Endovascular Treatment of Intrahepatic Hepatic Artery Pseudoaneurysms: Safety and Efficacy According to Embolization Strategies.

Abstract

Background Intrahepatic hepatic artery pseudoaneurysm (IHPA) is a rare, life-threatening vascular complication requiring prompt endovascular management, yet comparative data on embolization approaches are limited. Purpose To evaluate the safety and effectiveness of endovascular embolization for treating IHPA and to compare clinical outcomes across embolization strategies. Materials and Methods In this retrospective study at a tertiary referral center, patients who underwent endovascular treatment of IHPA between January 2019 and December 2024 were included. Embolization methods were categorized as type 1 (sandwich technique: six of 109 patients [6%]), type 2 (segmental embolization of the vessel across the aneurysm neck without sac embolization: 18 of 109 [16%]), type 3 (sac and adjacent vessel embolization: 77 of 109 [71%]), or type 4 (sac-only embolization preserving the parent artery: eight of 109 [7%]). Pseudoaneurysm refilling rates and adverse events were analyzed. Predictors of the composite clinical outcome (refilling or major adverse events) were identified using multivariable logistic regression. Results Technical success was achieved in 109 of 111 patients (98%). Among the 109 patients with technical success (mean age, 66.0 years ± 10.7 [SD]; 77 male), pseudoaneurysm refilling occurred in nine (8%); all of these patients were treated without sac embolization (type 1: <i>n</i> = 2; type 2: <i>n</i> = 7). No refilling events were observed in patients treated with sac embolization (type 3 or 4) (<i>P</i> < .001 for types 1 and 2 vs types 3 and 4). Fewer major adverse events were associated with sac embolization (types 3 and 4) than with parent artery embolization (types 1 and 2) (six of 85 [7%] vs six of 24 [25%]; <i>P</i> = .02). At multivariable analysis, sac embolization was associated with lower odds of the composite clinical outcome compared with parent artery embolization (odds ratio, 0.10 [95% CI: 0.03, 0.31]; <i>P</i> < .001). Conclusion In this study, endovascular embolization was a safe and effective treatment of IHPA. Sac embolization strategies resulted in no pseudoaneurysm refilling and were associated with fewer major adverse events than parent artery embolization. © RSNA, 2026 <i>Supplemental material is available for this article.</i>