Skip to main content
NCBI home page
Cureus logoLink to Cureus
. 2024 Jun 12;16(6):e62228. doi: 10.7759/cureus.62228

Combined Endovascular Repair of a Giant Symptomatic Hepatic Aneurysm: A Case Report and Comprehensive Literature Review

Konstantinos Tigkiropoulos 1,✉, Katerina Sidiropoulou 1, Manolis Abatzis-Papadopoulos 1, Dimitrios Karamanos 1, Ioannis Lazaridis 1, Nikolaos Saratzis 1
Editors: Alexander Muacevic, John R Adler
PMCID: PMC11244715  PMID: 39006572

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.

Keywords: covered stent, embolization, endovascular repair, giant aneurysm, hepatic artery aneurysm

Introduction

Splanchnic artery aneurysms are an uncommon but life-threatening vascular condition, with an incidence of 0.1-2% [1,2]. Hepatic artery aneurysms (HAAs) are the second most common splanchnic artery aneurysms. They represent 20% of all splanchnic aneurysms, and they have a 44% risk of rupture with high mortality rates [3]. The majority occur in the common hepatic artery and the proper hepatic artery, while men are more affected than women [4]. Giant HAAs are defined as aneurysms with a diameter >5 cm [5]. We present the case of a male patient with a giant symptomatic common HAA, who was treated with combined endovascular means, coil embolization, and stent graft deployment. A review of the current literature regarding endovascular repair of giant HAAs was additionally performed.

Case presentation

A 51-year-old Caucasian male patient was referred to our hospital from a secondary medical unit with abdominal and lower back pain. His medical history included arterial hypertension and multiple vertebral body fractures after a car accident 15 years ago. The patient did not refer alcohol consumption, smoking, and a recent infectious disease. A contrast-enhanced computed tomography (CT) was performed which revealed a giant common HAA of a maximum diameter of 11.1×6.8 cm with mural thrombus and no signs of rupture (Figure 1, Figure 2).

Figure 1. Contrast-enhanced CT axial view of the giant hepatic aneurysm.

Figure 1

Open in a new tab

CT: computed tomography

Figure 2. Contrast-enhanced CT coronal view of the giant hepatic artery (black arrow).

Figure 2

Open in a new tab

CT: computed tomography

The aneurysm was expanding from the celiac artery bifurcation to the liver hilum. The portal venous system was intact without the presence of thrombosis due to possible compression from the aneurysm. The gastroduodenal artery and the proper hepatic artery and its bifurcation were not identifiable at CT. Due to the anatomy of the aneurysm, an endovascular approach was deemed feasible. The patient was informed of his treatment options (open and endovascular) and possible adverse events, and endovascular repair was chosen. A written informed consent was obtained from the patient.

Under general anesthesia, the left arm and abdomen were prepped and draped. Vascular access was gained by the surgical cutdown of the left brachial artery. After systemic heparinization (75 units/kg), a 5-Fr introducer sheath was introduced, and a 0.035-inch guidewire (Radifocus™, Terumo, Tokyo, Japan) was advanced to the abdominal aorta with a RIM catheter (Boston Scientific, Marlborough, Massachusetts, United States) to cross the aortic arch. The sheath was exchanged with a 7-Fr 90-cm-long sheath (Arrow International, Brooklyn, Ohio, United States). The HAAs were catheterized with a 5-Fr Bern catheter 100 cm (Boston Scientific). An angiography was performed which revealed the presence of small collaterals in the liver hilum and the absence of right and left hepatic arteries (Figure 3).

Figure 3. Intraoperative angiography revealed the presence of small collaterals in the liver hilum and the absence of right and left hepatic arteries.

Figure 3

Open in a new tab

Seven coils (Interlock, Boston Scientific) of different sizes 18×20, 18×40, and 20×40 were released to the distal part of the aneurysm. Because of the lack of a proximal landing zone as well as the poor liver perfusion from the hepatic artery, we decided to exclude the inflow of the aneurysm by deploying a balloon-expandable covered stent 9×37 mm (Bentley®, Innomed, Germany) from the celiac artery to the splenic artery (Figure 4).

Figure 4. Intraoperative angiography showed the bifurcation of the hepatic and splenic artery with inadequate proximal landing zone.

