Hepatic artery aneurysm: factors that predict complications.
OBJECTIVE
We reviewed the Mayo Clinic experience with management and outcome of hepatic artery aneurysms (HAA).


METHODS
Retrospective review of charts for 306 patients with true visceral aneurysm diagnosed from 1980 to 1998 enabled identification of 36 patients (12%) with HAA.


RESULTS
Patients with HAA included 23 men and 13 women, with mean age of 62.2 years (range, 20-85 years). Most aneurysms were extrahepatic (78%) and single (92%). Mean aneurysm diameter at presentation was 3.6 cm (range, 1.5-14 cm). Five aneurysms had ruptured (14%), and four were symptomatic (11%). Mortality from rupture was 40%. Of the 9 patients with ruptured or symptomatic aneurysms, 2 patients had multiple HAA, 3 patients had fibromuscular dysplasia, and 2 patients had polyarteritis nodosa. All five HAAs that ruptured were of nonatherosclerotic origin (P =.001). Fourteen patients (39%) underwent elective procedures, including excision with vein graft (n = 7), excision with dacron graft (n = 3), excision alone (n = 2), and percutaneous embolization (n = 2). Two vein grafts and one dacron graft became occluded within 1 year. Nonoperative management was elected in 22 patients (61%) with mean aneurysm diameter 2.3 cm (range, 1.5-5 cm). No complications related to the aneurysm occurred during mean follow-up of 68.4 months (range, 1-372 months). Aneurysm growth was identified in 27%, the greatest being 0.8 cm over 34 months.


CONCLUSIONS
HAA are at definite risk for rupture (14%). Risk factors for rupture include multiple HAA and nonatherosclerotic origin. Patients with symptomatic aneurysms or any of these risk factors should be considered for intervention.
Abbas
Maher A
MA
Department of Surgery, Division of Vascular Surgery, Mayo Clinic Scottsdale, Scottsdale, AR 85259, USA.
Fowl
Richard J
RJ
Stone
William M
WM
Panneton
Jean M
JM
Oldenburg
W Andrew
WA
Bower
Thomas C
TC
Cherry
Kenneth J
KJ
Gloviczki
Peter
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000150:complications* / Q000628:therapy*; D017542:Aneurysm, Ruptured / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures