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Online ISSN 1827-1847
Fusari M., Agostinelli A., Esposito G., Parolari A. *
From the Vascular Surgery Operative Unit, Cliniche Gavazzeni, Bergamo
Department of Heart Surgery, “Fondazione Monzino” Cardiology Centre, University of Milan, Milan
Hepatic artery aneurysms represent about 40% of all visceral aneurysms. While the etiology is often atherosclerotic, traumatic or inflammatory, the release of pancreatic enzymes during acute pancreatitis may promote the onset of these lesions to the peripancreatic arteries in some cases. The treatment of these aneurysms entails restoring the integrity of the vascular axis affected by the lesion or its exclusion from the blood flow based on the anatomic variability of the hepatic collateral circulation and in particular the origin of the gastroduodenal artery compared to the site of the aneurysm. Both these solutions can be achieved using traditional surgical techniques, using ligation of the common hepatic artery or graft replacement, and with endovascular radiological methods such as embolisation of the aneurysm using metal coils or the insertion of vascular stents. The preoperative diagnostic iter includes ultrasonography and abdominal CT with contrast medium and selective angiography of the celiac trunk and possibly the superior mesenteric artery in order to make an accurate evaluation of hepatic circulation. We report the case of a female patient with an aneurysm of the common hepatic artery involving the origin of the gastroduodenal artery secondary to hemorrhagic acute pancreatitis. The patient underwent surgical aneurysmectomy and replacement of the common hepatic artery with vascular grafts in PTFE which were anastomised proximally to the start of the gastroduodenal artery. This method allowed the aneurysm to be removed while preserving adequate hepatic perfusion.
language: English, Italian