Figure 4

Open in a new tab

The final angiographic control revealed the occlusion of the aneurysm and perfusion of the splenic artery (Figure 5). 

Figure 5. Deployment of the covered stent to the splenic artery with inflow exclusion of the hepatic aneurysm.

Figure 5

Open in a new tab

The perioperative period was uneventful without any clinical and laboratory signs of liver ischemia. The patient was discharged on the fourth postoperative day (POD) under dual antiplatelet treatment (Salospir 100+clopidogrel 75 mg) for three months followed by a single lifelong antiplatelet treatment and proton pump inhibitor regimen. No significant changes in the hepatic enzyme's levels were observed during follow-up. At the three-month follow-up, the patient was free of symptoms, and the computed tomography angiography (CTA) showed a significant reduction in the size of the aneurysm. CT scan at six months revealed excellent patency of the stent graft to the splenic artery and shrinkage of hepatic aneurysm at 5 cm (Figure 6).

Figure 6. CTA at six months showed shrinkage of the aneurysm with no flow within and patent stent to the splenic artery.

Figure 6

Open in a new tab

CTA: computed tomography angiography

However, seven months after the operation, the patient presented to another hospital with upper gastrointestinal hemorrhage and anemia. A contrast-enhanced CT (Figure 7) and gastroduodenoscopy were performed which revealed a pylorus perforation with the presence of coils entering the lumen. A laparotomy was performed. After gastrotomy, multiple coils were found in the duodenum, as well as an arterio-pyloric fistula. Coils were removed, and a Heineke-Mikulicz pyloroplasty was performed with the placement of drainage next to the perforation site (Figure 8). His postoperative course was uncomplicated, and the patient was discharged on the 12th POD. 

Figure 7. Contrast-enhanced CT axial view depicted the pyloric erosion and protrusion of coils in the proximal part of the duodenum (black arrow).

Figure 7

Open in a new tab

CT: computed tomography

Figure 8. CT view after the removal of coils within the aneurysm (small arrow) and placement of drainage tube next to the lesion (long arrow).

Figure 8

Open in a new tab

CT: computed tomography

Discussion

HAAs, especially giants, are a rare pathological entity which, if left untreated, result in catastrophic consequences. Historically, open repair with aneurysmectomy and interposition graft placement was the treatment of choice. Nowadays, endovascular approach as a minimally invasive therapy offers lower morbidity and mortality and less duration of hospitalization [5]. Different endovascular techniques are available (packing embolization, isolation embolization, stent graft deployment) depending on the aneurysm's anatomy [6]. A narrative literature review regarding the endovascular repair of giant HAAs was performed. The search was conducted by two authors (KS, KT) for records published up until January 2024 and using the term "hepatic artery aneurysm" in the PubMed, Scopus, and Google Scholar databases (Figure 5). 

Figure 9. Flowchart diagram.

Figure 9

Open in a new tab

Screening was performed by title and abstract and in some cases using the full-text article. Eligibility criteria were HAAs with a minimum diameter of 5 cm that were treated using an endovascular approach. Manuscripts written in the English language were included in the review. Thirty-eight studies met the eligibility criteria [7-45] (Table 1). Male is the prevalent gender (73.2%). The mean age is 60.63 years, while in one case age is not reported. In 16 cases, the size of the aneurysm exceeds 8 cm in diameter (39%). The most common location of the aneurysm is the common hepatic artery (73.2%), proper hepatic artery (12.2%), right hepatic artery (9.7%), and left hepatic artery (4.9%). Arterial access was obtained in the majority of the cases through the femoral artery (58.5%), followed by the left brachial artery (9.7%), while in 13 cases (31.7%), vascular access was not reported.

Table 1. List of published studies regarding the endovascular repair of giant hepatic artery aneurysms.

