Late hepatic artery pseudoaneurysm: A rare complication after resection of hilar cholangiocarcinoma

Figure 1 Skeletonization for regional lymphadenectomy with removal of neural and lymphoid tissues from hepatoduodenal ligament and liver hilus in a type II hilar cholangiocarcinoma. A too-tight dissection around the right and left hepatic arteries (arrow heads) is shown. Left hepatic duct (arrow) is being prepared for bilio-enteric anastomosis.

Figure 2 MDCTA. A: Arterial phase image precisely depicts a large pseudoaneurysm originating from the right hepatic artery (arrow). B and C: Jejunum Y-limb did not show a demonstrable communication with the arterial sac in cross-sectional and coronal views, respectively.

Figure 3 Patency of the hepatic artery and its branches, and the occlusion of the pseudoaneurysm. A: Embolization of the pseudoaneurysm using microcoils to stop the inflow into the pseudoaneurysmal lumen with patency of the hepatic artery and its branches. B: Subtracted angiogram after right hepatic artery pseudoaneurysm occlusion with stainless steel coils.

Figure 4 Partial revascularization of the pseudoaneurysm and TAE of the right hepatic artery. A: Angiography 3 wk after the embolization of the right hepatic artery pseudoaneurysm with a partial revascularization of the arterial sac (arrow) and a distal migration of coils (arrow head). A partial enteric migration of microcoils after the first and selective embolization suggests an arterio-enteric fistula origin. B: TAE of the right hepatic artery with stainless steel coils and polyvinyl alcohol particles. No distal arterial flow can be shown.