2018 Volume 51 Issue 6 Pages 445-452
A 69-year-old woman visited our hospital because of hematemesis. Hemorrhage with shock was uncontrolled by upper gastrointestinal endoscopy, and we performed emergency interventional radiology (IVR). A celiac angiogram showed a proper hepatic aneurysm, but we could not embolize the proper hepatic artery because of the narrowing vessel lumen. A superior mesenteric angiogram showed the right hepatic artery was visualized by the back flow through the pancreaticoduodenal arcades. We embolized the common hepatic artery and gastroduodenal artery, so there was almost no blood flow to the aneurysm. An enhanced CT after TAE showed hepatic artery aneurysm had blood flow from the proper hepatic artery and right gastric artery. We performed urgent surgery to avoid re-rupture. We detached the right gastric artery, right hepatic artery and left hepatic artery, so there was no blood flow to the aneurysm. The postoperative course was uneventful, and she was discharged on postoperative day 15. A postoperative CT showed the hepatic artery aneurysm to be cured. The left hepatic artery had blood flow through the communicating arcade from the right hepatic artery.