NM: not mentioned

Author and year Sex Age Location/type Size (cm) Access site Endovascular intervention Complication
Larson et al. (2002) [8] Male 73 Common hepatic artery/pseudoaneurysm 8 Femoral artery Stent graft None
Qu et al. (2005) [9] Male 72 Common hepatic artery/pseudoaneurysm 10.3 Left femoral artery Endoaortic stent graft complex None
Dwivedi et al. (2006) [10] Male 56 Common hepatic artery/NM 8 Left femoral artery Coils None
Jenssen et al. (2007) [11] Male 61 Common hepatic artery aneurysm/true aneurysm 6 Right and left femoral artery Stent graft None
deFreitas et al. (2007) [12] Female 71 Common hepatic artery aneurysm/pseudoaneurysm 5.2 Brachial artery Stent graft None
Desai and Sekhar (2008) [13] Male 57 Common hepatic artery aneurysm/pseudoaneurysm 8.9 ΝΜ Coils None
Won et al. (2009) [14] Male 72 Common hepatic artery aneurysm/pseudoaneurysm 5 Femoral artery Stent graft None
Miraglia et al. (2010) [15] Male 52 Left hepatic artery/pseudoaneurysm 5 NM Coils, vascular plug None
Balderi et al. (2010) [16] Male 74 Common and proper hepatic artery aneurysm/NM 8.5 Right femoral artery Multilayer stent None
Christie et al. (2011) [17] Male 69 Common hepatic artery/pseudoaneurysm 11 NM Coils None
Huisman et al. (2011) [18] Female 48 Proper hepatic artery aneurysm/true aneurysm 6.3 Right femoral artery Bare metal stent, fibrin glue None
Ferrero et al. (2013) [19] Male 71 Common hepatic artery/NM 6 ΝΜ Stent grafts In 18 months, stent dislocation and sac expansion. Eventually, stent and CHA thrombosis
Cavalcante et al. (2014) [20] Female 56 Common hepatic artery and splenic artery/saccular aneurysm 12.5 Right femoral artery Vascular plug None
Buyukkaya et al. (2014) [21] Female 49 Proper hepatic artery/pseudoaneurysm 9.1 ΝΜ Covered stent None
Rossi et al. (2015) [22] Male 69 Common hepatic artery/NM 10 NM Non-adhesive liquid embolic ethylene-vinyl alcohol agent (Onyx®), vascular plug None
Hemmati et al. (2015) [23] Female 67 Common hepatic artery/true aneurysm 9.5 Left brachial artery Coils None
Yoon et al. (2016) [24] Male 67 Common hepatic artery/true aneurysm 15 Right femoral artery Stent grafts, metallic stents None
Pedersoli et al. (2016) [25] Male 56 Common hepatic artery/pseudoaneurysm 6.5 Right femoral artery Stent graft None
Attaoui et al. (2016) [26] Male 80 Proper hepatic artery/NM 6.2 NM Coils None
Zhang and Li (2016) [27] Female 7 Right hepatic artery/pseudoaneurysm 5.8 ΝΜ Coils None
Abdallah et al. (2017) [28] Male 66 Common hepatic artery/true aneurysm 11 NM Coils, non-adhesive liquid embolic ethylene-vinyl alcohol agent None
Abdelbaki et al. (2017) [29] Male 82 Right hepatic artery/pseudoaneurysm 14 ΝΜ Coils None
Soares et al. (2017) [30] Male 65 Common hepatic artery/true aneurysm 7.5 Right femoral artery Covered stent None
Ferrara et al. (2017) [31] Male 79 Common hepatic artery aneurysm/true aneurysm 7.2 Right femoral artery and left brachial artery Stent grafts None
Akasaka et al. (2018) [32] Female 73 Proper hepatic artery aneurysm/true aneurysm 6.5 Right femoral artery Microcoils None
Masuda et al. (2019) [33] Female 68 Common hepatic artery/true aneurysm 9 Right and left femoral artery Coils, vascular plug None
Gjoreski et al. (2019) [34] Female NR Common hepatic artery/true aneurysm 7 Brachial artery Closed-cell and double-layer micromesh stent None
Ferreras et al. (2019) [35] Male 45 Common hepatic artery and proper hepatic artery/pseudoaneurysm 6 NM Hydrocoils, vascular plug Immediate hepatic failure. The patient underwent liver transplantation
O'Connell et al. (2020) [36] Male 77 Common hepatic artery/true aneurysm 5.2 NM Covered stents None
Kwon et al. (2020) [37] Male 61 Common hepatic artery/true aneurysm 6 Right femoral artery Coils None
Hashem and Peddu (2020) [38] Female 54 Common hepatic artery/true aneurysm 7.6 Right femoral artery Covered stents in the common hepatic artery, coils in the gastroduodenal artery None
Gao et al. (2021) [39] Male 69 Common hepatic artery/true aneurysm 5.3 Right femoral artery Covered stents in the common hepatic artery, coils in the gastroduodenal artery Three months: sepsis, aerobilia, in-stent thrombosis, endoleak Ia. The patient underwent open repair
Mahmood et al. (2021) [40] Male 35 Left hepatic artery aneurysm/pseudoaneurysm 5.8 NM Gel foam, microcoils None
Kar and Patel (2021) [41] Male 50 Common hepatic artery/pseudoaneurysm 5.3 Right femoral artery Coils, thrombin injection, stent graft (1) In six months, endoleak: coils and stent graft. (2) In six years, coil extrusion into the duodenum and arterioenteric fistula: open repair
Tipaldi et al. (2021) [42] Male 69 Hepatic artery/true aneurysm 10 Right femoral artery Vascular plug, non-adhesive liquid embolic ethylene-vinyl alcohol agent (Onyx®) None
  Male 49 Hepatic artery/true aneurysm 5.6 Right femoral artery Peripheral occlusion device None
  Male 63 Hepatic artery/true aneurysm 5.2 Right femoral artery Covered stent None
  Male 69 Hepatic artery/true aneurysm 13 Right femoral artery Coils, vascular plug, peripheral occlusion device None
Clark et al. (2023) [43] Male 44 Proper hepatic artery/true aneurysm 5.5 Brachial artery Covered stents Three weeks: abdominal pain and endoleak via collateralization, followed by coil embolization
Çildağ et al. (2023) [44] Female 60 Right hepatic artery/true aneurysm 5 Right femoral artery and brachial artery Coils None
Ghasemi-Rad et al. (2023) [45] Male 20 Right hepatic artery/pseudoaneurysm 6.5 Femoral artery Balloon-assisted thrombin injection None
Open in a new tab

