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Operative Repair of Hepatic Artery Aneurysm

Operative Repair of Hepatic Artery Aneurysm Abstract ANEURYSM of the hepatic artery is rarely encountered, only 154 cases having been reported to date. While only four patients had successfully undergone surgical repair prior to 1951, vascular techniques have improved the previous grave prognosis. Ligation, endo-aneurysmorrhaphy, excision and reanastomosis of the hepatic artery, splenohepatic anastomosis, synthetic vessel substitution, cellophane wrapping, and intraaneurysmal wiring have been successful. There have been 43 patients reported who have been cured using these methods (Table 1). Eighty percent of the cases are initially seen after rupture of the aneurysm.1 Many of those which have not yet ruptured are first diagnosed at operation. The infrequency of preoperative diagnosis and the critical condition of the patient following rupture usually preclude the use of elaborate operative methods or adjuncts such as hypothermia. Reconstructive endo-aneurysmorrhaphy is simple, safe, gives immediate control of hemorrhage, and preserves hepatic arterial supply. The following case report illustrates the use of References 1. Gordon-Taylor, G.: Rare Cause of Severe Gastrointestinal Haemorrhage: With Note on Aneurysm of Hepatic Artery , Brit M J 1:504, 1943.Crossref 2. Smyth, N.P.D., and Teimourian, B.: Resection Hepatic Arterial Aneurysm Following Intraperitoneal Rupture: Report of a Case With Recovery , Ann Surg 160:61, 1964.Crossref 3. Foster, J.H., and Sandblom, P.: Portal Hypertension Secondary to a Hepato-portal Arteriovenous Fistula , Ann Surg 154:300, 1961.Crossref 4. Graham, W.P.; Eiseman, B.; and Taylor, R.: Hepatic Artery Aneurysm With Portal Vein Fistula in a Patient With Familial Hereditary Telangectasia , Ann Surg 159:326, 1964.Crossref 5. Hess, V.W., and Celio, A.: Das Aneurysma der Arteria Hepatica: Ein durch Aneurysmorrhaphie Geheilter Fall , Helv Chir Acta 22:286, 1955. 6. Howeison, J.L.: Hepatic Artery Aneurysm , Radiology 81:598, 1963.Crossref 7. Hufnagel, C.A., in Discussion of Postlethwait et al, Ann Surg 159:909, 1964. 8. Luke, J.C.: The Useful Splenic Artery , Surg Gynec Obstet 110:633, 1960. 9. Steinberg, I.: Diagnosis of Aneurysms of the Hepatic and Splenic Arteries by Intravenous Abdominal Aortography , New Eng J Med 263:341, 1960.Crossref 10. Dwight, R.W., and Ratcliffe, J.W.: Aneurysm of Hepatic Artery: Report of Case Treated by Wiring , Surgery 31:915, 1952. 11. Zeppa, R., and Womack, N.: Medial Degeneration and Aneurysm of the Hepatic Artery , Arch Surg 86:252, 1963.Crossref 12. Postlethwait, R.W.; Hernandez, R.R.; and Dillon, M.L.: Hepatic Artery Lesions , Ann Surg 159:895, 1964.Crossref 13. Wheeler, H.B., and Warren, R.: Duodenal Varices Due to Portal Hypertension From Arteriovenous Aneurysm: Report of a Case , Ann Surg 146:229, 1957.Crossref 14. Friedenwald, J., and Tannenbaum, K.H.: Aneurysm of the Hepatic Artery , Amer J Med Sci 165: 11, 1923. 15. Houdard, C.: Un cas D'anevrysme de l'artere hepatique , Mem Acad Chir 80:460, 1954. 16. Jarvis, L., and Hodes, P.J.: Aneurysm of the Hepatic Artery Demonstrated Roentgenographically: Case Report , Amer J Roentgen 72:1037, 1954. 17. Jontz, J.G.: Hepatic Artery Aneurysm: Report of a Case Treated by Excision , Surgery 46:896, 1959. 18. Regout, J.E.P.M.: Aneurysm of the Hepatic Artery , Arch Chir Neerl 11:3, 1959. 19. Bruwer, A.J., and Hallenbeck, G.A.: Aneurysm of the Hepatic Artery: Roentgenologic Features in One Case , Amer J Roentgen 78:270, 1957. 20. Robert; Pradel; and Brechot: A propos d'un anevrisme de l'artere hepatique avec infarctus secondaire du foie , Arch Mal Appar Dig 47:561, 1958. 