Targeted Surgical Repair of a Symptomatic Hepatic Artery Aneurysm: Case Insights and Outcomes

Hepatic artery aneurysms (HAAs) are rare but significant vascular lesions associated with high mortality due to rupture, particularly in symptomatic cases. This report highlights the clinical importance of timely intervention and presents a case of surgical management of a true HAA.

We present a 58-year-old man with a history of Crohn's disease who exhibited acute right upper quadrant and epigastric pain. Initial evaluation, including CT angiography (CTA), revealed a 24-mm fusiform HAA involving the common hepatic artery. Despite transient relief of pain with analgesics, surgical intervention was deemed necessary due to the aneurysm's size and risk of rupture. The patient underwent an aneurysmectomy with reconstruction using an inverted great saphenous vein graft through a bilateral subcostal incision. The surgical procedure was completed without intraoperative complications, successfully excising the aneurysm and restoring blood flow via the graft. The patient experienced a complex postoperative course, including a sudden episode of bleeding from the left gastric artery, which was effectively managed with endovascular coil embolization. Follow-up imaging at 12 months showed no residual aneurysm and confirmed graft patency, along with favorable perfusion of the intrahepatic arteries.

This case illustrates that surgical repair can be a safe and effective treatment for HAAs when endovascular options are not feasible. It underscores the necessity of personalized management strategies based on individual patient characteristics and specific aneurysm features. Further studies are required to optimize treatment protocols for HAAs.