Fifteen patients (36.6%) were treated using stent grafts and closed-cell and double-layer micromesh stent [8,11,12,14,16,19,21,24,25,30,31,34,36,42,43]. Ten patients were treated exclusively by coils (24.4%) [10,13,17,23,26,27,29,32,37,44], but in most cases, a combination of endovascular methods was used (liquid embolic agent+vascular plug [22,42], coils+vascular plug [15,33,35], covered stents+coils [38,39], coils+liquid embolic agent [28,40], coils+vascular plug+peripheral occlusion device [42]). In one case, a stent graft complex was deployed into the aorta to seal the orifice of the celiac trunk, due to aneurysm extension and lack of proximal landing zone [9].

Postoperative complications were reported in five cases (13.5%) [19,35,39,41,43], whereas the mortality rate was 0%. Two of the five cases were managed with an endovascular approach [19,43], while the rest with an open repair [35,39,41]. Ferrero et al. reported that a 3.4 cm HAA previously treated with two multilayer stents showed a stent dislocation and sac expansion in 18 months follow-up [19]. The patient was treated with a new multilayer stent placement, but due to incorrect stent expansion, all three stents were thrombosed. However, the perfusion of the proper hepatic artery remained adequate, due to rich collateralization. In Ferreras et al., the patient experienced a fulminant hepatic failure after the embolization and was subjected to an immediate liver transplantation [35]. In Clark et al., a coil embolization within the sac and the covered stent was required three weeks postoperatively due to endoleak through collaterals [43]. In Gao et al., an open repair was chosen due to presented aerobilia, sepsis, in-stent thrombosis, endoleak Ia, and infection of the aneurysm [39]. Lastly, Kar and Patel report a recurrent filling of the aneurysmal sac in six months, which was treated with coil, stent graft, and plug placement [41]. After six years, the patient presented massive gastrointestinal bleeding, and the CTA showed a coil extrusion into the duodenum in the form of an arterioenteric fistula; hence, the patient underwent open repair. A duodenotomy was performed, the coils, the stent graft, and the plug were removed, and the celiac artery trunk along with the left gastric artery was ligated.

