Hepatic artery aneurysms: evaluation and current management.

Twelve patients underwent surgical treatment for hepatic artery aneurysm (HAA) at Mayo Clinic between 1979 and 1991. Six patients presented with symptoms, while in six the HAA was asymptomatic. Two HAAs presented with rupture: one ruptured into the portal vein and one iatrogenic rupture occurred during cholecystectomy. Ultrasonography and computed tomography were important for diagnosis, while arteriography was used for planning of the operation. All HAAs were true aneurysms, with atherosclerosis being the etiology in 10 of 12 patients. The common hepatic artery was involved in 11 patients. Nine of 12 patients had aneurysms in other locations and half had major concomitant operations in addition to HAA repair. One patient had hepatic artery ligation, while in eleven the artery was reconstructed. Graft patency was poor (25%) when the gastroduodenal artery was excluded from the repair. No hepatic morbidity occurred. Mortality was 100% (1/1) for emergent operation, and 9.1% (1/11) in the elective setting. Because of the prevalence of other aneurysms, complete vascular evaluation and close follow-up are recommended.