Interventional treatment of hepatic arterial and venous pathology: A commentary

Abstract

Hepatic aneurysms, pseudoaneurysms and fistulas (arterial biliary and arterial portal) causing bleeding or portal hypertension, and arteriovenous malformations causing high output cardiac failure in adults can be successfully managed by embolization techniques. Results of embolization in infantile hemangioendotheliomas are less uniform and tumors with massive arteriovenous shunting are difficult to manage. Transjugular intrahepatic portal systemic shunts using expendable stents have been successfully created in patients and have effectively controlled portal hypertension and variceal bleeding.

Minimally invasive image-guided interventional management of hepatic artery pseudoaneurysms

“…Although less common, treatment with endovascular stenting has been reported as an alternative to selective arterial embolization when there is concern about hepatic infarction or vascular recanalisation. 17,25 The stents are a non-invasive method of excluding the pseudoaneurysm from the parent arterial circulation while retaining hepatic arterial flow. 26,27 Utmost precision during deployment, high cost, increased risk of stent thrombosis and the need for long term anticoagulation are some of the hindrances to their widespread use.…”

Hepatic Artery Pseudoaneurysm: A Report of Seven Cases and a Review of the Literature

“…19,20 Hoevels and Nilsson reported finding intrahepatic HAP in 14 (17%) of 83 patients who presented with jaundice after percutaneous transhepatic bile duct intubation. 21 In our series, intrahepatic HAP occurred after blunt abdominal trauma with concurrent liver laceration in one patient and after liver biopsy in one patient, both of whom were successfully treated by embolization.…”

Expand+In Vivoiv.iiarjournals.orgIn Vivo September-October 2017 vol. 31 no. 5 983-989 Management of a Fulminant Upper Gastrointestinal Bleeding Exteriorized Through Hemobilia Due to Arteriobiliary Fistula Between the Common Bile Duct and a Right Hepatic Artery Aneurysm – A Case Report

“…The risk of aneurysmal rupture has been estimated to range between 20-80%, this event being associated with a mortality rate of up to 21% (11-13); however, this risk cannot be related to the dimension of the aneurysms, therefore is stated that all lesions should be submitted to therapy (14). When it comes to the main therapeutic options of the uncomplicated aneurysms, percutaneous embolization or stenting have been successfully performed in the last decades (15,16). In cases presenting hepatic artery aneurysms and arteriocholedocal fistulas excision of the aneurysm en bloc with the affected segment of the common bile duct and bilio-digestive derivation remains the treatment of choice.…”