21. Inui, F.K., and Ferguson, T.A.: Aneurysm of Right Hepatic Artery: Preoperative Diagnosis and Successful Excision , Ann Surg 144:235, 1956.Crossref 22. Giuseffi, J., and Collins, C.C.: Successful Cure of False Aneurysm of Hepatic Artery , Surgery 36: 125, 1954. 23. Paul, M.: Large Traumatic Aneurysm of Hepatic Artery , Brit J Surg 39:278, 1951.Crossref 24. Orloff, M.J.; Peskin, G.W.; and Ellis, H.L.: A Bacteriologic Study of Human Portal Blood: Implications Regarding Hepatic Ischemia in Man , Ann Surg 148:738, 1958.Crossref 25. Markowitz, J.; Rappaport, A.; and Scott, A.C.: Prevention of Liver Necrosis Following Ligation of Hepatic Artery , Proc Soc Exp Biol Med 70:305, 1949.Crossref 26. Michels, N.A.: Collateral Pathways to Liver After Ligation of Hepatic Artery and Removal of the Celiac Axis , Cancer 6:708, 1953.Crossref 27. Kehr, H.: Der Erste Fall von Erfolgreicher Unterbindung der Arteria Hepatic Propria Wegen Aneurysma , Munchen Med Wehnschr 1903, 1, 1861-1867. 28. Anderson, E.B.: Aneurysms Amer J Surg 33: 129, 1919. 29. Kading, K.: Ein Geheilter Fall von Intrahepatischem Aneurysma mit Besonderer Berucksichtigung der Traumatischen Leberarterienaneurysmen , Deutsch Z Chir 150:82, 1919.Crossref 30. Colmers, F.: Intrahepatisches Aneurysma und Gallenfistel nach Leberzerreissung: Heilung durch Unterbindung der Arteria Hepatica Communis , Beitr Klin Chir 122:324, 1921. 31. Quattlebaum, J.K.: Aneurysm of Hepatic Artery: Report of Three Cases , Ann Surg 139:743, 1954.Crossref 32. Mainetti, J.M., and Amendolara, J.: Aneurisma de la arteria hepatica: a proposito de casos con exito , Bol Soc Circ B Air 40:173, 1956. 33. Spector, N.: Ligation of the Right Hepatic Artery in Hemobilia: Report of a Case With Recovery , Ann Surg 145:244, 1957.Crossref 34. Mackay, A.G., and Page, H.: Hematemesis Associated With Hemobilia: Report of a Case Due to an Intrahepatic Artery Aneurysm, With Survival , N Eng J Med 260:468, 1959.Crossref 35. Jesseph, J.E., and May, K.J., Jr.: False Aneurysm of the Hepatic Artery With Massive Hemobilia and Jaundice: A Case Report , Arch Surg 81:646, 1960.Crossref 36. Kirklin, J.W., et al: Treatment of Aneurysm of the Hepatic Artery by Excision: Report of a Case , Ann Surg 142:110, 1955.Crossref 37. Cosco Montaldo, H.: Higado Desarterializado: Primer caso de reseccion en el hombre de al arteria hepatica comun y propia por aneurisma permeable de la arteria hepatica, con sobrevida , Bol Soc Cir Uruguay 28:54, 1957. 38. Hejnal, J.: Pripad Aneusymato Arteriae Hepaticae , Rozlhl Chir 36:420, 1957. 39. Hansbrough, E.T., and Lipin, R.J.: Hepatic Artery Aneurysm With Excision of Celiac Axis , Ann Surg 149:273, 1959.Crossref 40. Heberer, G.: Zur Chirurgie von Aneurysmen der Bauch-aorta, der Milz- und Leberarterien , Chirurg 30:193, 1959. 41. Browning, L.D., Jr.; Clauss, R.H.; and MacFee, W.F.: Aneurysm of the Hepatic Artery: Report of Two Cases , Ann Surg 150:320, 1959.Crossref 42. Gallart-Mones, F., and Piulachs, P.: Anevrysme de l'artere hepatique , Arch Mal Appar Dig 49: 913, 1960. 43. McCorriston, J.R.; Allin, G.E.; and Crowell, D.E.: Splenohepatic Arterial Anastomosis for Aneurysm of Hepatic Artery , Surgery 47:636, 1960. 44. Steelquist, J.H.: Aneurysm of Hepatic Artery: Report of Three Cases , Amer J Surg 89:1244, 1955.Crossref 45. Rene, M.L.: Anevrysme de l'artere hepatique decouvert au decours d'une hemorragie digestive massive , Arch Mal Appar Dig 47:561, 1958. 46. Sheridan, J.T.: Hepatic Artery Aneurysm: Report of Case and Review of Literature , Arch Surg 72:30, 1956. 47. Jewett, T.C., Jr.: Aneurysm of the Hepatic Artery in a Child , Ann Surg 150:951, 1959.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Operative Repair of Hepatic Artery Aneurysm

