Liver Aneurysm: Causes, Complications And Treatment

The liver is a vital organ of the body responsible for many important functions, including blood volume regulation, immune system support, macronutrient metabolism, and lipid and cholesterol homeostasis. It is also responsible for the production of bile, a fluid that breaks fats down into fatty acids that can then be taken in via the digestive tract. Bile can also help to remove waste products. 

Liver aneurysms (hepatic artery aneurysms)

An aneurysm occurs when the wall of an artery weakens, allowing it to locally and excessively enlarge. Liver aneurysms are rare, comprising less than 1% of arterial aneurysms, with a 0.002% incidence in a study of over 2 million patients. Most hepatic artery aneurysms are extrahepatic, meaning that they occur outside the liver. Liver aneurysms are more common in males.¹ ² ³

Causes of a liver aneurysm

The most common cause of hepatic artery aneurysms is thought to be atherosclerosis (up to 50%), followed by cystic medial necrosis and trauma (each around 20–25%).

Other risk factors include:

• Pancreatitis

• Use of tobacco

• Diabetes

• Autoimmune diseases

• Hypertension 

• Vascular disease 

Symptoms of a liver aneurysm

Most hepatic artery aneurysms (HAA) are asymptomatic and are identified incidentally on imaging. For symptomatic HAAs, right upper quadrant or midepigastric pain that may radiate to the back alongside nausea are the typical symptoms. Also commonly, HAAs can be identified if they erode into the biliary tree or the portal vein leading to portal hypertension or rupture. 

If the aneurysm has ruptured, it can present as hemorrhagic shock due to blood loss. If hemobilia occurs, this would typically present with Quincke’s triad, i.e., jaundice, biliary colic, and GI bleeding. If the HAA is sufficiently big, it may also present as a pulsatile mass during a physical examination. Even more rarely, some HAAs may present with infections such as mycotic aneurysms, although this is progressively rare due to the common availability of antibiotics.⁴

How is a liver aneurysm diagnosed?

Generally, diagnosis is carried out via one or multiple imaging methods. Given the lack of specific symptomatology of a liver aneurysm, they can be challenging to diagnose clinically without imaging.

• Computerized tomographic (CT): A series of X-ray images are taken from different angles of your body, creating detailed images of organs, tissue, or bones. A CT scan takes around 10–20 minutes to complete. 

• Angiography: A specific type of X-ray used to investigate blood vessels. Firstly, a special dye will be injected to visualize your blood vessels. Then, a thin, flexible tube (catheter) will be inserted into one of your blood vessels via a small incision. 

• Ultrasound: US method that uses sound waves to produce images of your body. An ultrasound of your liver can show blood flow in the liver, as well as the presence of fatty liver, cirrhosis (scarring), and other conditions. 

• Abdominal X-rays: X-rays are a highly versatile imaging method that produce images of internal organs for diagnostic purposes. They use electroenergetic energy to produce these images. 

• MRI: MRI stands for magnetic resonance imaging and provides detailed 3D images of the body’s anatomy. It uses powerful magnets to help detect and diagnose various health conditions, including liver aneurysms. 

Dangers of a liver aneurysm

Aneurysms can become dangerous if they rupture, which occurs in around 44% of cases. They are at a higher risk of rupturing when the size of the aneurysm is over 0.78 inches. This means that once the aneurysm has been identified, treatment is likely required to repair the damaged blood vessel, depending on the size.⁵

However, data also demonstrates that hepatic artery aneurysms have the highest reported rate of rupture (44%) compared to other aneurysms, so they do warrant treatment vs observation.⁶

Liver aneurysm complications

A potential complication of an aneurysm is rupturing resulting in internal bleeding. Internal bleeding is a serious medical emergency and, for the best outcomes, needs to be detected early. Usually, this is addressed via providing IV fluids to restore blood volume in your body, helping to maintain oxygen delivery to your tissues first — and then addressing the cause of the bleeding. 

In patients with hepatic aneurysms, multiple aneurysms in both visceral and non-visceral circulation have been shown to be common, thus warranting further imaging to rule out the possibility of multiple concurrent aneurysms.⁷

Treatment of liver aneurysm

For unruptured aneurysms, an operation may be necessary for most hepatic artery aneurysms, particularly if the aneurysm is larger than 0.78 inches. Selecting the most appropriate treatment depends on the size and location of the aneurysm.⁸

However, endovascular treatment is preferred, as open surgical repair for hepatic artery aneurysm rupture carries a high burden of mortality and morbidity. For intrahepatic aneurysms, percutaneous embolization is typically the first-line treatment. Note that aneurysms don’t always need to be treated.⁹

Some treatment options include:

• Endovascular repair: a minimally invasive option using a small incision to deliver long, thin tubes (catheters) to blood vessels. 

• Percutaneous embolization: stops blood flow to a specific blood vessel. This is achieved by placing a substance in the vessel to prevent blood from flowing through it. Embolization procedures are less invasive than surgery. 

• Open surgical options include artery ligation: the tying off of an artery to slow or stop bleeding, as well as partial hepatic resection or even hepatectomy.

Following treatment, you may be required to have several outpatient check-ups to assess your progress and see how your recovery is going. The recovery time frame differs from person to person as well as the type of operation, but expect to take a few weeks off of your usual activities to give your body a chance to rest and heal. 

The lowdown

A liver aneurysm can sound like a scary and complicated condition. The good news is that it is very rare — so in most cases, your stomach pain is nothing to be worried about. However, it’s good to be proactive about your health, so have a conversation with your doctor about any symptoms you’re experiencing and potential management strategies. 

As always, it’s great to take steps to maintain your overall health. Exercising, eating healthy, sleeping regularly, and participating in the things you love are all great ways to boost your well-being and physical health.

Frequently asked questions

Can an aneurysm occur in the hepatic artery?

The two most common aneurysms are in the abdominal aorta and intracranial saccular aneurysms in the brain. Aneurysms can also occur viscerally in the spleen, intestines, and kidneys, among other locations. The hepatic artery is the short blood vessel that mainly provides blood to the liver but also to the stomach, pancreas, and the start of the small intestine. 

How serious is an aneurysm in the liver?

An aneurysm in the liver is rare, but in cases where it does occur, it can be quite serious. The primary concern is if the aneurysm ruptures, in which case you will need immediate medical attention.