Common hepatic artery true aneurysm: Case report and review of the literature

• Hepatic artery aneurysms (HAAs) are a rare condition (< 0,4% incidence) but can be life-threatening due to the risk of rupture, which carries a high mortality rate (> 70%). • HAAs are in > 75% cases asymptomatic and therefore detected incidentally. • Society for Vascular Surgery (SVS) recommends intervention for symptomatic HAAs of any size and asymptomatic HAAs >2 cm. • Endovascular techniques are preferred when anatomically feasible, but open surgery remains essential in complex cases. • A collaborative, multidisciplinary strategy is key to achieving the best outcomes. Hepatic artery aneurysms (HAAs) are rare but potentially life-threatening vascular conditions that can be life-threatening. Their natural history remains poorly understood, and management guidelines are based on limited evidence due to their rarity. We describe the case of a 70-year-old male diagnosed incidentally with a saccular HAA during an oncologic workup for right colon adenocarcinoma. Due to aneurysm's size, its inherent risk of rupture, and the patient's history of carotid artery dissection, surgical intervention was indicated. A multidisciplinary approach was adopted, prioritizing right hemicolectomy, followed by open aneurysmectomy and primary vascular reconstruction. Histopathology confirmed an atherosclerotic aneurysm with no signs of vasculopathy. The patient recovered well after surgery. HAAs’ most frequent etiology is atherosclerosis, with other etiologies including infections, connective tissue disorders, and trauma. Most HAAs are asymptomatic and therefore are detected incidentally. Rupture is the primary concern since it carries high mortality. Current SVS guidelines recommend intervention for symptomatic HAAs of any size and those exceeding 2 cm. While an “endovascular first” approach is preferred due to multiple benefits, open surgery remains essential in complex cases, particularly when anatomical variations pose technical challenges. The management of HAAs requires individualized decision-making. In our case, open surgery allowed for the simultaneous treatment of two pathologies and addressed anatomical constraints. A collaborative, multidisciplinary strategy is key to achieving the best outcomes. Further case reporting of this rare condition is essential to refine current management strategies.