Replaced right hepatic artery pseudoaneurysm presenting with GI bleed management strategies

Background Visceral artery pseudoaneurysms (PSA) carry high morbidity. While endovascular interventions are preferred, open surgical revascularization remains essential when anatomical constraints preclude stenting. Methods A 39-year-old male presented with epigastric pain, hematochezia, and syncope. CT angiography revealed a 3.5 cm pseudoaneurysm of a replaced right hepatic artery (RRHA). Results Due to the small vessel diameter (<4 mm) and critical need to preserve hepatic perfusion, endovascular stenting was deemed high-risk. He underwent open distal ligation and splenic artery to RRHA bypass using a great saphenous vein graft. Postoperative imaging confirmed pseudoaneurysm thrombosis and patent revascularization. Conclusion Open surgical bypass remains a vital strategy for hepatic artery pseudoaneurysms. It ensures definitive exclusion and preserves end-organ perfusion in patients with challenging vascular anatomy where endovascular options are unsafe.