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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

A Journal on Vascular and Endovascular Surgery


Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 2001 June;8(2):117-24

language: English, Italian

Hepatic artery aneurysm secondary to acute pancreatitis

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


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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.

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