Endovascular Treatment Options for Pseudoaneurysm Associated with Metallic Biliary Stent

Introduction Hepatic artery pseudoaneurysms are a potential complication of local surgery, trauma, or infection. After formation, they can compress surrounding structures, create a nidus for infection, or rupture and bleed.

Case Report A 61-year-old male with pancreatic adenocarcinoma who had undergone ERCP with metallic biliary stent placement due to tumor invasion of the common bile duct presented to the emergency department (ED) with gastrointestinal (GI) bleeding 1 month after stent placement. The bleeding resolved spontaneously and reoccurred on several occasions over the next month, but a definitive source was never able to be identified. Two months after the stent placement, the patient presented with hematemesis and hematochezia and underwent a tagged red blood cells (RBC) scan, which demonstrated a possible source of bleeding near the hepatic artery. An interventional radiologist performed celiac angiography, which demonstrated a pseudoaneurysm of the hepatic artery located directly posterior to the metallic biliary stent, which was then embolized with coils.

Another patient, a 55-year-old female with colon adenocarcinoma metastases to the liver presented to the ED with the same symptoms of hematemesis and hematochezia. She had undergone endoscopic retrograde cholangiopancreatography (ERCP) with metallic biliary stent placement 1 year prior to admission. During her admission, she was also found to have a hepatic artery pseudoaneurysm posterior to the metallic biliary stent, which was treated with a self-expanding covered stent.

Learning Points These cases demonstrate a possible causal relationship between metallic biliary stent placement and the formation of hepatic artery pseudoaneurysms. In the event of pseudoaneurysm formation, coiling or stent placement are effective endovascular treatment options to prevent or stop recurrent bleeding.