Zaraca Francesco, Ebner Heinrich
Department of Vascular and Thoracic Surgery, Central Hospital, Bolzano.
Chir Ital. 2008 May-Jun;60(3):453-6.
Hepatic artery aneurysms are uncommon and account for 20% of splanchnic artery aneurysms. The real incidence is unknown, but it is estimated to be 0.4% or less. Therapeutic procedures can be performed either surgically or as endovascular treatment. We report a case of a 77-year old man who was referred to our institute for an asymptomatic atherosclerotic hepatic artery aneurysm, measuring 4.5 cm in diameter, without evidence of dissection or rupture, involving the common and the proper hepatic artery. Resection of the aneurysm was performed, and the gastroduodenal artery was ligated. Reconstruction consisted in placement of an end-to-end prosthetic graft between the origin of the common hepatic artery and the distal third of the proper hepatic artery. An intraoperative arteriogram revealed a complete interruption of flow in the left hepatic artery. Intraoperatively, dissection of the left hepatic artery was revealed. Therefore the left hepatic artery was ligated and a new end-to-end prosthetic graft was performed between the origin of the common hepatic artery and the right hepatic artery. The postoperative course was complicated by respiratory failure requiring ventilator-assisted breathing. The patient was subsequently weaned from the ventilator and was discharged to our ward 4 days after surgery. No long-term hepatic or pancreatic complications were detected.
肝动脉瘤并不常见，占内脏动脉瘤的20%。实际发病率尚不清楚，但估计在0.4%或更低。治疗方法可以是手术治疗或血管内治疗。我们报告一例77岁男性，因无症状性动脉粥样硬化性肝动脉瘤转诊至我院，动脉瘤直径4.5 cm，无夹层或破裂迹象，累及肝总动脉和肝固有动脉。对动脉瘤进行了切除，并结扎了胃十二指肠动脉。重建包括在肝总动脉起始部与肝固有动脉远侧三分之一之间放置端端人工血管移植物。术中动脉造影显示左肝动脉血流完全中断。术中发现左肝动脉有夹层。因此，结扎了左肝动脉，并在肝总动脉起始部与右肝动脉之间进行了新的端端人工血管移植物手术。术后病程因呼吸衰竭需要呼吸机辅助呼吸而复杂化。患者随后脱机，并在术后4天出院至我们的病房。未发现长期肝脏或胰腺并发症。
