Management of iatrogenic hepatic artery pseudoaneurysm

Background
Visceral aneurysms are rare, with a prevalence of ∼1%. Hepatic artery aneurysms are the second most common type, accounting for ∼20% of all visceral aneurysms. Pseudoaneurysm is a rare complication that can happen after any intervention. The treatment is through interventional radiology by either insertion of an arterial stent or coiling at the neck of the aneurysm versus surgical intervention.
Patients and methods
The authors analyzed the data of 12 cases in a retrospective pattern. All cases were referred to our Hepatopancreaticbiliary Unit in Ain Shams University Hospitals during the period between January 2017 and December 2020.
Results
The most common cause of hepatic artery pseudoaneurysm was following cholecystectomy. The time of presentation was ranging from 2 to 17 weeks from the intervention. The most common presentation was right hypochondrial pain in 100% of cases. The most common site of the aneurysm was main right hepatic, which constituted 41.7% of the cases. Interventional treatment was attempted in 11 cases (91.7% of the cases) through either coiling in four cases or arterial stenting in seven cases. Successful intervention occurred only in five cases (41.7% of the cases), and seven cases required surgical intervention.
Conclusion
Although it is a rare, pseudoaneurysm is a serious and challenging complication that requires multidisciplinary team management with cooperation between the interventional radiologist and the hepatopancreaticbiliary surgeon. Coiling or arterial stent insertion can solve the problem, but surgical treatment may be needed either after failure of interventional radiology treatment or in case of unstable patients who need urgent surgical treatment.