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Cizman Z, Saad W. Transplant Hepatic Artery Complications. Tech Vasc Interv Radiol 2023; 26:100923. [PMID: 38123292 DOI: 10.1016/j.tvir.2023.100923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Hepatic artery complications can be divided into 2 different categories, nonocclusive and steno-occlusive disease. Steno-occlusive disease is a collective term that encompasses hepatic artery thrombosis, hepatic artery stenosis, and hepatic arterial kinks, while nonocclusive arterial disease encompasses less than 5% of complications and is a collective term used to describe arteriovenous fistulae, pseudoaneurysms, arterial rupture and nonocclusive hepatic artery hypoperfusion syndrome. This article details the angiographic techniques and definitions needed to accurately diagnose arterial transplant complications and describes the technical aspects and results of endoluminal management of these arterial complications. In addition, this article discusses the presentation, etiology and indications for treatment, including surgical management of these various complications.
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Affiliation(s)
- Ziga Cizman
- Department of Radiology and Imaging Sciences, University of Utah Hospital/Huntsman Cancer Institute, Salt Lake City, UT.
| | - Wael Saad
- Department of Radiology and Imaging Sciences, University of Utah Hospital/Huntsman Cancer Institute, Salt Lake City, UT
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Vermeersch W, Topal H, Laenen A, Bonne L, Claus E, Jaekers J, Pirenne J, Topal B, Maleux G. Coronary covered stents in the management of late-onset arterial complications post-hepato-pancreato-biliary surgery. Abdom Radiol (NY) 2023; 48:2406-2414. [PMID: 37055587 DOI: 10.1007/s00261-023-03906-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE To retrospectively evaluate the safety, efficacy, and late clinical outcome of coronary covered stent placement for the treatment of late-onset arterial complications after hepato-pancreato-biliary surgery. MATERIALS AND METHODS Consecutive patients presenting with post-hepato-pancreato-biliary surgery-related arterial lesions and subsequently treated with a covered coronary stent in the authors institution between January 2012 and November 2021 were included. Primary endpoints were technical and clinical success; secondary endpoints were covered stent patency and end-organ perfusion of the affected artery. RESULTS The study included 22 patients (13 men and 9 women) with a mean age of 67 years ± 9.6 years. Initial surgery included pancreaticoduodenectomy (n = 15; 68%), liver transplantation (n = 2; 9%), left hepatectomy (n = 1; 5%), bile duct resection (n = 1; 5%), hepatogastrostomy (n = 1; 5%), and segmental enterectomy (n = 1; 5%). Technically, coronary covered stents were successfully placed in n = 22 patients (100%) without immediate complication. Definitive bleeding control was observed in n = 18 patients (81.1%) with recurrent bleeding within 30 days postintervention in n = 5 patients (23%). No ischemic liver or biliary complications occurred during the follow-up period. The 30-day mortality rate was 0%. CONCLUSION Coronary covered stents are a safe and efficient treatment option in most of the patients presenting with late-onset postoperative arterial injuries following hepato-pancreato-biliary surgery and are associated with an acceptable recurrent bleeding rate and no late, ischemic, parenchymal complications.
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Affiliation(s)
- Wout Vermeersch
- Department of Radiology, University Hospitals KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Halit Topal
- Department of Abdominal Surgery, University Hospitals KU Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Department of Public Health and Primary Care, Leuven Biostatistics and Statistical Bioinformatics Centre, Leuven, Belgium
| | - Lawrence Bonne
- Department of Radiology, University Hospitals KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Eveline Claus
- Department of Radiology, University Hospitals KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Joris Jaekers
- Department of Abdominal Surgery, University Hospitals KU Leuven, Leuven, Belgium
| | - Jacques Pirenne
- Department of Abdominal Transplant Surgery, University Hospitals KU Leuven, Leuven, Belgium
| | - Baki Topal
- Department of Abdominal Surgery, University Hospitals KU Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
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Maaty MEGAE, Ibrahim AM, Soliman AH, Mohamed AH. Role of interventional radiology in management of post-liver transplant anastomotic complications. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [PMCID: PMC9344456 DOI: 10.1186/s43055-022-00853-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Liver transplantation is considered to be the treatment of choice in cases of end-stage liver disease; however, as a major procedure, the operation is fraught with complications. The etiology, symptoms, and diagnostic methods for arterial, portal, and biliary issues are thoroughly discussed. Interventional procedures such as balloon angioplasty and stent placement in the arterial and portal systems, as well as biliary interventional procedures, are described.
Results In our study, we reviewed 25 cases of post-living donor transplanted liver, with anastomotic complications including biliary stenosis 40%, hepatic vein stenosis 20%, portal vein stenosis 16%, biliary leakage 16%, and hepatic artery stenosis or pseudo-aneurysm 16%. We had 10 cases of biliary stenosis, 7 of which were successfully treated with the insertion of an internal/external drain, and one case failed. Two patients died. We had four cases of hepatic venous obstruction with successfully implanted stents and a perfect outcome, efficacy, and patency rate of 100%. We also had two cases of hepatic artery stenosis that were perfectly managed by stent placement, with a patency rate of 100%. We came across two cases of hepatic artery pseudo-aneurysm. One case failed due to large sac size, while the other was successful. Finally, in our study, we had a 100% success rate in 5 cases of portal vein stenosis in the early postoperative period.
