Tokue Hiroyuki, Takeuchi Yoshito, Sofue Ketaro, Arai Yasuaki, Tsushima Yoshito
Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Maebashi, Gunma, Japan.
J Med Case Rep. 2011 Oct 21;5:518. doi: 10.1186/1752-1947-5-518.
Percutaneous transhepatic portal embolization is often performed to expand the indications for hepatic resection. Various etiologies of hepatic artery pseudoaneurysm have been reported, but regardless of the etiology, hepatic artery pseudoaneurysm is usually managed with an endovascular approach or open surgery, depending on the location and clinical symptomatology. However, it is difficult to manage hepatic artery pseudoaneurysm after percutaneous transhepatic portal embolization, since embolization of the hepatic artery may cause hepatic infarction
A 58-year-old Japanese man with hilar bile duct cancer underwent percutaneous transhepatic portal embolization to expand the indication for hepatic resection. Two days after percutaneous transhepatic portal embolization, our patient suddenly complained of abdominal pain. Contrast-enhanced computed tomography confirmed a pseudoaneurysm arising from a segmental branch of his right hepatic artery. Since embolization of the hepatic arterial branches may cause hepatic infarction, ultrasound-guided thrombin injection therapy was successfully performed for the pseudoaneurysm.
We performed a thrombin injection instead of arterial embolization to avoid hepatic infarction. The rationale of this choice may be insufficient. However, ultrasound-guided percutaneous thrombin injection therapy may be considered as an alternative to percutaneous transarterial embolization or surgical intervention for an iatrogenic hepatic artery pseudoaneurysm.
经皮经肝门静脉栓塞术常用于扩大肝切除术的适应证。已报道了肝动脉假性动脉瘤的多种病因，但无论病因如何，肝动脉假性动脉瘤通常根据其位置和临床症状采用血管内介入方法或开放手术进行处理。然而，经皮经肝门静脉栓塞术后难以处理肝动脉假性动脉瘤，因为肝动脉栓塞可能导致肝梗死。
一名58岁的日本男性患有肝门部胆管癌，接受了经皮经肝门静脉栓塞术以扩大肝切除术的适应证。经皮经肝门静脉栓塞术后两天，患者突然主诉腹痛。增强计算机断层扫描证实右肝动脉一个节段分支出现假性动脉瘤。由于肝动脉分支栓塞可能导致肝梗死，因此对该假性动脉瘤成功实施了超声引导下凝血酶注射治疗。
我们进行了凝血酶注射而非动脉栓塞以避免肝梗死。这一选择的理论依据可能并不充分。然而，超声引导下经皮凝血酶注射治疗可被视为医源性肝动脉假性动脉瘤经皮经动脉栓塞或手术干预的一种替代方法。
