Il trattamento chirurgico ed endovascolare degli aneurismi dell’arteria epatica Esperienza personale


COD: 149-152-2 Categorie: ,

Giovanni Nano, Ilias Dalainas, Paolo Bianchi, Elena Ciarmoli, Giovanni Malacrida, Fabio Ramponi, Domenico G. Tealdi

Ann. Ital. Chir., 2007; 78: 149-152

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OBJECTIVE: The aim of this single-institution retrospective study is to report the results of surgical and endovascular treatment
of hepatic artery aneurysms.
MATERIALS AND METHODS: Twenty patients with an extraparenchimal hepatic artery aneurysm made part of the study.
In the first period, between February 1980 and December 1996, 12 patients were admitted and treated surgically. In
the second period, January 1997 until December 2005, 8 patients were admitted. Four were treated surgically and 4
with an endovascular procedure. The aneurysms ranged from 2.3 cm to 6.2 cm Seventeen patients were asymptomatic,
while three were symptomatic for pain and obstructive icterus. In 13 patients aneurysmectomy and graft interposition
was performed, in three patients aneurysmectomy with dacron patch interposition was performed, and in 4 patients the
aneurysm was excluded with a stent-graft.
RESULTS: No perioperative mortality was noted and no major complication occurred. All endovascular procedures successfully
excluded the aneurysm without signs of endoleak. Follow-up in 4 months, 6 months and 10 months postoperatively
showed patency of the stent-graft with no signs of migration or endoleak. Only in one case, in the 8th post-operative
month, thrombosis of the stent-graft occurred and the patient was completely asymptomatic.
CONCLUSION: The natural history of hepatic artery aneurysms is rupture, and consequently there is an indication of
treatment. Actually, we consider endovascular treatment as the first-choice-treatment whenever possible. Endovascularlly
treated patients need a strict follow-up surveillance by imaging means. Particular attention so be given in the preoperative
study of the collateral circulation in patient treated surgically.