Hemorrhage from a right hepatic artery pseudoaneurysm: endovascular treatment with a coronary stent-graft.
OBJECTIVE
To report a novel case demonstrating the successful endovascular treatment of a right hepatic artery pseudoaneurysm using a balloon-expandable coronary stent-graft.


METHODS
A 60-year-old woman underwent surgical treatment for a Klatskin tumor, but her postoperative course was complicated by serious blood loss. An emergent celiac angiogram through a right transfemoral approach demonstrated a small iatrogenic pseudoaneurysm in the proximal right hepatic artery. A 7-F guiding catheter was positioned at the origin of the celiac trunk, and a Jostent coronary stent-graft mounted on a 2.7-F, 4-mm x 30-mm balloon catheter was successfully placed across the aneurysm neck. The final angiogram demonstrated total exclusion of the pseudoaneurysm with preservation of the arterial lumen. The hemodynamic condition of the patient became stable. At 12-month follow-up, duplex scanning confirmed regular right hepatic artery patency and absence of thrombotic tissue or signs of infection around the stent-graft.


CONCLUSIONS
For hepatic artery pseudoaneurysms, endovascular repair using small covered stents may be a viable alternative to transcatheter embolization. The use of coronary instruments facilitates treatment of vascular lesions in small caliber visceral vessels.
Venturini
Massimo
M
Department of Radiology, Scientific Institute S. Raffaele, University Hospital, Milan, Italy. radiologia@hsr.it
Angeli
Enzo
E
Salvioni
Marco
M
De Cobelli
Francesco
F
Trentin
Chiara
C
Carlucci
Michele
M
Staudacher
Carlo
C
Del Maschio
Alessandro
A
D017541:Aneurysm, False / Q000150:complications* / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation; D002404:Catheterization; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000628:therapy*; D006499:Hepatic Artery; D006801:Humans; D007049:Iatrogenic Disease; D008875:Middle Aged; D015607:Stents