Spontaneous Thrombosis of a Long-Segment Hepatic Artery Aneurysm During Conservative Management: A Case Report on an 11-Year Follow-Up

Hepatic artery aneurysms (HAAs) can rupture, yet the management of small, asymptomatic, long-segment lesions remains controversial. We report a 64-year-old man with an incidentally detected, long-segment aneurysmal change extending from the proximal common hepatic artery to the distal proper hepatic artery (approximately 80 mm). CT showed irregular, multilobulated ectasia with a focal saccular component (17 mm), an intimal flap, and mural thrombus, suggesting aneurysmal degeneration after dissection; a subtle dissection-like change was also suspected in the celiac trunk. Given the small maximal diameter, absence of symptoms, and concern for hepatic/biliary ischemia with intervention, close imaging surveillance was chosen. Progressive thrombosis led to complete occlusion at 5.5 years, with preserved hepatic enhancement and a more prominent left-gastric-right gastric collateral pathway. The aneurysm remained stably thrombosed without ischemic complications over 11 years. This case highlights that carefully selected, asymptomatic, anatomically complex HAAs may be managed conservatively with strict long-term follow-up.