Successful endovascular management of multiple mycotic aneurysms after liver transplantation - A case report and review of the literature

Background

Mycotic vascular complications after liver transplantation are rare but can be pose a serious threat to the liver graft and the patient’s life. Mycotic complications can present as an incidental finding on routine imaging, or as haemorrhagic shock. Traditionally, these mycotic vascular complications were managed with open surgery.

Method/results

In this case report, we describe a patient who had developed multiple sequential mycotic aneurysms after liver transplantation which were managed successfully using endovascular and percutaneous techniques.

Conclusion

An endovascular approach is minimally invasive and will be the way forward in managing these mycotic vascular complications.

How to do it: value-driven sharp recanalization of central vein occlusion

Patients on haemodialysis are susceptible for central vein occlusions, which can result in debilitating clinical consequences. These may be resistant to conventional revascularization with guidewire and catheter technique. Value-driven sharp recanalization of central vein occlusion is depicted as a safe and affordable option.

Lumbar Artery Bleed as a Complication of Percutaneous Renal Biopsy and a Proposed Workflow for Massive Bleeding

Injuries to extrarenal arteries caused by percutaneous biopsy needles are very rare but highly lethal due to delay in recognition. Here we report the case of an inadvertent lumbar artery puncture after native renal biopsy and provide a literature review and a proposed workflow for management of massive bleed after renal biopsy. This case highlights evidence-based management considerations regarding massive bleed after renal biopsy, including the first-line imaging modality and the need to consider extrarenal site bleed. While angiographic embolization is an effective method of control of haemorrhage, surgical exploration is required in a proportion of cases for control of bleeding. Centre-specific workflows should be adopted to minimize the mortality and morbidity associated with massive bleed after renal biopsy.