Complications

Two types of complications can be anticipated: isch-aemia due to thrombosis or distal embolization and rupture.

Rupture with bleeding is a rare but often catastrophic complication.

The symptoms are usually abdominal pain and shock. If rupture occurs in the peritoneal cavity, shock is deep and the time for diagnostic tests is not available, then emergency laparotomy is performed, at which time the diagnosis is made often with high mortality.

Fig. 6.2.1a Asymptomatic aneurysm of the hepatic artery. The various branches [common hepatic artery, left (LHA) and right hepatic artery (RHA), gastroduodenal artery] are secured with vessel loops

If contained rupture occurs within the mesenterium or gastroduodenal ligament, the severity of shock is often moderate, allowing for time to perform diagnostic tests.

As a result, a diagnosis is made which allows for selection of optimal therapy, with either endovascular or open surgical techniques.

A review showed that aneurysms of the hepatic artery were associated in half of the patients with pain and/or gastrointestinal bleeding.

Lesions were diagnosed in only 65% when the patient presented with a rupture and the resulting mortality rate was 17%.

Aneurysms of the splenic artery associated with a rupture had an even higher mortality rate of 36%. Aneurysms of the intestinal arteries may also present with gastrointestinal bleeding caused by rupture in the gastrointestinal tract.

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