title: Stentgraft Implantation for the Treatment of Postoperative Hepatic Artery Pseudoaneurysm.
abstract: OBJECTIVE
  Hepatic artery pseudoaneurysms are a rare but potentially life-threatening complication of major pancreaticobiliary surgery. We evaluated the safety and efficacy of endovascular stentgraft implantation for the management of such vascular lesions.
  
  
  METHODS
  Between May 2013 and October 2015, ten patients with postoperative hepatic artery pseudoaneurysm, of which eight presented with active hemorrhage, were treated with endovascular stentgraft implantation. All patients had undergone major pancreatic or hepatic surgery before (pylorus-preserving pancreaticoduodenectomy, pancreatectomy, hemihepatectomy, extended hemihepatectomy). The pseudoaneurysms were diagnosed 13-202 days after surgery and were associated with postsurgical complications (e.g., leakage of pancreaticojejunal anastomosis).
  
  
  RESULTS
  In 9/10 patients, the pseudoaneurysm was completely excluded via stentgraft implantation. In 1/10 patient, the pseudoaneurysm ruptured during the procedure and was successfully treated by immediate open surgery. In 1/10 patient, a second intervention was performed after 6 days because of rebleeding; this was successfully treated by implantation of a second overlapping stentgraft. Mean follow-up time is 51 days. None of the patients died due to stentgraft- or aneurysm-related complications. Further episodes of hemorrhage were not observed. In one patient, clinically asymptomatic complete occlusion of the stentgraft was discovered at follow-up imaging.
  
  
  CONCLUSIONS
  Stentgraft implantation is a safe and effective technique to treat hepatic artery pseudoaneurysms related to major pancreatic or hepatic surgery, especially in the setting of acute hemorrhage.
authors.affiliation: Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany. fpedersoli@ukaachen.de.
authors.forename: F
authors.initials: F
authors.lastname: Pedersoli
authors.affiliation: Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Isfort
authors.affiliation: Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Keil
authors.affiliation: Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Goerg
authors.affiliation: Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Zimmermann
authors.affiliation: Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Liebl
authors.affiliation: Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schulze-Hagen
authors.affiliation: Clinic for General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schmeding
authors.affiliation: Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: C K
authors.initials: CK
authors.lastname: Kuhl
authors.affiliation: Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Bruners
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging* / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D057510:Endovascular Procedures; D006499:Hepatic Artery / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D019919:Prosthesis Implantation; D015607:Stents
keywords: Hepatic artery aneurysm; Postoperative complications; Stentgraft implantation