Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2019 Apr 2;14(6):711-713.
doi: 10.1016/j.radcr.2019.03.021. eCollection 2019 Jun.

Placement of a Viabahn stent-graft for hepatic artery pseudoaneurysm complicated by arterial dissection caused by a guiding sheath

Yasuyuki Onishi  1 , Hiroyuki Kimura  1 , Mitsunori Kanagaki  1 , Shojiro Oka  1 , Genki Fukumoto  1 , Tomoaki Otani  1 , Naoko Matsubara  1 , Kazuna Kawabata  1
Affiliations
Case Reports

Placement of a Viabahn stent-graft for hepatic artery pseudoaneurysm complicated by arterial dissection caused by a guiding sheath

Yasuyuki Onishi et al. Radiol Case Rep. .

Abstract

A 69-year-old man was transferred to our hospital for massive hemorrhage from a right hepatic artery pseudoaneurysm 5 months after surgery for gastric cancer. Stent-graft placement was planned to avoid fatal hepatic infarction, and a guiding sheath was advanced deeply into the tortuous and stenotic right hepatic artery beyond the pseudoaneurysm for safe deployment of a stent-graft. However, this advancement caused arterial dissection of the right hepatic artery. After the guiding sheath was pulled back, a Viabahn stent-graft was successfully advanced over a guidewire to exclude the pseudoaneurysm. We consider that a Viabahn stent-graft is more flexible than a guiding sheath and that advancing a Viabahn stent-graft directly from a proximally placed guiding sheath is safer than advancing a guiding sheath into a tortuous and stenotic abdominal artery.

Keywords: Pseudoaneurysm, Arterial dissection; Stent-graft.

PubMed Disclaimer

Figures

Fig 1
Fig. 1
Angiography of the celiac artery demonstrating a pseudoaneurysm (star) arising from the proximal part of the right hepatic artery (arrow). The origin of the pseudoaneurysm is close to the left hepatic artery (arrowhead) and gastroduodenal artery (curved arrow).
Fig 2
Fig. 2
Angiography after embolization of the left hepatic artery and gastroduodenal artery demonstrating occlusion of both arteries (arrows). Severe stenosis of the right hepatic artery (arrowhead) is noted.
Fig 3
Fig. 3
Abdominal X ray during advancement of a guiding catheter and a guiding sheath. (A) The tip of a 4-F catheter (arrow) and a 6-F diagnostic catheter (arrowhead) have passed the stenotic right proximal hepatic artery, while a 7-F guiding sheath is placed in the celiac artery. (B) After advancement of the guiding sheath (curved arrow) beyond the stenotic proximal part of the right hepatic artery, straightening of the tortuous hepatic artery is demonstrated. (C) Angiography from the guiding sheath demonstrates dissection of the right hepatic artery. Contrast medium (arrows) is pooled in the false lumen.
Fig 4
Fig. 4
Angiography of the celiac artery after placement of 2 Viabahn stent-grafts (arrows) demonstrating successful exclusion of the pseudoaneurysm and the patent right hepatic artery.
See this image and copyright information in PMC

References

    1. Han K., Ahmed B.M., Kim M.D., Won J.Y., Lee D.Y., Kim G.M. Clinical outcome of transarterial embolization for postgastrectomy arterial bleeding. Gastric Cancer. 2017;20(5):887–894. - PubMed
    1. Stoupis C., Ludwig K., Inderbitzin D., Do D.D., Triller J. Stent grafting of acute hepatic artery bleeding following pancreatic head resection. Eur Radiol. 2007;17(2):401–408. - PubMed
    1. Wang M-Q. Stent-grafts placement for treatment of massive hemorrhage from ruptured hepatic artery after pancreaticoduodenectomy. World J Gastroenterol. 2010;16(29):3716. - PMC - PubMed
    1. Venturini M., Marra P., Colombo M., Panzeri M., Gusmini S., Sallemi C. Endovascular repair of 40 visceral artery aneurysms and pseudoaneurysms with the viabahn stent-graft: technical aspects, clinical outcome and mid-term patency. Cardiovasc Intervent Radiol. 2018;41(3):385–397. - PubMed
    1. Ching K.C., Santos E., McCluskey K.M., Orons P.D., Bandi R., Friend C.J. Covered stents and coil embolization for treatment of postpancreatectomy arterial hemorrhage. J Vasc Interv Radiol. 2016;27(1):73–79. - PubMed

Publication types

LinkOut - more resources