Successful Surgical Treatment for Large Common Hepatic Arterial Aneurysm Incidentally Discovered during Evaluation for Mallory-Weiss Syndrome.

Although both open and endovascular repair are available for hepatic artery aneurysms (HAAs), the optimal treatment strategy remains controversial, particularly in anatomically complex cases. In the present case, a large common HAA measuring 100 × 49 mm with a short proximal neck posed significant challenges for both modalities. To ensure intraoperative hemostasis, a hybrid approach was adopted: open surgical ligation combined with prophylactic balloon occlusion at the aneurysmal neck. This strategy enabled safe exclusion of the aneurysm without hepatic ischemia. The case underscores the importance of selecting open, endovascular, or hybrid techniques based on individual anatomical complexity to optimize outcomes in HAA management.