Stent Graft Placement for the Treatment of Hepatic Artery Pseudoaneurysms: A Single-Center Experience

Hepatic artery pseudoaneurysms (HAPs) represent a rare but serious complication after major pancreatic, hepatic, or gastric surgery. Apart from surgical repair, endovascular treatment such as stent graft placement or coil embolization is a less invasive alternative in these patients. Among the endovascular options, treatment of pseudoaneurysms by stent graft placement has the advantage of preserving hepatic arterial perfusion, which reduces the risk of hepatic ischaemia and major postoperative complications in these patients. The purpose of our study was to evaluate the technical feasibility, efficacy, procedural complications, and outcomes, including graft patency in HAPs treated with a stent graft.

A retrospective analysis of patients who had undergone endovascular treatment of HAPs with stent grafts between January 2021 and January 2024 was conducted. Patient characteristics, including age, sex, surgical history, and type of cancer on final pathology, were recorded. Angiographic data on target vessel, material used, and technical success, defined as the exclusion of the pseudoaneurysm by means of a stent graft with sufficient control of bleeding, any major complications, and follow-up data, were collected.

A total of seven patients were included, five of them were male patients (71.4%), while two of them were female patients (28.6%). Mean age was 70.8 (range: 59-75). All of our patients were postoperative patients who developed HAPs, likely secondary to anastomotic dehiscence. Stent graft deployment was technically successful in six of the patients (85.7%). One case was unsuccessful due to vascular tortuosity, leading to a dislodged stent graft, which was subsequently repositioned and deployed at a branch of the splenic artery. The HAP was embolized with coils. No major procedural complication was recorded. Complete exclusion of the pseudoaneurysm while preserving patency of the hepatic artery was achieved in all of the patients in which stent graft deployment was technically successful. A follow-up enhanced computed tomography scan was performed at an average of 3.3 months (range: one to eight months), which showed the disappearance of HAP and patency of the stent without in-stent stenosis. In patients who had successful deployment of the stent, six-month all-cause mortality was 42.7% (three out of seven). Two of the patients died of chest infection, while the other patient died of uncontrolled sepsis. None of the patients died of bleeding due to liver failure.

Endovascular treatment of HAPs using stent grafts is technically feasible and has the potential benefit of maintaining hepatic artery blood flow, and could be considered as an alternative to surgery and other endovascular treatments.