Successful treatment of an iatrogenic right hepatic artery pseudoaneurysm and stenosis with a stent graft

A 53-year-old woman presented with an iatrogenic right hepatic artery pseudoaneurysm after a laparoscopic cholecystectomy. Approximately 1 year after the cholecystectomy, liver transaminases were elevated, and she complained of recurrent “crampy” right upper quadrant pain that radiated posteriorly to her back. Imaging studies demonstrated an aneurysm or pseudoaneurysm of the hepatic artery at the porta hepatis, with possible infiltration into the parenchyma between the right and left lobes of the liver. Selective celiac arteriography showed a 90% stenosis of the right hepatic artery with a large pseudoaneurysm arising from the stenotic segment. This was treated with a 3- × 16-mm stent graft (Jostent; Abbott Vascular, Temecula, Calif) with good result. The completion arteriogram showed wide patency of the stent graft with total exclusion of the pseudoaneurysm. Follow-up serial duplex scans up to 40 months after the procedure showed no evidence of residual pseudoaneurysm and wide patency of the stent graft, with no evidence of focal velocity changes in the right hepatic artery. The patient continues to do well clinically.