Introduction

Hepatic artery aneurysms are rare lesions but of significant clinical importance because rupture is associated with elevated mortality (₁,₂). Historically, most aneurysms had ruptured at presentation or were incidentally discovered at autopsy (₂).

Case Report

A 54 years old male patient with compliants such as pain and disturbance in the epigastrium and dyspepsia was consulted by the cardiovascular surgery department. A pulsatile mass was detected in upper abdomen at ultrasound. Computerized tomogram (CT) with contrast medium showed a five cm diametered aneurysm in the common hepatic artery which contained mural thrombi in the aneurysmal sac (Figure 1).

Figure 1

Figure 1: A hepatic artery aneurysm (black arrow) is showing in abdominal computerized tomogram.

A magnetic resonance aortogram (Figure 2-a) and selective angiogram of the celiac artery (CA) (Figure 2-b) showed a fusiform true aneurysm in almost of common hepatic artery, with normal splenic, gastroduodenal, right and left hepatic arteries. Elective laparotomy was performed through a midline incision and incision of the lesser omentum near the pylorus revealed an aneurysm arising from the common and proper hepatic artery (Figure 3).

Figure 2

Figure 2: a. In magnetic resonance aortogram and b. in selective celiac artery angiogram, a hepatic artery aneurysm is showing.

Figure 3

Figure 4

Figure 3: Intraoperative photograph showing the fusiform aneurysm of common hepatic artery.

After resecting the aneurysm, we reconstructed the inflow and outflow arteries with a synthetic polytetrafluoroethylene (PTFE) graft interposition. The duration of clamping of these arteries was 50 minutes. The postoperative laboratory data did not show any remarkable changes, with normal serum transaminase levels.

The patient had an uneventful postoperative course. Pathologic examination of aneurysm sac showed intimal thickening with focal atheromas and excess calcification.

Discussion

Due to the high spontaneous rupture rate, hepatic artery aneurysms greater than 2 cm diameter must usually be treated when the diagnosis is confirmed (₂,₃). Recently, non-surgical interventions such as coil embolization and stented graft insertion into the aneurysm sac was being more frequent applied by in treatment of visceral artery aneurysm (₃,₄,₅). Thrombosis of the aneurysm with coil embolization in this patient was not considered because of the risk of ischemic hepatic injury due to the insufficient collateral flow. Aneurysms is arising from the common hepatic artery from CA to left and right hepatic and gastroduodenal arteries, and the proximal and distal necks of the aneurysm sac are not suitable for stented graft insertion. For this reason, surgical intervention was preferred.

Correspondence to

Dr. Suat CANBAZ, Department of Cardiovascular Surgery, School of Medicine, Trakya University, TR 22030 Edirne, Turkey Phone: + 90 284 235 76 56 Faxcimile: + 90 284 235 06 65 E. Mail: scanbaz2001@yahoo.com scanbaz@trakya.edu.tr