CardioVascular and Interventional Radiology

, Volume 39, Issue 4, pp 575–581 | Cite as

Stentgraft Implantation for the Treatment of Postoperative Hepatic Artery Pseudoaneurysm

  • F. Pedersoli
  • P. Isfort
  • S. Keil
  • F. Goerg
  • M. Zimmermann
  • M. Liebl
  • M. Schulze-Hagen
  • M. Schmeding
  • C. K. Kuhl
  • P. Bruners
Clinical Investigation
First Online:
Received:
Accepted:

Abstract

Purpose

Hepatic artery pseudoaneurysms are a rare but potentially life-threatening complication of major pancreaticobiliary surgery. We evaluated the safety and efficacy of endovascular stentgraft implantation for the management of such vascular lesions.

Materials and Methods

Between May 2013 and October 2015, ten patients with postoperative hepatic artery pseudoaneurysm, of which eight presented with active hemorrhage, were treated with endovascular stentgraft implantation. All patients had undergone major pancreatic or hepatic surgery before (pylorus-preserving pancreaticoduodenectomy, pancreatectomy, hemihepatectomy, extended hemihepatectomy). The pseudoaneurysms were diagnosed 13–202 days after surgery and were associated with postsurgical complications (e.g., leakage of pancreaticojejunal anastomosis).

Results

In 9/10 patients, the pseudoaneurysm was completely excluded via stentgraft implantation. In 1/10 patient, the pseudoaneurysm ruptured during the procedure and was successfully treated by immediate open surgery. In 1/10 patient, a second intervention was performed after 6 days because of rebleeding; this was successfully treated by implantation of a second overlapping stentgraft. Mean follow-up time is 51 days. None of the patients died due to stentgraft- or aneurysm-related complications. Further episodes of hemorrhage were not observed. In one patient, clinically asymptomatic complete occlusion of the stentgraft was discovered at follow-up imaging.

Conclusion

Stentgraft implantation is a safe and effective technique to treat hepatic artery pseudoaneurysms related to major pancreatic or hepatic surgery, especially in the setting of acute hemorrhage.

Keywords

Hepatic artery aneurysm Stentgraft implantation Postoperative complications 
This is a preview of subscription content, log in to check access.

Notes

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflicts of interest.

