# Post-traumatic pseudoaneurysm of the right hepatic artery: Two case reports – New Ukrainian reality

## TL;DR

This paper presents two cases of liver artery pseudoaneurysms caused by blast injuries and highlights the importance of ultrasound and proper medical evacuation for effective treatment.

## Contribution

The paper provides new clinical insights into managing hepatic artery pseudoaneurysms in the context of high-energy blast injuries in a conflict zone.

## Key findings

- Pseudoaneurysm of hepatic arteries occurs in 3.2% of severe liver injuries.
- Ultrasound with color Doppler mapping effectively visualizes and monitors pseudoaneurysms.
- Patients with pseudoaneurysms should be evacuated to facilities with endovascular correction capabilities.

## Abstract

The diagnostics and treatment management in conditions of massive sanitary losses with the use of staged treatment have their own specifics and require a multidisciplinary approach with the involvement of a wide range of specialists and the use of modern technologies. The number of sources covering the ultrasound diagnostics and clinical course of hepatic artery pseudoaneurysm as a complication of gunshot wounds is quite limited in world literature.

We present the experience of the observation and management of the right hepatic artery pseudoaneurysm in case of the blast injury of liver in two patients: the example of successful resolution with spontaneous occlusion and the example with the occurrence of internal bleeding as a result of pseudoaneurysm rupture.

Clinical cases presented here belong to the category of severe injuries caused by high-energy weapons, which are characterized by a syndrome of mutual aggravation and need for simultaneous treatment of several damaged organs. The use of contrast methods in severely injured patients requires instrumental justification, and results of daily ultrasound monitoring with the use of color Doppler program can be the one.

Pseudoaneurysm of hepatic arteries is a dangerous complication of severe liver wounds and injuries, which occurs in 3·2 % of patients according to our data. The method of ultrasound examination with the use of color Doppler mapping program allows to visualize pseudoaneurysms and monitor their progress. When identifying patients with pseudoaneurysm of hepatic arteries at the level II–III medical care (Role II–III), their further evacuation should be carried out to medical institutions equipped with endovascular correction technologies.

•Pseudoaneurysm of hepatic arteries is a dangerous complication of severe liver wounds and injuries•Cases of the spontaneous thrombosis and cases of pseudoaneurysm rupture with a massive bleeding are seen•Sonography method with the use of color Doppler mapping allows to visualize pseudoaneurysms and monitor their progress.•Patients with pseudoaneurysm of hepatic arteries should be evacuated to medical institutions with endovascular technologies.

Pseudoaneurysm of hepatic arteries is a dangerous complication of severe liver wounds and injuries

Cases of the spontaneous thrombosis and cases of pseudoaneurysm rupture with a massive bleeding are seen

Sonography method with the use of color Doppler mapping allows to visualize pseudoaneurysms and monitor their progress.

Patients with pseudoaneurysm of hepatic arteries should be evacuated to medical institutions with endovascular technologies.