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STANDARD AND ALTERNATIVESEMBOLISATIONTECHNIQUEIN HEPATIC ARTERY LESIONS. AN ICONOGRAPHIC ESSAY
M. LANGLEIB, , E. SQUARZA
IDITE. CETRO CARDIOVASCULAR CASA DE GALICIA.
MONTEVIDEO , URUGUAY.
DEPARTAMENTO CLÍNICO DE IMAGENOLOGÍA . HOSPITAL
DE CLINICAS DR.MANUEL QUINTELA. MONTEVIDEO
,URUGUAY
NO FINANCIAL DISCLOUSURES
Learning Objetives
• 1To illustrate different modalities of
endovascular treatment of lesions in the
vascular tree of the hepatic artery.
• 2. To illustrate posible pitfalls in the treatment
of these injuries.
• 3.To discuss endovascular treatments
including differents materials and techniques.
BackgroundHepatic artery aneurysm and pseudoaneurysmare rare but important
entities with a high morbimortality.
They are the second most common visceral aneurysm and account for
approximately half the pseudoaneurysm.
Endovascular treatment is the first line treatment for such lesions.
Differents materials and techniques have been used depending on the
characteristicsand location of the lesions.
Currently the standard treatment for visceral aneurysm and
pseudoaneurysm is the exclussion of the lesions by coils along the
aneurysm or pseudoaneurysm neck. (sándwich technique, deconstructive
treatment)
Other techniques and materials have been used to preserve parent vessel
permeability. (Reconstructive treatment)
Clinical Finding /Procedures
We present an iconographic essay with
differnt lesions and techniques with
empasis on the preservation of the hepatic
circulation.
Fibered coils , bare platinum coils ,
hydrocoils and glue were used.
We presented a review of the literature
and discussion in relation to out cases
series.
CASE 1. TRUE ANEURYSM OF PROPER HEPATIC ARTERY FAILUREATTEMPT WITH STENT GRAFT WITH DISTAL THROMBOEMBOLICCOMPLICATION. DEFINITIVE TREATMENT WITH HIDROCOILS ( O,O18) FROM A LEFT BRACHIAL APPROACH.
CASE 2RECONSTRUCTIVETREATMENT. PROXIMAL PROPERARTERYPSEUDOANEURYSMAND INTRAHEPATICSMALLPSEUDOANEURYSMIN PATIENT WITHHEMODIYNAMICINESTABILITY.TREATMENTWITHMICROCATHETERAND NBCA 20%. BOTH LESIONS WASOCCLUDED..
CASE 3. INTRAHEPATIC PSEUDOANEURYSM.RECONSTRUCTIVE TREATMENT. WITH A SINGLE FIBRILARMICROCOIL IN THE NECK OF PSEUDOANEURYSM.
CASE 4: PROPER HEPATIC ARTERY PSEUDOANEURYSMFIRST ATTEMPT: RECONSTRUCTIVE TREATMENT WITH FIBRILARCOILS
CASE 4. SECOND ATTEMPT. 48HS LATTER: DECONSTRUCTIVE TREATMENT WITH SANDWICHE TECHNIQUE DISTAL AND PROXIMAL TO NECK.
CASE 5. CYSTIC ARTERY PSEUDOANEURYSM. OCLUSSION PROXIMAL TO ORIGIN OF CYSTIC ARTERY. OCLUSSION OF CYSTIC ARTERY IS CONTROVERSIAL BECAUSE CAN PRODUCE GALLBLADDER NECROSIS
Conclusions
• Hepatic artery aneurysm and
pseudoaneurysm are uncommon lesions and
endovascular treatment is the preferred
option.
• Good results can be obtained using the
appropiate technique.
• Materials and different options and pitfalls
must be known and have been exposedin this
iconographic essay
Suggested Reading
1.Huang YK, HsiehHC.Tsai FC et al. Visceral artery aneurysm: risk factors analysis and
therapeutic options. Eur J Vasc Endovas Surg 2007 Mar .;33(3):293-301.
2.Tulsyan N, Kashyap VS, Greenberg RK et al. The endovascular management of visceral artery
aneurysm and pseudoaneurysm. J.Vasc. Surg 2007; 45 : 276-83.
3.Fankhauser GT, Stone WM, Naidu SG et al . The minimally invasive management of visceral
artery aneurysm and pseudoaneurysm. J. Vasc Surg 2011 Apr. ; 5 3(4):966-70.
4.Nosher Jl. Chung J,Brevetti LS et al. Visceral and renal artery aneurysm : a pictorial essay on
endovascular therapy. Rdaiographics 2006. Nov Dec.; 26(6): 1687-704.
5.Baldery A, Antonietti A , Pedrazzini F et al. Treatment of a hepatic artery aneurysm by
endovascular exclusion using the multilayer cardiatis stent. Cardiovasc Intervet Radiol 2010
Dec.;33(6):1282-6
6.Mokrane FZ, Garcia Alba C, Lebbadi M . Et al. Pseudoaneurism of the cystic artery treated
with hyperselective embolisation alone. Diagnostic and interventional imaging. Vol 94 Issue 6
June 2013 641-643
7-Mine T, Murata S, Takeda M et al Contribution of extrahepatic colaterals to liver parenchimal
circulation after proper hepatic artery embolisation. J GastroenterolHepatol 2014 ;29(7)1515-
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