PMC6218669_01
(a) Contrast enhanced computed tomography revealed a huge aneurysm of the common hepatic artery. (b) Coeliac angiography demonstrated a saccular aneurysm 11 mm distal to the origin of the proper hepatic artery and 7 mm proximal to the junction of the left and right hepatic artery. Note. CA = coeliac artery; CHA = common hepatic artery; SA = splenic artery; GDA = gastroduodenal artery; LHA = left hepatic artery; RHA = right hepatic artery; HAA = hepatic artery aneurysm.
gr1.jpg
PMC6218669_01_gr1.jpg
fig1
Contrast enhanced abdominal computed tomography (CT) and coeliac artery angiography confirmed the diagnosis of PHAA, which had a diameter of 65 mm (Fig. 1a and b). Coeliac artery angiography through the right femoral artery showed that the PHAA was located 11 mm distal to the origin of the GDA proximally, and 7 mm from the junction of the right and left hepatic arteries distally (Fig. 1b).
Coil embolisation using the distal balloon occlusion technique. (a) Angiography during catheterisation shows a microcatheter inserted into the right hepatic artery (RHA) under distal balloon occlusion (white arrow) in the RHA. (b) Angiography during coil embolisation shows a tight and compact coil. (c, d) Similar to the left hepatic artery (LHA). (e, f) Under proximal balloon occlusion in the proper hepatic artery.
gr2.jpg
PMC6218669_01_gr2.jpg
fig2
Fr microcatheter (MARVEL, Tokai Medical, Kasugai, Japan) was inserted into the 2.7 Fr high flow microcatheter in the form of a dual coaxial system. First, the RHA was successfully embolised using the distal balloon occlusion technique (Fig. 2a) with two microcoils (Orbit Galaxy; Cerenovus, Irvine, CA, USA) (Fig. 2b). Second, the LHA was embolised using two microcoils in the same manner as the RHA, and an additional microcoil was placed at the junction between the right and left hepatic arteries (Ruby coil; Penumbra, Inc., Alameda, CA, USA) (Fig. 2c and d). Next, the proper hepatic artery was successfully embolised using the proximal balloon occlusion technique (Fig. 2e) with three microcoils (two Orbit Galaxy coils and a Ruby coil) distal to the origin of the GDA, without occluding it (Fig. 2f).
Angiography of the coeliac artery after embolisation.
gr3.jpg
PMC6218669_01_gr3.jpg
fig3
Coeliac angiography after embolisation showed the completely occluded aneurysm (Fig. 3).
(a) Abdominal enhanced computed tomography one year after treatment showing the hepatic artery aneurysm diameter reduced to 3 cm. (b) The white arrow shows the collateral artery from the superior mesenteric artery, and the white dotted arrow shows the collateral artery from the gastroduodenal artery to the right hepatic artery.
gr4.jpg
PMC6218669_01_gr4.jpg
fig4
Enhanced abdominal CT examination one year after treatment revealed no exacerbation of the PHAA sac, and aneurysm shrinkage to 3 cm (Fig. 4a).