Ruptured Hepatic Artery Aneurysm: A Novel Approach to Distal Arterial Control

Objectives: When hepatic artery aneurysm rupture occurs, the result is almost uniformly fatal. This report describes a unique method for obtaining distal control of a ruptured left hepatic artery aneurysm.
Methods: A 45 year old male presented to a local emergency room with severe abdominal pain and CT evidence of a ruptured hepatic artery aneurysm. The 3 cm aneurysm originated in the left hepatic artery. Evidence of free intraperitoneal blood was present. The distal most aspect of the aneurysm was within the parenchyma of the left lobe of the liver.
His past medical history was significant for Ehlers Danlos Type IV. He had undergone an aortobifemoral bypass graft for an infrarenal aortic occlusion.
Results: At exploration, a ruptured left hepatic artery aneurysm was found with free intraperitoneal blood. Proximal control was obtained and pledgeted prolene sutures were utilized to ligate the left hepatic artery proximally. The distal left hepatic artery was aneurysmal throughout its course into the parenchyma of the liver. Distal control was initially obtained with a Fogarty balloon catheter. Injection of 5cc of thrombin into the distal left hepatic artery resulted in thrombosis of the distal hepatic artery and control of the hemorrhage.
Conclusions: This unique approach should be considered in select patients in whom distal arterial control is technically challenging or impossible.