Hepatic artery aneurysms are classified into intrahepatic and extrahepatic types, with the latter being more common. The intrahepatic type is more frequently observed in the right lobe of the liver. Major causes include trauma, infection, atherosclerosis, and congenital abnormalities of the hepatic artery. Hepatic artery aneurysms may also arise as a result of transcatheter hepatic artery chemoembolization or angiography. Rarely, bile duct stones or T-tube biliary drainage can lead to the development of hepatic artery aneurysms.
When the aneurysm is small and does not cause biliary obstruction, clinical symptoms are often nonspecific or limited to discomfort in the upper abdomen. Enlargement of the aneurysm causing compression of the biliary tract may result in symptoms such as fever or jaundice. Rupture of the aneurysm may present with clinical features of hypovolemic shock, whereas rupture into the biliary tract or gastrointestinal tract can lead to hemobilia or gastrointestinal bleeding, respectively.
Surgical treatment of hepatic artery aneurysms depends on the location, size, and specific characteristics of the lesion. Treatment strategies are broadly categorized into endovascular and open surgical approaches. Endovascular methods include covered stent placement, embolization, or embolization assisted by bare-metal stents. Open surgical options involve aneurysm resection for extrahepatic lesions, partial liver resection, or hepatic artery ligation for intrahepatic aneurysms.