It is interesting that only one patient with giant HAA experienced acute ischemic hepatic failure after the embolization technique of distal outflow [35]. The liver has a dual blood supply from the portal vein (70%) and the hepatic artery (30%). Approximately 50% of oxygen demand is met by the portal vein and 50% by the hepatic artery [46]. Interruption of hepatic collateral circulation distal to the origin of the gastroduodenal artery can impair hepatic perfusion. However, the buffer response of the portal venous system with the ongoing angiogenesis which has been described during aneurysm evolution and is related to the presence of collateral circulation can minimize ischemia [46,47]. In our case, the patient had a patent portal venous system with the presence of small hepatic arterial collaterals in the liver hilum which probably minimized hepatic ischemia.

Endovascular treatment of giant visceral aneurysms offers different techniques such as coils, plugs, covered stents, glue, and microcatheters which can exclude flow in the aneurysm. Anatomical characteristics of the aneurysms like length, angulation, tortuosity, and proximal and distal landing zones should be evaluated preoperatively to choose the appropriate endovascular modality. In our case, we chose the double inflow-outflow blockage of the aneurysm by two endovascular means, proximally covered stent to deviate the flow to the splenic artery since there was inadequate proximal landing zone and distally coils to prevent backflow to the aneurysm. However, the patient presented seven months later with pylorus erosion due to coils and upper gastrointestinal hemorrhage and was managed by open repair. Kar and Patel [41] described duodenal erosion by coils six years after the operation. They concluded that the number of coils used to thrombose the aneurysm should be at the minimum to achieve hemostasis. 

Conclusions

Endovascular repair of giant hepatic aneurysms is an effective and feasible therapeutic approach. Proper preoperative planning and correct selection of endovascular devices are mandatory to achieve the exclusion of the aneurysm. A great concern should be raised regarding the possible erosion of the upper gastrointestinal tract by coils used for embolization during follow-up.

Acknowledgments

Konstantinos Tigkiropoulos and Katerina Sidiropoulou share first authorship.

Disclosures

Human subjects: Consent was obtained or waived by all participants in this study.

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following:

Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work.

Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work.

Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Author Contributions

Concept and design:  Konstantinos Tigkiropoulos, Katerina Sidiropoulou, Ioannis Lazaridis, Nikolaos Saratzis

Acquisition, analysis, or interpretation of data:  Konstantinos Tigkiropoulos, Katerina Sidiropoulou, Manolis Abatzis-Papadopoulos, Dimitrios Karamanos

Drafting of the manuscript:  Konstantinos Tigkiropoulos, Katerina Sidiropoulou

Critical review of the manuscript for important intellectual content:  Konstantinos Tigkiropoulos, Manolis Abatzis-Papadopoulos, Dimitrios Karamanos, Ioannis Lazaridis, Nikolaos Saratzis

