Christie Amy B, Christie D Benjamin, Nakayama Don K, Solis Maurice M
Department of Surgery, Medical Center of Central Georgia, Macon, Georgia 31201, USA.
Am Surg. 2011 May;77(5):608-11.
With the development of endovascular therapy, treatment for hepatic artery aneurysm (HAA) has evolved from open excision and repair to include endovascular approaches. We reviewed our recent experience with HAA to help define the treatment of HAA. From 2002 to 2010, five patients underwent treatment of HAA, all men with a median age of 63.2 years (range, 41-75). The median diameter of HAA was 5.8 cm (range, 2.4 cm-11 cm). Four lesions involved the extrahepatic portion of the hepatic artery, and one was an intrahepatic HAA that involved the right hepatic artery. Three were true aneurysms and two were pseudoaneurysms associated with trauma. Four of the five HAA patients were symptomatic, three with nonspecific abdominal pain, and one with free hemorrhage from a ruptured intrahepatic pseudoaneurysm. All five underwent computed tomography and selective arteriography. Two patients underwent open surgical aneurysmectomy and revascularization because of aneurysm location and concerns of the potential lack of collateral flow. Three patients underwent an endovascular coil embolization because obliteration of a saccular aneurysm could be achieved without compromising arterial flow of the native hepatic vessel. Re-embolization was necessary in the intrahepatic aneurysm because of recanalization of a feeding vessel. Endovascular embolization is an important minimally invasive approach in the treatment of HAA. Depending on HAA location and the adequacy of collateral arterial flow around the lesion, open aneurysmectomy and revascularization may be required.
随着血管内治疗的发展，肝动脉瘤（HAA）的治疗已从开放切除和修复发展到包括血管内治疗方法。我们回顾了我们近期治疗HAA的经验，以帮助明确HAA的治疗方法。2002年至2010年，5例患者接受了HAA治疗，均为男性，中位年龄63.2岁（范围41 - 75岁）。HAA的中位直径为5.8 cm（范围2.4 cm - 11 cm）。4个病变累及肝动脉肝外部分，1个是累及右肝动脉的肝内HAA。3个是真性动脉瘤，2个是与创伤相关的假性动脉瘤。5例HAA患者中有4例有症状，3例有非特异性腹痛，1例因肝内假性动脉瘤破裂出现游离性出血。所有5例患者均接受了计算机断层扫描和选择性动脉造影。2例患者因动脉瘤位置以及担心潜在的侧支血流不足而接受了开放手术动脉瘤切除术和血管重建术。3例患者接受了血管内弹簧圈栓塞术，因为可以在不影响肝固有血管动脉血流的情况下实现囊状动脉瘤的闭塞。由于供血血管再通，肝内动脉瘤需要再次栓塞。血管内栓塞是治疗HAA的一种重要的微创方法。根据HAA的位置以及病变周围侧支动脉血流的充足情况，可能需要进行开放动脉瘤切除术和血管重建术。