Conclusions Percutaneous IR was effective treatment for hepatic vein occlusion, portal vein stenosis, hepatic artery stenosis, and anastomotic biliary stricture after living donor liver transplantation. The interventional radiology team is now an integral part of the multi-disciplinary care of transplant patients. As new interventional instruments are developed and experience is gained, the outcomes of interventional treatments will continue to improve.
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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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Joh D, Sharma M, Taj M, Surani S. An infrequently encountered case of spontaneous subcapsular liver hematoma with hepatic artery pseudoaneurysm. J Community Hosp Intern Med Perspect 2021; 11:81-84. [PMID: 33552423 PMCID: PMC7850349 DOI: 10.1080/20009666.2020.1821468] [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] [Indexed: 11/02/2022] Open
Abstract
Hepatic artery pseudoaneurysm (HAP) is a rare complication of liver trauma and liver transplant, and spontaneous subcapsular liver hematoma is not frequently encountered outside the setting of preeclampsia and hemolysis, elevated liver enzyme and low platelet (HELLP) syndrome. We report a rare case of spontaneous subcapsular liver hematoma with hepatic artery pseudoaneurysm without any apparent liver trauma or recent interventional procedures of the hepatobiliary system. Although subcapsular hepatic hematoma and HAP are uncommon diagnoses, clinicians should be aware of these diagnoses to promptly diagnose and effectively treat them. Clinicians should also not forget these diseases could be masked by other common etiologies, such as gastritis.
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Affiliation(s)
- Daniel Joh
- Department of Internal Medicine, Corpus Christi Medical Center - Bay Area, Corpus Christi, TX, USA
| | - Munish Sharma
- Department of Pulmonary Medicine, Corpus Christi Medical Center, Corpus Christi, TX, USA
| | - Mehrunissa Taj
- Department of Nursing, John Hopkins University School of Nursing, Baltimore, MD, USA
| | - Salim Surani
- Department of Internal Medicine, Corpus Christi Medical Center - Bay Area, Corpus Christi, TX, USA.,Department of Pulmonary Medicine, Corpus Christi Medical Center, Corpus Christi, TX, USA.,Department of Internal Medicine, University of North Texas, Dallas, TX, USA
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Hepatic Artery Pseudoaneurysm in the Liver Transplant Recipient: A Case Series. Case Rep Transplant 2019; 2019:9108903. [PMID: 31976118 PMCID: PMC6959152 DOI: 10.1155/2019/9108903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/18/2019] [Accepted: 11/23/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction Hepatic artery pseudoaneurysm is a rare and potentially fatal complication of liver transplantation with a reported incidence of 0.3–2.6% and associated mortality approaching 75%. Clinical presentation typically includes sudden hypotension, gastrointestinal bleed or abnormal liver function tests within two months of transplantation. We report a series of four cases of hepatic artery pseudoaneurysm in adult liver transplant recipients with the goal of identifying factors that may aid in early diagnosis, prior to the development of life threatening complications. Methods A retrospective chart review at a high volume transplant center revealed 4 cases of hepatic artery pseudoaneurysm among 553 liver transplants (Incidence 0.72%) between March 2013 and March 2017. Results Two of the four patients died immediately after intervention, one patient survived an additional 151 days prior to death from an unrelated condition and one patient survived at two years follow up. All cases utilized multiple imaging modalities that failed to identify the pseudoaneurysm prior to diagnosis with computed tomography angiography (CTA). Two cases had culture proven preoperative intrabdominal infections, while the remaining two cases manifested a perioperative course highly suspicious for infection (retransplant for hepatic necrosis after hepatic artery thrombosis and infected appearing vessel at reoperation, respectively). Three of the four cases either had a delayed biliary anastomosis or development of a bile leak, leading to contamination of the abdomen with bile. Additionally, three of the four cases demonstrated at least one episode of hypotension with acute anemia at least 5 days prior to diagnosis of the hepatic artery pseudoaneurysm. Conclusions Recognition of several clinical features may increase the early identification of hepatic artery pseudoaneurysm in liver transplant recipients. These include culture proven intrabdominal infection or high clinical suspicion for infection, complicated surgical course resulting either in delayed performance of biliary anastomosis or a biliary leak, and an episode of hypotension with acute anemia. In combination, the presence of these characteristics can lead the clinician to investigate with appropriate imaging prior to the onset of life threatening complications requiring emergent intervention. This may lead to increased survival in patients with this life threatening complication.
