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Emergency hepatic artery embolization in a patient with post-traumatic ruptured hepatic artery pseudoaneurysm.

Mohanty S, Mukhopadhyay S, Yusuf J, Tyagi S - J Emerg Trauma Shock (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, GB Pant Hospital and Associated Maulana Azad Medical College, Delhi, India. E-mail: drsubhendu@gmail.com.

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Dear Editor, Hepatic artery pseudoaneurysms (HAP) are usually a consequence of abdominal trauma, inadvertent arterial injury during abdominal surgery or chronic pancreatitis... We present a case of acute severe abdominal bleeding secondary to rupture of the HAP, which was managed by an emergency coil embolization of the right hepatic artery (RHA)... Since the clinical course of these aneurysms is unpredictable with a possibility of rupture and acute hemodynamic compromise, detection of a HAP warrants a definite intervention irrespective of the size or symptoms... The HAP may rupture into the adjacent portal vein system, biliary tract, or even the abdominal cavity depending on its location... Endovascular coil embolization is a safe and effective procedure with no major complications... Since the major vascular supply to the liver is from the portal system, hepatic artery occlusion is unlikely to cause any significant hepatic ischemia... Endovascular stent implantation has also been used... However, since the covered stent grafts have a poor profile, it may not be easy to deliver them distally in a tortuous vessel, and they are not readily available in all sizes... Coils are, however, commonly available, are inexpensive, and relatively easy to deliver... In a difficult situation like acute severe bleeding from a ruptured HAP, with hemodynamic compromise, coil embolization can be used as a relatively simple emergency procedure to arrest bleeding... Awareness of this complication, and its emergency management, can help in early diagnosis and intervention in such potentially fatal cases.

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Image shows active bleeding from the right hepatic artery with multiple jets. The arterio-venous fistula has caused the filling of the portal venous system in the late phase
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Figure 1: Image shows active bleeding from the right hepatic artery with multiple jets. The arterio-venous fistula has caused the filling of the portal venous system in the late phase

Mentions: A 21-year-male presented with blunt trauma to right side of chest and abdomen with clinical features of peritonitis. Exploratory laparotomy revealed a right hepatic lobe laceration with active bleeding, which was surgically repaired and bleeding points secured. All other solid and hollow viscera were normal. Patient had bilious discharge from the suture line post-operatively, which stopped by the 20th post-operative day. On the 23rd day, while having his meals, patient suddenly developed profuse bleeding from the suture line needing urgent blood transfusions. He was immediately referred to our center for an opinion and possible intervention. Emergency selective angiogram showed a large RHA pseudoaneurysm with active bleeding [Figures 1 and 2]. A distal hepatic artery-portal vein fistula was also noted. It was decided to embolize the RHA both proximal and distal to the aneurysm to prevent any retrograde filling of the HAP from the fistula. Distal coil embolization was done with two 4 × 6 mm coils, another 6 × 8 mm coil was released across the aneurysm, and then proximal artery was embolized with two 4 × 6 mm coils, one 6 × 8 mm coil and one 8 × 6 mm coil. There was no communication with the aneurysm in the final angiogram [Figure 3]. The patient showed good recovery and had an uneventful subsequent hospital stay and discharge.


Emergency hepatic artery embolization in a patient with post-traumatic ruptured hepatic artery pseudoaneurysm.

Mohanty S, Mukhopadhyay S, Yusuf J, Tyagi S - J Emerg Trauma Shock (2014)

Image shows active bleeding from the right hepatic artery with multiple jets. The arterio-venous fistula has caused the filling of the portal venous system in the late phase
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4126131&req=5

Figure 1: Image shows active bleeding from the right hepatic artery with multiple jets. The arterio-venous fistula has caused the filling of the portal venous system in the late phase
Mentions: A 21-year-male presented with blunt trauma to right side of chest and abdomen with clinical features of peritonitis. Exploratory laparotomy revealed a right hepatic lobe laceration with active bleeding, which was surgically repaired and bleeding points secured. All other solid and hollow viscera were normal. Patient had bilious discharge from the suture line post-operatively, which stopped by the 20th post-operative day. On the 23rd day, while having his meals, patient suddenly developed profuse bleeding from the suture line needing urgent blood transfusions. He was immediately referred to our center for an opinion and possible intervention. Emergency selective angiogram showed a large RHA pseudoaneurysm with active bleeding [Figures 1 and 2]. A distal hepatic artery-portal vein fistula was also noted. It was decided to embolize the RHA both proximal and distal to the aneurysm to prevent any retrograde filling of the HAP from the fistula. Distal coil embolization was done with two 4 × 6 mm coils, another 6 × 8 mm coil was released across the aneurysm, and then proximal artery was embolized with two 4 × 6 mm coils, one 6 × 8 mm coil and one 8 × 6 mm coil. There was no communication with the aneurysm in the final angiogram [Figure 3]. The patient showed good recovery and had an uneventful subsequent hospital stay and discharge.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, GB Pant Hospital and Associated Maulana Azad Medical College, Delhi, India. E-mail: drsubhendu@gmail.com.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Dear Editor, Hepatic artery pseudoaneurysms (HAP) are usually a consequence of abdominal trauma, inadvertent arterial injury during abdominal surgery or chronic pancreatitis... We present a case of acute severe abdominal bleeding secondary to rupture of the HAP, which was managed by an emergency coil embolization of the right hepatic artery (RHA)... Since the clinical course of these aneurysms is unpredictable with a possibility of rupture and acute hemodynamic compromise, detection of a HAP warrants a definite intervention irrespective of the size or symptoms... The HAP may rupture into the adjacent portal vein system, biliary tract, or even the abdominal cavity depending on its location... Endovascular coil embolization is a safe and effective procedure with no major complications... Since the major vascular supply to the liver is from the portal system, hepatic artery occlusion is unlikely to cause any significant hepatic ischemia... Endovascular stent implantation has also been used... However, since the covered stent grafts have a poor profile, it may not be easy to deliver them distally in a tortuous vessel, and they are not readily available in all sizes... Coils are, however, commonly available, are inexpensive, and relatively easy to deliver... In a difficult situation like acute severe bleeding from a ruptured HAP, with hemodynamic compromise, coil embolization can be used as a relatively simple emergency procedure to arrest bleeding... Awareness of this complication, and its emergency management, can help in early diagnosis and intervention in such potentially fatal cases.

No MeSH data available.


Related in: MedlinePlus