IS Case 104: Replaced Right Hepatic Artery. Iatrogenic right hepatic artery pseudoaneurysm.
Imaging Sciences URMC 2008
Publication Date: 2009-05-20
Patient is a 48-year-old male with metastatic pancreatic cancer with biliary obstruction. Patient had external biliary drain placed in Interventional Radiology (IR). Approximately two weeks later he had bright red blood coming from around the drain. The catheter was up sized to attempt the tamponade. When further bleeding was observed, angiogram was performed.
No bleeding seen on the celiac arteriogram. SMA arteriogram showed large replaced right hepatic artery with pseudoaneurysm at the intersection with the drain. The artery was superselected and pseudoaneurysm coiled.
Replaced right hepatic artery originating from the SMA is a common anatomic variant occurring in 12% of population. It is important to consider in the procedure planning. In the present case, if SMA arteriogram was not performed, the pathology would have been missed.
Major complications to the percutaneous biliary drainage include hemorrhage, bile leak, and sepsis. The total incidence is 5-10%. More serious hemorrhage occurs several days, rather than immediately after the drain placement. Such hemorrhage may be secondary to pseudoaneurysm or tumor bleeding. Replacing the catheter with a bigger one can tamponade the bleeding from the pseudoaneurysm. If not successful, embolization may be necessary.
- Kaufman JA, Lee MJ. Vascular and Interventional Radiology: The Requisites, Mosby, 2004; 287, 573-6.