STANDARD AND ALTERNATIVESEMBOLISATIONTECHNIQUEIN HEPATIC ARTERY LESIONS. AN ICONOGRAPHIC ESSAY

M. LANGLEIB, , E. SQUARZA

IDITE. CETRO CARDIOVASCULAR CASA DE GALICIA.

MONTEVIDEO , URUGUAY.

DEPARTAMENTO CLÍNICO DE IMAGENOLOGÍA . HOSPITAL

DE CLINICAS DR.MANUEL QUINTELA. MONTEVIDEO

,URUGUAY

NO FINANCIAL DISCLOUSURES

Learning Objetives

• 1To illustrate different modalities of

endovascular treatment of lesions in the

vascular tree of the hepatic artery.

• 2. To illustrate posible pitfalls in the treatment

of these injuries.

• 3.To discuss endovascular treatments

including differents materials and techniques.

BackgroundHepatic artery aneurysm and pseudoaneurysmare rare but important

entities with a high morbimortality.

They are the second most common visceral aneurysm and account for

approximately half the pseudoaneurysm.

Endovascular treatment is the first line treatment for such lesions.

Differents materials and techniques have been used depending on the

characteristicsand location of the lesions.

Currently the standard treatment for visceral aneurysm and

pseudoaneurysm is the exclussion of the lesions by coils along the

aneurysm or pseudoaneurysm neck. (sándwich technique, deconstructive

treatment)

Other techniques and materials have been used to preserve parent vessel

permeability. (Reconstructive treatment)

Clinical Finding /Procedures

We present an iconographic essay with

differnt lesions and techniques with

empasis on the preservation of the hepatic

circulation.

Fibered coils , bare platinum coils ,

hydrocoils and glue were used.

We presented a review of the literature

and discussion in relation to out cases

series.

CASE 1. TRUE ANEURYSM OF PROPER HEPATIC ARTERY FAILUREATTEMPT WITH STENT GRAFT WITH DISTAL THROMBOEMBOLICCOMPLICATION. DEFINITIVE TREATMENT WITH HIDROCOILS ( O,O18) FROM A LEFT BRACHIAL APPROACH.

CASE 2RECONSTRUCTIVETREATMENT. PROXIMAL PROPERARTERYPSEUDOANEURYSMAND INTRAHEPATICSMALLPSEUDOANEURYSMIN PATIENT WITHHEMODIYNAMICINESTABILITY.TREATMENTWITHMICROCATHETERAND NBCA 20%. BOTH LESIONS WASOCCLUDED..

CASE 3. INTRAHEPATIC PSEUDOANEURYSM.RECONSTRUCTIVE TREATMENT. WITH A SINGLE FIBRILARMICROCOIL IN THE NECK OF PSEUDOANEURYSM.

CASE 4: PROPER HEPATIC ARTERY PSEUDOANEURYSMFIRST ATTEMPT: RECONSTRUCTIVE TREATMENT WITH FIBRILARCOILS

CASE 4. SECOND ATTEMPT. 48HS LATTER: DECONSTRUCTIVE TREATMENT WITH SANDWICHE TECHNIQUE DISTAL AND PROXIMAL TO NECK.

CASE 5. CYSTIC ARTERY PSEUDOANEURYSM. OCLUSSION PROXIMAL TO ORIGIN OF CYSTIC ARTERY. OCLUSSION OF CYSTIC ARTERY IS CONTROVERSIAL BECAUSE CAN PRODUCE GALLBLADDER NECROSIS

Conclusions

• Hepatic artery aneurysm and

pseudoaneurysm are uncommon lesions and

endovascular treatment is the preferred

option.

• Good results can be obtained using the

appropiate technique.

• Materials and different options and pitfalls

must be known and have been exposedin this

iconographic essay

Suggested Reading

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therapeutic options. Eur J Vasc Endovas Surg 2007 Mar .;33(3):293-301.

2.Tulsyan N, Kashyap VS, Greenberg RK et al. The endovascular management of visceral artery

aneurysm and pseudoaneurysm. J.Vasc. Surg 2007; 45 : 276-83.

3.Fankhauser GT, Stone WM, Naidu SG et al . The minimally invasive management of visceral

artery aneurysm and pseudoaneurysm. J. Vasc Surg 2011 Apr. ; 5 3(4):966-70.

4.Nosher Jl. Chung J,Brevetti LS et al. Visceral and renal artery aneurysm : a pictorial essay on

endovascular therapy. Rdaiographics 2006. Nov Dec.; 26(6): 1687-704.

5.Baldery A, Antonietti A , Pedrazzini F et al. Treatment of a hepatic artery aneurysm by

endovascular exclusion using the multilayer cardiatis stent. Cardiovasc Intervet Radiol 2010

Dec.;33(6):1282-6

6.Mokrane FZ, Garcia Alba C, Lebbadi M . Et al. Pseudoaneurism of the cystic artery treated

with hyperselective embolisation alone. Diagnostic and interventional imaging. Vol 94 Issue 6

June 2013 641-643

7-Mine T, Murata S, Takeda M et al Contribution of extrahepatic colaterals to liver parenchimal

circulation after proper hepatic artery embolisation. J GastroenterolHepatol 2014 ;29(7)1515-

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