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Gao W, Li X, Huang L. Treatment of obstructive jaundice caused by hepatic artery pseudoaneurysm after liver transplantation: A case report. Medicine (Baltimore) 2019; 98:e18015. [PMID: 31860951 PMCID: PMC6940052 DOI: 10.1097/md.0000000000018015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RATIONALE Despite vast improvements in technique, several complications still challenge surgeons and medical practitioners alike, including biliary and vascular complications, acute and chronic rejection, and disease recurrence. PATIENT CONCERNS A 59-year-old man was admitted to hospital on July, 2016. He had hepatitis B cirrhosis related recurrent hepatocellular carcinoma and underwent living donor liver transplantation in our hospital. DIAGNOSIS At the time of admission, the patient's spirit, diet, sleep, normal urine and stool, and weight did not change significantly. The test indicators are as follows: total bilirubin: 100.1 μmol/L, direct bilirubin: 65.0 μmol/L. Emergency CT in the hospital after admission showed that hepatic artery pseudoaneurysm formation after liver transplantation was observed. INTERVENTIONS This patient underwent minimal invasive endovascular treatment. The demographic, clinical, and laboratory data were collected and reviewed. He was treated successfully by endovascular stent grafting and thrombolytic treatment. OUTCOMES The blood concentration of tacrolimus (FK506) was 6.3 ng/mL total bilirubin 19.6 μmol/L before discharge. The changing of total bilirubin and direct bilirubin were investigated (Fig. 1). The patient recovered well and was discharged 2 weeks later. The patient is doing well and regularly followed up. LESSONS Coil embolization of aneurysmal sac or placement of a stent graft is a minimally invasive alternative to surgery and definitively excludes a bleeding hepatic artery pseudoaneurysm. This technique can be considered as an effective treatment option for hepatic artery pseudoaneurysm instead of a difficult surgical repair.
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MESH Headings
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/etiology
- Aneurysm, False/therapy
- Carcinoma, Hepatocellular/pathology
- Carcinoma, Hepatocellular/surgery
- Carcinoma, Hepatocellular/virology
- Embolization, Therapeutic/methods
- Follow-Up Studies
- Graft Survival
- Hepatic Artery
- Hepatitis B, Chronic/complications
- Hepatitis B, Chronic/diagnosis
- Humans
- Jaundice, Obstructive/etiology
- Jaundice, Obstructive/physiopathology
- Jaundice, Obstructive/therapy
- Liver Cirrhosis/etiology
- Liver Cirrhosis/physiopathology
- Liver Transplantation/adverse effects
- Liver Transplantation/methods
- Male
- Middle Aged
- Postoperative Complications/diagnosis
- Postoperative Complications/therapy
- Risk Assessment
- Treatment Outcome
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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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Idiopathic Giant Hepatic Artery Pseudoaneurysm. Case Rep Vasc Med 2017; 2017:4658065. [PMID: 29181219 PMCID: PMC5664268 DOI: 10.1155/2017/4658065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 08/06/2017] [Indexed: 01/16/2023] Open
Abstract
Hepatic artery pseudoaneurysm (HAP) incidence is rising due to more common use of endoscopic and percutaneous hepatic interventions. HAP is potentially fatal, as it could lead to sudden life-threatening hemorrhage. HAP can be intrahepatic or extrahepatic. On computed tomography angiogram (CTA) and magnetic resonance angiogram (MRA), HAP follows blood pool on multiphasic examination, with brisk arterial enhancement that washes out, similar to the abdominal aorta on later phases. We present a case of idiopathic giant HAP in an 82-year-old male. Currently, angioembolization is replacing surgery as the initial modality of choice for management of this condition.
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Ma L, Chen K, Lu Q, Ling W, Luo Y. Case report of hepatic artery dissection secondary to hepatic artery pseudoaneurysm after living donor liver transplantation. BMC Gastroenterol 2016; 16:44. [PMID: 27036207 PMCID: PMC4818394 DOI: 10.1186/s12876-016-0458-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/19/2016] [Indexed: 02/06/2023] Open
Abstract
Background Hepatic artery pseudoaneurysm (HAP) and Hepatic artery dissection are rare vascular complications after living donor liver transplantation (LDLT), which may lead to graft loss and death of the recipients. Conventional gray-scale and Doppler ultrasound, as well as contrast-enhanced ultrasound (CEUS), play important roles in identifying vascular complications in the early postoperative period and during follow-up. We report a case of hepatic artery dissection secondary to HAP after LDLT, which was diagnosed and followed for one year by ultrasound. To the best of our knowledge, few studies have reported similar cases after liver transplantation in the English literature. Case presentation A 43-year-old man underwent right-lobe LDLT for treatment of a severe acute hepatitis B infection and was followed up with ultrasound examinations for one year. Conventional gray-scale and Doppler ultrasound combined with contrast-enhanced ultrasound (CEUS) accurately revealed the occurrence of HA dissection secondary to HAP and accompanied by thrombosis and collateral circulation, as well as secondary biliary complications, which provided a prompt diagnosis and guidance for the treatment. Conclusion Our case suggests that ultrasound can help detect hepatic artery pseudoaneurysm and dissection, as well as secondary biliary lesions after LDLT in an accurate and timely manner and provide useful information for the treatment chosen. CEUS shows potential as an important complementary technique to gray-scale and Doppler ultrasound.
