Djalal Fakim, Landau John, Dubois Luc
Division of Vascular Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
J Surg Case Rep. 2024 Aug 28;2024(8):rjae545. doi: 10.1093/jscr/rjae545. eCollection 2024 Aug.
We present a case of a 4.2-cm hepatic artery aneurysm following remote pancreaticoduodenectomy, which extended to the first division of the right hepatic artery. Given the absence of collateral flow from the superior mesenteric artery (SMA) and the inability to place a covered stent, we treated the patient with a saphenous vein graft to the right hepatic artery bifurcation. A CT scan at 1-year demonstrated a patent bypass to the right hepatic artery. We would advise caution when considering hepatic embolization following pancreaticoduodenectomy due to loss of SMA-based collaterals. Techniques that preserve arterial flow should be favored in this situation.
我们报告一例在远端胰十二指肠切除术后出现的4.2厘米肝动脉瘤病例，该动脉瘤延伸至肝右动脉第一分支。鉴于肠系膜上动脉（SMA）无侧支血流且无法放置覆膜支架，我们采用大隐静脉移植至肝右动脉分叉处对患者进行治疗。术后1年的CT扫描显示肝右动脉旁路通畅。我们建议，由于基于SMA的侧支循环丧失，在考虑胰十二指肠切除术后进行肝动脉栓塞时应谨慎。在这种情况下，应优先选择保留动脉血流的技术。
