Superselective microcoil embolization: treatment of choice in high-risk patients with extrahepatic pseudoaneurysms of the hepatic arteries.
BACKGROUND: Only a few isolated case reports of extrahepatic pseudoaneurysms of the hepatic arteries have been published. We present the first documented series of patients with extrahepatic pseudoaneurysms treated at a single institution, and discuss the etiology and management of this condition. STUDY DESIGN: A retrospective review of all cases of extrahepatic pseudoaneurysms of the hepatic arteries between 1989 and 1997. RESULTS: A total of seven patients with extrahepatic pseudoaneurysms of the hepatic arteries all had upper abdominal pain; five patients were also in shock secondary to a gastrointestinal bleeding from ruptured pseudoaneurysms. The most common factor of the pseudoaneurysms was previous pancreatobiliary surgery in five patients with blunt truncal trauma and chronic pancreatitis in the remaining two patients. Initial endoscopy and ultrasonography were unrevealing, whereas dynamic computed tomography (CT) scan and angiography were diagnostic. The median size of the pseudoaneurysms was 3.6 cm (range 2.1-5.7). Treatment consisted of superselective transcatheter microcoil embolization in five hemodynamically unstable patients and surgical resection of the pseudoaneurysms with vascular reconstruction in the two stable patients. Mortality and morbidity were 0% and 43%, respectively. In a median followup of 35 months (range 2-96), no recurrence of pseudoaneurysm has been found. CONCLUSIONS: A high index of suspicion combined with appropriate diagnostic modalities are required for the diagnosis of extrahepatic pseudoaneurysms. In high-risk patients, superselective transcatheter microcoil embolization should be considered the treatment of choice.