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Kadohisa M, Inomata Y, Sakisaka M, Sugawara Y, Hibi T. Massive duodenal ulcer bleeding due to the ruptured hepatic artery pseudoaneurysm after living donor liver transplantation. Surg Case Rep 2022; 8:199. [PMID: 36253636 PMCID: PMC9576833 DOI: 10.1186/s40792-022-01558-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/12/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The rupture of a hepatic artery pseudoaneurysm (HAP) is a rare but lethal complication after living donor liver transplantation (LDLT) and often manifests as acute gastrointestinal bleeding. CASE PRESENTATION This report describes three patients who experienced HAP after LDLT. These patients initially presented with active bleeding of a duodenal ulcer (DU) in the duodenal bulb, followed by diagnosis of the ruptured HAP by angiography. None of the patients had evidence of an active intra-abdominal infection or bile leakage preceding the rupture of HAP. All patients were initially treated by transcatheter arterial coil embolization (TAE). In all cases, TAE was successful for hemostasis but resulted in complete obstruction of the arterial inflow to the graft. Arterial revascularization by surgical reconstruction using the autologous arterial graft in one case and re-LDLT in another one was successfully performed. The other one succumbed to sepsis caused by later liver abscesses. CONCLUSION This is the first detailed case series of massive DU bleeding as a warning signal of ruptured HAP after LDLT. HAP should be included in the differential diagnosis when an LDLT recipient presents with gastrointestinal bleeding.
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Affiliation(s)
- Masashi Kadohisa
- grid.274841.c0000 0001 0660 6749Department of Transplantation and Pediatric Surgery, Kumamoto University, Honjo 1-1-1, Chuo-Ku, Kumamoto-Shi, Kumamoto 860-8556 Japan
| | - Yukihiro Inomata
- grid.274841.c0000 0001 0660 6749Department of Transplantation and Pediatric Surgery, Kumamoto University, Honjo 1-1-1, Chuo-Ku, Kumamoto-Shi, Kumamoto 860-8556 Japan ,Kumamotorousai Hospital, Kumamoto, Japan
| | - Masataka Sakisaka
- grid.274841.c0000 0001 0660 6749Department of Transplantation and Pediatric Surgery, Kumamoto University, Honjo 1-1-1, Chuo-Ku, Kumamoto-Shi, Kumamoto 860-8556 Japan ,Sakisaka Hospital, Kumamoto, Japan
| | - Yasuhiko Sugawara
- grid.274841.c0000 0001 0660 6749Department of Transplantation and Pediatric Surgery, Kumamoto University, Honjo 1-1-1, Chuo-Ku, Kumamoto-Shi, Kumamoto 860-8556 Japan
| | - Taizo Hibi
- grid.274841.c0000 0001 0660 6749Department of Transplantation and Pediatric Surgery, Kumamoto University, Honjo 1-1-1, Chuo-Ku, Kumamoto-Shi, Kumamoto 860-8556 Japan
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2
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Zhang J, Khalifeh A, Santini-Dominguez R, Barth RN, Bruno D, Desikan S, Gupta A, Toursavadkohi S. Endovascular Reconstruction of the Hepatic Arterial System for the Management of Mycotic Pseudoaneurysm in a Liver Transplant Patient. Ann Vasc Surg 2019; 61:473.e7-473.e11. [PMID: 31394235 DOI: 10.1016/j.avsg.2019.05.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 05/19/2019] [Accepted: 05/29/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hepatic artery pseudoaneurysm is a rare but very morbid complication after liver transplant. Treatment options include ligation or endovascular embolization, followed by revascularization. We describe a new endovascular approach by stent exclusion in a high-risk patient. RESULTS A 62-year-old male who received a second liver transplant after failed allograft presented with hemobilia and was diagnosed with a hepatic artery pseudoaneurysm in the setting of infection. Given his hostile abdomen, an endovascular approach was sought. We excluded the mycotic pseudoaneurysm with multiple covered stent grafts extending from the common hepatic artery to the right and left hepatic arteries. He was discharged with long-term antibiotics. On his 6-month follow-up visit, his stent was patent and hepatic function was stable. CONCLUSIONS Endovascular stent-graft placement for management of hepatic artery pseudoaneurysm after liver transplant should be considered as a lower morbidity alternative to surgical repair, even in the setting of infection.