Supervision:  Dimitrios Karamanos, Ioannis Lazaridis, Nikolaos Saratzis

References

  • 1.Natural history of splanchnic artery aneurysms. Batagini NC, Constantin BD, Kirksey L, Vallentsits Estenssoro AE, Puech-Leão P, De Luccia N, Simão da Silva E. Ann Vasc Surg. 2021;73:290–295. doi: 10.1016/j.avsg.2020.10.047. [DOI] [PubMed] [Google Scholar]
  • 2.Visceral artery aneurysm rupture. Carr SC, Mahvi DM, Hoch JR, Archer CW, Turnipseed WD. J Vasc Surg. 2001;33:806–811. doi: 10.1067/mva.2001.112320. [DOI] [PubMed] [Google Scholar]
  • 3.Assessment of open surgical and endovascular management of true hepatic artery aneurysms over 20 years highlights increased rupture risk in females. Stark JC, Eisenberg N, Mafeld S, McGilvray I, Roche-Nagle G, Howe KL. J Vasc Surg. 2022;75:1334–1342. doi: 10.1016/j.jvs.2021.12.054. [DOI] [PubMed] [Google Scholar]
  • 4.Common splanchnic artery aneurysms: splenic, hepatic, and celiac. Shanley CJ, Shah NL, Messina LM. Ann Vasc Surg. 1996;10:315–322. doi: 10.1007/BF02001900. [DOI] [PubMed] [Google Scholar]
  • 5.Contemporary management of splanchnic and renal artery aneurysms: results of endovascular compared with open surgery from two European vascular centers. Cochennec F, Riga CV, Allaire E, et al. Eur J Vasc Endovasc Surg. 2011;42:340–346. doi: 10.1016/j.ejvs.2011.04.033. [DOI] [PubMed] [Google Scholar]
  • 6.Hepatic artery aneurysms: endovascular therapeutic techniques. Rossi UG, Petrocelli F. Ann Hepatobiliary Pancreat Surg. 2021;25:167–170. doi: 10.14701/ahbps.2021.25.2.167. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Sonographic diagnosis of a giant aneurysm of the common hepatic artery. Bachar GN, Belenky A, Lubovsky L, Neuman-Levine M. J Clin Ultrasound. 2002;30:300–302. doi: 10.1002/jcu.10077. [DOI] [PubMed] [Google Scholar]
  • 8.Stent graft repair of visceral artery aneurysms. Larson RA, Solomon J, Carpenter JP. J Vasc Surg. 2002;36:1260–1263. doi: 10.1067/mva.2002.129645. [DOI] [PubMed] [Google Scholar]
  • 9.Endoaortic stent grafting of a giant infected hepatic-celiac pseudoaneurysm. Qu L, Jing Z, Feng R. J Vasc Surg. 2005;42:159–162. doi: 10.1016/j.jvs.2005.03.057. [DOI] [PubMed] [Google Scholar]
  • 10.Catheter embolization of an hepatic artery aneurysm: a case report. Dwivedi AJ, Greben C, Krishnasastry KV. Vasc Endovascular Surg. 2006;40:79–83. doi: 10.1177/153857440604000112. [DOI] [PubMed] [Google Scholar]
  • 11.Treatment of a hepatic artery aneurysm by endovascular stent-grafting. Jenssen GL, Wirsching J, Pedersen G, et al. Cardiovasc Intervent Radiol. 2007;30:523–525. doi: 10.1007/s00270-006-0089-5. [DOI] [PubMed] [Google Scholar]
  • 12.Endovascular stent exclusion of a hepatic artery pseudoaneurysm. deFreitas D, Phade S, Stoner M, Bogey W, Powell CS, Parker F. Vasc Endovascular Surg. 2007;41:161–164. doi: 10.1177/1538574406298517. [DOI] [PubMed] [Google Scholar]
  • 13.A rare cause of an abdominal mass. Desai D, Sekhar R. Indian J Surg. 2008;70:77–79. doi: 10.1007/s12262-008-0020-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Successful management of a ruptured hepatic artery pseudoaneurysm with a stent-graft. Won YD, Ku YM, Kim KT, Kim KH, Kim JI. Emerg Radiol. 2009;16:247–249. doi: 10.1007/s10140-008-0716-3. [DOI] [PubMed] [Google Scholar]
  • 15.Role of sonography in the diagnosis and treatment of a large iatrogenic pseudoaneurysm of a hepatic artery. Miraglia R, Caruso S, Maruzzelli L, Luca A, Gridelli B. J Clin Ultrasound. 2010;38:450–453. doi: 10.1002/jcu.20679. [DOI] [PubMed] [Google Scholar]
  • 16.Treatment of a hepatic artery aneurysm by endovascular exclusion using the multilayer cardiatis stent. Balderi A, Antonietti A, Pedrazzini F, Ferro L, Leotta L, Peano E, Grosso M. Cardiovasc Intervent Radiol. 2010;33:1282–1286. doi: 10.1007/s00270-010-9913-z. [DOI] [PubMed] [Google Scholar]
