Hepatic artery aneurysm post remote pancreaticoduodenectomy

Area of Science:

• Vascular surgery
• Hepatobiliary surgery
• Interventional radiology

Background:

• Pancreaticoduodenectomy can alter hepatic arterial anatomy and collateral flow.
• Hepatic artery aneurysms are rare but serious complications.
• Superior mesenteric artery (SMA) collaterals are crucial after certain pancreatic surgeries.

Observation:

• A 4.2-cm hepatic artery aneurysm was identified after a remote pancreaticoduodenectomy.
• The aneurysm extended to the right hepatic artery bifurcation.
• Collateral flow from the SMA was absent, and stent placement was not feasible.

Findings:

• A saphenous vein graft bypass to the right hepatic artery bifurcation was performed.
• One-year follow-up CT scan confirmed a patent bypass.
• The patient's hepatic artery was successfully reconstructed.

Implications:

• Hepatic embolization should be approached with caution after pancreaticoduodenectomy due to compromised SMA collaterals.
• Surgical techniques preserving arterial flow are preferred for managing hepatic artery complications post-pancreaticoduodenectomy.
• Vascular reconstruction offers a viable alternative to embolization in complex cases.