Hepatic artery aneurysm: A case report of a novel approach to an age old problem

INTRODUCTION: Visceral artery aneurysms are a relatively uncommon but potentially devastating pathology. The most common site is the splenic artery followed by the hepatic (Stanley et al., 1986) [1]. In the event of rupture, mortality has been estimated at anywhere between 20% and 100% (Schweigert et al., 2011) [2]. Emergency surgery in such a scenario has previously been dependent on an open approach with high morbidity and mortality associated (Schweigert et al., 2011) [2]. The advent of endovascular techniques may improve both short and long term outcomes as highlighted in this case. PRESENTATION OF CASE: We present the case of a ruptured common hepatic artery aneurysm presenting with acute abdominal pain and haemodynamic instability. Minimally invasive surgery in the form of endovascular repair via two covered stents from the coeliac trunk in to the splenic artery (excluding flow in to the common hepatic artery aneurysm) allowed for immediate management without the significant morbidity and mortality with which open surgery is associated. DISCUSSION: This resulted in resolution of acute haemorrhage while liver perfusion was maintained via the portal vein and arterial collaterals. Follow-up highlighted both short and medium term success. CONCLUSION: This case highlights that endovascular management in the case of visceral artery aneurysm rupture is a viable option while also portraying several important anatomic considerations essential to hepatic perfusion.