Display options
Cite
Christensen T, Matsuoka L, Heestand G, et al. Iatrogenic pseudoaneurysms of the extrahepatic arterial vasculature: management and outcome. HPB (Oxford). 2006;8(6):458-64doi: 10.1080/13651820600839993.
Christensen, T., Matsuoka, L., Heestand, G., Palmer, S., Mateo, R., Genyk, Y., Selby, R., & Sher, L. (2006). Iatrogenic pseudoaneurysms of the extrahepatic arterial vasculature: management and outcome. HPB : the official journal of the International Hepato Pancreato Biliary Association, 8(6), 458-64. https://doi.org/10.1080/13651820600839993
Christensen, T, et al. "Iatrogenic pseudoaneurysms of the extrahepatic arterial vasculature: management and outcome." HPB : the official journal of the International Hepato Pancreato Biliary Association vol. 8,6 (2006): 458-64. doi: https://doi.org/10.1080/13651820600839993
Christensen T, Matsuoka L, Heestand G, Palmer S, Mateo R, Genyk Y, Selby R, Sher L. Iatrogenic pseudoaneurysms of the extrahepatic arterial vasculature: management and outcome. HPB (Oxford). 2006;8(6):458-64. doi: 10.1080/13651820600839993. PMID: 18333102; PMCID: PMC2020760.
Copy Download .nbib Format: NLM
Share it on

HPB (Oxford). 2006;8(6):458-64. doi: 10.1080/13651820600839993.

Iatrogenic pseudoaneurysms of the extrahepatic arterial vasculature: management and outcome.

HPB : the official journal of the International Hepato Pancreato Biliary Association

T Christensen, L Matsuoka, G Heestand, S Palmer, R Mateo, Y Genyk, R Selby, L Sher

Affiliations

  1. Department of Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California 90033, USA.

PMID: 18333102 PMCID: PMC2020760 DOI: 10.1080/13651820600839993

Abstract

BACKGROUND: Pseudoaneurysms of the extrahepatic arterial vasculature are relatively uncommon lesions following surgery and trauma. In this report we analyze the presentation, management and outcomes of these vascular lesions. Of the related surgical procedures, the reported incidence is highest following laparoscopic cholecystectomy. We hereby analyze the literature on this subject and report our experience, specifically with extrahepatic pseudoaneurysms, drawing an important distinction from intrahepatic pseudoaneurysms.

METHODS: From September 1995 until July 2004, six patients, including three males and three females with a mean age of 67 years, were treated for seven extrahepatic arterial pseudoaneurysms. Patients were evaluated by endoscopy, ultrasound, computerized tomography, and angiography. Management included coil embolization or arterial ligation and/or hepatic resection.

RESULTS: The mean pseudoaneurysm size was 4.9-cm (range 1.0-11.0-cm) and the locations included the right hepatic artery (n = 5), inferior pancreaticoduodenal artery (n = 1), and gastroduodenal artery (n = 1). All six patients had prior surgical or percutaneous procedures. Median latency period between the original procedure and treatment of pseudoaneurysm was 17 weeks (range one month-16 years). Clinical features ranged from the dramatic presentation of hypotension secondary to intraperitoneal aneurysmal rupture to the subtle presentation of obstructive jaundice secondary to pseudoaneurysm mass effect. The range of patient presentations created diagnostic challenges, proving that accurate diagnosis is made only by early consideration of pseudoaneurysm. Management was ligation of the right hepatic artery (n = 4) and embolization of the pseudoaneurysms (n = 2). Post-treatment sequelae included liver failure requiring liver transplant (n = 1), intrahepatic biloma requiring percutaneous drainage (n = 1) and cholangitis with right hepatic duct strictures requiring right lobectomy and biliary reconstruction (n = 1). These complications followed arterial ligation, with no complications resulting from embolization. All six patients are alive and well after a mean follow-up of 53 months.

