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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
The Journal of Cardiovascular Surgery 2016 May 06
Hepatic artery aneurysms: open and endovascular repair
Germano MELISSANO 1, Daniele MASCIA 1, Sthefano A. GABRIEL 1, Luca BERTOGLIO 1, Massimo VENTURINI 2, Francesco DE COBELLI 2, Alessandro Del MASCHIO 2, Roberto CHIESA 1 ✉
1 Vascular Surgery, Cardio-Thoracic Department, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy; 2 Angiography, Radiology Department, Vita-Salute
University, San Raffaele Scientific Institute, Milan, Italy
BACKGROUND: Describe our experience with endovascular and open repair of hepatic artery aneurysms (HAA).
METHODS: A retrospective review of 26 patients (18 males and 8 females; mean age: 62+/- 9 years) who underwent surgical open repair of HAA between 1998 and 2015 was performed. Indications to open or endovascular procedure was based on aneurysm size, anatomical features and operative risk.
RESULTS: Aneurysm size ranged between 2 and 17 cm (mean value: 3.3 cm). Endovascular treatment was performed in 9 patients (34.6%) while open repair in 17 (65.4%). Endovascular procedures included 5 (55.5%) coils embolization and 4 (44.5%) endograft exclusion. Open repair included 9 (53%) aneurysmectomies with end-to-end anastomosis, 7 (41.1%) aneurysmectomies and bypass grafting and 1 (5.9%) simple ligation. In the surgical group, one case of respiratory insufficiency and one myocardial infarction were observed. A 7 cm pseudoaneurysm was found during followup for an hepatic artery aneurysm treated 8 years before: the patient underwent re-laparotomy and artery ligation. In the endovascular group, a stent-graft thrombosis occurred and one case of aneurysm repercussion after coils embolization was found at 48 months follow-up: both patients were treated by means of surgical conversion with aorto-hepatic bypass.
CONCLUSIONS: Endovascular and open repair are both effective in the treatment of HAA. Type of treatment selection is individualized based on patients’ clinical status, aneurysm location and the presence of hepatic collateral circulation.