Surgical management of hepatic artery aneurysm: a case report

Hepatic artery aneurysms are uncommon and account for 20% of splanchnic artery aneurysms. The real incidence is unknown, but it is estimated to be 0.4% or less. Therapeutic procedures can be performed either surgically or as endovascular treatment. We report a case of a 77-year old man who was referred to our institute for an asymptomatic atherosclerotic hepatic artery aneurysm, measuring 4.5 cm in diameter, without evidence of dissection or rupture, involving the common and the proper hepatic artery. Resection of the aneurysm was performed, and the gastroduodenal artery was ligated. Reconstruction consisted in placement of an end-to-end prosthetic graft between the origin of the common hepatic artery and the distal third of the proper hepatic artery. An intraoperative arteriogram revealed a complete interruption of flow in the left hepatic artery. Intraoperatively, dissection of the left hepatic artery was revealed. Therefore the left hepatic artery was ligated and a new end-to-end prosthetic graft was performed between the origin of the common hepatic artery and the right hepatic artery. The postoperative course was complicated by respiratory failure requiring ventilator-assisted breathing. The patient was subsequently weaned from the ventilator and was discharged to our ward 4 days after surgery. No long-term hepatic or pancreatic complications were detected.