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Affiliation(s)
- Lin Ma
- Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, China
| | - Kefei Chen
- Department of liver and Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Qiang Lu
- Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, China
| | - Wenwu Ling
- Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, China
| | - Yan Luo
- Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, China.
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Ma L, Lu Q, Luo Y. Vascular complications after adult living donor liver transplantation: Evaluation with ultrasonography. World J Gastroenterol 2016; 22:1617-1626. [PMID: 26819527 PMCID: PMC4721993 DOI: 10.3748/wjg.v22.i4.1617] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/12/2015] [Accepted: 11/13/2015] [Indexed: 02/06/2023] Open
Abstract
Living donor liver transplantation (LDLT) has been widely used to treat end-stage liver disease with improvement in surgical technology and the application of new immunosuppressants. Vascular complications after liver transplantation remain a major threat to the survival of recipients. LDLT recipients are more likely to develop vascular complications because of their complex vascular reconstruction and the slender vessels. Early diagnosis and treatment are critical for the survival of graft and recipients. As a non-invasive, cost-effective and non-radioactive method with bedside availability, conventional gray-scale and Doppler ultrasonography play important roles in identifying vascular complications in the early postoperative period and during the follow-up. Recently, with the detailed vascular tracing and perfusion visualization, contrast-enhanced ultrasound (CEUS) has significantly improved the diagnosis of postoperative vascular complications. This review focuses on the role of conventional gray-scale ultrasound, Doppler ultrasound and CEUS for early diagnosis of vascular complications after adult LDLT.
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Shuaib W, Tiwana MH, Vijayasarathi A, Sadiq MF, Anderson S, Amin N, Khosa F. Imaging of vascular pseudoaneurysms in the thorax and abdomen. Clin Imaging 2015; 39:352-62. [PMID: 25682302 DOI: 10.1016/j.clinimag.2015.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 12/27/2014] [Accepted: 01/14/2015] [Indexed: 12/17/2022]
Abstract
INTRODUCTION This review article illustrates a spectrum of arterial pseudoaneurysms that may occur in various locations throughout the thoracoabdominal region. This article discusses the common etiologies and typical clinical presentations of arterial pseudoaneurysms as well as the imaging modalities employed in their diagnosis and potential treatment options. OBJECTIVE The goal of this review article is to familiarize radiologists with the diagnosis of thoracoabdominal arterial pseudoaneurysms, the prompt identification and treatment of which are crucial in this patient population. CONCLUSION In summary, a thorough understanding of the etiologies, imaging characteristics, and clinical implications of pseudoaneurysms can help optimize identification and management of this spectrum of disease.
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Affiliation(s)
- Waqas Shuaib
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA.
| | | | - Arvind Vijayasarathi
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA
| | | | - Stephen Anderson
- Department of Radiology, Boston University School of Medicine, Boston, MA
| | - Neil Amin
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA
| | - Faisal Khosa
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA
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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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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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15
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Verzini F, Biello A, Marucchini A, Parente B, Parlani G, Cao P. Total endovascular solution for complex visceral aneurysms. J Vasc Surg 2013; 58:1412-6. [PMID: 23827335 DOI: 10.1016/j.jvs.2013.05.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 03/28/2013] [Accepted: 05/10/2013] [Indexed: 10/26/2022]
Abstract
Visceral aneurysms are rare in the general population (<2%), and the most serious complication is represented by aneurysm rupture. The use of stent grafts to exclude visceral aneurysms is described in several reports but is reserved for patients with favorable anatomy. We report here on a hepatic artery pseudoaneurysm in a liver transplant patient and a patient with an aneurysmal vein graft degeneration of a renal bypass, both with no suitable proximal neck for standard stent grafting. Both patients were successfully treated with a custom-made aortic endograft with a single fenestration for the hepatic or renal artery, together with a visceral covered stent. Although initial results are promising, long-term follow-up is required to assess durability.
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Affiliation(s)
- Fabio Verzini
- Unit of Vascular and Endovascular Surgery, Ospedale S. Maria della Misericordia, Università degli Studi di Perugia, Perugia, Italy.