  • 17.Hepatic artery aneurysms: evolution from open to endovascular repair techniques. Christie AB, Christie DB 3rd, Nakayama DK, Solis MM. https://pubmed.ncbi.nlm.nih.gov/21679596/ Am Surg. 2011;77:608–611. [PubMed] [Google Scholar]
  • 18.Endovascular treatment of a patient with an aneurysm of the proper hepatic artery and a duodenal fistula. Huisman M, van den Bosch MA, Mooiweer E, Molenaar IQ, van Herwaarden JA. J Vasc Surg. 2011;53:814–817. doi: 10.1016/j.jvs.2010.10.089. [DOI] [PubMed] [Google Scholar]
  • 19.Disconnection of multilayer stents 2 years after treatment of a hepatic artery aneurysm. Ferrero E, Ferri M, Carbonatto P, Viazzo A, Calvo A, Nessi F. J Endovasc Ther. 2013;20:393–397. doi: 10.1583/12-4174R.1. [DOI] [PubMed] [Google Scholar]
  • 20.Endovascular treatment of a giant hepatic artery aneurysm with Amplatzer vascular plug. Cavalcante RN, Couto VA, da Fonseca AV, de Miranda RB, Costa AJ, Correa JA. J Vasc Surg. 2014;60:500–502. doi: 10.1016/j.jvs.2013.06.077. [DOI] [PubMed] [Google Scholar]
  • 21.Successful emergency endovascular treatment of iatrogenic giant hepatic artery pseudoaneurysm. Buyukkaya R, Aydın Ö, Erdogan C, Kaya E, Hakyemez B. https://pubmed.ncbi.nlm.nih.gov/25855988/ Ann Ital Chir. 2014;85:0. [PubMed] [Google Scholar]
  • 22.Giant hepatic artery aneurysm associated with immunoglobulin G4-related disease successfully treated using a liquid embolic agent. Rossi M, Virgilio E, Laurino F, et al. Korean J Radiol. 2015;16:953–954. doi: 10.3348/kjr.2015.16.4.953. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Endovascular treatment of a huge hepatic artery aneurysm by coil embolization method: a case report. Hemmati H, Karimian M, Moradi H, Farid Marandi K, Haghdoost A. Iran J Radiol. 2015;12:0. doi: 10.5812/iranjradiol.5200. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Endograft component separation in giant hepatic artery aneurysm. Yoon DY, Resnick SA, Eskandari MK, Rodriguez HE. J Vasc Surg. 2016;64:1140. doi: 10.1016/j.jvs.2015.12.063. [DOI] [PubMed] [Google Scholar]
  • 25.Stentgraft implantation for the treatment of postoperative hepatic artery pseudoaneurysm. Pedersoli F, Isfort P, Keil S, et al. Cardiovasc Intervent Radiol. 2016;39:575–581. doi: 10.1007/s00270-015-1274-1. [DOI] [PubMed] [Google Scholar]
  • 26.Huge aneurysm of the proper hepatic artery. Attaoui MA, Bayar R, Mzoughi Z, Omrani S, Gharbi L, Khalfallah MT. Clin Pract. 2016;6:846. doi: 10.4081/cp.2016.846. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Successful embolization of a huge hepatic artery pseudoaneurysm after blunt abdominal trauma. Zhang X, Li X. J Pediatr. 2016;168:252. doi: 10.1016/j.jpeds.2015.09.052. [DOI] [PubMed] [Google Scholar]
  • 28.Giant hepatic aneurysm presenting with hematemesis successfully treated with an endovascular technique. Abdallah FF, Serracino-Inglott F, Ananthakrishnan G. Vasc Endovascular Surg. 2017;51:331–334. doi: 10.1177/1538574417707145. [DOI] [PubMed] [Google Scholar]
  • 29.Idiopathic giant hepatic artery pseudoaneurysm. Abdelbaki A, Bhatt N, Gupta N, Li S, Abdelbaki S, Kumar Y. Case Rep Vasc Med. 2017;2017:4658065. doi: 10.1155/2017/4658065. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Endovascular treatment of proper hepatic artery aneurysm - case report. Soares T, Castro-Ferreira R, Neto M, et al. https://pubmed.ncbi.nlm.nih.gov/29701401/ Rev Port Cir Cardiotorac Vasc. 2017;24:171. [PubMed] [Google Scholar]
  • 31.Endovascular management of a large hepatic artery aneurysm. Ferrara D, Giribono AM, Viviani E, Padricelli A, Santagata A, Del Guercio L. Clin Ter. 2017;168:0–80. doi: 10.7417/T.2017.2001. [DOI] [PubMed] [Google Scholar]
