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Journal of Medical Case Reports

, 3:18

First Online: 21 January 2009Received: 28 November 2007Accepted: 21 January 2009DOI: 10.1186-1752-1947-3-18

Cite this article as: Jaunoo, S., Tang, T., Uzoigwe, C. et al. J Med Case Reports 2009 3: 18. doi:10.1186-1752-1947-3-18

Abstract

IntroductionHepatic artery aneurysms remain a clinically significant entity. Their incidence continues to rise slowly and mortality from spontaneous rupture is high. Repair is recommended in those aneurysms greater than 2 cm in diameter. It is not surprising that vascular comorbidities, such as ischaemic heart disease, are common in surgical patients, particularly those with arterial aneurysms such as these. The decision of when to operate on patients who require urgent surgery despite having recently suffered an acute coronary syndrome remains somewhat of a grey and controversial area. We discuss the role of delayed surgery and postoperative followup of this vascular problem.

Case presentationA 58-year-old man was admitted with a 5.5 cm hepatic artery aneurysm. The aneurysm was asymptomatic and was an incidental finding as a result of an abdominal computed tomography scan to investigate an episode of haemoptysis Figure 1. Three weeks prior to admission, the patient had suffered a large inferior myocardial infarction and was treated by thrombolysis and primary coronary angioplasty. Angiographic assessment revealed a large aneurysm of the common hepatic artery involving the origins of the hepatic, gastroduodenal, left and right gastric arteries and the splenic artery Figures 2 and 3. Endovascular treatment was not considered feasible and immediate surgery was too high-risk in the early post-infarction period. Therefore, surgery was delayed for 3 months when aneurysm repair with reconstruction of the hepatic artery was successfully performed. Graft patency was confirmed with the aid of an abdominal arterial duplex. Plasma levels of conventional liver function enzymes and of alpha-glutathione-S-transferase were within normal limits. This was used to assess the extent of any hepatocellular damage perioperatively. The patient made a good recovery and was well at his routine outpatient check-ups.

ConclusionThere is no significant difference in cardiac risk in patients who have undergone vascular surgery within 6 months of a myocardial infarction compared with those who have had the operation in the 6 to12 month time frame. Use of alpha-glutathione-S-transferase gives an indication of the immediate state of hepatic function and should be used in addition to traditional liver function tests to monitor hepatic function postoperatively.

AbbreviationsACAmerican College of Cardiology

AHAAmerican Heart Association

alpha-GSTalpha-glutathione-S-transferase

HAAhepatic artery aneurysms

MImyocardial infarction

SAAsplenic artery aneurysm.

Electronic supplementary materialThe online version of this article doi:10.1186-1752-1947-3-18 contains supplementary material, which is available to authorized users.

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Autor: SS Jaunoo - TY Tang - C Uzoigwe - SR Walsh - ME Gaunt

Fuente: https://link.springer.com/







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