Endovascular treatment of hepatic artery bleeding and pseudoaneurysms using stent-grafts: a retrospective single-centre analysis

Objectives To evaluate technical and clinical success rates and complications of stent-grafting for hepatic artery bleeding or pseudoaneurysms. Materials and methods This single-centre retrospective study consecutively included 58 patients who underwent attempted stent-grafting for hepatic artery bleeding ( n = 40) or pseudoaneurysm ( n = 18) between January 2010 and June 2021. Results Technical success was achieved in 97% (56/58) of cases. Insufficient haemostasis after technical success was present in five cases (88% primary clinical success), decreasing to three cases after reintervention. In 3/5 cases, it was due to undersizing of the stent-graft, which occurred frequently, especially in vessel sizes ≥ 6 mm ( n = 19, compared to the non-acute vessel diameter; n = 11, compared to the acute one). Median occlusion-free survival was 763 days. Patency rates were 81 ± 6% at 30 days and 56 ± 10% at two years. Early occlusion (≤ 30 days) was associated with significantly smaller stent-graft diameters (4.7 ± 0.7 mm vs 5.4 ± 0.7 mm; p = 0.014). In multivariate Cox regression analysis, a small diameter (4 mm) was confirmed as a risk factor for stent-graft occlusion (HR = 8.59, p = 0.006). Liver necrosis or liver failure due to insufficient collateralization occurred only in early occlusions. Median overall survival was 714 days. In 6/29 documented deaths, mortality was procedure-related (four because of insufficient haemostasis, with two after technical failure and two after technical success, and two because of fatal liver failure after stent-graft occlusion). Conclusion Stent-grafting is effective for managing hepatic artery bleeding, but precise sizing is crucial, as undersizing and small diameters increase the risk of inadequate haemostasis and occlusion. Key Points Question What are the technical and clinical outcomes of stent-graft treatment for hepatic artery bleeding or pseudoaneurysm, and which factors influence these outcomes ? Findings Stent-graft treatment achieved high technical and clinical success rates. Stent-graft undersizing and smaller stent-graft diameters were associated with inadequate haemostasis and occlusion . Clinical relevance Stent-graft treatment is an effective option for managing hepatic artery bleeding or pseudoaneurysm in critically ill patients. Accurate stent-graft sizing is a key determinant of clinical success .