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OBJECTIVES: Hepatic artery aneurysms (HAA) represent a rare visceral pathology, with only 500 cases noted in the literature. Interestingly, the incidence of these splanchnic vessel aneurysms is rising as of late, likely due to increased spiral imaging, iatrogenic trauma from endoscopic interventions, minimally invasive procedures for hepatobiliary disease and non-operative management of blunt trauma. Many of these cases are asymptomatic, though they have the highest rate of rupture among all splanchnic artery aneurysms. The natural history of HAA is not clearly defined, prompting a more aggressive approach to operative management. We present an interesting case report demonstrating this rare pathology followed by an extensive literature review of the management of HAA from 2000-2013 to better describe the operative indications for repair of this arterial anomaly.
METHODS: We performed an in-depth literature search using PubMed and MEDLINE with the search terms "hepatic artery aneurysm" and “operative management.”
RESULTS: We present the case of a 72-year-old female who was incidentally found to have a 4cm asymptomatic HAA noted on a CT scan that was initially ordered for evaluation of kidney stones. Additionally, she was found to have occlusion of her celiac artery with retrograde flow into the celiac axis circulation via a markedly enlarged gastroduodenal artery. She underwent repair of the aneurysm with supraceliac aortosplenic and aortohepatic bypass using a bifurcated Dacron graft. This case represents a key aspect in the management of HAA; though asymptomatic, her risk of rupture was high and required intervention. Our literature search revealed that the vast majority of these aneurysms are asymptomatic and diagnosis occurs incidentally or after rupture. Patients were more often male, with an average age of 60 years. The average aneurysmal size was 2.8cm. Although some were managed with close observation, most required surgical intervention. Both endovascular and open approaches were employed, with embolization, stent, ligation or bypass graft being utilized. CONCLUSIONS: HAA is a rare and dangerous condition, many of which ultimately rupture. Given the high mortality, these patients should be closely monitored and surgical repair should be at the forefront of treatment. Repair is recommended for aneurysms that are symptomatic, rapidly enlarging, greater than 2cm in diameter, or associated with fibromuscular dysplasia or polyarteritis nodosa. There is ongoing debate over endovascular versus open repair.