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Iatrogenic Hepatic Artery Pseudoaneurysms: An Uncommon Complication after Hepatic, Biliary, and Pancreatic Procedures

  • Papers Presented at the Thirteenth Annual Winter Meeting of the Peripheral Vascular Surgery Society
  • Published:
Annals of Vascular Surgery

Abstract

Hepatic artery pseudoaneurysms are uncommon but potentially lethal complications of hepatic, biliary, and pancreatic interventions. To enhance our knowledge about these pseudoaneurysms, we reviewed our institution’s experience with the management of these lesions. We reviewed the literature on 136 cases of hepatic artery pseudoaneurysms as well as our experience with 17 patients (excluding patients who were post-transplantation or had suffered abdominal trauma). The causes, pathogenesis, and clinical features were analyzed. Ten women and seven men developed hepatic artery pseudoaneurysms after undergoing hepatic (65%), biliary (30%), or pancreatic procedures (5%). The mean time between initial intervention and diagnosis was 5.7 months (range 7 days-38 months). Rupture occurred in 13 patients (76%). Mean pseudoaneurysm size was 1.9 cm (range 0.7-4 cm). Embolization was successful in 12 of 14 patients (86%). Four patients (24%), including the two who failed embolization, required operative intervention. Postoperative mortality was 25% while postembolization mortality was 14%. One patient was observed, and the aneurysm thrombosed at 72 months follow-up. Mean follow-up was 48 months (range 1-184 months) for 13 of the 14 survivors (93%) (1 patient was lost to follow-up) without any clinical sequela. Hepatic artery pseudoaneurysms are rare. Rupture is common and occurred in 76% of patients. For both ruptured and nonruptured cases angiography with embolization of the pseudoaneurysm is safe and effective. Operative intervention should be reserved for patients for whom embolization fails or for whom it is not feasible.

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Authors and Affiliations

  1. Department of Surgery, Division of Vascular Surgery, Mayo Clinic Scottsdale, Scottsdale, AZ, USA

    Deron J. Tessier MD, Richard J. Fowl MD, William M. Stone MD & Maher A. Abbas MD

  2. Department of Radiology, Mayo Clinic Rochester, Rochester, MN, USA

    Michael A. McKusick MD

  3. Department of Surgery, Mayo Clinic Rochester, Rochester, MN, USA

    Michael G. Sarr MD & David M. Nagorney MD

  4. Division of Vascular Surgery, Mayo Clinic Rochester, Rochester, MN, USA

    Kenneth J. Cherry MD & Peter Gloviczki MD

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  1. Deron J. Tessier MD
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  2. Richard J. Fowl MD
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  3. William M. Stone MD
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  4. Michael A. McKusick MD
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  5. Maher A. Abbas MD
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  6. Michael G. Sarr MD
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  7. David M. Nagorney MD
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  8. Kenneth J. Cherry MD
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  9. Peter Gloviczki MD
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Correspondence to Richard J. Fowl MD.

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Tessier, D.J., Fowl, R.J., Stone, W.M. et al. Iatrogenic Hepatic Artery Pseudoaneurysms: An Uncommon Complication after Hepatic, Biliary, and Pancreatic Procedures. Ann Vasc Surg 17, 663–669 (2003). https://doi.org/10.1007/s10016-003-0075-1

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