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16
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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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17
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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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18
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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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19
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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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20
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Use of a Multilayered Stent for the Treatment of Hepatic Artery Pseudoaneurysm After Liver Transplantation. Cardiovasc Intervent Radiol 2011; 35:207-10. [DOI: 10.1007/s00270-011-0335-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Uchiyama H, Shirabe K, Morita M, Kakeji Y, Taketomi A, Soejima Y, Yoshizumi T, Ikegami T, Harada N, Kayashima H, Morita K, Maehara Y. Expanding the applications of microvascular surgical techniques to digestive surgeries: a technical review. Surg Today 2011; 42:111-20. [DOI: 10.1007/s00595-011-0032-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 03/15/2011] [Indexed: 01/27/2023]
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22
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Ushigome H, Koshino K, Sakai K, Suzuki T, Nobori S, Matsuyama M, Okajima H, Okamoto M, Yoshimura N. Rare spontaneous remission of hepatic artery aneurysm following ABO incompatible living donor liver transplantation: a case report. Transplant Proc 2011; 43:2424-7. [PMID: 21839283 DOI: 10.1016/j.transproceed.2011.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 60-year-old male patient with an unknown cause for cirrhosis and a hepatoma underwent an ABO incompatible living donor liver transplantation (LDLT) from his son. The transplanted graft was his son's right lobe. For ABO incompatible transplantation, splenectomy was performed for desensitization. A catheter was inserted into the recipient's right hepatic artery for subsequent local immunosuppression. On the 15th postoperative day, a fusiform 15 × 10 mm aneurysm was observed in the graft right hepatic artery using ultrasonography and hepatic arteriography. At that time, the patient was also diagnosed to have an intraperitoneal abscess at the bottom of his left diaphragm. Administering antibiotics, we tried to embolize the aneurysm because of fear of rupture, but this manever failed because it was difficult to insert the wire in to the aneurysm to produce a stenosis around its proximal neck. However, because the aneurysm was not detectable on the 37th postoperative day, it was assumed to have embolized spontaneously. This relatively rare case revealed a hepatic artery aneurysm that spontaneously regressed after ABO incompatible LDLT.
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Affiliation(s)
- H Ushigome
- Department of Transplantation and Regenerative Surgery, Kyoto Prefectural University Graduate School of Medical Science, Kyoto City, Japan.
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23
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Acute gastrointestinal bleeding: CT angiography with multi-planar reformatting. ACTA ACUST UNITED AC 2010; 36:115-25. [DOI: 10.1007/s00261-010-9615-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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24
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Golse N, Spina A, Abdelaal A, Mennesson N, Feugier P, Dumortier J, Boillot O, Adham M. Extra-anatomical hepatic artery reconstruction following post-embolization iatrogenic dissection and arterial anastomotic rupture in two liver transplant recipients. ACTA ACUST UNITED AC 2010; 34:111-4. [PMID: 20071115 DOI: 10.1016/j.gcb.2009.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 09/07/2009] [Accepted: 11/12/2009] [Indexed: 12/13/2022]
Abstract
When hepatic artery reconstruction is required during hepatic transplantation, this is generally performed with donor vessels. We describe two cases requiring a prosthesis. The first case was a 58-year-old man transplanted for cirrhosis complicated by hepatocellular carcinoma. During transplantation, dissection of the celiac trunk occurred due to arterial embolization and the use of the patient's vessels was impossible. An extra-anatomical bypass between the infra-renal aorta and the donor hepatic artery was performed via the interposition of a graft tube. The second case was a 52-year-old man transplanted for cirrhosis complicated by hepatocellular carcinoma. On day 16, a ruptured anastomosis was suspected and the patient underwent emergency revision laparotomy. Arterial revascularisation was performed with an aortohepatic bypass using a synthetic GoreTex((R)) graft. Patient follow-up was uneventful.
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Affiliation(s)
- N Golse
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Edouard Herriot Hospital, HCL, UFR Grange Blanche-UCBL1, Pavillon D 5, Place d'Arsonval, 69437 Lyon cedex, France
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25
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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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26
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Common hepatic artery aneurysm treated with an endovascular stent-graft: a case report. ACTA ACUST UNITED AC 2009; 35:215-7. [DOI: 10.1007/s00261-008-9498-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 12/28/2008] [Indexed: 10/21/2022]
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27
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Embolization of the Gastroduodenal Artery Before Selective Internal Radiotherapy: A Prospectively Randomized Trial Comparing Platinum-Fibered Microcoils with the Amplatzer Vascular Plug II. Cardiovasc Intervent Radiol 2009; 32:455-61. [DOI: 10.1007/s00270-008-9498-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 11/18/2008] [Accepted: 11/26/2008] [Indexed: 12/20/2022]
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28
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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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29
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Briceño J, Naranjo &A, Ciria R, Sánchez-Hidalgo JM, Zurera L, López-Cillero P. Late hepatic artery pseudoaneurysm: A rare complication after resection of hilar cholangiocarcinoma. World J Gastroenterol 2008; 14:5920-3. [PMID: 18855995 PMCID: PMC2751906 DOI: 10.3748/wjg.14.5920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We report an unusual pathological entity of a pseudoaneurysm of the right hepatic artery, which developed two years after the resection of a type II hilar cholangiocarcinoma and secondary to an excessive skeletonization for regional lymphadenectomy and neoadjuvant external-beam radiotherapy. After a sudden and massive hematemesis, a multidetector computed tomographic angiography (MDCTA) showed a hepatic artery pseudoaneurysm. Angiography with embolization of the pseudoaneurysm was attempted using microcoils with adequate patency of the hepatic artery and the occlusion of the pseudoaneurysm. A new episode of hematemesis 3 wk later revealed a partial revascularization of the pseudoaneurysm. A definitive interventional radiological treatment consisting of transarterial embolization (TAE) of the right hepatic artery with stainless steel coils and polyvinyl alcohol particles was effective and well-tolerated with normal liver function tests and without signs of liver infarction.
