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Massive Hemorrhage From Multiple Hepatic Artery Aneurysms
S Lowell Kahn1, Jonathan McClain1, Jeffrey L Kaufman2
1Department of Surgery, Baystate Vascular Services, Baystate Medical Center, Springfield, MA, USA.
Vascular and Endovascular Surgery
|September 16, 2016
Summary
Massive hepatic bleeding from aneurysms was controlled with coil embolization, but the patient died from organ failure. This case highlights risks of hepatic artery embolization in unstable patients.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Hepatology
Background:
- Massive hepatic bleeding presents a critical management challenge, particularly when surgical intervention is not feasible.
- Hepatic artery aneurysms, though rare, can lead to life-threatening hemorrhage.
- Conditions like polyarteritis nodosa and segmental arterial mediolysis are associated with arterial abnormalities.
Observation:
- A 66-year-old male presented with massive bleeding from hepatic artery aneurysms.
- An abnormal porta hepatis suggested underlying tumor or inflammation.
- Coil embolization successfully controlled the acute hemorrhage.
Findings:
- The patient experienced subsequent multisystem organ failure, leading to death.
- The most probable diagnoses were polyarteritis nodosa or segmental arterial mediolysis.
- Hepatic artery embolization, even with dual blood supply, carries risks in hemodynamically unstable patients.
Implications:
- This case underscores the potential complications of extensive hepatic arterial embolization.
- It emphasizes the need for careful consideration of hemodynamic status during embolization procedures.
- Management strategies for massive hepatic bleeding without surgical options require further discussion.
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