Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.202300631
Jornal Vascular Brasileiro
Therapeutic Challenge

Aneurisma de artéria hepática sem colo proximal e acometendo bifurcação de artéria hepática própria

Hepatic artery aneurysm with no proximal neck and proper hepatic artery bifurcation involvement

Pedro Luciano Mellucci Filho; Bruno Aparecido Lourenço de Marqui; Letícia Isper; Adrielle Andrade Pugas; César Alberto Talavera Martelli; Rodolfo Dahlem Melo; Matheus Bertanha; Marcone Lima Sobreira

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Resumo

Apresentamos um relato de caso acerca de um paciente portador de aneurisma sacular de artéria hepática, com diâmetro máximo de 2,8 cm, sem colo proximal e com acometimento da bifurcação da artéria hepática própria, denotando anatomia hostil para tratamento endovascular, que geralmente é a primeira escolha para esses casos. Realizamos tratamento cirúrgico aberto com ressecção e reconstrução a partir de substituto autólogo (veia safena interna). Ilustramos a técnica cirúrgica empregada para a adequada exposição vascular do tronco celíaco e hilo hepático, que muitas vezes é uma área pouco explorada pelo cirurgião vascular, além dos cuidados necessários com estruturas anatomicamente próximas à artéria hepática e da técnica de anastomose com telescopagem. Demonstramos a necessidade de que o cirurgião vascular, mesmo na era dos procedimentos minimamente invasivos, domine a anatomia e a técnica cirúrgica clássica sobre ramos viscerais.

Palavras-chave

 artéria hepática; aneurisma; circulação hepática; cirurgia vascular

Abstract

We report the case of a patient with a saccular aneurysm of the hepatic artery with maximum diameter of 2.8 cm, no proximal neck, and involving the bifurcation of the proper hepatic artery, constituting a hostile anatomy for endovascular treatment, which would usually be the first choice for such cases. We performed open surgical treatment with resection and reconstruction using an autologous graft (internal saphenous vein). We illustrate the surgical technique used for adequate vascular exposure of the celiac trunk and hepatic hilum (which is often an area little explored by vascular surgeons) and of structures anatomically close to the hepatic artery. We also illustrate the anastomosis with telescoping technique. We demonstrate the need for vascular surgeons to master the anatomy and classical surgical technique for visceral branches, even in the era of minimally invasive procedures.

Keywords

hepatic artery; aneurysm; hepatic circulation; vascular surgery

References

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Submitted date:
06/05/2023

Accepted date:
09/21/2023

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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