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Affiliation(s)
- Jackie Zhang
- Division of Vascular Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, MD
| | - Ali Khalifeh
- Division of Vascular Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, MD.
| | - Rafael Santini-Dominguez
- Division of Vascular Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, MD
| | - Rolf N Barth
- Division of Organ Transplant, Department of Surgery, University of Maryland Medical Center, Baltimore, MD
| | - David Bruno
- Division of Organ Transplant, Department of Surgery, University of Maryland Medical Center, Baltimore, MD
| | - Sarasijhaa Desikan
- Division of Vascular Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, MD
| | - Anuj Gupta
- Department of Cardiology, University of Maryland Medical Center, Baltimore, MD
| | - Shahab Toursavadkohi
- Division of Vascular Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, MD
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3
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Treatment of Visceral Transplant Pseudoaneurysms Using Physician-Modified Fenestrated Stent Grafts: Initial Experience. Cardiovasc Intervent Radiol 2019; 42:920-926. [PMID: 30725157 PMCID: PMC6502774 DOI: 10.1007/s00270-019-02168-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/16/2019] [Indexed: 01/28/2023]
Abstract
Pseudoaneurysms after visceral transplantation represent a significant risk to patients. We report the successful treatment of three transplant (pancreas, liver and kidney) artery anastomotic pseudoaneurysms using physician-modified fenestrated endovascular stent grafts. In all cases, surgical repair was considered high risk and would have compromised the arterial supply to the graft. The endovascular approach in all cases obviated the need for surgical intervention and maintained graft arterial supply.
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4
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Jeng KS, Huang CC, Lin CK, Lin CC, Liang CC, Chung CS, Weng MT, Chen KH. Early Detection of a Hepatic Artery Pseudoaneurysm After Liver Transplantation Is the Determinant of Survival. Transplant Proc 2016; 48:1149-55. [PMID: 27320576 DOI: 10.1016/j.transproceed.2015.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/16/2015] [Accepted: 11/11/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hepatic artery pseudoaneurysm (PA) after liver transplantation (LT) is a rare but potentially fatal complication. Among a series of 50 patients of LT, we experienced 3 such cases. Some authors also have reported cases of PA, either intrahepatic or extrahepatic. The aim of this study was to investigate the important factors that affect the treatment outcome. METHODS Three patients were presented. To analyze the factors, not only our patients but also the patients with PA reported in the literature (including 10 case series and 23 case reports) were enrolled for analysis. The possible factors probably affecting the survival were compared statistically, including age, sex, clinical manifestation as bleeding (including gastrointestinal bleeding, hemobilia, or intra-abdominal bleeding), treatment (with embolization or surgical exploration or stent), diagnosis establishment before or after bleeding, and so forth. RESULTS From univariate analysis, the significant factors that affect survival are sex (female) (P = .036), stent treatment (P = .006), and early detection (P = .036), whereas age (P = .493) and presentation with hemorrhage (P = .877) are not significant factors. However, according to multivariate analysis, stent treatment has a borderline significance (P = .056). CONCLUSIONS Early detection of such a life-threatening complication is a key determinant of survival. "Early" does not refer to early postoperative days but means the detection prior to the rupture of the pseudoaneurysm. Postoperative imaging studies such as computed tomographic scan or magnetic resonance cholangiopancreatography early and periodically to follow up the graft status is recommended, especially for those who had received other interventions before or after the liver transplantation.
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Affiliation(s)
- K-S Jeng
- Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan.