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30
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Lee CC, Jeng LB, Poon KS, Chen YF, Ho YJ, Lai HC. Fatal Duodenal Hemorrhage Complicated After Living Donor Liver Transplantation: Case Report. Transplant Proc 2008; 40:2840-1. [DOI: 10.1016/j.transproceed.2008.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Jiang XZ, Yan LN, Li B, Zhao JC, Wang WT, Li FG, Wen TF, Ma YK, Zeng Y, Xu MQ, Yang JY, Li ZH. Arterial complications after living-related liver transplantation: single-center experience from West China. Transplant Proc 2008; 40:1525-8. [PMID: 18589143 DOI: 10.1016/j.transproceed.2007.11.078] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Revised: 08/27/2007] [Accepted: 11/09/2007] [Indexed: 02/08/2023]
Abstract
Vascular complications after liver transplantation remain a major source of morbidity and mortality for recipients. In particular, patients receiving living-related liver transplantation (LRLT) experience a higher rate of vascular complications owing to the complex vascular reconstruction. Between July 2001 and December 2005, LRLTs were performed in our center on 33 patients with end-stage liver diseases. The 23 men and 10 women had a mean age of 32.6 +/- 11.3 years (range = 5 to 58 years). Of the 33 patients, the percentage of vascular complications was 9.09% (3 cases), including hepatic arterial thrombosis (HAT), hepatic arterial stenosis (HAS), or hepatic artery pseudoaneurysm (HAP) in one patient, respectively. No portal vein or hepatic vein complication occurred in our patients. Thrombectomy was performed in the patient with thrombosis. The patient with stenosis was treated with balloon angioplasty and endoluminal stent placement. The pseudoaneurysm was also successfully embolized to restore the blood flow toward the donor liver. Mean follow-up for all patients after LRLT was 18.0 +/- 5.4 months. The overall postoperative 30-day mortality rate was 6.06% (2/33). The 1-year survival rate was 86.36% in 22 patients with benign diseases and 72.73% in 11 patients with malignant diseases. However, no death was associated with vascular complications. Careful preoperative evaluation and intraoperative microsurgical technique for hepatic artery reconstructions are the keys to prevent vascular complications following LRLT. Immediate surgical intervention is required for acute vascular complications, whereas late complications may be treated by balloon angioplasty and endoluminal stent placement. Embolization may be a safe and effective approach in the treatment of a pseudoaneurysm of the hepatic artery.
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Affiliation(s)
- X-Z Jiang
- Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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32
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Pasklinsky G, Gasparis AP, Labropoulos N, Pagan J, Tassiopoulos AK, Ferretti J, Ricotta JJ. Endovascular covered stenting for visceral artery pseudoaneurysm rupture: report of 2 cases and a summary of the disease process and treatment options. Vasc Endovascular Surg 2008; 42:601-6. [PMID: 18583306 DOI: 10.1177/1538574408318478] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present 2 cases of hemorrhage from a visceral artery pseudoaneurysm, managed successfully with endovascular covered stent placement. The first case was a 59-year-old man, 3 months after a laparoscopic distal pancreatectomy for adenoma, presenting with diffuse abdominal pain. The patient was evaluated with a computed tomography scan revealing a splenic artery pseudoaneurysm (PA) bleeding into a pancreatic pseudocyst. He was emergently taken to the angiography suite where a covered stent was deployed at the level of splenic artery PA. The second case was a 52-year-old woman with recurrent left retroperitoneal mass 5 years after distal pancreatectomy and splenectomy for a nonfunctional neuroendocrine tumor. She underwent resection of the mass in the left upper quadrant. Postoperative course was complicated by hematoma, abscess formation, reexploration, and repair of the duodenotomy and the portal vein. Subsequently, she was noted to have intermittent gastrointestinal hemorrhage, which prompted an angiogram revealing a hepatic artery PA that was repaired with a covered balloon-expandable stent. A completion angiogram was obtained in each case demonstrating exclusion of the PA. Our experience with these 2 cases supports the notion that endovascular covered stenting is a safe and effective therapy for exclusion of visceral artery aneurysm.
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Affiliation(s)
- Garri Pasklinsky
- Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, New York 11794-8191, USA
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33
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Won YD, Ku YM, Kim KT, Kim KH, Kim JI. Successful management of a ruptured hepatic artery pseudoaneurysm with a stent-graft. Emerg Radiol 2008; 16:247-9. [PMID: 18401604 DOI: 10.1007/s10140-008-0716-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Accepted: 03/05/2008] [Indexed: 11/24/2022]
Abstract
Hepatic artery pseudoaneurysm is a rare and potentially life-threatening vascular disorder. Careful consideration and early management of this lesion can be life-saving. The authors report a case of a hepatic artery pseudoaneurysm which was successfully controlled by endovascular repair using a covered stent-graft.
