title: Operative management of hepatic artery aneurysms.
abstract: OBJECTIVE
  Degenerative hepatic artery aneurysms (HAAs) are an uncommon pathologic process. The aim of this study was to evaluate the approach to and outcomes of operative management of HAA with open techniques (OTs) and endovascular techniques (ETs).
  
  
  METHODS
  Twenty-one patients who underwent intervention for HAA from January 1, 1992, to January 30, 2015, at a single institution were retrospectively reviewed. Patient presentation, risk factors, and operative approach were reviewed. The primary outcome was operative morbidity and mortality. Secondary outcomes included long-term survival, patency, and need for reintervention.
  
  
  RESULTS
  Of the 21 patients, 14 (67%) were men. The mean age of all patients was 66 years (range, 30-85 years), with a mean HAA size of 45 ± 28 mm (12 common hepatic, 5 common and proper hepatic, 3 right hepatic, and 1 accessory left hepatic). Nine patients (43%) had connective tissue disorders. More than half of the patients (63%) had synchronous aneurysms (29% in the aorta, 24% in the splenic and iliac arteries, and 10% in the celiac arteries). Ten patients (48%) were asymptomatic. Right upper quadrant pain was the most common symptom at presentation (43%), followed by transaminitis (5%) and obstructive jaundice (5%). Five patients (24%) presented with rupture (size, 15-40 mm). OT was performed in 17 patients; 4 patients had ET. Fourteen patients (67%) underwent open reconstruction of the common hepatic (n = 10), the common and proper hepatic (n = 2), and the right and left accessory hepatic arteries (n = 1 each). Seven bypasses were performed with saphenous vein, six with Dacron, and one with polytetrafluoroethylene. Endoaneurysmorrhaphy alone, patch, and ligation were performed in one instance each. Postoperative complications occurred in six patients (29%), including hemorrhage, graft thrombosis, common bile duct stricture that required reoperation, duodenal perforation, and enterocutaneous fistula. ET was attempted in five patients; coil embolization was performed in four patients (two of the common and two of the right hepatic arteries). Overall mortality was 14% (6% after elective OT, 40% for emergency OT, 0% for ET). Mean follow-up was 32 ± 46 months. Overall survival was 86% at 5 years. Primary and secondary graft patency was 86% at 5 years. One patient underwent reintervention because of occlusion of saphenous vein graft.
  
  
  CONCLUSIONS
  Open repair remains the mainstay treatment for degenerative HAA repairs to preserve arterial flow to the liver, with notable morbidity and mortality, particularly in the setting of rupture. However, coil embolization may be applied safely in select patients with aneurysms not involving the proper hepatic artery if adequate collateral circulation ensures hepatic perfusion.
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Young
authors.initials: Y
authors.lastname: Erben
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn. Electronic address: demartino.randall@mayo.edu.
authors.forename: Randall R
authors.initials: RR
authors.lastname: De Martino
authors.affiliation: Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, Minn.
authors.forename: Haraldur
authors.initials: H
authors.lastname: Bjarnason
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Audra A
authors.initials: AA
authors.lastname: Duncan
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Manju
authors.initials: M
authors.lastname: Kalra
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Gustavo S
authors.initials: GS
authors.lastname: Oderich
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Bower
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Peter
authors.initials: P
authors.lastname: Gloviczki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000601:surgery; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D003097:Collateral Circulation; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006499:Hepatic Artery / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008102:Liver Circulation; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency