真の肝動脈瘤に対する開腹手術および血管内治療の比較：解剖学的複雑性と術後適応性

Selection of a surgical approach for hepatic artery aneurysms (HAAs) depends on a complex interplay of anatomical, clinical, and technical considerations. This study aimed to evaluate the indications, techniques, and outcomes of endovascular versus open surgical repair in patients with true HAAs.

A retrospective review of 33 patients who underwent surgical management for true HAAs (2009-2023). Patients were stratified by treatment modality. Outcomes (procedural success, complications, follow-up) were compared.

Most common aneurysm site was the common hepatic artery (75.7 %), with mean diameter of 3.4 ± 2.6 cm. Seventeen patients (51.5 %) underwent endovascular treatment; sixteen (48.5 %) had primary open repair. Four patients (23.5 %) failed endovascular therapy and required surgical conversion. Patients undergoing open repair had significantly larger aneurysms (4.1 vs. 2.4 cm, p = 0.041) and higher thrombosis rate (60 % vs. 30.8 %, p = 0.049). Reversed saphenous vein grafting was the most common (50 %) reconstructive technique in open surgery. Length of stay (5.8 ± 4.9 vs.8.4 ± 5.1 days), complication rates (15%vs.15.4 %), and follow-up outcomes were comparable between groups.

Both endovascular and open approaches offer effective management for true HAAs when selected based on anatomical and clinical factors. Open repair remains essential in complex cases and ensures durable outcomes when endovascular strategies are not feasible or fail.