Percutaneous transhepatic coil embolisation of a common hepatic artery aneurysm in vascular Ehlers-Danlos syndrome.

BACKGROUND: 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. CASE PRESENTATION: 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. CONCLUSIONS: 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.