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.