Covered stent placement for hepatic artery pseudoaneurysm

Abstract

PurposeTo evaluate the efficacy and safety of covered stent placement for the treatment of hepatic artery pseudoaneurysm (HAP).Methods
Between March 2006 and March 2019, 17 consecutive patients underwent emergency covered stent placement for treatment of HAP. There were 12 men and 5 women aged 24–71 years, with an average age of 49.4 years. Eleven patients had undergone Whipple procedure, 3 had hepatic abscess following hepatectomy, 2 had undergone hepatectomy under extracorporeal circulation, and 1 had received surgical exploration after a car accident. The average interval from surgical intervention to massive bleeding was 15.3 days (range: 6–35 days). After HAP was confirmed by angiography, 1–3 covered stent grafts (3–8 mm in diameter and 13 mm–5 cm in length) were implanted. Adequate drainage, anti-infection treatment, and symptomatic treatment were offered after stent placement, and no anticoagulation or antiplatelet drug was used.ResultsThe interventions were successful in all 17 patients. Angiography revealed pseudoaneurysms in common hepatic artery in 16 patients (in gastroduodenal artery stumps in 4 patients) and hemorrhage from a ruptured right hepatic artery in 1 patient. All patients were successfully implanted with 1–3 covered stent grafts. Bleeding was completely controlled in 12 patients (stent diameter: 4.5–8 mm). Four patients (stent diameter: 3–4.5 mm) experienced bleeding recurrence 1 h to 3 days after stent implantation, and type 1 endoleaks were identified during second angiography. Finally, these 4 patients died of multiple organ failure 2–10 days after embolization/blockage. The remaining patient suffered from abdominal hemorrhage again 2 weeks after stent implantation, and second angiography showed hemorrhage from a branch of the superior mesenteric artery; no bleeding occurred after embolization. Thirteen patients survived at discharge, and the average length of hospital stay was 26.53 days (range: 11–58 days). The average follow-up time was 23 months (range: 16–37 months), during which 6 patients died of tumor progression. No bleeding recurred during the follow-up period, and routine color Doppler ultrasound revealed that the common hepatic artery was patent and the blood flow was smooth at the stent implantation site.Conclusion
Covered stent placement is a safe and effective alternative for treating HAP patients with high risk of severe complications after hepatic artery embolization. Larger stent grafts (> 4 mm in diameter) may achieve better prognosis.

Full text

Vol.:(0123456789)
1 3
Abdominal Radiology (2020) 45:3337–3341
https://doi.org/10.1007/s00261-020-02452-3
INTERVENTIONAL RADIOLOGY
Covered stent placement forhepatic artery pseudoaneurysm
LiCui1 · LuKong2 · Yan‑HuaBai1 · Xiao‑HuiLi1 · Xiu‑QiWang1 · Jing‑jingHao3 · FengDuan1
Published online: 24 February 2020
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
Purpose To evaluate the efficacy and safety of covered stent placement for the treatment of hepatic artery pseudoaneurysm
(HAP).
Methods Between March 2006 and March 2019, 17 consecutive patients underwent emergency covered stent placement for
treatment of HAP. There were 12 men and 5 women aged 24–71years, with an average age of 49.4years. Eleven patients
had undergone Whipple procedure, 3 had hepatic abscess following hepatectomy, 2 had undergone hepatectomy under
extracorporeal circulation, and 1 had received surgical exploration after a car accident. The average interval from surgical
intervention to massive bleeding was 15.3days (range: 6–35days). After HAP was confirmed by angiography, 1–3 covered
stent grafts (3–8mm in diameter and 13mm–5cm in length) were implanted. Adequate drainage, anti-infection treatment,
and symptomatic treatment were offered after stent placement, and no anticoagulation or antiplatelet drug was used.
Results The interventions were successful in all 17 patients. Angiography revealed pseudoaneurysms in common hepatic
artery in 16 patients (in gastroduodenal artery stumps in 4 patients) and hemorrhage from a ruptured right hepatic artery in
1 patient. All patients were successfully implanted with 1–3 covered stent grafts. Bleeding was completely controlled in 12
patients (stent diameter: 4.5–8mm). Four patients (stent diameter: 3–4.5mm) experienced bleeding recurrence 1h to 3days
after stent implantation, and type 1 endoleaks were identified during second angiography. Finally, these 4 patients died of
multiple organ failure 2–10days after embolization/blockage. The remaining patient suffered from abdominal hemorrhage
again 2weeks after stent implantation, and second angiography showed hemorrhage from a branch of the superior mesenteric
artery; no bleeding occurred after embolization. Thirteen patients survived at discharge, and the average length of hospital
stay was 26.53days (range: 11–58days). The average follow-up time was 23months (range: 16–37months), during which 6
patients died of tumor progression. No bleeding recurred during the follow-up period, and routine color Doppler ultrasound
revealed that the common hepatic artery was patent and the blood flow was smooth at the stent implantation site.
Conclusion Covered stent placement is a safe and effective alternative for treating HAP patients with high risk of severe
complications after hepatic artery embolization. Larger stent grafts (> 4mm in diameter) may achieve better prognosis.
Keywords Covered stent· Hepatic artery pseudoaneurysm· HAP· Hepatic artery embolization
Background
Hepatic artery pseudoaneurysm (HAP) is a serious compli-
cation of injury to the hepatic artery. It usually occurs after
acute/chronic severe pancreatitis, blunt abdominal trauma,
or surgical treatment. Since HAP may lead to sudden life-
threatening hemorrhage, active treatment is required [1, 2].
Surgical treatment used to be the mainstream approach for
managing visceral aneurysms, and in recent years, emboli-
zation has become the preferred treatment for such lesions
[3–5]. However, for patients with a high risk of complica-
tions (e.g., liver failure and liver abscess) following hepatic
artery embolization, implantation of covered stent grafts can
Li Cui and Lu Kong contributed equally as first authors in this
study.
* Feng Duan
duanfeng@vip.sina.com
1 Department ofInterventional Radiology, The General
Hospital ofChinese People’s Liberation Army,
Beijing100853, China
2 The General Hospital ofChinese People’s Liberation Army,
Beijing100853, China
3 Capital Medical University, Beijing100069, China
Content courtesy of Springer Nature, terms of use apply. Rights reserved.