# Percutaneous transhepatic coil embolisation of a common hepatic artery aneurysm in vascular Ehlers–Danlos syndrome

## TL;DR

A novel percutaneous transhepatic coiling technique was used to treat a rare and complex hepatic artery aneurysm in a patient with vascular Ehlers–Danlos syndrome.

## Contribution

The study introduces a direct percutaneous transhepatic approach for aneurysm coiling in patients with fragile vasculature.

## Key findings

- A 17-year-old male with vascular Ehlers–Danlos syndrome had a 50-mm hepatic artery aneurysm successfully treated with transhepatic coiling.
- The transhepatic approach was chosen due to infeasibility of traditional endovascular techniques and lack of surgical alternatives.
- Post-procedure imaging confirmed hemodynamic stability and adequate liver perfusion without complications.

## Abstract

Vascular Ehlers–Danlos syndrome is a rare connective tissue disorder characterised by arterial fragility, predisposing patients to life-threatening vascular complications. Endovascular aneurysm management in these individuals poses significant challenges due to their delicate vasculature and limited surgical options. This case report highlights the novel use of a direct percutaneous transhepatic approach for aneurysm coiling in a patient with a rapidly expanding hepatic artery aneurysm, demonstrating an innovative solution to a complex vascular emergency.

A 17-year-old male with a known diagnosis of vascular Ehlers–Danlos syndrome presented with a perforated sigmoid colon. After undergoing a midline exploratory laparotomy, imaging revealed a rapidly expanding 50-mm aneurysm in his common hepatic artery. Traditional endovascular coiling was infeasible due to significant proximal stenosis, creating similar limitations for vascular reconstruction and liver transplantation. The multidisciplinary team opted for a direct transhepatic approach to coil the aneurysm. The patient recovered without complications, and follow-up imaging confirmed haemodynamic stability and adequate liver perfusion.

This case highlights the importance of an integrative multidisciplinary approach in managing complex vascular emergencies and successfully demonstrates how a direct percutaneous transhepatic approach can serve as a valuable reference for similar cases, expanding the repertoire of endovascular interventional radiology techniques for challenging pathologies.