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Affiliation(s)
- Yoo Dong Won
- Department of Radiology, Catholic University Medical College, Uijeongbu St. Marys Hospital, Gyeonggi-do, South Korea
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34
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Saad WEA. Management of nonocclusive hepatic artery complications after liver transplantation. Tech Vasc Interv Radiol 2008; 10:221-32. [PMID: 18086427 DOI: 10.1053/j.tvir.2007.09.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Nonocclusive arterial disease represents less than 5% of posttransplant arterial complications. Nonocclusive arterial complications are classified into (1) nonocclusive diminished flow in the hepatic artery, (2) arteriovenous fistulae, (3) pseudoaneurysms, and (4) arterial rupture. Due to the rarity of these complications, particularly when considering them individually, many of the opinions and managements of these complications are anecdotal. Transcatheter embolization is the main mode of minimal invasive management of these uncommon complications. Other minimal invasive methods have been described such as stent placement or direct percutaneous embolization/thrombosis. The article discusses the presentation, etiology, types, treatment indications, and various modes of minimal invasive therapy used to manage these complications.
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Affiliation(s)
- Wael E A Saad
- Vascular Interventional Radiology Section, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY 14618, USA.
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35
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Abstract
Transplantation has become the method of choice for treatment of patients with irreversible severe liver dysfunction. Vascular thrombosis or stenosis, biliary obstruction, hemorrhage, posttransplantation neoplasm, and rejection are some of the most common potential complications. Most complications cause significant morbidity and mortality after liver transplantation. The appearance of vascular complications in posttransplantation patients is illustrated in this article.
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Chang CW, Chen MJ, Shih SC, Chang WH, Yang WJ, Chu CH. Hepatic subcapsular hematoma secondary to intrahepatic pseudoaneurysm following cholecystectomy. Dig Dis Sci 2007; 52:3303-6. [PMID: 17410458 DOI: 10.1007/s10620-006-9686-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2006] [Accepted: 11/26/2006] [Indexed: 01/16/2023]
Affiliation(s)
- Chen-Wang Chang
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Chung-Shan N. Road, Taipei, Taiwan
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Luebke T, Heckenkamp J, Gawenda M, Beckurts KTE, Lackner K, Brunkwall J. Combined Endovascular–Open Surgical Procedure in a Great Hepatic Artery Aneurysm. Ann Vasc Surg 2007; 21:807-12. [PMID: 17703916 DOI: 10.1016/j.avsg.2007.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 04/21/2007] [Accepted: 06/28/2007] [Indexed: 10/21/2022]
Abstract
Visceral artery aneurysms are rare lesions. They involve the hepatic artery in approximately 20% of cases. Various therapeutic options are available for patients with hepatic artery aneurysms (HAAs). Dictated predominately by the need to maintain distal end-organ perfusion, potential therapies include traditional surgical techniques and laparoscopic surgery, endovascular methods of embolization, and stenting of the lesions. There is still a lack of studies demonstrating the comparative efficacy or inefficacy of any particular treatment, so there are currently no precise indications for determining which type of treatment should be used. In this paper, we present a case of great HAA in a 59-year-old man. He was preoperatively diagnosed and treated with a combined surgical and endovascular approach. The clinical presentation, management, and therapy of patients with HAAs are discussed. In addition to that, we reviewed the literature dealing with HAAs. This case report lays emphasis on the aspect that the treatment strategy in HAAs has to be determined individually in each case due to the high anatomic variability of the arterial supply of the liver. Treatment with a combined surgical and endovascular approach may reduce the risk of liver ischemia and morbidity.
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Affiliation(s)
- T Luebke
- Division of Vascular Surgery, University of Cologne, Cologne, Germany.
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Elias G, Rastellini C, Nsier H, Nazarey P, Brown M, Pahari M, Shick L, Kim D, Cicalese L. Successful long-term repair of hepatic artery pseudoaneurysm following liver transplantation with primary stent-grafting. Liver Transpl 2007; 13:1346-8. [PMID: 17763391 DOI: 10.1002/lt.21137] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Georg Elias
- Department of Surgery, University of Massachusetts, Worcester, MA 01655-0333, USA
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Moukaddam H, Al-Kutoubi A. Pseudoaneurysms of Hepatic Artery Branches: Treatment with Self-expanding Stent-grafts in Two Cases. J Vasc Interv Radiol 2007; 18:897-901. [PMID: 17609450 DOI: 10.1016/j.jvir.2007.04.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Pseudoaneurysms of the hepatic artery or its branches are rare complications with several potential causes. Herein, the authors report two cases of pseudoaneurysms of hepatic artery branches, one secondary to laparoscopic surgery and the other probably due to malignancy. The pseudoaneurysms were treated with the placement of self-expanding stent-grafts. Complete and prompt occlusion of the pseudoaneurysm was achieved in both patients, with resolution of symptoms and preservation of the blood flow in the parent arterial branch at long-term follow-up.