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Publisher
American Medical Association
Copyright
Copyright © 1966 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1966.01330030039009
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Abstract

Abstract ANEURYSM of the hepatic artery is rarely encountered, only 154 cases having been reported to date. While only four patients had successfully undergone surgical repair prior to 1951, vascular techniques have improved the previous grave prognosis. Ligation, endo-aneurysmorrhaphy, excision and reanastomosis of the hepatic artery, splenohepatic anastomosis, synthetic vessel substitution, cellophane wrapping, and intraaneurysmal wiring have been successful. There have been 43 patients reported who have been cured using these methods (Table 1). Eighty percent of the cases are initially seen after rupture of the aneurysm.1 Many of those which have not yet ruptured are first diagnosed at operation. The infrequency of preoperative diagnosis and the critical condition of the patient following rupture usually preclude the use of elaborate operative methods or adjuncts such as hypothermia. Reconstructive endo-aneurysmorrhaphy is simple, safe, gives immediate control of hemorrhage, and preserves hepatic arterial supply. The following case report illustrates the use of References 1. Gordon-Taylor, G.: Rare Cause of Severe Gastrointestinal Haemorrhage: With Note on Aneurysm of Hepatic Artery , Brit M J 1:504, 1943.Crossref 2. Smyth, N.P.D., and Teimourian, B.: Resection Hepatic Arterial Aneurysm Following Intraperitoneal Rupture: Report of a Case With Recovery , Ann Surg 160:61, 1964.Crossref 3. Foster, J.H., and Sandblom, P.: Portal Hypertension Secondary to a Hepato-portal Arteriovenous Fistula , Ann Surg 154:300, 1961.Crossref 4. Graham, W.P.; Eiseman, B.; and Taylor, R.: Hepatic Artery Aneurysm With Portal Vein Fistula in a Patient With Familial Hereditary Telangectasia , Ann Surg 159:326, 1964.Crossref 5. Hess, V.W., and Celio, A.: Das Aneurysma der Arteria Hepatica: Ein durch Aneurysmorrhaphie Geheilter Fall , Helv Chir Acta 22:286, 1955. 6. Howeison, J.L.: Hepatic Artery Aneurysm , Radiology 81:598, 1963.Crossref 7. Hufnagel, C.A., in Discussion of Postlethwait et al, Ann Surg 159:909, 1964. 8. Luke, J.C.: The Useful Splenic Artery , Surg Gynec Obstet 110:633, 1960. 9. Steinberg, I.: Diagnosis of Aneurysms of the Hepatic and Splenic Arteries by Intravenous Abdominal Aortography , New Eng J Med 263:341, 1960.Crossref 10. Dwight, R.W., and Ratcliffe, J.W.: Aneurysm of Hepatic Artery: Report of Case Treated by Wiring , Surgery 31:915, 1952. 11. Zeppa, R., and Womack, N.: Medial Degeneration and Aneurysm of the Hepatic Artery , Arch Surg 86:252, 1963.Crossref 12. Postlethwait, R.W.; Hernandez, R.R.; and Dillon, M.L.: Hepatic Artery Lesions , Ann Surg 159:895, 1964.Crossref 13. Wheeler, H.B., and Warren, R.: Duodenal Varices Due to Portal Hypertension From Arteriovenous Aneurysm: Report of a Case , Ann Surg 146:229, 1957.Crossref 14. Friedenwald, J., and Tannenbaum, K.H.: Aneurysm of the Hepatic Artery , Amer J Med Sci 165: 11, 1923. 15. Houdard, C.: Un cas D'anevrysme de l'artere hepatique , Mem Acad Chir 80:460, 1954. 16. Jarvis, L., and Hodes, P.J.: Aneurysm of the Hepatic Artery Demonstrated Roentgenographically: Case Report , Amer J Roentgen 72:1037, 1954. 17. Jontz, J.G.: Hepatic Artery Aneurysm: Report of a Case Treated by Excision , Surgery 46:896, 1959. 18. Regout, J.E.P.M.: Aneurysm of the Hepatic Artery , Arch Chir Neerl 11:3, 1959. 19. Bruwer, A.J., and Hallenbeck, G.A.: Aneurysm of the Hepatic Artery: Roentgenologic Features in One Case , Amer J Roentgen 78:270, 1957. 20. Robert; Pradel; and Brechot: A propos d'un anevrisme de l'artere hepatique avec infarctus secondaire du foie , Arch Mal Appar Dig 47:561, 1958. 