References

  1. 1.
    Hossain A, Reis ED, Dave SP, Kerstein MD, Hollier LH. Visceral artery aneurysms: experience in a tertiary-care center. Am Surg. 2001;67(5):432–7.PubMedGoogle Scholar
  2. 2.
    O’Driscoll D, Olliff SP, Olliff JF. Hepatic artery aneurysm. Br J Radiol. 1999;72(862):1018–25.CrossRefPubMedGoogle Scholar
  3. 3.
    Berceli SA. Hepatic and splenic artery aneurysms. Semin Vasc Surg. 2005;18(4):196–201.CrossRefPubMedGoogle Scholar
  4. 4.
    Iswanto S, Nussbaum ML. Hepatic artery pseudoaneurysm after surgical treatment for pancreatic cancer: minimally invasive angiographic techniques as the preferred treatment. N Am J Med Sci. 2014;6(6):287–90.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Chen J, Weinstein J, Black S, Spain J, Brady PS, Dowell JD. Surgical and endovascular treatment of hepatic arterial complications following liver transplant. Clin Transplant. 2014.Google Scholar
  6. 6.
    Belli AM, Markose G, Morgan R. The role of interventional radiology in the management of abdominal visceral artery aneurysms. Cardiovasc Intervent Radiol. 2012;35(2):234–43.CrossRefPubMedGoogle Scholar
  7. 7.
    Sachdev-Ost U. Visceral artery aneurysms: review of current management options. Mt Sinai J Med. 2010;77(3):296–303.CrossRefPubMedGoogle Scholar
  8. 8.
    Spiliopoulos S, Sabharwal T, Karnabatidis D, Brountzos E, Katsanos K, Krokidis M, et al. Endovascular treatment of visceral aneurysms and pseudoaneurysms: long-term outcomes from a multicenter European study. Cardiovasc Intervent Radiol. 2012;35(6):1315–25.CrossRefPubMedGoogle Scholar
  9. 9.
    Abbas MA, Fowl RJ, Stone WM, Panneton JM, Oldenburg WA, Bower TC, et al. Hepatic artery aneurysm: factors that predict complications. J Vasc Surg. 2003;38(1):41–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Sachdev U, Baril DT, Ellozy SH, Lookstein RA, Silverberg D, Jacobs TS, et al. Management of aneurysms involving branches of the celiac and superior mesenteric arteries: a comparison of surgical and endovascular therapy. J Vasc Surg. 2006;44(4):718–24.CrossRefPubMedGoogle Scholar
  11. 11.
    Tulsyan N, Kashyap VS, Greenberg RK, Sarac TP, Clair DG, Pierce G, Ouriel K. The endovascular management of visceral artery aneurysms and pseudoaneurysms. J Vasc Surg. 2007;45(2):276–83.CrossRefPubMedGoogle Scholar
  12. 12.
    Kasirajan K, Greenberg RK, Clair D, Ouriel K. Endovascular management of visceral artery aneurysm. J Endovasc Ther. 2001;8(2):150–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Carrafiello G, Rivolta N, Fontana F, Piffaretti G, Mariscalco G, Bracchi E, et al. Combined endovascular repair of a celiac trunk aneurysm using celiac-splenic stent graft and hepatic artery embolization. Cardiovasc Intervent Radiol. 2010;33(2):352–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Pasha SF, Gloviczki P, Stanson AW, Kamath PS. Splanchnic artery aneurysms. Mayo Clin Proc. 2007;82:472–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Balderi A, Antonietti A, Pedrazzini F, Sortino D, Vinay C, Grosso M. Treatment of visceral aneurysm using multilayer stent: two-year follow-up results in five consecutive patients. Cardiovasc Intervent Radiol. 2013;36:1256–61.CrossRefPubMedGoogle Scholar
  16. 16.
    Claessen BE, Henriques JP, Jaffer FA, Mehran R, Piek JJ, Dangas GD. Stent thrombosis: a clinical perspective. JACC Cardiovasc Interv. 2014;7(10):1081–92.CrossRefPubMedGoogle Scholar
  17. 17.
    Greenhalgh RM, Powell JT. Endovascular repair of abdominal aortic. N Engl J Med. 2008;358(5):494–501.CrossRefPubMedGoogle Scholar
  18. 18.
    de Castro SM, Kuhlmann KF, Busch OR, van Delden OM, Laméris JS, van Gulik TM, Obertop H, Gouma DJ. Delayed massive hemorrhage after pancreatic and biliary surgery: embolization or surgery? Ann Surg. 2005;241(1):85–91.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Suzuki K, Mori Y, Komada T, Matsushima M, Ota T, Naganawa S. Stent-graft treatment for bleeding superior mesenteric artery pseudoaneurysm after pancreaticoduodenectomy. Stent-graft treatment for bleeding superior mesenteric artery pseudoaneurysm after pancreaticoduodenectomy. Cardiovasc Interv Radiol. 2009;32(4):762–6.CrossRefGoogle Scholar
  20. 20.
    Lü PH, Zhang XC, Wang LF, Chen ZL, Shi HB. Stent graft in the treatment of pseudoaneurysms of the hepatic arteries. Vasc Endovascular Surg. 2013;47(7):551–4.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2016

Authors and Affiliations

  • F. Pedersoli
    • 1
  • P. Isfort
    • 1
  • S. Keil
    • 1
  • F. Goerg
    • 1
  • M. Zimmermann
    • 1
  • M. Liebl
    • 1
  • M. Schulze-Hagen
    • 1
  • M. Schmeding
    • 2
  • C. K. Kuhl
    • 1
  • P. Bruners
    • 1
  1. 1.Department of Diagnostic and Interventional RadiologyRWTH Aachen University HospitalAachenGermany
  2. 2.Clinic for General, Visceral and Transplant SurgeryRWTH Aachen University HospitalAachenGermany

Personalised recommendations