Treatment Strategies for Management of True Hepatic Artery Aneurysms: A Systematic Review and Meta-Analysis

Aims To synthesize evidence on outcomes of treatment strategies for management of primary hepatic artery aneurysms (HAAs). Methods A PRISMA-compliant systematic review was conducted. Due to rarity of the disease, all reported cases which underwent operative or endovascular intervention for true HAA were pooled from case reports and case series to create a single cohort of patients. Descriptive statistics, logistic regression models, and Kaplan-Meier statistics were used for analyses. Results 62 patients from 41 case reports and one case series were included. The mean age was 60.9 and 77% were male; 66% were symptomatic with pain as the most common symptom (76%). The mean diameter and length of aneurysms were 47.4 mm and 55.8 mm, respectively. The anatomy of aneurysm was hostile in 39% and 11% were ruptured at presentation. In terms of treatment, 74% were treated via operative approach and 26% via endovascular approach. Hostile anatomy was the only predictor for selecting operative approach (OR: 8.72, P = .031). Technical success was achieved in 98%; postoperative mortality and morbidity occurred in 5% and 16%, respectively. The probabilities of graft patency at 60 months were not different between the operative and endovascular approaches (86% vs 90%, P = .961); however, the probability of recurrence-free survival was higher after operative approach (100% vs 85%, P = .046). Conclusions Accepting type 2 error and confounding by indication as the limitations, both operative and endovascular techniques seem to be safe and feasible in management of true HAA. Hostile anatomy may be the main determinant of selecting operative approach over the endovascular approach.