Endovascular Treatment of Mycotic Hepatic Artery Aneurysm in the Hostile Abdomen

Abstract

Mycotic hepatic artery aneurysms are rare. This report documents a case in which a mycotic hepatic artery aneurysm was associated with Crohn's disease, renal adenocarcinoma, and a urinary tract infection. Endovascular management of this mycotic hepatic artery aneurysm was successful in the setting of a hostile abdomen based on multiple previous operations, a stoma, and a scarred abdomen.

Post–liver transplant mycotic aneurysm of the hepatic artery

“…Although most mycotic aneurysms occur in the aorta, they have also been described in other sites like the iliac, femoral, splenic, gastroduodenal, renal, mesenteric, and the hepatic arteries [8][9][10][11]. Infective endocarditis, urinary tract infection, renal carcinoma, Crohn's disease, tuberculosis, and umbilical artery catheterization have been reported as various sources of infection leading on to the development of mycotic aneurysms [12][13][14][15].…”

Right hepatic artery false aneurysm secondary to acalculous cholecystitis

“…Infections cited in the literature include embolic phenomenon from infective endocarditis, which is now mainly seen among intravenous drug taking populations, severe systemic sepsis and amoebic infections 13. In addition immunosuppression has been reported as a cause for mycotic aneurysms in conjunction with liver transplantation or treatment for other malignancies or disorders such as Crohn's disease 14–16. This case is particularly interesting as it occurred in a case of presumed acalculous cholecystitis that was not severe as it necessitated only a short admission and no intervention other than antibiotic treatment at that time.…”

Giant visceral artery pseudoaneurysm treated with endovascular transradial coil embolization

“… 8 Coil embolization offers a stable treatment for exclusion of the VAPA with good short- and long-term results and complete symptom resolution and no increased risk of continued infection. 9 , 10 , 11 , 12 …”

“…8 Coil embolization offers a stable treatment for exclusion of the VAPA with good short-and longterm results and complete symptom resolution and no increased risk of continued infection. 9,[10][11][12] Coil embolization was the preferred choice in this patient owing to the small, distal quality of the vessel with poor collateralization, stent-assisted coil vs pipeline stenting are alternative options. Uncovered flow directing stents such as Pipeline Embolization Device (ev3 Endovascular Inc, Plymouth, Minn) or Multilayer Aneurysm Repair System (Cardiatis, Isnes, Belgium) have been used.…”