haven Health, Bridgeport Hospital, 267 Grant St, Bridgeport, CT 06610, USA
                4Department of Radiology, Columbia University at Bassett Healthcare, 1 Atwell Rd, Cooperstown, NY 1332, USA
                Author notes

                Academic Editor: Nikolaos Papanas

                Author information
                http://orcid.org/0000-0001-6280-415X
                Article
                DOI: 10.1155/2017/4658065
                PMC ID: 5664268
                SO-VID: 6fe494ff-e42d-4535-b19a-6d629fe7d329
                Copyright © Copyright © 2017 Ahmed Abdelbaki et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 6 May 2017
                Date accepted : 6 August 2017
                Categories
                Subject: Case Report

                Data availability:

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