Tratamento endovascular de aneurisma de artéria hepática assintomático: relato de caso
Endovascular treatment of an asymptomatic hepatic artery aneurism: case report
João Lucas O’Connell; Lucas Antônio Oliveira Faria; Marcela Gomes de Souza; Gabriel Alves Meneses; Alice Mirane Malta Carrijo
We report a case of an asymptomatic, 77-year-old, male patient with arterial hypertension and no other comorbidities or risk factors for coronary disease. During a routine abdominal ultrasound examination, he was diagnosed with a hepatic vascular mass with an approximate diameter of 5 cm. Abdominal computed angiotomography was requested, showing an aneurysm of the hepatic artery, with maximum diameter of up to 5.2 cm, longest longitudinal axis of 7.2 cm, and a maximum true lumen caliber of 3.0 cm. We opted for endovascular aneurysm repair with implantation of three sequential Lifestream covered vascular stents (7x58mm, 8x58mm, and 8x37mm), successfully diverting the flow through the stents and excluding the aneurysm. The patient remains asymptomatic and free from clinical complications 2 years after the procedure. Control examinations with arterial duplex ultrasound 6 and 12 months after the procedure showed good flow through the stents with no leakage into the aneurysmal sac.
1 Stanziale SF, Wholey M, Makaroun MS. Large hepatic artery aneurysm with portal vein fistula. J Vasc Surg. 2006;43(3):631.
2 Harlaftis NN, Akin JT. Hemobilia from ruptured hepatic artery aneurysm: report of a case and review of the literature. Am J Surg. 1977;133(2):229-32.
3 Hemp JH, Sabri SS. Endovascular management of visceral arterial aneurysms. Tech Vasc Interv Radiol. 2015;18(1):14-23.
4 Bernal A, Loures P, Calle J, Cunha B, Córdoba J. Right hepatic artery aneurysm. Rev Col Bras Cir. 2016;43(5):401-3.
5 Doğan R, Yildirim E, Göktürk S. Gastrointestinal hemorrhage caused by rupture of a pseudoaneurysm of the hepatic artery. Turk J Gastroenterol. 2012;23(2):160-4.
6 Gonçalves M, Moreira R, Lira N, Cordeiro R, Lima D, Andrade G. Aneurisma de artéria hepática comum: relato de caso e discussão de literatura. Rev Med (São Paulo). 2019;98(5):353-7.
7 Hogendoorn W, Lavida A, Hunink MG, et al. Open repair, endovascular repair, and conservative management of true splenic artery aneurysms. J Vasc Surg. 2014;60(6):1667-76.e1.
8 Pasha S, Gloviczki P, Stanson A, Kamath P. Splanchnic artery aneurysms. Mayo Clin Proc. 2007;82(4):472-9.
9 Huang YK, Hsieh HC, Tsai FC, Chang SH, Lu MS, Ko PJ. Visceral artery aneurysm: risk factor analysis and therapeutic opinion. Eur J Vasc Endovasc Surg. 2007;33(3):293-301.
10 Pareja E, Barber S, Montes H, Arango J, Lloret M. Giant hepatic artery aneurysm: management of an infrequent entity. Gastroenterol Hepatol. 2014;37(10):567-70.
11 Abbas MA, Fowl RJ, Stone WM, et al. Hepatic artery aneurysm: factors that predict complications. J Vasc Surg. 2003;38(1):41-5.
12 Pilleul F, Valette PJ. Management of aneurysms of the hepatic artery. 15 patients. Presse Med. 2001;30(23):1139-42. PMid:11505830.
13 Narula HS, Kotru A, Nejim A. Hepatic artery aneurysm: an unusual cause for gastrointestinal haemorrhage. Emerg Med J. 2005;22(4):302.
14 Shanley CJ, Shah NL, Messina LM. Common splanchnic artery aneurysms: splenic, hepatic, and celiac. Ann Vasc Surg. 1996;10(3):315-22.
15 Routh WD, Keller FS, Cain WS, Royal SA. Transcatheter embolization of a high-flow congenital intrahepatic arterial-portal venous malformation in an infant. J Pediatr Surg. 1992;27(4):511-4.
16 Kantarci M, Karakaya A, Aydinli B, Yalcin Polat K, Ceviz M. Giant hepatic artery aneurysm causing portal hypertension. Dig Liver Dis. 2009;41(12):913.
17 Chaer RA, Abularrage CJ, Coleman DM, et al. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg. 2020;72(1S):1-37.
18 Gabelmann A, Gorich J, Merkle EM. Endovascular treatment of visceral artery aneurysms. J Endovasc Ther. 2002;9(1):38-47.
19 Grotemeyer D, Duran M, Park EJ, et al. Visceral artery aneurysms – follow-up of 23 patients with 31 aneurysms after surgical or interventional therapy. Langenbecks Arch Surg. 2009;394(6):1093-100.
20 McQuade K, Gable D, Pearl G, Theune B, Black S. Four-year randomized prospective comparison of percutaneous ePTFE/nitinol self-expanding stent graft versus prosthetic femoral-popliteal bypass in the treatment of superficial femoral artery occlusive disease. J Vasc Surg. 2010;52(3):584-91.e7.
21 Cordova AC, Sumpio BE. Visceral artery aneurysms and pseudoaneurysms: should they all be managed by endovascular techniques? Ann Vasc Dis. 2013;6(4):687-93.