Figure 1. Computed tomographic scan of abdomen demonstrating a calcified hepatic artery aneurysm.
Figure 2. Intraoperative photograph of the hepatic artery aneurysm. RHA indicates right hepatic artery; LHA, left hepatic artery; CHA, common hepatic artery, and GDA, gastroduodenal artery.
Most extrahepatic artery aneurysms are solitary, involving the common or right hepatic artery (Figure 2). In general, because most patients are asymptomatic, the diagnosis is usually made as an incidental finding on imaging studies performed for other reasons.
Most of these aneurysms are true aneurysms and have pathologic changes suggestive of medial degeneration with secondary atherosclerosis. Other causes include mycotic aneurysms and the postinflammatory aneurysms that occur in the setting of acute pancreatitis or cholecystitis.
The exact natural history and rate of rupture are unknown because of their rarity. The incidence of rupture has been reported to be from 20%1to 80%2,3; this variation is the result of the large number of asymptomatic aneurysms that are undetected.
Once the diagnosis is made, arteriography is needed to localize the lesion and identify collateral and aberrant hepatic arteries. In general, all extrahepatic arterial aneurysms greater than 2 cm in diameter should be treated with resection or ligation (if the aneurysm involves the common hepatic artery) depending on the anatomic location of the aneurysm.4Those extrahepatic aneurysms of the proper hepatic artery require resection and revascularization.
Corresponding author and reprints: Thomas F. Dodson, MD, Division of Vascular Surgery, Emory University Hospital, 1364 Clifton Rd, Suite H-124, Atlanta, GA 30329.
Image of the Month. Arch Surg. 2002;137(9):1076. doi: