Hepatic artery aneurysm is a rare and potentially life-threatening entity. We report a case of ruptured common hepatic artery aneurysm in a patient with Behçet’s disease. The ruptured aneurysm was treated successfully with transcatheter arterial coil embolization. Transcatheter arterial embolization is the preferred treatment modality in patients at high risk of surgical intervention.
Behçet’s disease is a multisystem disorder characterized by recurrent ulcers of the mouth and genitalia and relapsing iritis. It was first described by the Turkish dermatologist Hulusi Behçet in 1937 and most often affects men between 20 and 40 years of age. The disease is most prevalent in the Mediterranean region, Middle East, and far east. The cause of Behçet’s disease is unclear. Vascular involvement appears in 5% to 30% of patients [
We describe a case in which we successfully used transcatheter arterial coil embolization to treat a ruptured common hepatic artery (CHA) aneurysm in a patient with Behçet’s disease.
A 34-year-old man presented to our hospital with acute right abdominal pain. He had been diagnosed with Behçet’s disease 10 years before. The patient had undergone aortic replacement with celiac and superior mesenteric artery restoration for aortic dissection 18 months previously. He also had undergone ligation for aneurysms of the gastroduodenal artery and both renal arteries. He had not taken steroid before and after surgery. He had been receiving hemodialysis for the past 18 months. He also had hypertension.
Nonenhanced CT showed a 6 cm aneurysm of the CHA, with a hematoma extending inferiorly (Figure
(a) Nonenhanced CT shows an aneurysm (arrow) of the common hepatic artery, with a hematoma (arrowhead) extending inferiorly. (b) Contrast-enhanced CT two and a half hours later reveals extravasation (arrow) from the aneurysm and hematoma extending to the lateral aspect of the right lobe of the liver (arrowhead).
Angiography and embolization of the aneurysm were then planned. A 4-Fr Cobra catheter (Selecon PA, Terumo Clinical Supply, Gifu, Japan) was placed at the celiac artery via a femoral artery approach. Celiac angiography showed a saccular aneurysm 2 cm distal to the origin of the CHA (Figure
(a) Celiac angiography demonstrates a saccular aneurysm (arrow) 2 cm distal to the origin of the common hepatic artery (CHA). (b) Celiac angiography after embolization of the right hepatic artery and CHA (arrow) shows the occluded aneurysm. Incidentally migrated coils (arrowhead) are seen in the distal part of the RHA.
The patient developed a fever after embolization. There was no evidence of liver necrosis nor severe liver dysfunction without elevation of liver transaminases. His fever abated after intravenous antibiotic administration. Abdominal CT 2 weeks after the treatment showed that the hematoma had decreased greatly, and there was no evidence of active bleeding. Abdominal CT 1 year after the treatment documented the disappearance of the hematoma and gave no evidence of residual or recurrent aneurysms. Clinical and CT follow-up at three and half years after the treatment showed no new abnormalities and well-healed treatment sites.
Behçet’s disease is a multisystemic disorder that affects the mucocutaneous, ocular, articular, neurologic, cardiovascular, gastrointestinal, and respiratory systems. Vascular involvement occurs in 5% to 30% of patients with Behçet’s disease [
In general, hepatic artery aneurysm (HAA) is the second most frequent type of visceral aneurysm after splenic artery aneurysm [
The basic pathogenesis underlying the vascular complications of Behçet’s disease is vasculitis of the vasa vasorum in medium and large vessels [
Transcatheter embolization is a reasonable alternative to traditional surgical approaches to prevent complications or recurrences and is considered to be safe and effective for arterial aneurysms in the context of Behçet’s disease. A single review and several reports support it [
In the single report of aneurysm of the CHA with a fistulous communication with the superior mesenteric vein in a patient with Behçet’s disease [
In summary, we successfully performed transcatheter arterial coil embolization to treat a ruptured CHA aneurysm in a patient with Behçet’s disease. Transcatheter arterial embolization is the preferred treatment modality for patients at high risk of complications during and after surgery.
The authors declare that they have no conflict of interests.