Aneurisma de artéria hepática sem colo proximal e acometendo bifurcação de artéria hepática própria
Hepatic artery aneurysm with no proximal neck and proper hepatic artery bifurcation involvement
Pedro Luciano Mellucci Filho; Bruno Aparecido Lourenço de Marqui; Letícia Isper; Adrielle Andrade Pugas; César Alberto Talavera Martelli; Rodolfo Dahlem Melo; Matheus Bertanha; Marcone Lima Sobreira
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Abstract
We report the case of a patient with a saccular aneurysm of the hepatic artery with maximum diameter of 2.8 cm, no proximal neck, and involving the bifurcation of the proper hepatic artery, constituting a hostile anatomy for endovascular treatment, which would usually be the first choice for such cases. We performed open surgical treatment with resection and reconstruction using an autologous graft (internal saphenous vein). We illustrate the surgical technique used for adequate vascular exposure of the celiac trunk and hepatic hilum (which is often an area little explored by vascular surgeons) and of structures anatomically close to the hepatic artery. We also illustrate the anastomosis with telescoping technique. We demonstrate the need for vascular surgeons to master the anatomy and classical surgical technique for visceral branches, even in the era of minimally invasive procedures.
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Referências
1 Barrionuevo P, Malas MB, Nejim B, Seisa M, Chaer R, Murad MH. A systematic review and meta-analysis of the management of visceral artery aneurysms. J Vasc Surg. 2019;70(5):1694-9.
2 Abbas MA, Fowl RJ, Stone WM, et al. Hepatic artery aneurysm: factors that predict complications. J Vasc Surg. 2003;38(1):41-5.
3 Janata F, Fezoulidis N, Barachini O, Mirzaei S, Hergan K, Zandieh S. Common hepatic artery aneurysm detected by 18F-FDG PET/CT Imaging. Radiol Case Rep. 2021;16(11):3157-61.
4 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):3S-39S.
5 Kar R, Patel ST. Vascular coil extrusion into the duodenum 6 years after hepatic artery aneurysm embolization. J Vasc Surg Cases Innov Tech. 2021;7(4):772-7.
6 Graham I, Kanitra J, Haouilou J. Management of a common and proper hepatic artery aneurysm. J Vasc Surg Cases Innov Tech. 2021;7(2):283-5.
7 Frank M, Phillips R, Aldin Z, Ghosh D. Hepatic artery aneurysm: an unusual cause of upper gastrointestinal bleed. BMJ Case Rep. 2017;2017:bcr2017219865.
8 O’Connel JL, Faria LAO, Souza MG, Meneses GA, Carrijo AMM. Tratamento endovascular de aneurisma de artéria hepática assintomático: relato de caso. J Vasc Bras. 2021;20:e20200123.
9 Mirajkar A, Walker A, Gray S, Webb AL, Ganti L. Ruptured hepatic artery aneurysm. Cureus. 2020;12(4):e7715. PMid:32431993.
10 Zhang J, Qian HG, Leng JH, et al. Ischemic liver injury after complete occlusion of hepatic artery in the treatment of delayed postoperative arterial bleeding. J Gastrointest Surg. 2015;19(12):2235-45.
11 Bernal ADPA, Loures P, Calle JCO, Cunha B, Córdoba JC. Right hepatic artery aneurysm. Rev Col Bras Cir. 2016;43(5):401-3.
12 Hosn MA, Xu J, Sharafuddin M, Corson JD. Visceral artery aneurysms: decision making and treatment options in the new era of minimally invasive and endovascular surgery. Int J Angiol. 2019;28(1):11-6.
Submetido em:
05/06/2023
Aceito em:
21/09/2023