PICTURES IN DIGESTIVE PATHOLOGY

 

Successfully endovascular resolution of iatrogenic right hepatic artery pseudoaneurysm

Resolución endovascular exitosa de pseudoaneurisma iatrogénico de arteria hepática derecha

 

 

Francisco José Diéguez-Rascón, Francisco Javier Moreno-Machuca, Andrés García-León, Guillermo Núñez-de-Arenas-Baeza, Jorge Haurie-Girelli and José Vicente González-Herraez

Department of Angiology, Vascular and Endovascular Surgery. Hospital Universitario Nuestra Señora de Valme. Sevilla, Spain

 

 

Case Report

A 83-year-old man attended the emergency service due to abdominal pain in the right upper quadrant, with fever and malaise. Laboratory studies revealed leukocytosis with neutrophilia, and elevated PCR. Ultrasound imaging showed a cholecystitis complicated with a pericholecystic abscess. Due to the clinical condition of the patient, an urgent open cholecystectomy was performed, showing recurrent abdominal pain and anemia during the postoperatory period, that required multiple transfusions during the following week. Due to this evolution, a TC was done, demonstrating a right hepatic artery pseudoaneurysm of 5 x 4 cm (Fig. 1).

 

After femoral catheterization under local anesthesia, a selective celiac arteriography was done, showing a pseudoaneurysm of the right hepatic artery (Fig. 2). A covered stent was implanted (Jostent GraftMaster 3.5 x 16 mm Abbot), with complete exclusion of the pseudoaneurysm and correct patency of the distal right hepatic artery (Fig. 3). During the rest of the hospitalization there were no new anemic episodies, and the patient was discharged in five days.

 

 

Discussion

Iatrogenic pseudoaneurysms of the right hepatic artery are a rare complication of biliar surgery, but with a high mortality rate if not immediately controlled. Endovascular treatment with a covered stent can be a valid therapeutic option, due to its effectiveness, safety and minimaly invasive technique that allows the occlusion of the pseudoaneurysm while maintaining the patency of the hepatic artery, thus minimizing the risk of hepatic ischemia and necrosis.

 

Recomemended References

1. Hylton JR, Pevec WC. Successful treatment of an iatrogenic right hepatic artery pseudoaneurysm and stenosis with astent graft. J Vasc Surg 2011;53:814-7.         [ Links ]

2. Paci E, Antico E, Candelari R, Alborino S, Marmorale C, Landi E. Pseudoaneurysm of the common hepatic artery: treatment with a stent graft. Cardiovasc Intervent Radiol 2000;23:472-84.         [ Links ]

3 Singh CS, Giri K, Gupta R, Aladdin M, Sawhney H. Successful management of hepatic artery pseudoaneurysm complicating chronic pancreatitis by stenting. World J Gastroenterol 2006;12:5733-4.         [ Links ]