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Archives of cardiovascular diseases
Volume 105, n° 12
pages 678-679 (décembre 2012)
Doi : 10.1016/j.acvd.2011.07.008
Received : 3 July 2011 ;  accepted : 23 July 2011
Huge aneurysm of the common hepatic artery
Anévrisme géant de l’artère hépatique commune
 

Hsiang-Yu Yang, Yi-Ting Tsai, Chien-Sung Tsai
Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defence Medical Centre, Taipei, Taiwan, Republic of China 

Corresponding author. No. 325, Sec. 2, Chenggong Rd., Neihu District, Taipei City 114, Taiwan, People’s Republic of China.

Keywords : Aneurysm, Common hepatic artery, Aneurysmectomy

Mots clés : Anévrisme, Artère hépatique commune, Anévrysmectomie


A 65-year-old Asian man presented with a pulsatile mass in the right upper abdomen. There was no history of chronic disease. Physical examination revealed a pulsatile mass with tenderness at the right upper quadrant of the abdomen. Laboratory investigation revealed a total bilirubin concentration of 1.5mg/dL. Ultrasonography and Doppler scan showed a cystic mass about 6×6cm2 in size with a to-and-fro colour flow. Computed tomography of the abdomen revealed an aneurysm of the common hepatic artery, 6.3×6×6cm3 in size, with mural thrombus (Figure 1, Figure 2). The proximal common hepatic artery exhibited severe stenosis.



Figure 1


Figure 1. 

Contrast-enhanced computed tomography of the abdomen demonstrating aneurysmal dilatation of common hepatic artery about 6.3×6×6cm3 with huge mural thrombus (arrow).

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Figure 2


Figure 2. 

Computed tomography angiography with three-dimensional reconstruction showing an aneurysm of common hepatic artery with severe stenosis of proximal site (arrow), just beyond the bifurcation of the celiac trunk and the common hepatic artery.

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Endovascular treatment was attempted, but failed due to difficulty in engaging the proximal common hepatic artery. Aneurysmectomy with interposition of a great saphenous vein graft was performed. The pathological report showed features of a degenerative aneurysm. At 2-year follow-up, computed tomography imaging showed patency of the graft (Figure 3).



Figure 3


Figure 3. 

Contrast-enhanced computed tomography of the abdomen with coronal reformatted image showing patent hepatic artery and vein graft (arrow).

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Hepatic artery aneurysms are very rare with an incidence of 0.4%; most are asymptomatic. Large aneurysms can present a pulsatile mass. Obstructive jaundice is reported in cases with compression of the bile duct. Ruptured hepatic artery aneurysms have a mortality rate of 35%. Surgical intervention is suggested a size greater than 5cm. Risk factors for rupture include multiple hepatic artery aneurysms and nonatherosclerotic origin. Although endovascular surgery is becoming increasingly popular, open surgery is indicated for patients for whom endovascular treatment is not suitable. In this case, excision with vein graft bypass led to complete regression of the aneurysm.

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.



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