Purpose

To evaluate the efficacy and safety of covered stent placement for the treatment of hepatic artery pseudoaneurysm (HAP).

Methods

Between March 2006 and March 2019, 17 consecutive patients underwent emergency covered stent placement for treatment of HAP. There were 12 men and 5 women aged 24–71 years, with an average age of 49.4 years. Eleven patients had undergone Whipple procedure, 3 had hepatic abscess following hepatectomy, 2 had undergone hepatectomy under extracorporeal circulation, and 1 had received surgical exploration after a car accident. The average interval from surgical intervention to massive bleeding was 15.3 days (range: 6–35 days). After HAP was confirmed by angiography, 1–3 covered stent grafts (3–8 mm in diameter and 13 mm–5 cm in length) were implanted. Adequate drainage, anti-infection treatment, and symptomatic treatment were offered after stent placement, and no anticoagulation or antiplatelet drug was used.

Results

The interventions were successful in all 17 patients. Angiography revealed pseudoaneurysms in common hepatic artery in 16 patients (in gastroduodenal artery stumps in 4 patients) and hemorrhage from a ruptured right hepatic artery in 1 patient. All patients were successfully implanted with 1–3 covered stent grafts. Bleeding was completely controlled in 12 patients (stent diameter: 4.5–8 mm). Four patients (stent diameter: 3–4.5 mm) experienced bleeding recurrence 1 h to 3 days after stent implantation, and type 1 endoleaks were identified during second angiography. Finally, these 4 patients died of multiple organ failure 2–10 days after embolization/blockage. The remaining patient suffered from abdominal hemorrhage again 2 weeks after stent implantation, and second angiography showed hemorrhage from a branch of the superior mesenteric artery; no bleeding occurred after embolization. Thirteen patients survived at discharge, and the average length of hospital stay was 26.53 days (range: 11–58 days). The average follow-up time was 23 months (range: 16–37 months), during which 6 patients died of tumor progression. No bleeding recurred during the follow-up period, and routine color Doppler ultrasound revealed that the common hepatic artery was patent and the blood flow was smooth at the stent implantation site.

Conclusion

Covered stent placement is a safe and effective alternative for treating HAP patients with high risk of severe complications after hepatic artery embolization. Larger stent grafts (> 4 mm in diameter) may achieve better prognosis.

中文翻译：

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肝动脉假性动脉瘤的覆膜支架置入术。

目的

评价覆膜支架置入治疗肝动脉假性动脉瘤（HAP）的疗效和安全性。

方法

2006 年 3 月至 2019 年 3 月，连续 17 名患者接受紧急覆膜支架置入治疗 HAP。24～71岁男性12例，女性5例，平均年龄49.4岁。Whipple手术11例，肝切除术后肝脓肿3例，体外循环肝切除2例，车祸后探查1例。从手术干预到大出血的平均间隔为 15.3 天（范围：6-35 天）。经血管造影证实HAP后，植入1-3个覆膜覆膜支架（直径3-8mm，长度13mm-5cm）。支架置入后给予充分引流、抗感染治疗和对症治疗，未使用抗凝或抗血小板药物。

结果

所有 17 名患者的干预措施均取得成功。血管造影显示 16 名患者的肝总动脉假性动脉瘤（4 名患者的胃十二指肠动脉残端）和 1 名患者的右肝动脉破裂出血。所有患者均成功植入 1-3 个覆膜覆膜支架。12 名患者的出血得到完全控制（支架直径：4.5-8 毫米）。4 名患者（支架直径：3-4.5 毫米）在支架植入后 1 小时至 3 天出现出血复发，并在第二次血管造影期间发现了 1 型内漏。最后，这 4 名患者在栓塞/阻塞后 2-10 天死于多器官衰竭。其余患者在支架植入2周后再次腹腔出血，第二次血管造影显示肠系膜上动脉分支出血；栓塞后无出血。出院时存活了 13 名患者，平均住院时间为 26.53 天（范围：11-58 天）。平均随访时间为 23 个月（范围：16-37 个月），其中 6 名患者死于肿瘤进展。随访期间未再出血，常规彩色多普勒超声显示肝总动脉通畅，支架置入部位血流畅通。

结论

覆膜支架置入是治疗肝动脉栓塞后严重并发症高风险的 HAP 患者的一种安全有效的替代方法。较大的覆膜支架（直径 > 4 mm）可能会获得更好的预后。