Hepatic artery pseudoaneurysms: Two cases, 2 novel solutions, and a brief review of current treatments

Despite their rarity, hepatic artery pseudoaneurysms present a major risk to patients associated with high mortality. Effective, timely treatment is crucial. Options include percutaneous, endovascular, and surgical management. The first case involved a 68-year-old female with a fusiform pseudoaneurysm at the bifurcation of the common hepatic into the proper hepatic artery and the gastroduodenal arteries. Onyx (ev3,Plymouth,MN) was used to reconstruct the vessel lumen while angiography confirmed embolization of the pseudoaneurysm and arterial patency. Postoperatively, the Hgb stabilized with discharge 5 days later. The second case involved a 45-year-old male with nausea, emesis, pain, elevated liver function tests, and a pseudoaneurysm of the proper hepatic artery seen on imaging. Balloon occlusion was performed for 50 minutes until complete thrombosis. This method was only feasible due to the dual blood supply of the liver. Postoperatively, the abdominal pain immediately resolved and liver enzymes returned to baseline with discharge 2 days later. Being both rare and deadly, effective treatments of hepatic artery pseudoaneurysms are necessary, but novel treatments are seldom documented. Here 2 cases are described: vessel reconstruction with Onyx and Prolonged Balloon Occlusion. Both proved to be effective. Future studies should investigate additional options.