CONCLUSIONS: Our six patients demonstrate the diversity and unpredictability with which a pseudoaneurysm of the extrahepatic arterial vasculature may present in terms of initial symptoms, prior procedures, and the latency period between presentation and prior procedure. Through our experience and an analysis of the literature, we recommend a diagnostic and management approach for these patients.

References

  1. Gastrointest Radiol. 1980 Apr 30;5(2):127-35 - PubMed
  2. AJR Am J Roentgenol. 2001 Jun;176(6):1483-91 - PubMed
  3. Dig Surg. 1999;16(6):528-30 - PubMed
  4. J Vasc Surg. 2003 Jul;38(1):41-5 - PubMed
  5. Ann Vasc Surg. 1997 May;11(3):300-3 - PubMed
  6. Am J Gastroenterol. 1987 May;82(5):448-53 - PubMed
  7. Ann Vasc Surg. 2003 Nov;17(6):663-9 - PubMed
  8. J Magn Reson Imaging. 1999 Sep;10(3):369-75 - PubMed
  9. Transplantation. 2001 Nov 15;72(9):1527-33 - PubMed
  10. N Engl J Med. 1974 May 2;290(18):993-6 - PubMed
  11. Can J Surg. 1996 Jun;39(3):240-2 - PubMed
  12. J Vasc Interv Radiol. 2002 Sep;13(9 Pt 1):935-8 - PubMed
  13. Nouv Presse Med. 1978 Feb 25;7(8):633-7 - PubMed
  14. Langenbecks Arch Chir. 1994;379(5):291-3 - PubMed
  15. J Am Soc Nephrol. 2002 Jan;13(1):158-169 - PubMed
  16. J Clin Ultrasound. 2001 Oct;29(8):466-71 - PubMed
  17. Surg Endosc. 1998 Mar;12(3):276-7 - PubMed
  18. Chirurg. 2001 Jan;72(1):78-81 - PubMed
  19. Aust N Z J Surg. 1995 Mar;65(3):185-8 - PubMed
  20. Arch Surg. 1985 Nov;120(11):1241-9 - PubMed
  21. Am J Surg. 1994 Sep;168(3):235-8 - PubMed
  22. J Trauma. 2001 Jul;51(1):153-8 - PubMed
  23. Arch Surg. 1988 Jun;123(6):718-21 - PubMed
  24. Br J Radiol. 1999 Oct;72(862):1018-25 - PubMed
  25. J Vasc Surg. 2002 Dec;36(6):1260-3 - PubMed
  26. J Clin Gastroenterol. 1994 Jul;19(1):50-3 - PubMed
  27. World J Surg. 1984 Feb;8(1):2-8 - PubMed
  28. Am J Gastroenterol. 2001 Jan;96(1):233-7 - PubMed
  29. Arch Surg. 2002 Jan;137(1):55-9 - PubMed
  30. Hypertension. 2003 Jan;41(1):114-8 - PubMed
  31. Surgery. 1998 Jul;124(1):114-5 - PubMed
  32. J Am Coll Surg. 1998 Mar;186(3):325-30 - PubMed
  33. Gastrointest Endosc. 1997 Dec;46(6):544-9 - PubMed
  34. J Magn Reson Imaging. 1997 Jan-Feb;7(1):171-6 - PubMed
  35. AJR Am J Roentgenol. 2000 Feb;174(2):433-9 - PubMed
  36. Am Surg. 2003 Nov;69(11):933-40 - PubMed
  37. Surg Endosc. 1994 Mar;8(3):201-4 - PubMed
  38. Cardiovasc Intervent Radiol. 2000 Nov-Dec;23(6):472-4 - PubMed
  39. Am J Surg. 1992 Sep;164(3):215-9 - PubMed
  40. Surg Clin North Am. 1997 Apr;77(2):425-42 - PubMed
  41. J Clin Ultrasound. 1999 Mar-Apr;27(3):151-5 - PubMed
  42. Hepatogastroenterology. 2001 Jan-Feb;48(37):179-83 - PubMed
  43. Cardiovasc Intervent Radiol. 1999 Jan;22(1):20-4 - PubMed

Publication Types