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Affiliation(s)
- Hicham Moukaddam
- Department of Diagnostic Radiology, the American University of Beirut Medical Center, Beirut, Lebanon
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Fistouris J, Herlenius G, Bäckman L, Olausson M, Rizell M, Mjörnstedt L, Friman S. Pseudoaneurysm of the Hepatic Artery Following Liver Transplantation. Transplant Proc 2006; 38:2679-82. [PMID: 17098038 DOI: 10.1016/j.transproceed.2006.07.028] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We report 12 cases of pseudoaneurysm hepatic artery (PA) among 825 liver transplantations (OLT) performed between January 1985 and December 2005. In the early period (1985 to 1995), the incidence was 2.6% and in the later period (1996 to 2005), 0.9%. Median time to onset was 39.5 days post-OLT (range 14 days to 5 years). Six patients presented with rupture into the peritoneum (n = 4) or gastrointestinal tract (n = 2), while five patients presented with gastrointestinal bleed due arteriobiliary fistulation with hemobilia. The twelfth PA was found incidentally during retransplantation. PAs were detected with radiological imaging (n = 4), exploratory laparotomy (n = 6), at autopsy (n = 1) or at retransplantation (n = 1). We performed immediate revascularization, after surgical excision was performed in three and endovascular embolization in one patient. In six patients hepatic artery ligation without revascularization was inevitable with subsequent successful retransplantation in four patients. No PA-specific treatment was attempted in two cases due to the poor prognosis or diagnostic ambiguity. In 10 cases microbial pathogens were cultured in the blood, subhepatic abscesses, or from the wall of the hepatic artery. A hepaticojejunostomy was performed for biliary reconstruction in six patients and two had a hepaticojejunostomy conversion due to biliary leak. Survival in the early period (1985 to 1995) was 14%, whereas during the later period (1996 to 2005), the survival increased to 100% with a 4.2-year median follow-up (range 7.4 months to 6.9 years). Infrequently PA complicates OLT, becoming evident primarily after rupture with hemoperitoneum or a gastrointestinal bleed. Early recognition with angiography is important but acute hemorrhage often requires immediate exploration with ligation of the PA, although surgical or endovascular exclusion of the PA followed by revascularization provides a feasible treatment option.
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Affiliation(s)
- J Fistouris
- Department of Transplantation and Liver Surgery Sahlgrenska University Hospital, Gothenburg, Sweden
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Singh CS, Giri K, Gupta R, Aladdin M, Sawhney H. Successful management of hepatic artery pseudoaneurysm complicating chronic pancreatitis by stenting. World J Gastroenterol 2006; 12:5733-4. [PMID: 17007032 PMCID: PMC4088180 DOI: 10.3748/wjg.v12.i35.5733] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 41-year old alchoholic male with a history of chronic pancreatitis was admitted for nausea, vomiting and weight loss. Angiogram was performed and demonstrated an aneurysmal sac with a narrow neck originating from the inferior aspect of the distal portion of the proper hepatic artery. The origin of the pseudoaneurysm was covered with a 5 mm × 2.5 cm Viabahn cover stent (Gore). A repeat angiogram showed some leak and a second stent (6 mm × 2.3 cm) was deployed and overlapped with the first stent by 3 mm. Contrast was injected and a repeat angiogram demonstrated complete exclusion of the aneurysm. A repeat computerized axial tomography (CAT) scan of the abdomen after 24 h showed successful stenting. The patient had an uneventful post-operative course.
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Affiliation(s)
- Cynthia Sudar Singh
- Wyckoff Heights Medical Center, 374 Stockholm Street, Brooklyn, NY 11237, USA.
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Harvey J, Dardik H, Impeduglia T, Woo D, DeBernardis F. Endovascular management of hepatic artery pseudoaneurysm hemorrhage complicating pancreaticoduodenectomy. J Vasc Surg 2006; 43:613-7. [PMID: 16520182 DOI: 10.1016/j.jvs.2005.11.031] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2005] [Accepted: 11/12/2005] [Indexed: 12/19/2022]
Abstract
Gastrointestinal bleeding is a morbid complication of pancreaticoduodenectomy. Determining its etiology is often a daunting challenge in that both common and unusual mechanisms may be operative. Visceral artery pseudoaneurysms, although rare, must be considered in that minimally invasive means are available for effective therapy. Our recent experience with two cases highlights the importance for both general and vascular surgeons to be aware of the diagnostic and therapeutic role for early angiography and deployment of endovascular techniques to achieve a successful outcome.
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Affiliation(s)
- John Harvey
- Vascular Surgery Service, Englewood Hospital and Medical Center, Englewood, NJ 07631, USA
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Abstract
Improvements in surgical technique, advances in the field of immunosuppresion and the early diagnosis and treatment of complications related to liver transplantation have all led to prolonged survival after liver transplantation. In particular, advances in diagnostic and interventional radiology have allowed the Interventional Radiologist, as part of the transplant team, to intervene early in patients presenting with complications related to organ transplant with resultant increase in graft and patient survival. Such interventions are often achieved using minimally invasive percutaneous endovascular techniques. Herein we present an overview of some of these diagnostic and therapeutic approaches in the treatment and management of patients before and after liver transplantation.
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Affiliation(s)
- Nikhil B Amesur
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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