| | - C-C Huang
- Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - C-K Lin
- Division of HepatoGastroenterology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - C-C Lin
- Division of HepatoGastroenterology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - C-C Liang
- Division of HepatoGastroenterology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - C-S Chung
- Division of HepatoGastroenterology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - M-T Weng
- Division of HepatoGastroenterology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - K-H Chen
- Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
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5
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Miyazaki T, Yamazaki S, Takayama T, Moriguchi M, Higaki T, Kashimura T, Nakazawa H, Matsuoka S, Moriyama M, Makuuchi M. Late-onset arterial hemorrhage mimicking pseudoaneurysm after living donor liver transplantation. Liver Transpl 2016; 22:257-60. [PMID: 26439090 DOI: 10.1002/lt.24351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 09/19/2015] [Accepted: 09/27/2015] [Indexed: 01/13/2023]
Affiliation(s)
- Teruyuki Miyazaki
- Department of Digestive Surgery, Division of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Shintaro Yamazaki
- Department of Digestive Surgery, Division of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Tadatoshi Takayama
- Department of Digestive Surgery, Division of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Masamichi Moriguchi
- Department of Digestive Surgery, Division of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Tokio Higaki
- Department of Digestive Surgery, Division of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Tsutomu Kashimura
- Department of Plastic and Reconstructive Surgery, Division of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroaki Nakazawa
- Department of Plastic and Reconstructive Surgery, Division of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Shyunichi Matsuoka
- Department of Medicine, Division of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Mitsuhiko Moriyama
- Department of Medicine, Division of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Masatoshi Makuuchi
- Hepato-Biliary-Pancreatic Surgery and Transplantation Division, Department of Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
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6
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The role of interventional radiology in complications associated with liver transplantation. Clin Radiol 2015; 70:1323-35. [DOI: 10.1016/j.crad.2015.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/21/2015] [Accepted: 07/08/2015] [Indexed: 02/07/2023]
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Thorat A, Lee CF, Wu TH, Pan KT, Chu SY, Chou HS, Chan KM, Wu TJ, Lee WC. Endovascular treatment for pseudoaneurysms arising from the hepatic artery after liver transplantation. Asian J Surg 2014; 40:227-231. [PMID: 25183291 DOI: 10.1016/j.asjsur.2014.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 07/06/2014] [Accepted: 07/14/2014] [Indexed: 10/24/2022] Open
Abstract
Hepatic artery pseudoaneurysm after liver transplantation is an uncommon but potentially lethal complication. Early diagnosis and treatment are essential to avoid life-threatening hemorrhage in these patients. We herein report the case of three patients who developed hepatic artery pseudoaneurysms after living donor liver transplantation. Two patients presented with massive duodenal bleeding secondary to erosion of the hepatic artery into the bile duct, and one patient presented with intra-abdominal bleeding. These patients were managed by catheter-based minimal invasive endovascular procedures including coil embolization and stent grafting. All the patients were treated successfully with uneventful recovery. This technique can be considered as an effective treatment option for hepatic artery pseudoaneurysms instead of a difficult surgical intervention.
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Affiliation(s)
- Ashok Thorat
- Chang-Gung Transplantation Institute, Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Chen-Fang Lee
- Chang-Gung Transplantation Institute, Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Tsung-Han Wu
- Chang-Gung Transplantation Institute, Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Kuang-Tse Pan
- Chang-Gung Transplantation Institute, Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Sung-Yu Chu
- Chang-Gung Transplantation Institute, Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Hong-Shiue Chou
- Chang-Gung Transplantation Institute, Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Kun-Ming Chan
- Chang-Gung Transplantation Institute, Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Ting-Jung Wu
- Chang-Gung Transplantation Institute, Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Wei-Chen Lee
- Chang-Gung Transplantation Institute, Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, College of Medicine, Chang-Gung University, Taoyuan, Taiwan.
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8
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Lim SJ, Park KB, Hyun DH, Do YS, Park HS, Shin SW, Cho SK, Choi DW. Stent graft placement for postsurgical hemorrhage from the hepatic artery: clinical outcome and CT findings. J Vasc Interv Radiol 2014; 25:1539-48. [PMID: 25149115 DOI: 10.1016/j.jvir.2014.06.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 06/24/2014] [Accepted: 06/24/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the clinical results and imaging follow-up findings of stent grafts placed for hemorrhage from hepatic arteries following surgery. MATERIALS AND METHODS The investigation included 17 patients (14 men and 3 women) who underwent endovascular stent graft placement for hepatic arterial hemorrhage following surgery. Bleeding occurred from the common hepatic artery (n = 1; 6%), right hepatic artery (n = 1; 6%), proper hepatic artery (n = 6; 35%), and gastroduodenal artery stump (n = 9; 53%). Stent graft patency, thrombus at the graft, target hepatic artery diameter, and liver perfusion status were analyzed by comparing computed tomography (CT) scans performed before the procedure with follow-up CT scans. Laboratory data were also analyzed before the procedure and at follow-up intervals. RESULTS There were 17 stent grafts placed in 17 patients. The mean follow-up period was 356 days (range, 1-2,119 d). The stent graft primary patency rate was 79.5% at 1 month, 69.6% at 6 months, and 69.6% at 1 year. The clinical success rate was 82% (14 of 17 patients), and the technical success rate was 94% (16 of 17 patients). Mortality related to the stent graft was 12% (2 of 17 patients). Occlusion occurred in 4 of 16 stent grafts (25%). There was one technical failure. The mean stent graft diameter was 6.2 mm (range, 3.5-8.0 mm), and the degree of stent graft oversizing was 38% of the hepatic artery diameter on CT scans and 58% on angiography. Hepatic parenchymal perfusion was preserved in 80% of patients (12 of 15). CONCLUSIONS Hepatic artery hemorrhage following surgery can be treated effectively with stent graft placement.
