title: Hepatic artery aneurysms: open and endovascular repair.
abstract: BACKGROUND
  During the last decade endovascular treatment has emerged as an important alternative to open surgical repair because of its reduced invasiveness. Results of both modalities are evaluated in this study.
  
  
  METHODS
  A retrospective review of 26 patients (18 males and 8 females; mean age: 62±9 years) who underwent surgical open repair of hepatic artery aneurysm (HAA) between 1998 and 2015 was performed. Indications to open or endovascular procedure was based on aneurysm size, anatomical features and operative risk.
  
  
  RESULTS
  Aneurysm size ranged between 2 and 17 cm (mean value: 3.3 cm). Endovascular treatment was performed in 9 patients (34.6%) while open repair in 17 (65.4%). Endovascular procedures included 5 (55.5%) coils embolization and 4 (44.5%) endograft exclusion. Open repair included 9 (53%) aneurysmectomies with end-to-end anastomosis, 7 (41.1%) aneurysmectomies and bypass grafting and 1 (5.9%) simple ligation. In the surgical group, one case of respiratory insufficiency and one myocardial infarction were observed. A 7 cm pseudoaneurysm was found during follow-up for a hepatic artery aneurysm treated 8 years before: the patient underwent re-laparotomy and artery ligation. In the endovascular group, a stent-graft thrombosis occurred and one case of aneurysm reperfusion after coils embolization was found at 48 months follow-up: both patients were treated by means of surgical conversion with aorto-hepatic bypass.
  
  
  CONCLUSIONS
  Endovascular and open repair are both effective in the treatment of HAA. Type of treatment selection is individualized based on patients' clinical status, aneurysm location and the presence of hepatic collateral circulation.
authors.affiliation: Unit of Vascular Surgery, Cardio-Thoracic Department, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy - melissano.germano@hsr.it.
authors.forename: Germano
authors.initials: G
authors.lastname: Melissano
authors.affiliation: Unit of Vascular Surgery, Cardio-Thoracic Department, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Mascia
authors.affiliation: Unit of Vascular Surgery, Cardio-Thoracic Department, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Sthefano
authors.initials: S
authors.lastname: Atique Gabriel
authors.affiliation: Unit of Vascular Surgery, Cardio-Thoracic Department, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Bertoglio
authors.affiliation: Unit of Angiography, Department of Radiology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Venturini
authors.affiliation: Unit of Angiography, Department of Radiology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: DE Cobelli
authors.affiliation: Unit of Angiography, Department of Radiology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Del Maschio
authors.affiliation: Unit of Vascular Surgery, Cardio-Thoracic Department, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Chiesa
mesh_terms: D000714:Anastomosis, Surgical; D000783:Aneurysm / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D003097:Collateral Circulation; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome