Gavrancic Tatjana, Tahir Muhammad Waqas, Gorasevic Marko, Dumic Igor, Rueda Prada Libardo, Cortes Melissa, Chipi Patricia, Devcic Zlatko, Ritchie Charles, Murawska Baptista Aleksandra
Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, United States.
Department of Research, Mayo Clinic, Jacksonville, FL, United States.
Front Med (Lausanne). 2024 Dec 10;11:1484966. doi: 10.3389/fmed.2024.1484966. eCollection 2024.
Hepatic artery pseudoaneurysm (HAP) is a rare and potentially life-threatening condition associated with high mortality. This study aims to review the etiology, clinical manifestations, management, and outcomes of patients diagnosed and treated for HAP at the Mayo Clinic.
This study was a retrospective chart review of medical records for patients diagnosed and treated for hepatic artery pseudoaneurysm (HAP) at the Mayo Clinic (Florida, Minnesota, and Arizona) between September 1, 1998, and June 30, 2022. A total of 27 patients with HAP were identified, and their demographics, presenting symptoms, location of HAP, etiology, associated liver pathology, type of intervention, and outcomes were analyzed.
The majority of patients with hepatic artery pseudoaneurysm (HAP) were male (63%), with a median age of 57 years (range: 25-87 years). HAP was predominantly intrahepatic (85.2%) and most commonly located on the right hepatic artery (RHA) (70.4%). In 89.9% of cases, the condition was attributable to hepatobiliary procedures or trauma, while only 10.1% occurred spontaneously. Presenting symptoms at the time of HAP diagnosis varied, including gastrointestinal (GI) bleeding (29.6%), abdominal pain (14.81%), non-GI bleeding (11.1%), traumatic bodily injury (11.1%), and other symptoms (14.81%). Asymptomatic or incidental findings of HAP were observed in 18% of cases. Malignancy was identified in 52% of patients, and 26% were liver transplant recipients. Statistical analysis revealed that factors such as prior knowledge of HAP ( = 0.381), HAP rupture ( = 0.382), anticoagulation therapy ( = 0.856), hemorrhagic shock ( = 0.25), liver cirrhosis ( = 0.143), gastrointestinal bleeding ( = 0.879), hepatobiliary abscess ( = 0.079), liver transplantation ( = 0.738), spontaneous HAP ( = 0.381), and malignancy ( = 0.163) were not significantly associated with increased mortality. In contrast, the need for transfusions ( = 0.021), tumor invasion ( = 0.023), portal vein thrombosis (PVT) ( = 0.02), and liver necrosis ( = 0.02) were significantly associated with higher mortality. The overall infection rate was 3%, while the mortality rate was 18.5%.
Hepatic artery pseudoaneurysm (HAP) is a rare but serious condition often associated with hepatobiliary procedures, trauma, or liver transplants, though it can also occur spontaneously. While HAP is commonly detected incidentally, its diagnosis is frequently linked to complications such as rupture and gastrointestinal bleeding. However, our study suggests that these complications do not necessarily increase mortality. Key factors associated with higher mortality include the need for blood transfusions, tumor invasion, portal vein thrombosis, and liver necrosis at the time of diagnosis. The overall infection rate was low, but the mortality rate was 18.5%, highlighting the importance of early detection and management.
肝动脉假性动脉瘤（HAP）是一种罕见且可能危及生命的疾病，死亡率很高。本研究旨在回顾在梅奥诊所诊断和治疗的HAP患者的病因、临床表现、治疗方法及预后。
本研究是一项对1998年9月1日至2022年6月30日期间在梅奥诊所（佛罗里达州、明尼苏达州和亚利桑那州）诊断和治疗的肝动脉假性动脉瘤（HAP）患者病历的回顾性分析。共识别出27例HAP患者，并对他们的人口统计学资料、症状表现、HAP位置、病因、相关肝脏病理、干预类型及预后进行分析。
大多数肝动脉假性动脉瘤（HAP）患者为男性（63%），中位年龄57岁（范围：25 - 87岁）。HAP主要位于肝内（85.2%），最常见于右肝动脉（RHA）（70.4%）。89.9%的病例病因是肝胆手术或创伤，仅10.1%为自发形成。HAP诊断时的症状表现各异，包括胃肠道（GI）出血（29.6%）、腹痛（14.81%）、非GI出血（11.1%）、外伤性身体损伤（11.1%）及其他症状（14.81%）。18%的病例为无症状或偶然发现HAP。52%的患者确诊为恶性肿瘤，26%为肝移植受者。统计分析显示，诸如对HAP的既往了解情况（P = 0.381）、HAP破裂（P = 0.382）、抗凝治疗（P = 0.856）、失血性休克（P = 0.25）、肝硬化（P = 0.143）、胃肠道出血（P = 0.879）、肝胆脓肿（P = 0.079）、肝移植（P = 0.738）、自发HAP（P = 0.381）及恶性肿瘤（P = 0.163）等因素与死亡率增加无显著相关性。相比之下，输血需求（P = 0.021）、肿瘤侵犯（P = 0.023）、门静脉血栓形成（PVT）（P = 0.02）及肝坏死（P = 0.02）与较高死亡率显著相关。总体感染率为3%，死亡率为18.5%。
肝动脉假性动脉瘤（HAP）是一种罕见但严重的疾病，常与肝胆手术、创伤或肝移植相关，不过也可自发发生。虽然HAP常为偶然发现，但其诊断常与破裂和胃肠道出血等并发症相关。然而，我们的研究表明这些并发症不一定会增加死亡率。与较高死亡率相关的关键因素包括诊断时的输血需求、肿瘤侵犯、门静脉血栓形成及肝坏死。总体感染率较低，但死亡率为18.5%，凸显了早期检测和治疗的重要性。