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Affiliation(s)
- Seong Joo Lim
- Department of Radiology, Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, 135-710, Irwon-Dong, Gangnam Gu, Seoul, Korea
| | - Kwang Bo Park
- Department of Radiology, Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, 135-710, Irwon-Dong, Gangnam Gu, Seoul, Korea.
| | - Dong Ho Hyun
- Department of Radiology, Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, 135-710, Irwon-Dong, Gangnam Gu, Seoul, Korea
| | - Young Soo Do
- Department of Radiology, Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, 135-710, Irwon-Dong, Gangnam Gu, Seoul, Korea
| | - Hong Suk Park
- Department of Radiology, Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, 135-710, Irwon-Dong, Gangnam Gu, Seoul, Korea
| | - Sung Wook Shin
- Department of Radiology, Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, 135-710, Irwon-Dong, Gangnam Gu, Seoul, Korea
| | - Sung Ki Cho
- Department of Radiology, Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, 135-710, Irwon-Dong, Gangnam Gu, Seoul, Korea
| | - Dong Wook Choi
- Division of Hepato-Biliary and Pancreas, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, 135-710, Irwon-Dong, Gangnam Gu, Seoul, Korea
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9
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Panaro F, Miggino M, Bouyabrine H, Carabalona JP, Berthet JP, Canaud L, Nougaret S, Ramos J, Navarro F. Reversed saphenous bypass for hepatic artery pseudoaneurysm after liver transplantation. Ann Vasc Surg 2013; 27:1088-97. [PMID: 23972638 DOI: 10.1016/j.avsg.2013.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 10/23/2012] [Accepted: 01/12/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatic artery pseudoaneurysm (HAP) is found in 1-2% of liver transplantation (LT) patients. The mortality associated with pseudoaneurysm formation after orthotopic LT is reported to be as high as 75%. Because of the rarity of complications, particularly when considered individually, much of the direction for the management of complications is anecdotal. This article discusses the presentation, etiology, types, treatment indications, and vascular procedures used to manage complications with LT. METHODS Between January 2004 and December 2011, 464 LTs were performed at our institution. Of these, 9 (1.9%) consecutive patients underwent surgical treatment of HAP (8 men and 1 woman; median age, 58.4 years [range, 46-67 years]). Four patients underwent transarterial chemoembolization before LT for hepatocellular carcinoma. In all cases, revascularization with a reversed autologous saphenous vein bypass was performed. RESULTS Four patients had ruptured pseudoaneurysms, and the others were diagnosed as having asymptomatic pseudoaneurysms during the follow-up period. The median delay between LT and the diagnosis of HAP was 39.6 days (range, 22-92 days). All were anatomically extrahepatic. The median diameter was 15.3 mm (range, 9-30 mm). Four patients had a T-tube. In 6 cases, biliary leakage was associated with the LT and, in the remaining 3, mycosis was recorded. After surgery, 1 patient underwent retransplantation because of ischemic cholangitis. Five years later, 5 patients had normal arterial anatomy, and the other 3 patients had stenosis that was successfully treated by stents. All of the patients had normal liver function at follow-up. One patient died 16 months later because of a heart attack. CONCLUSIONS HAP with massive intraperitoneal bleeding is a rare but serious life-threatening complication when it occurs after LT. The majority of HAP cases are associated with bile leakage and mycosis; therefore, surgery must be the treatment of choice. Our conclusions support surgical revascularization with reversed saphenous grafts as a feasible and efficient treatment in cases of HAP.
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Affiliation(s)
- Fabrizio Panaro
- Department of General and Liver Transplant Surgery, University of Montpellier, Hôpital Saint Eloi, Montpellier, France.
