Preservation of arterial flow to the liver: goal in treatment of extrahepatic and post-traumatic intrahepatic aneurysms of the hepatic artery.

Post-traumatic intrahepatic aneurysms are frequent sources of intrahepatic and intrabiliary bleeding. The authors describe selective management of ten recent post-traumatic intrahepatic aneurysms, five extrahepatic aneurysms, and one ruptured hepatic artery in a patient with Ehlers-Danlos syndrome. Twelve patients had gastrointestinal bleeding or jaundice. Intraperitoneal rupture occurred twice. One aneurysm grew to 9 cm in diameter during nine years. Angiography should precede surgery whenever possible, and transcatheter occlusion should in general receive first priority. Aneurysms of the common hepatic artery usually can be excluded by proximal and distal ligation. Arterial bypass or serial angiographic occlusion is preferred for aneurysms of the proper hepatic artery. Intrahepatic aneurysms should usually be treated by angiographic thrombosis. Eigation of the proper hepatic artery or its branches should be reserved for exsanguination from unsuspected intrahepatic aneurysms encountered in the operating room. Lobectomy is required rarely.