21. Inui, F.K., and Ferguson, T.A.: Aneurysm of Right Hepatic Artery: Preoperative Diagnosis and Successful Excision , Ann Surg 144:235, 1956.Crossref 22. Giuseffi, J., and Collins, C.C.: Successful Cure of False Aneurysm of Hepatic Artery , Surgery 36: 125, 1954. 23. Paul, M.: Large Traumatic Aneurysm of Hepatic Artery , Brit J Surg 39:278, 1951.Crossref 24. Orloff, M.J.; Peskin, G.W.; and Ellis, H.L.: A Bacteriologic Study of Human Portal Blood: Implications Regarding Hepatic Ischemia in Man , Ann Surg 148:738, 1958.Crossref 25. Markowitz, J.; Rappaport, A.; and Scott, A.C.: Prevention of Liver Necrosis Following Ligation of Hepatic Artery , Proc Soc Exp Biol Med 70:305, 1949.Crossref 26. Michels, N.A.: Collateral Pathways to Liver After Ligation of Hepatic Artery and Removal of the Celiac Axis , Cancer 6:708, 1953.Crossref 27. Kehr, H.: Der Erste Fall von Erfolgreicher Unterbindung der Arteria Hepatic Propria Wegen Aneurysma , Munchen Med Wehnschr 1903, 1, 1861-1867. 28. Anderson, E.B.: Aneurysms Amer J Surg 33: 129, 1919. 29. Kading, K.: Ein Geheilter Fall von Intrahepatischem Aneurysma mit Besonderer Berucksichtigung der Traumatischen Leberarterienaneurysmen , Deutsch Z Chir 150:82, 1919.Crossref 30. Colmers, F.: Intrahepatisches Aneurysma und Gallenfistel nach Leberzerreissung: Heilung durch Unterbindung der Arteria Hepatica Communis , Beitr Klin Chir 122:324, 1921. 31. Quattlebaum, J.K.: Aneurysm of Hepatic Artery: Report of Three Cases , Ann Surg 139:743, 1954.Crossref 32. Mainetti, J.M., and Amendolara, J.: Aneurisma de la arteria hepatica: a proposito de casos con exito , Bol Soc Circ B Air 40:173, 1956. 33. Spector, N.: Ligation of the Right Hepatic Artery in Hemobilia: Report of a Case With Recovery , Ann Surg 145:244, 1957.Crossref 34. Mackay, A.G., and Page, H.: Hematemesis Associated With Hemobilia: Report of a Case Due to an Intrahepatic Artery Aneurysm, With Survival , N Eng J Med 260:468, 1959.Crossref 35. Jesseph, J.E., and May, K.J., Jr.: False Aneurysm of the Hepatic Artery With Massive Hemobilia and Jaundice: A Case Report , Arch Surg 81:646, 1960.Crossref 36. Kirklin, J.W., et al: Treatment of Aneurysm of the Hepatic Artery by Excision: Report of a Case , Ann Surg 142:110, 1955.Crossref 37. Cosco Montaldo, H.: Higado Desarterializado: Primer caso de reseccion en el hombre de al arteria hepatica comun y propia por aneurisma permeable de la arteria hepatica, con sobrevida , Bol Soc Cir Uruguay 28:54, 1957. 38. Hejnal, J.: Pripad Aneusymato Arteriae Hepaticae , Rozlhl Chir 36:420, 1957. 39. Hansbrough, E.T., and Lipin, R.J.: Hepatic Artery Aneurysm With Excision of Celiac Axis , Ann Surg 149:273, 1959.Crossref 40. Heberer, G.: Zur Chirurgie von Aneurysmen der Bauch-aorta, der Milz- und Leberarterien , Chirurg 30:193, 1959. 41. Browning, L.D., Jr.; Clauss, R.H.; and MacFee, W.F.: Aneurysm of the Hepatic Artery: Report of Two Cases , Ann Surg 150:320, 1959.Crossref 42. Gallart-Mones, F., and Piulachs, P.: Anevrysme de l'artere hepatique , Arch Mal Appar Dig 49: 913, 1960. 43. McCorriston, J.R.; Allin, G.E.; and Crowell, D.E.: Splenohepatic Arterial Anastomosis for Aneurysm of Hepatic Artery , Surgery 47:636, 1960. 44. Steelquist, J.H.: Aneurysm of Hepatic Artery: Report of Three Cases , Amer J Surg 89:1244, 1955.Crossref 45. Rene, M.L.: Anevrysme de l'artere hepatique decouvert au decours d'une hemorragie digestive massive , Arch Mal Appar Dig 47:561, 1958. 46. Sheridan, J.T.: Hepatic Artery Aneurysm: Report of Case and Review of Literature , Arch Surg 72:30, 1956. 47. Jewett, T.C., Jr.: Aneurysm of the Hepatic Artery in a Child , Ann Surg 150:951, 1959.Crossref

Journal

Archives of Surgery – American Medical Association

Published: Sep 1, 1966

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