  • 32.Coil embolisation for endovascular treatment of proper hepatic artery aneurysm using the balloon occlusion technique. Akasaka J, Saguchi T, Kennoki N, Shindo S. EJVES Short Rep. 2018;41:1–4. doi: 10.1016/j.ejvssr.2018.09.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.A case of giant common hepatic artery aneurysm successfully treated by transcatheter arterial embolization with isolation technique via pancreaticoduodenal arcade. Masuda K, Takenaga S, Morikawa K, Ashida H, Ojiri H. Radiol Case Rep. 2019;14:195–199. doi: 10.1016/j.radcr.2018.10.029. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Successful endovascular treatment of a giant hepatic artery aneurysm with dual layer stents placement as flow-diverting option: case report. Gjoreski A, Risteski F, Damjanoski G. Open Access Maced J Med Sci. 2019;7:403–406. doi: 10.3889/oamjms.2019.120. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Liver transplantation as a rescue surgery after failure of embolization of a giant hepatic artery pseudoaneurysm. Ferreras D, López-López V, Robles Campos R, Sánchez Bueno F, Ramírez P. Rev Esp Enferm Dig. 2019;111:798–801. doi: 10.17235/reed.2019.6223/2018. [DOI] [PubMed] [Google Scholar]
  • 36.Endovascular treatment of an asymptomatic hepatic artery aneurism: case report. O'Connell JL, Faria LA, de Souza MG, Meneses GA, Carrijo AM. J Vasc Bras. 2021;20:0. doi: 10.1590/1677-5449.200123. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Interventional treatment of a huge hepatic artery aneurysm as an unusual cause of upper gastrointestinal bleeding. Kwon SH, Yoon J, Noh SY, Ahn HJ, Oh JH. Int J Gastrointest Interv. 2020;9:24–26. [Google Scholar]
  • 38.Endovascular stenting of large hepatic artery aneurysm: case report. Hashem E, Peddu P. Surg Case Rep. 2020;3:3. [Google Scholar]
  • 39.Unsuccessful stent graft repair of a hepatic artery aneurysm presenting with haemobilia: case report and comprehensive literature review. Gao X, de Jonge J, Verhagen H, Dinkelaar W, Ten Raa S, van Rijn MJ. EJVES Vasc Forum. 2021;52:30–36. doi: 10.1016/j.ejvsvf.2021.06.008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Late development of giant hepatic artery pseudoaneurysm following abdominal trauma due to tire blast: case report and literature review. Mahmood I, Kasim M, El-Menyar A, et al. J Surg Case Rep. 2021;2021:0. doi: 10.1093/jscr/rjab564. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Vascular coil extrusion into the duodenum 6 years after hepatic artery aneurysm embolization. Kar R, Patel ST. J Vasc Surg Cases Innov Tech. 2021;7:772–777. doi: 10.1016/j.jvscit.2021.10.009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42.Endovascular management of giant visceral artery aneurysms. Tipaldi MA, Krokidis M, Orgera G, et al. Sci Rep. 2021;11:700. doi: 10.1038/s41598-020-80150-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43.Endovascular management of a symptomatic giant hepatic artery aneurysm. Clark A, Hicks AC, Cheadle G, Wayne E, Dwivedi A, Sigdel A. Am Surg. 2023;89:3922–3923. doi: 10.1177/00031348231173990. [DOI] [PubMed] [Google Scholar]
  • 44.Endovascular treatment of a giant aneurysm of the aberrant right hepatic artery in a patient with Osler-Weber-Rendu syndrome: a case report. Çildağ MB, Gök M, Öztürk T, Köseoğlu ÖFK. Vasc Specialist Int. 2023;39:25. doi: 10.5758/vsi.230055. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45.Trans-arterial balloon-assisted embolization of traumatic giant hepatic pseudoaneurysm with thrombin. Ghasemi-Rad M, Shastri R, Amaresh A, Wynne D, Whigham C. Vasc Endovascular Surg. 2023;57:764–767. doi: 10.1177/15385744231165595. [DOI] [PubMed] [Google Scholar]
  • 46.Lautt WW. San Rafael (CA): Morgan & Claypool Life Sciences. San Rafael (CA): Morgan & Claypool Life Sciences; 2009. Hepatic circulation: physiology and pathophysiology. [PubMed] [Google Scholar]
  • 47.Ongoing angiogenesis in blood vessels of the abdominal aortic aneurysm. Paik DC, Fu C, Bhattacharya J, Tilson MD. Exp Mol Med. 2004;36:524–533. doi: 10.1038/emm.2004.67. [DOI] [PubMed] [Google Scholar]

Articles from Cureus are provided here courtesy of Cureus Inc.

RESOURCES