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10
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Boleslawski E, Bouras AF, Truant S, Liddo G, Herrero A, Badic B, Audet M, Altieri M, Laurent A, Declerck N, Navarro F, Létoublon C, Wolf P, Chiche L, Cherqui D, Pruvot FR. Hepatic artery ligation for arterial rupture following liver transplantation: a reasonable option. Am J Transplant 2013; 13:1055-1062. [PMID: 23398886 DOI: 10.1111/ajt.12135] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 11/21/2012] [Accepted: 12/07/2012] [Indexed: 01/25/2023]
Abstract
Hepatic artery (HA) rupture after liver transplantation is a rare complication with high mortality. This study aimed to review the different managements of HA rupture and their results. From 1997 to 2007, data from six transplant centers were reviewed. Of 2649 recipients, 17 (0.64%) presented with HA rupture 29 days (2-92) after transplantation. Initial management was HA ligation in 10 patients, reanastomosis in three, aorto-hepatic grafting in two and percutaneous arterial embolization in one. One patient died before any treatment could be initiated. Concomitant biliary leak was present in seven patients and could be subsequently treated by percutaneous and/or endoscopic approaches in four patients. Early mortality was not observed in patients with HA ligation and occurred in 83% of patients receiving any other treatment. After a median follow-up of 70 months, 10 patients died (4 after retransplantation), and 7 patients were alive without retransplantation (including 6 with HA ligation). HA ligation was associated with better 3-year survival (80% vs. 14%; p=0.002). Despite its potential consequences on the biliary tract, HA ligation should be considered as a reasonable option in the initial management for HA rupture after liver transplantation. Unexpectedly, retransplantation was not always necessary after HA ligation in this series.
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Affiliation(s)
- E Boleslawski
- UMR 8161, CNRS, Institut Biologique de Lille, France.,Service de Chirurgie Digestive et Transplantations, Hôpital Huriez, CHU, Univ Nord-de-France, F-59000, Lille, France
| | - A F Bouras
- Service de Chirurgie Digestive et Transplantations, Hôpital Huriez, CHU, Univ Nord-de-France, F-59000, Lille, France
| | - S Truant
- Service de Chirurgie Digestive et Transplantations, Hôpital Huriez, CHU, Univ Nord-de-France, F-59000, Lille, France
| | - G Liddo
- Service de Chirurgie Digestive et Transplantations, Hôpital Huriez, CHU, Univ Nord-de-France, F-59000, Lille, France
| | - A Herrero
- Service de Chirurgie Digestive, Hôpital St-Eloi, Montpellier, France
| | - B Badic
- Département de Chirurgie Digestive et de l'Urgence, CHU, Grenoble, France
| | - M Audet
- Service de Chirurgie Digestive et Transplantation, Hôpitaux Universitaires de Strasbourg, France
| | - M Altieri
- Service de Chirurgie Digestive, CHU Côte de Nacre, Caen, France
| | - A Laurent
- Service de Chirurgie Digestive, Hôpital Henri-Mondor, APHP, Paris, France
| | - N Declerck
- Service de Chirurgie Digestive et Transplantations, Hôpital Huriez, CHU, Univ Nord-de-France, F-59000, Lille, France
| | - F Navarro
- Service de Chirurgie Digestive, Hôpital St-Eloi, Montpellier, France
| | - C Létoublon
- Département de Chirurgie Digestive et de l'Urgence, CHU, Grenoble, France
| | - P Wolf
- Service de Chirurgie Digestive et Transplantation, Hôpitaux Universitaires de Strasbourg, France
| | - L Chiche
- Service de Chirurgie Digestive, CHU Côte de Nacre, Caen, France
| | - D Cherqui
- Service de Chirurgie Digestive, Hôpital Henri-Mondor, APHP, Paris, France
| | - F R Pruvot
- UMR 8161, CNRS, Institut Biologique de Lille, France
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11
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Ramalingam V, Kabutey NK, Vilvendhan R, Kim D. Endovascular management of anastomotic blowout of proper hepatic to common hepatic artery saphenous vein bypass with coil embolization and hepatic artery stent placement. Vasc Endovascular Surg 2013; 47:310-3. [PMID: 23471199 DOI: 10.1177/1538574413481116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mesenteric and visceral artery pseudoaneurysms in the abdomen are a relatively rare complication after abdominal surgery. It is a complication primarily associated with pancreatic and hepatobiliary surgery, trauma, iatrogenic causes and inflammatory diseases. Regardless of etiology, visceral artery pseudoaneurysms of the abdomen reportedly occur only in 0.01% to 2% of the population. Although rare, these are associated with life-threatening bleeding complications and need to be appropriately managed. We present the case of a patient who presented with bleeding after developing a pseudoaneurysm at the distal anastomotic site of a common hepatic to proper hepatic artery interposition saphenous vein bypass that was subsequently excluded by coil embolization and stent graft placement.
