Balloon-expandable covered stenting of a large right hepatic artery aneurysm

Abstract

Hepatic artery aneurysms (HAAs) are rare visceral aneurysms with a high rupture rate. We report the case of an 88-year-old man with a 4.2-cm right HAA treated with covered stenting. Balloon-expandable covered stents effectively excluded the HAA with excellent proximal and distal seals. Our case is one of a limited number of reports on successfully repairing a hepatic aneurysm with a balloon-expandable stent graft. This case demonstrates that balloon expandable covered stenting is a viable approach in patients with appropriate anatomy and may be favorable in patients precluded from open bypass.

Keywords: Aneurysm; Balloon expandable; Endovascular; Hepatic artery; Stent.

Fig 1

A 4.5-cm asymptomatic right hepatic artery (RHA) aneurysm (HAA) with bifurcation of left hepatic and gastroduodenal arteries in the (A) axial and (B) sagittal views.

Fig 2

Angiogram (A) before and (B) after deployment of endovascular stents with exclusion of the aneurysm and filling of the right hepatic artery (RHA) and retrograde filling of the left hepatic artery (LHA) via the gastroduodenal artery.

Fig 3

Computed tomography angiography in the axial view at 30 days after the procedure demonstrating patent right hepatic artery (RHA) stents.

Fig 4

Comparison of Atrium iCAST (left) and Gore VBX (right) balloon-expandable covered stents after inflation with saline aligned at the distal balloon attachment point.