Rothenberg Kara A, McFarland Graeme E, Stern Jordan R
1 Department of Surgery, University of California San Francisco-East Bay, Oakland, CA, USA.
2 Division of Vascular Surgery, Stanford University, Stanford, CA, USA.
Vasc Endovascular Surg. 2019 Jan;53(1):66-70. doi: 10.1177/1538574418794075. Epub 2018 Aug 16.
We describe successful endovascular treatment of a patient with fibromuscular dysplasia of the celiac axis leading to development of a common hepatic artery pseudoaneurysm with contained rupture. An 81-year-old woman was transferred to our quaternary care center with concern for a hepatic artery rupture. Further imaging demonstrated a common hepatic artery pseudoaneurysm with surrounding hematoma as well as multifocal areas of narrowing and dilatation in the celiac trunk consistent with fibromuscular dysplasia. A similar pattern was subsequently identified in the bilateral renal and carotid arteries. The patient underwent successful endovascular exclusion of the pseudoaneurysm with a balloon-expandable covered stent and was discharged home without incident. Fibromuscular dysplasia is a nonatherosclerotic arteriopathy that can lead to stenosis, occlusion, dissection, and aneurysm formation. While it primarily affects the carotid and renal arteries, there are rare case reports involving the mesenteric vasculature. Endovascular therapy appears to be a feasible treatment option for the complicated sequelae of this condition in the rare case of mesenteric arterial involvement.
我们描述了对一名患有腹腔干纤维肌发育不良并导致肝总动脉假性动脉瘤伴局限性破裂的患者进行成功血管内治疗的病例。一名81岁女性因肝动脉破裂被转至我们的四级医疗中心。进一步的影像学检查显示肝总动脉假性动脉瘤伴周围血肿，以及腹腔干内多灶性狭窄和扩张区域，符合纤维肌发育不良表现。随后在双侧肾动脉和颈动脉中也发现了类似的表现。患者通过球囊扩张式覆膜支架成功进行了血管内假性动脉瘤封堵术，出院时未发生任何意外。纤维肌发育不良是一种非动脉粥样硬化性动脉病，可导致狭窄、闭塞、夹层形成和动脉瘤形成。虽然它主要影响颈动脉和肾动脉，但也有罕见的病例报告涉及肠系膜血管系统。在肠系膜动脉受累的罕见情况下，血管内治疗似乎是这种疾病复杂后遗症的一种可行治疗选择。
