Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery

Table 1 Clinical characteristics of patients with ruptured hepatic artery pseudoaneurysms after hepatobiliary pancreatic surgery

Case	Age/	Underlying diseases	Surgical procedures	Hepatic	Postoperative	Postoperative	Clinical	Sentinel	Pseudoaneurysm
no.	sex			lobes	complications	interval	presentation	bleed	Location	size	Extra-
				mobilized		(d)				(cm)	vasation
1	75/M	Metastatic liver cancer	HTX (S7 + 8), BDR	R	None	256	Melena	No	PHA	2.7	Yes
2	74/M	Intrahepatic cholangiocarcinoma	HTX (S1 + 2 + 3 + 4), BDR	R&L	HJ leak	105	Hematemesis, shock	No	PHA	0.7	Yes
3	66/M	Hilar bile duct carcinoma	HTX (S1 + 2 + 3 + 4), PD	R&L	HJ leak	28	BFD, shock	Yes	PHA, RHA	2.2, 3.1	Yes
4	71/M	Hilar bile duct carcinoma	HTX (S1 + 2 + 3 + 4), BDR	L	HJ leak	19	BFD, shock	Yes	RHA	2.8	Yes
5	76/F	Intrahepatic cholangiocarcinoma	HTX (S1 + 2 + 3 + 4), BDR	L	None	17	Hematemesis, shock	No	PHA	1.5	Yes
6	72/M	Hilar bile duct carcinoma	HTX (S1 + 2 + 3 + 4), BDR	L	HJ leak	15	BFD	Yes	CHA	1.3	No
7	67/F	Gallbladder carcinoma	HTX (S4a + 5), PD	None	PJ leak	35	BFD	No	CHA	1.2	Yes
8	63/M	Ampullary carcinoma	PD	None	PJ leak	23	BFD, shock	Yes	CHA, RHA	1.5, 2.3	Yes
9	66/F	Ampullary carcinoma	PPPD	None	None	12	BFD, shock	Yes	CHA	0.8	No

HTX: hepatectomy; BDR: bile duct resection; S7 + 8: hepatic posterior inferior and superior segments; S1 + 2 + 3 + 4: caudate lobe and hepatic lateral and medial segments; S4a + 5: hepatic medial inferior and anteror inferior segments; PD: pancreaticoduodenectomy; PPPD: pylorus-preserving pancreaticoduodenectomy; R: right; L: left; HJ: hepaticojejunal anastomosis; PJ: pancreaticojejunal anastomosis; BFD: bleeding from drain; PHA: proper hepatic artery; RHA: right hepatic artery; CHA: common hepatic artery.

Table 2 Results of embolotherapy for ruptured hepatic artery pseudoaneurysms after hepatobiliary pancreatic surgery

Case	Arteries	No.of	Migration	TAE	Collateral pathways				Hepatic	Changes in liver function tests:			Follow-up	Outcome
no.	embolized	coils	of coils	success	RIPA	Jejunal	aberrant	intrahepatic	arterial	pre-TAE→post-TAE (days after TAE)			interval
		placed				branches	LHA	branches	stenosis	T-Bil (mg/dL)	AST (IU/L)	ALT (IU/L)	after TAE
1	PHA	17	No	Complete	Good	Good	None	Fair	Yes	1.2→3.2 (3)	29→131 (3)	22→112 (3)	34 mo	Alive
2	PHA, GDA	18	No	Complete	Good	Good	None	Good	Yes	1.1→1.3 (5)	26→41 (1)	12→16 (1)	52 d	Died of MOF
3	PHA, RHA	13	No	Complete	Poor	Poor	None	?	No	1.3→19.4 (3)	65→9750 (2)	79→7865 (3)	9 d	Died of liver failure
4	RHA	10	No	Complete	Good	Poor	None	Good	Yes	1.7→5.6 (1)	46→214 (1)	34→132 (1)	7 mo	Died of local recurrence
5	PHA	9	No	Complete	Fair	Poor	None	Fair	No	0.9→2.5 (5)	20→141 (4)	24→289 (4)	6 mo	Alive
6	CHA	12	No	Complete	Good	Poor	None	Good	Yes	1.6→6.2 (3)	22→118 (3)	21→95 (4)	54 d	Died of MOF
7	CHA	6	Yes	Complete	Fair	Poor	None	Fair	No	1.2→3.2 (3)	29→965 (3)	22→947 (3)	9 mo	Died of liver metastasis
8	CHA, RHA	13	Yes	Complete	Poor	Poor	Good	Good	Yes	0.6→1.1 (5)	38→439 (1)	57→700 (2)	48 mo	Alive
9	CHA	22	No	Complete	Poor	Poor	Good	Good	Yes	0.5→2.2 (3)	20→144 (1)	48→241 (1)	58 mo	Alive

PHA: proper hepatic artery; DGA: gastroduodenal artery; RHA: right hepatic artery; CHA: common hepatic artery; RIPA: right inferior phrenic artery; LHA: left hepatic artery; T-Bil: total bilirubin; AST: aspartate aminotransferase; ALT: alanine aminotranferease; MOF: multiple organ failure.