Hepatic artery aneurysms: the management of 22 patients

Hepatic artery aneurysms (HAAs) are being encountered with increasing frequency. A retrospective study of the management of HAAs at a single institution over an 18-year period is presented. The medical records of all patients diagnosed with HAA were reviewed. There were 22 patients who collectively had 23 HAAs. They were of equal gender distribution with a mean age of 53 +/- 16 years. Sixteen patients were symptomatic. Angiography was definitive in all cases and was necessary for determining therapy. There were 16 true aneurysms and 7 pseudoaneurysms. The method of treatment depended on the anatomic location of the aneurysm and the status of the patient. Treatment was by surgery (n = 10 patients), embolization (n = 8 patients), or by observation (n = 3 patients). There were two acute deaths; one patient died on admission without therapy, and one patient died following surgery. Two patients had surgical complications. Three of seven patients required repeat embolization, and one had open surgery after failed embolization. Three patients died of unrelated causes. The follow-up period was 2 months to 8 years. Thus, early HAA mortality and morbidity rates were 9.1 and 22.7%, respectively. Unless precluded by significant comorbidities, active treatment is advocated in the management of patients with HAAs. Surgery is the preferred treatment for extrahepatic lesions, while embolization is appropriate for intrahepatic aneurysms, the majority of which are pseudoaneurysms. Increased clinical awareness and aggressive, definitive management are necessary in obtaining optimal outcomes.