Hepatic artery aneurysms are a type of visceral arterial aneurysm.
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Epidemiology
They are rare representing ~1% (range 0.01-2%) of all arterial aneurysms but are considered the second most common aneurysm of the splanchnic system after splenic artery aneurysms. They may account for 20% of all visceral aneurysms 1.
Clinical presentation
They are usually asymptomatic before rupture 2. If symptomatic they can have a varied clinical presentation from a dull abdominal ache, lump, obstructive jaundice, or rarely as gastrointestinal hemorrhage 1.
Pathology
They may occur in the intra-hepatic or extra-hepatic portions of the hepatic artery.
Treatment and prognosis
A rupture of hepatic artery aneurysms can be seen in more than 80% of patients with mortality rates approaching 40% with surgical treatment 1,3.
Early treatment is preferred over follow-up 2.
Embolization is the treatment of choice in intrahepatic forms as it does not impair the liver vasculature due to the presence of collateral flows. Instead, endovascular stenting may be the best alternative solution in aneurysms of the extrahepatic portion of the hepatic artery. Secondary management options may include prosthetic graft reconstruction, excision and surgical ligation 2.
Differential diagnosis
In traumatic situations consider
hepatic arterial pseudoaneurysm
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