Department of Neurosurgery, University of Michigan Health System, Ann Arbor, MI 48109-5338, USA.
Neurocrit Care. 2012 Feb;16(1):154-7. doi: 10.1007/s12028-011-9590-z.
Concomitant intracranial and visceral artery aneurysms are a rare occurrence. We report the case of a patient who underwent surgical repair of a ruptured intracranial aneurysm but subsequently experienced a ruptured hepatic artery aneurysm in the immediate postoperative period.
A 59-year-old woman presented with a ruptured posterior communicating artery aneurysm and was treated with coil occlusion. On postoperative day 3, she became hypotensive with a rigid abdomen and was found to have a ruptured hepatic artery aneurysm. Rapid transfusion of packed red blood cells was begun, and the patient was taken to the angiography suite where the hepatic artery aneurysm was identified and successfully occluded using detachable coils to prevent further hemorrhage.
Recovery was complicated by an ileus and mild pulmonary edema. Over several weeks, neurological status and third nerve paresis improved, with eventual discharge to a subacute rehabilitation center. Subsequent follow-up is notable for recurrence of the intracranial aneurysm, and multiple strictures of right intrahepatic arteries and hepatic ducts. The patient is currently being evaluated for liver transplant, but continues to improve neurologically.
Prior to this report, there have only been 2 documented cases of concomitant intracranial and visceral artery aneurysms. These reports serve to remind the clinician that intracranial aneurysms may be only part of a systemic pathology, which should be taken into account when unexpected complications arise postoperatively.
颅内动脉和内脏动脉同时发生动脉瘤较为罕见。我们报告了一例患者，该患者在接受颅内动脉瘤破裂的手术修复后，在术后即刻发生了肝动脉破裂。
一名 59 岁女性因后交通动脉瘤破裂而就诊，并接受了线圈栓塞治疗。术后第 3 天，她出现低血压、腹部僵硬，并被诊断为肝动脉破裂。立即开始输注红细胞悬液，并将患者送往血管造影室，在那里发现肝动脉动脉瘤，并使用可解脱的线圈成功地进行了栓塞，以防止进一步出血。
恢复过程中出现肠梗阻和轻度肺水肿等并发症。数周后，神经状态和第三对颅神经麻痹有所改善，最终出院至亚急性康复中心。随后的随访发现颅内动脉瘤复发，并且右肝内动脉和肝内胆管多处狭窄。目前正在评估该患者进行肝移植，但神经功能仍在不断改善。
在此报告之前，仅有 2 例颅内和内脏动脉同时发生动脉瘤的文献报道。这些报告提醒临床医生，颅内动脉瘤可能只是系统性疾病的一部分，当术后出现意外并发症时，应考虑到这一点。
