SUPERSELECTIVE MICROCOIL EMBOLIZATION - TREATMENT OF CHOICE IN HIGH-RISK PATIENTS WITH EXTRAHEPATIC PSEUDOANEURYSMS OF THE HEPATIC ARTERIES

Background: Only a few isolated case reports of extrahepatic pseudoane urysms of the hepatic arteries have been published. We present the fir st documented series of patients with extrahepatic pseudoaneurysms tre ated at a single institution, and discuss the etiology and management of this condition. Study Design: A retrospective review of all cases o f extrahepatic pseudoaneurysms of the hepatic arteries between 1989 an d 1997. Results: A total of seven patients with extrahepatic pseudoane urysms of the hepatic arteries all had upper abdominal pain; live pati ents were also in shock secondary to a gastrointestinal bleeding from ruptured pseudoaneurysms. The most common factor of the pseudoaneurysm s was previous pancreatobiliary surgery in five patients with blunt tr uncal trauma and chronic pancreatitis in the remaining two patients. I nitial endoscopy and ultrasonography were unrevealing, whereas dynamic computed tomography (CT) scan and angiography were diagnostic. The me dian size of the pseudoaneurysms was 3.6 cm (range 2.1-5.7). Treatment consisted of superselective transcatheter microcoil embolization in f ive hemodynamically unstable patients and surgical resection of the ps eudoaneurysms with vascular reconstruction in the two stable patients. Mortality and morbidity were 0% and 43%, respectively. In a median fo llowup of 35 months (range 2-96), no recurrence of pseudoaneurysm has been found. Conclusions: A high index of suspicion combined with appro priate diagnostic modalities are required for the diagnosis of extrahe patic pseudoaneurysms. In high-risk patients, superselective transcath eter microcoil embolization should be considered the treatment of choi ce. (C) 1998 by the American College of Surgeons.