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12
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Lu NN, Huang Q, Wang JF, Wei BJ, Gao K, Zhai RY. Treatment of post-liver transplant hepatic artery pseudoaneurysm with balloon angioplasty after failed stent graft placement. Clin Res Hepatol Gastroenterol 2012; 36:e109-13. [PMID: 22766148 DOI: 10.1016/j.clinre.2012.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 05/10/2012] [Accepted: 05/21/2012] [Indexed: 02/04/2023]
Abstract
Hepatic artery pseudoaneurysm is a rare complication following liver transplantation but can lead to life threatening hemorrhage if not treated effectively and in a timely manner. We describe a hepatic artery pseudoaneurysm that occurred after liver transplantation in a 53-year-old woman. The pseudoaneurysm was initially treated by implantation of a balloon-expandable covered stent-graft, but an endoleak was observed 6 days later. The endoleak was successfully resolved by further balloon angioplasty, which expanded the cylindrical stent to a conical stent, matching the anatomy of the anastomotic hepatic artery. Follow-up ultrasound examinations demonstrated patent hepatic arteries, with no evidence of pseudoaneurysm. Balloon-expandable covered stent-graft may be utilized to treat hepatic artery pseudoaneurysm following liver transplantation, due to the remodeling ability of stent-grafts, enabling them to fit the diseased vessels.
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Affiliation(s)
- Ning-Ning Lu
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongren Tiyuchang Nan Road, Chaoyang District, Beijing 100020, China
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13
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Saad WEA, Dasgupta N, Lippert AJ, Turba UC, Davies MG, Kumer S, Gardenier JC, Sabri SS, Park AW, Waldman DL, Schmitt T, Matsumoto AH, Angle JF. Extrahepatic Pseudoaneurysms and Ruptures of the Hepatic Artery in Liver Transplant Recipients: Endovascular Management and a New Iatrogenic Etiology. Cardiovasc Intervent Radiol 2012; 36:118-27. [DOI: 10.1007/s00270-012-0408-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 04/08/2012] [Indexed: 02/07/2023]
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Ginat DT, Saad WEA, Waldman DL, Davies MG. Stent-Graft Placement for Management of Iatrogenic Hepatic Artery Branch Pseudoaneurysm After Liver Transplantation. Vasc Endovascular Surg 2009; 43:513-7. [DOI: 10.1177/1538574409334831] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pseudoaneurysm of the hepatic arteries is uncommon following liver transplantation and is usually iatrogenic. We describe a case of balloon angioplasty of a left hepatic artery stenosis complicated by an iatrogenic pseudoaneurysm. Resolution of the stenosis and the pseudoaneurysm was achieved through a combination of a bare stent and a balloon-expandable covered stent. The completion angiogram demonstrated excellent appearance of the patent hepatic arteries with exclusion of the pseudoaneurysm. No surgery was required. The graft and the patient did well for the following 6 months. Doppler ultrasound examination at 2 and 6 months postintervention revealed patent hepatic arteries and no evidence of the pseudoaneurysm.
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Affiliation(s)
- Daniel T. Ginat
- Department of Imaging Science and Interventional Radiology, University of Rochester Medical Center, Rochester, New York,
| | - Wael E. A. Saad
- Department of Imaging Science and Interventional Radiology, University of Rochester Medical Center, Rochester, New York
| | - David L. Waldman
- Department of Imaging Science and Interventional Radiology, University of Rochester Medical Center, Rochester, New York
| | - Mark G. Davies
- Department of Imaging Science and Interventional Radiology, University of Rochester Medical Center, Rochester, New York
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Krokidis ME, Hatzidakis AA. Acute hemobilia after bilioplasty due to hepatic artery pseudoaneurysm: treatment with an ePTFE-covered stent. Cardiovasc Intervent Radiol 2008; 32:605-7. [PMID: 19093147 DOI: 10.1007/s00270-008-9486-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 11/19/2008] [Accepted: 11/26/2008] [Indexed: 12/25/2022]
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Graft Vessel Wall Pathology in a Case of Hepatic Artery Pseudo-Aneurysm in a Liver Transplant Recipient. Transplant Proc 2008; 40:3800-3. [DOI: 10.1016/j.transproceed.2008.06.095] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 04/22/2008] [Accepted: 06/16/2008] [Indexed: 11/21/2022]
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Johnston T, Jeon H, Gedaly R, Ranjan D. Importance of local infection in hepatic artery pseudoaneurysms. Liver Transpl 2008; 14:388. [PMID: 18306365 DOI: 10.1002/lt.21413] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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