Abstract:

Case report of successful endovascular treatment of pseudoaneurysm of common hepatic artery (patient underwent laparoscopic gastrectomy, cholecystectomy with lymph node dissection in treatment of gastric adenocarcinoma) is presented.

Materials and methods: patient E., 61 year. In anamnesis: ulcer disease for the period of 8 years. In 2013, gastric adenocarcinoma T4N0M0 had been revealed and in January 2014 patient underwent laparoscopic gastrectomy, cholecystectomy with lymph node dissection D2. Postoperative period was complicated by thrombosis of left branch of portal vein, external biliary fistula, left subdiaphragmatic abscess with further drainage. During CT-angiography - adenoma of left adrenal gland and aneurysm of proper hepatic artery were revealed. Selective angiography revealed aneurysm of common hepatic artery in middle third, sized 10x20 mm. Patient underwent double-staged treatment. Primary patient underwent embolization of aneurysm with Azur-18 coils, but aneurysm cavity had incomplete thrombosis. As a second stage patient underwent stent-graft implantation in hepatic artery.

Results: stent implantation was uncomplicated, aneurysm was excluded from blood flow. Patient was discharged in good condition, without any additional operation. Control angiography was performed in 3 months and thrombosis of stent with collateral blood flow were revealed. 

References

1.     Wagner W.H., Allins A.D., Treiman R.L., Cohen J.L., Foran R.F., Levin PM., Cossman D.V. Ruptured visceral artery aneurysms. Ann. Vasc. Surg. 1997 Jul; 11(4): 342-347.

2.     Hossain A., Reis E.D., Dave S.P, Kerstein M.D., Hollier L.H. Visceral artery aneurysms: experience in a tertiary-care center. Am. Surg. 2001 May;67(5):432-7.

3.     Kasirajan K., Greenberg R.K., Clair D., Ouriel K. Endovascular management of visceral artery aneurysm. J. Endovasc. Ther. 2001 Apr; 8(2):150-5.

4.     Gabelmann A., Gorich J., Merkle E.M. Endovascular treatment of pseudoaneurysm of the common hepatic artery with intra-aneurysmal glue (N-butyl 2-cyanoacrylate) embolization. Cardiovasc. Intervent. Radiol. 2007 Sep-Oct; 30(5):999-1002.

5.     Grego F.G., Lepidi S., Ragazzi R., Iurilli V., Stramanа R., Deriu G.P Visceral artery aneurysms: a single center experience. Cardiovasc. Surg. 2003 Feb;11(1):19-25.

6.     Garg A., Banait S., Babhad S., Kanchankar N.. Nimade P, Panchal C. Endovascular treatment of visceral artery aneurysms. J. Endovasc. Ther. 2002 Feb;9(1): 38-47.

7.     Sakai H., Urasawa K., Oyama N., Oabatake A., Successful covering of a hepatic artery aneurysm with a coronary stent graft. Cardiovasc. Intervent. Radiol. 2004 May- Jun;27(3):274-7.

8.     Jenssen G.L., Wirsching J., Pedersen G., Amundsen S.R., Aune S., Dregelid E., Jonung T., Daryapeyma A., Lax- dal E. Treatment of a hepatic artery aneurysm by endovascular stent-grafting. Cardiovasc. Intervent. Radiol. 2007 May-Jun;30(3):523-5.

9.     Suhny Abbara, T. Gregory Walker, Steven G. Imbesi. Diagnostic imaging, cardiovascular. First edition, 2008; II, 5: 62-65.

10.   Jecko V., Benali L., Vignes J.F., Vignes J.R. Hepatic artery aneurysm rupture after lumbar stenosis surgery. Medico-legal thinking. France Neurochirurgie. 2014 Feb- Apr;60(1-2):38-41.

11.   Fatic N., Music D., Zornic N., Radojevic N. Hepatic artery aneurysm developing after Billroth's operation. Ann. Vasc. Surg. 2014 May; 28(4):1033.e1-3.

12.   Asai K., Watanabe M., Kusachi S., Matsukiyo H., Saito T., Kodama H., Enomoto T., Nakamura Y, Okamoto Y, Saida Y, lijima R., Nagao J. Successful treatment of a common hepatic artery pseudoaneurysm using a coronary covered stent following pancreatoduodenectomy: report of a case. Surg. Today. 2014 Jan; 44(1):160-5.

13.   Lu PH., Zhang X.C., Wang L.F., Chen Z.L., Shi H.B. Stent graft in the treatment of pseudoaneurysms of the hepatic arteries. ^ina Vasc. Endovascular Surg. 2013 Oct; 47(7):551-4.

14.   Suvorova U.V., Tarazov P.G., Polikarpov A.A., Balahin P.V., Polehin A.S. Stentirovanie obschey pechenochnoy i verhney bryzheechnoy arterii dlia ostanovki massivnogo arterialnogo krovotechenia [Stenting of common hepatic artery and superior mesenteric artery for stopping of massive arterial bleeding.] Mezhdunarodniy zhurnal interventsionnoy kardioangiologii. 2013; 35: 73 [In Russ].

15.   Kokov L.S., Cygankov V.N., Shutihina I.V., Zjatenkov A.V. Implantacija samoraskryvajushhihsja stentov-graftov v lechenii lozhnyh anevrizm selezenochnoj arterii [Implantation of self-expanding stent-graft in treatment of pseudoaneurysm of splenic artery]. Diagnosticheskaja i intervencionnaja radiohgija. 2013; 7(1): 75-82 [ In Russ].

16.  Sundeep Punamia, Singapore Transhepatic arterial cannulation and embolisation of hepatic artery pseudoaneurism. poster report frome CIRSE 2014, Glasgow, UK.