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Covered stent placement for hepatic artery pseudoaneurysm

  • Interventional Radiology
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

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.

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Acknowledgements

We would like to extend our sincere gratitude to our departmental chair for all these support. Also, we would like to give many thanks to our physicians, engineers, nurses, as well as other staff of the department.

Funding

Funding is not applicable.

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Authors and Affiliations

Authors

Contributions

FD contributed to the study conception and design. Material preparation, data collection and analysis were performed by LC, LK, YB, and JH. The interventional treatments were performed by FD, XL, and XW. The first draft of the manuscript was written by LC, LK, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Feng Duan.

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The authors declare that they have no competing interests.

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Cui, L., Kong, L., Bai, YH. et al. Covered stent placement for hepatic artery pseudoaneurysm. Abdom Radiol 45, 3337–3341 (2020). https://doi.org/10.1007/s00261-020-02452-3

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  • DOI: https://doi.org/10.1007/s00261-020-02452-3

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