Hepatic artery aneurysm rupture into the biliary tract during long-term left ventricular assist device support successfully treated by transcatheter arterial embolization: a case report.

Abstract

Bleeding complications remain a major concern in patients supported by long-term left ventricular assist devices (LVADs). Although gastrointestinal bleeding is common, hemobilia due to rupture of a hepatic artery aneurysm is extremely rare. A 47-year-old man with end-stage heart failure underwent implantation of a continuous-flow LVAD as a bridge to transplantation and was maintained on long-term anticoagulation therapy. He developed anemia with abdominal pain and melena. Imaging at the first hospitalization revealed a hepatic artery aneurysm with suspected hemobilia. After temporary stabilization, he was readmitted with recurrent melena and abdominal pain. Subsequent imaging demonstrated rapid aneurysmal enlargement with rupture into the biliary tract. Emergency angiography followed by transcatheter arterial embolization using detachable coils and n-butyl cyanoacrylate achieved complete hemostasis while preserving hepatic arterial flow. Anticoagulation was resumed without thrombotic complications, and the patient subsequently underwent successful transplantation without recurrence. Hepatic artery aneurysm rupture into the biliary tract is a rare but life-threatening complication in patients receiving long-term LVAD support. Prompt multidisciplinary management and endovascular intervention are essential for favorable outcomes.